Monday, October 31 -- Halloween -- the great white north

We pile in the cars early this morning.  Breakfast is very
continental, with croissant, fruit, yogurt, coffee, tea.  Once the
Halls are gone, I have to nail down lunch issues, then cut out
breakfast, or fail to resolve lunch, and turn breakfast into an egg
thing.  Too many meals, too much fat.

But meanwhile, it's another day of sloth -- beautiful scenery, nice
people, interesting things, and no work at all.

I sit in the back seat of Lanto's Toyota Land Cruiser, which by the
way, is having real trouble starting.  With me, back here, are Doug
and Ramona.  Lanto drives and Dr. Olivier sits in the passenger seat.
We eat up the miles at 40 Kph -- that's 25 Mph or so -- for much of
the way.  There are brief periods where we do 60 Kph, but mostly,
it's pretty slow.  This is good, because no one, but no one, follows
traffic signs in Madagascar, and cars drive right up close to people,
back up without clearing people away, etc.  If we drove fast, there
would be fatalities.

This part of the near-Tana area has trees, fewer and fewer, mind you,
but nonetheless it is a lumber region.  Malagasy men fell trees, then
strip the bark and hand-hew out fairly straight and square lumber, all
with no power tools at all.

I'm reminded of Easter Island, with all its statues and no trees.
Apparently, trees were needed to put up the statues.  People cut down
trees to put them up, and one day, someone decided to put up the last
statue, and for this, he cut down the last tree.  No more trees on
Easter Island, therefore no more statues.  It's a pretty nasty place,
now, I have read.  Oh, and they eat the brains of their dead, so the
get Jacob-Crutchfeld, or whatever it's called.

So I hope the Malagasy take note from that: Plant a lot of trees or
become a comic-book parable against utter stupidity.  Choose.

After a long drive (three or four hours) we arrive at Antsirabe, at a
town known by the French as ville d'eu.  Translation: Watertown.  It's
got hot springs, or rather had them.  The hotter one no longer puts
out water, but a lukewarm one 150 meters away still pours out of an
ancient fountain.  These are very metallic smelling, and somewhat
salty.  The Malagasy name for the two means "salty here".  The French,
British and Norwegian all had a presence here, and to some extent,
still do, in the form of buildings, restaurants and some missions.
There's a Catholic cathedral, a Lutheran church and a mosque.  There's
probably more that I didn't see.  But this is the prize for the area.
It's a health spa and vacation spot for the Antananarivo area.  We see
a lot of white faces.

But there's work to be done here -- serious work by Rivo, who needs to
set up the machines, and some work by me helping him, supplies to be
dropped off and paper to be shuffled, as SALFA takes careful notes as
to who gets what and when, because these things are billed back to the
clinics and ultimately the patients.  Lastly, there's some good
old-fashioned meet-and-greet to be done by Lanto, Doug, Ramona, and to
a small extent, me.

There's a nursing school and a hospital.  At the hospital, Doug and
Ramona get a good tour, which I hang back on -- on one hand, I'm
squeamish, as these are truly sick and injured people.  One boy had a
spear jabbed through his gut, for instance, and had to be sown up.  It
was neat work, Ramona, the surgical nurse, reports.  Another boy has
an arm in a split, as it is broken in several places, and required
pins.  There are plenty of other cases that I don't see.  I lag
outside, I talk with Rivo and Lanto -- I don't take many pictures.
And secondly, it feels like gawking, and on some level it is.  This
hospital, like all the hospitals that SALFA is associated with, needs
equipment, more space, staff and money for medicine.  Our tour guide,
the chief surgeon and director of the hospital, makes this abundantly clear.

He shows us the operating room (which is pretty good) and the
infrastructure of the place, which works, but just barely.  They have
just one auto-clave, for example, and it's old.  If it dies, they'll
have no sterility -- this one works all day long.  In a tub in a sink,
the gauze towels which American hospitals consider disposable are 
being washed for reuse -- it's disturbing on several levels, not the
least of which is the bloody water they are soaking in.  There aren't
enough beds.  The padded operating tables and gurneys are old and
tattered.  The surgeon is alone and, as we'll see the next morning,
when we catch him after a whole night of cutting, doing too much with
too little help.

