Volunteer Guide 2011 by Mada Clinics Intenational

Mada Clinics 2011 Volunteer Guide

H ealth O pportunity P eople E nvironment

Jan 2011

[Type text]

1. Introduction to Madagascar ....................................................................................................... 1 2. Volunteer Opportunities ............................................................................................................. 2 2.1.

Maventibao Village........................................................................................................... 2

2.2.

Other Medical Positions ................................................................................................... 3

2.3

Teaching Positions ............................................................................................................ 3

3. Our Work at the Clinic................................................................................................................. 4 3.1.

Background....................................................................................................................... 4

3.2.

HIV, STIs and family planning in Madagascar .................................................................. 4

4. Arrivals ........................................................................................................................................ 5 4.1.

Visas.................................................................................................................................. 5

4.2.

Arrival at Nosy Be Airport................................................................................................. 5

4.3.

Arrival at Ambilobe .......................................................................................................... 5

4.4.

Arrival at Tana Airport ...................................................................................................... 6

4.5.

Arrival at Diego-Suarez Airport ........................................................................................ 6

4.6.

Transport to the Clinic ...................................................................................................... 6

4.7.

General ............................................................................................................................. 6

5. Money Matters ........................................................................................................................... 7 5.1.

Donations ......................................................................................................................... 7

5.2.

Living Costs ....................................................................................................................... 7

5.3.

Local Money ..................................................................................................................... 8

5.4.

Indicative prices ............................................................................................................... 9

6. What to Bring ............................................................................................................................ 10 6.1.

Clothing .......................................................................................................................... 10

6.2.

Personal Items ................................................................................................................ 10

6.3.

Medical Kit...................................................................................................................... 11

6.4.

Communications ............................................................................................................ 11

7. Useful Contact Numbers/email addresses ............................................................................... 11 8. Volunteer Health ....................................................................................................................... 12 9. Nearby Places of Interest .......................................................................................................... 13 9.1.

Ankarana National Park/Mahasima Village ................................................................... 13

9.2.

Anivorano/The Sacred Lake ........................................................................................... 13

9.3.

Ambilobe ........................................................................................................................ 13

9.4.

Diego Suarez ................................................................................................................... 14

9.5.

Ramena Beach ................................................................................................................ 14

10. Other useful info, web addresses & airline information ........................................................ 14 11. Terms ...................................................................................................................................... 15 12. Useful Malagasy Phrases ........................................................................................................ 16

1. Introduction to Madagascar Madagascar is the fourth largest island in the world and stretches an impressive 1600km/1000 miles in length and 570km/350 miles across at its widest point. Consequently, the country boasts an array of different climates and environments. Geographically, the island can be split into three regions: the West being typically a dry, spiny desert or forest; the Middle which is forested (and de-forested) highland; and the East a lush rainforest. Mada Clinics is based at the village of Maventibao, in the Middle region. Madagascar has a world-wide reputation for the richness of its wildlife and the large numbers of endemic species. The island‘s separation from mainland Africa, around 165 million years ago, has resulted in the evolution of a rich array of unique fauna and flora. Lemurs are amongst the most famous of the island‘s endemic animals. They are members of the primate family, and their ‗pro-simian‘(i.e. primates that are not monkeys or apes) order is comprised of over 50 different species which can be found throughout the country, mainly in the 14 national parks (and also in the forest behind the Clinic!). Alongside these unique creatures there are 209 species of breeding birds, 346 reptile species, and over 4000 tree species found solely in Madagascar. For a long time, the evolution of the natural environment of Madagascar was without human influence, with the first settlers being Indo-Malayan seafarers about 2000 years ago. Since then the people of Madagascar have been under strong influence from outside cultures. Arabian and African traders gradually started to appear, and early in the sixteenth century the island was ‗discovered‘ by European settlers. In the centuries that followed, conflict between European powers for control of Madagascar was rife. By 1850 Christianity had established a foothold. In 1896 there was an end of sorts to the various European countries‘ struggle for control of Madagascar, with France claiming the prize and colonising the island. Independence from France came in 1960, though strong French influences remain. Malagasy people hold several values in very high regard; one of the most important is family, and the idea of brotherhood – which results in large extended families. Reverence of the dead is another firm belief, especially with regard to deceased relatives. Around half the population of Madagascar consider themselves Christians (roughly equal Catholics and Protestants), with the other half standing by traditional belief systems and around five-ten percent Muslim (higher in the North). Even amongst the Christian population, many of the traditional beliefs and practices still hold. As part of the traditional belief systems, the Malagasy have hundreds of fadys (taboos), though there is considerable variation depending on the region and to whom you are speaking. Some fadys which exist around the area of the Clinic include stealing zebus (including killing the free-grazing ones for food); working the earth (including digging) on Tuesdays and cutting wood on Thursdays! Visitors, known as ―Vazahas‖ (white people), are not expected to be aware of fadys, but it does show respect to local cultures to abide by the ones we are aware of. In redemption for fadys there are purification ceremonies, normally involving large amounts of rum! Traditional Malagasy food is quite simple, rice being the staple diet of a Madagascan (a legacy from the Indo-Malayan founders). This is often supplemented by Zebu (beef), fish or beans. Fresh fruit and vegetables are readily available in the towns and agricultural areas but are scarcer up at the Clinic, where the hot climate, combined with a lack of electricity, makes storage of perishable goods problematic.

