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 anything. 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.