For contrast reasons I left out a little stop we made along the way --
let me return there for a second:  It's a fairly small town, which by
Malagasy standards is a city.  In it, a preacher has set up a clinic.
He and his family live upstairs, and the clinic forms the first floor
of the building.  The ceilings are low, like most Malagasy homes, and
the rooms have less ventilation than they should.  The cook-house is
larger than others we've seen, since it's common for up to ten members
of a family to come to join a sick person, and that requires a lot of
cooking.  The lying in room is so moldy that I can't breath well in
it, a step backwards into the hallway fixes the problem perfectly, as
step forward chokes my throat, as though the threshold was a magic
portal into a vacuum.

Lanto, Momy and Dr. Olivier show a little weariness as they sign over
medicine and a computer.  Too many family members here --
consideration for custom is one thing, an army around the sick is
another.  The place is not clean enough.  The are workers not
following best practices.  These men and SALFA are here to support the
people who are trying to help, but they'd still like to see things
working better.

The computer we install bounces every few minutes.  Their power is at
times insufficient.  They had been told to acquire a $30 stabilizer, and
have not done so -- we tell them not to use the computer until they
do.  The operating system will turn itself into hash if the machine
keeps dying unexpectedly.  "If they use it, and it dies, they are not
getting another." Lanto says, clearly aggravated.

We drive out of the clinic, the town, and on to what the French called
Ville d'Eau.

So you see, this hospital, as opposed to that little clinic, knows
that it has problems, which is a start, and the people here are doing
the best that they can in a professional manner.  Most of the people
SALFA works with fall into this class.  It's one thing to mean well,
but SALFA, by its example, shows that its possible to both mean well
and do a damn good job.

Ramona and Doug, hats off to them, conjecture about getting beds and
an auto-clave for the hospital from Ramona's workplace, where the beds
and auto-clave are being upgraded.  Doug's mind is racing about shipping
and how to get the equipment to Madagascar.  It can be done.  [See
notes for 11-01]

And last, we visit the school of nursing, here.  It hasn't got its own
building.  Instead, it rents space in a public classroom.  A building
will be built soon.  It's the school's first year and the students have
two years to go.  After they complete their three year course, they'll
owe SALFA six years hospital work, but the education doesn't cost them

We set up the computers, and the students pile around them.  It's a
mob of about 25 girls and a few boys around four machines.

We go off to visit the hospital, again, and buy Doug and Ramona a
ruby from the local gem merchants.  It's getting dark, and in a gasp!
moment, Ramona drops the ruby onto the gravel at her feet.  It takes a
few minutes to find it, for the rubies are small, but we do.  Then,
having killed two solid hours, we return to the nursing school.

They're still mobbed around the computers.  It's as though we never
left, except that now, there are big thank-you notes on the screens of
the machines, all done with Microsoft Word, using big curving fonts in
many colors, complete with clip-art.  This is moving and gratifying,
and it's a testament to what a joyless asshole I am that I can't help
but think that I would happier if one of the machines had on the
screen a professional looking form letter they'd cooked up, thanking
us for our donation and reminding us that winter was coming and that
we should send money.

These students are, of course, incredible singers, as so many people
I've met in Madagascar are, but the nurses take the prize.  Firing off
a number of songs with clapping, multiple parts and harmony, they
ultimately move into a circle, dancing in the center like a singing
hoedown.  After a number of pairs of students (mostly girl-girl, as
the boys are outnumbered eight to one, here) dance in the center,
Lanto and I manage to push Ramona and Doug (who don't need all that
much encouragement, really) into the ring, where they dance an
excellent polka.

At the last minute of the song, a pretty young nurse runs out of the
circle and drags ME in, and I spin her a bit in my aimless two-step
style -- she looks confused, but pleased, and carries it off well.
It's great.

Through the evening, I'll look over what one or another of the nurses
are doing or read a t-shirt, and the young nurses will turn away and
giggle to each other, and as the girls say goodnight the one who
brought me into the dance shakes my hand with her other hand over her
face, half looking at me and half giggling at her friends.  It's nice
to know I still got it, even though I'm not available any more.