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2. Volunteer Opportunities 2.1. Maventibao Village All volunteers are encouraged to help at the Clinic based in the village of Maventibao - whether they have medical experience or not. You will be able to experience a developing-world health care system and help contribute to the smooth running of the Clinic. Alternatively, volunteers are welcome to teach the local children (mostly aged under 8) at our school or get involved in assessing the local biodiversity/ farming projects. You will soon settle into the simple and beautiful lifestyle which Maventibao has to offer. Days begin early, with Mama Falavi bringing a cup of piping coffee to your door at 06.30 and breakfast being served between 7.00 and 8.00. When you surface from your hut, you will see patients already waiting! After breakfast you can head straight to the Clinic to help with the day‘s arrivals. The number of patients varies from day to day, so sometimes this may take all morning or all day and other times you will find yourself helping with other aspects of village life such as teaching the village children in our school or helping develop our vegetable allotment or assessing the local biodiversity – the choice is yours! On Tuesdays and Fridays the Clinic moves one of the other local villages, preceded by a 1½ hour hike. We also visit our second clinic in Amboagamay every two weeks, which is staffed by our second Nurse, Ernest. This is an arduous 2½ hike (each way). After lunch and a siesta period during the hottest part of the day, you are free to resume the morning‘s activities or perhaps take a hike, saunter through the village or maybe even help Mama Falavi to sort rice or make homemade peanut butter! Your hot shower water will be waiting for you around 17.00, the perfect way to unwind as you bathe in the beauty of a setting sun. Then after supper and a chat, it‘s time to snuggle up with a good book in the cosiness of your candlelit room! You will have a personal bedroom or hut in the village near other volunteers. Your room will have a simple bed, a table, and a small reading light/candle. A pillow, sheet, blanket and mosquito net are provided for each volunteer. Malagasy is the main language spoken in the village. Although French is also one of the national languages, it is not widely spoken in rural Madagascar, including Maventibao, except by our Nurse, Didier. If you do speak some French, you will find it spoken/understood in Tana and Diego. Ben Shipley, our President, who spends most of his time at the Clinic, is a retired American Mining Engineer. The other Clinic staff speak/understand rudimentary English, including Didier. Communication has never been a problem for our volunteers. You are advised to let someone know where you are going at all times. Any trekking, excursions, or weekend outings should be approved in advance. The trails around Maventibao are rough, so it is advisable to wear your walking boots/sturdy training shoes. The rural Malagasy people are almost always very honest. However, avoid temptation by putting valuable things out of sight. There is very little violence in Madagascar. Most people feel safer walking around Madagascar than their home towns. The Malagasy are kind-natured and respectful of women, but if female tourists wear skimpy clothing then they may be stared at, as this not normal practice. Please always behave in a professional manner and with courtesy, reflecting the sensitive nature of working in a health clinic. Always show respect for elders and also for grave sites. If you need to get past someone, use the Malagasy word 'azafady', which means please/excuse me. We like all volunteers to join us in Maventibao regardless of the other projects on which they volunteer. The best timing for a visit is two weeks, but this can be extended for up to four weeks in some cases.

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2.2. Other Medical Positions Anivarano Hospital Dr Ginette is the only qualified doctor for the surrounding 100,000 patients! She works tirelessly at the small hospital and in the (busy) maternity ward. She gets help from a midwife and a dentist. She speaks fluent French and good English as is always willing to have medically qualified or interested volunteers work alongside her – for a maximum of two weeks. Accommodation etc is listed below under the costs section. Diego Suarez Hospitals There are two hospitals in Diego and we have contacts at both the state run hospital and the military/private hospital. At any one time the doctors rotate so it is not possible to say in advance where you would be allocated. In any event we have doctors who speak English and who welcome premed/med students and qualified personnel. They are ‗full service‘ hospitals with surgery, obstetrical and pediatric wards. We allow medically focussed volunteers to work alongside the doctors at these hospitals to gain an insight into life at a city hospital. For further details please contact our Medical Director.

2.3

Teaching Positions

It is an advantage, but not a requirement if you have had previous experience of ‗Teaching English as a Foreign Language‘ or have completed a basic TEFL course before. If not, we would expect you to have read a TEFL text book and our TEFL notes. There are some basic materials at our schools, but whatever you can bring out will be much appreciated – particularly ‗early learning‘ children‘s books. In addition we it is extremely useful to have some basic French to help communicate with the school staff. Maventibao School This is a new school established in 2010. It has 25 children who are aged between 2-10. They come from Maventibao and its surrounding villages. All volunteers are expected to help in teaching English and other lessons at our local school and will get to know all the children who live in our village.. Mahamasima School This is a primary school where the 160 or so children are aged between 7-12. They come from the surrounding villages, as well as the children of the guides who offer their services in the local National Reserve – Ankaranana, which has its entrance across the road. The head teacher needs help with teaching English which is part of the curriculum but no-one in the village speaks English! This position is for a volunteer who can stay with us for 4 weeks. The volunteer will be expected to work Monday to Friday 7.30am to 12.30pm at the school and the afternoons teaching English to the guides who work in the National Park. Weekends will be free to walk or camp in the National Park. Further details about the Park and the accommodation here are set out at the end of this guide. Anivarano School The work involves teaching at the large secondary school in a small rural town. The local economy is predominately agricultural based. The school has 700 pupils aged 12-16. The volunteer will teach English Monday to Friday from 8am to 3pm, with a break for lunch. The baccalaureate in Madagascar has English in the curriculum but it is only sporadically taught at this school due to the lack of teachers. Volunteers will also be encouraged to join in the teaching of football/soccer and other sports. Details of the housing etc in Anivarano are included below. To ensure best use can be made of the volunteer‘s time, this position is for periods of 4 weeks or more.

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Jan 2011

3. Our Work at the Clinic 3.1. Background Since Mada Clinics was set up approximately 5 years ago it has provided free health care and medicines to the people of Maventibao and surround villages and now provides health care for approximately 15,000 people in a 14 village district. Without Mada Clinics, the local population would have to walk at least 1½ hours to the nearest main road then take a bus journey of over 25miles/35 kilometres, and most cannot afford the fare, let alone the cost of the medicines. Both of clinics offer basic facilities for primary health care. Each clinic is staffed by one nurse, but like all malagasy nurses they are trained to act more like ‗western‘ doctors - diagnosing medical conditions, performing minor procedures and dispensing medications.

3.2. HIV, STIs and family planning in Madagascar The local area where Mada Clinics operates encompasses a sapphire mining area, and hence there is a very transient population who travel for work. The town near to the mine has many females who work in the sex industry. Our anecdotal evidence is that the transient nature of the mining workers increases the already high rate of sexually transmitted infections (STIs) which we see at the clinic. For instance, of all the 80 patients seen at the clinic per week, between 5 to 10 will present with STI symptoms. At the moment we see little use of contraceptives amongst the population and a marked reluctance of males to use condoms. Owing to the isolation and lack of infrastructure, access to sexual and reproductive health services is very limited in rural Madagascar. On the basis of our research, the average fertility rate in the villages in which we operate is higher than the national average, with anecdotal reports also suggestive of high rates of untreated STIs. Following the successful establishment of the clinic and the provision of treatment for STIs, our services receive widespread support and therefore we are planning for the expansion of its scope and outreach to incorporate additional neighbouring villages. Continuing to respond effectively to meet this demand is considered a priority for planning in the region. Taking steps to prevent an epidemic of HIV and other STIs has led to the development of our action plan to expand sexual and reproductive health services and education to reach the youth in our locality. Currently family planning services are offered as part of our routine, free, daily clinics. We offer a broad range of free contraceptives – including progesterone shots, which lasts 12 weeks, a daily oral pill and condoms. Mada Clinics believes that only by offering free advice and contraceptives can we change the high rates of fertility seen in Madagascar, which currently has the 17th highest total fertility rate in the World. Hence it has have one of the fastest growing populations of any country in the world and currently less than one in five women have access to contraception. Whilst we have all sorts of patients coming thought the doors of the clinic, we try to emphasise education to our patients. Madagascar is counted as part of Southern Africa, but unlike its mainland counterparts, to date, it does not have a high HIV infection rate. Currently HIV prevalence in Madagascar is under estimated at below 0.1%. This contrasts markedly with the prevalence in other countries of Southern Africa where estimates range from 5% to 15% However with the increasing amount of foreigners travelling to Madagascar and the lack of knowledge of HIV among the Malagasy youth, it is doubtful that this will remain low unless steps are taken now.

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Jan 2011

4. Arrivals Please try to make your travel arrangements so that your initial arrival into Diego Suarez / Ambilobe is on a Thursday, Friday or Saturday.

4.1. Visas You have the option to obtain a visa from your local embassy prior to your arrival but this is not necessary – see http://www.embassy.org/madagascar/visas.html for more information. If you have not obtained a visa before you arrive, and are staying longer than 30 days or the fee waiver has finished, you will need to have cash to pay for your visa at the airport on your arrival. The current amount is about $90/60 Euros, as of Dec 2010. Have this ready to hand over when you arrive at the airport in Tana, as the line forms quickly (at a different cubical) and you do not have time to search around for the correct amount of cash. During 2009 & 2010, the visa fee was waived for stays of up to 30 days. We are unsure if this will remain the case, so it is best to have the cash ready! If you are staying longer than 30 days, you need to purchase the visa stamp when you first arrive in the Immigration Hall then join the entry queue. NB Ensure that your visa is for the length of your stay as renewing can be both time-consuming and problematic. This is usually done automatically by the officials, provide you fill out your departure date on the entry form correctly (see below) and pay the visa fee (if staying >30days). The visa entry forms are handed out on your flight prior to arrival and should be filled out before you land and enter in the Immigration hall. The standard Visa is for up to 90 days. When arriving at the airport in Tana/Nosy Be the visa system seems a bit chaotic, so be prepared to wait in line for an hour or so once you have landed – as it happens it normally takes that long for your luggage to get off the plane! If you are staying longer than 90 days with Mada Clinics, ask for the 90 days and we will help you apply for an extension once you are staying with us.

4.2. Arrival at Nosy Be Airport As of January 2011, this is our preferred arrival airport. It is in the North and allows you to avoid Tana completely. However we recognise that flights here are not as frequent. When flying into Nosy Be you may have to spend a night in Nosy Be. It is a small island geared for tourists with many good clean tourist hotels in the local town (Helleville) or near the beaches. You can arrange for your hotel to pick you up or you can take an (expensive) taxi from the airport (approx $20-30; no buses!). Refer to your guide book for hotel options and details about the local town/facilities. From Nosy Be island you take a ferry/small boat to the mainland (1 hour) then there is a a 4-6 hours taxibrousse ride to Ambilobe (a small town close to our village). If your flight arrives early enough, and have the stamina, you can catch the ferry in the morning to the mainland (ferries stop after mid-day as the waves get bigger). It is best to get to the ferry dock between 7am and 8am in Helleville. The ferry takes an hour then you catch a taxi-brousse (lined up at the dock when you reach the mainland) to Ambilobe. A taxi brousse (bush taxi) is, in reality, a very overcrowded minibus or truck! Sitting alongside chickens and sacks of rice, this is certainly a unique experience and one not to be missed for true Malagasy experience. From Nosy Be you can also fly to Diego on Air Mada.

4.3. Arrival at Ambilobe If using this route, it is best to reserve a room in advance at Hotel National in Ambilobe when you arrive in Madagascar (032 42 577 84) and stay the night in Ambilobe as we will not know what time you are arriving by Taxi Brousse in Ambiobe. The next morning (Saturday or Sunday), you will met by a Mada Clinics representative, probably Nurse Didier, in front of Hotel National on the main street, where there are concrete tables in front of the entrance.

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4.4. Arrival at Tana Airport For most people flying into Tana, your onward flight connection to Diego will mean you may have to spend one night in Tana. We are unable to meet our volunteers when they arrive in Tana. We recommend that if you are spending just one night in Tana, you stay at a hotel close by the airport, as traffic can be very slow - particularly during the rush-hour. We also recommend that you book in advance your hotel in Tana – look in your guide book, although the most popular is L‘Auberge du Cheval Blanc which offers a free shuttle bus. If you have more than one day in Tana and wish to stay or visit the centre of Tana, we know friendly taxi drivers who we will arrange to meet you off your flight, and who should not overcharge you on your trip into town. As of January 2011, it is considered safe to take the 24 hour taxi-brousse to Diego, if that is all your budget will allow. If you prefer to fly, we do recommend that you should book your Air Mada a flight to Diego Suarez in advance– see below for their web site.

4.5. Arrival at Diego-Suarez Airport You will be met by our representative at the airport, who will either be a member of our team or from a local hotel. We will let you know in advance which it will be. In any event, you should budget for one night in a small hotel in Diego, which we will arrange for you. This will allow to catch up on some rest, check emails, purchase a SIM card for a mobile telephone (see below), do some local shopping and perhaps see a bit of the town (hotel cost: 40,000Ar/$20 per night). As stated above, please try to arrange your flight to arrive in Diego on or before the weekend, to facilitate arrangements to take you up to the village.

4.6. Transport to the Clinic When you are ready, you will make the 2-3 hour journey (again by Taxi-brousse) from Ambilobe or Diego Suarez to Ambondromifehy. This is a small sapphire mining village and the nearest large village on the main road to our village, Maventibao. Maventibao is 8km/5m up a dirt track into the picturesque hills. The ascent up the hill involves a 1½ hour uphill hike or if you are lucky and it is working (!) using the Clinic‘s 4WD, if available. Either way, Clinic staff will be in Ambondromifehy to meet you and to help you with your belongings, but it is vital that you bring a rucksack style bag and not suitcase for this reason! (You will likely be met and accompanied from Diego or Ambilobe, but otherwise you will need to ask the driver to stop in Ambondromifehy).

4.7. General When you arrive in Madagascar, please let our local team know (and confirm your meeting time and place) by calling or by SMS text. Nurse Didier‘s mobile is 032 61 697 95 and Ben's is 033 03 486 15 – but these may change, so please check before you leave on your trip. At least one week before your arrival, you should confirm by email to our local representative (operations@madaclinic.org) and Dr Philip Trangmar details of your flight arrival time into Tana/Nosy Be and then onward journey plans. We also recommend you label your baggage: Mada Clinics Charity, Madagascar, Diego Suarez, Tel 032 61 697 95. Madagascar is 3 hours ahead of GMT.

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5. Money Matters 5.1. Donations We ask for a donation of $250 per week when staying up at the Village of Maventibao. This covers all your food and accommodation. In addition, your donation goes towards the cost of the Madagascar staff salaries and medicines that we provide free to patients at the Clinic. For stays of 4 weeks or more this reduces to $200 per week. If volunteering at one of the hospitals or schools, we ask for a donation of $100 per week. This sum will be split equally between the Clinic and the school/hospital where you are working. This reduction takes into account the fact that you are paying for your own accommodation/ meals as set out below. All donations should be paid in advance to Mada Clinics via the website. Please pay 50% on confirmation of the dates of your stay (which is non-refundable) and the remainder 2 weeks before your visit.

5.2. Living Costs In Maventibao when volunteering at the clinic/village, all food and accommodation are paid for within the volunteer‘s donation. Our staff provides three meals a day and boiled water to drink from our source. You also get nightly hot water for baths/showers and free clothes washing, albeit you can help if you wish at the nearby waterfall! In Mahamasima the volunteer lives in a small hut provided by the School and cooks for him/herself. It is in the village next to the school and next door to the hut of the head teacher. The only additional costs are food – estimated to be under $50 per week. Washing is done with the local villagers in the nearby stream. In Anivarano, the volunteers will stay in small rooms situated behind the local pharmacy, 5 minutes from the school and 100 yards/meters from the hospital. These cost 10,000Ar ($5) per night for stays of one week or greater. The rooms are very clean and have en-suite bathrooms and there are shared facilities to wash clothes. Food can be purchased very reasonable at road-sides stalls and local restaurants for about $5-10 per day. Total costs per week for food and accommodation are therefore about $70-100. In Diego Suarez, we have arranged accommodation at a small, immaculately clean, well run hotel about 10 minutes from the hospital for 40,000Ar ($20) per night – for one or two persons sharing. Food can be purchased at local stalls and restaurants for about $8-10 per day. Expected food and accommodation costs are hence about $200 per week for one person and $130 if sharing.

Many of our volunteers raise funds to help cover travel expenses and the donation. There are many different ways you can carry out your fundraising – e.g. donations from friends and family, partake in a sponsored event or get the support of local businesses or church groups.

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5.3. Local Money There are currently two currencies used in Madagascar, the Ariary (abbreviated to Ar and pronounced ―Arry-Arry‖) and the Malagasy Franc (abv: FMg). This can be VERY confusing – particularly when you first arrive. The Ariary was brought in to replace the Malagasy Franc more than five years ago. However, the FMg is still quoted on the street, in markets and in some shops. The Ariary is worth five times the FMg, so please make sure you check what currency you are dealing in when buying goods or being quoted taxi fares. All notes now in circulation are the Ariary (you might very occasionally still see FMg notes in the countryside) but even though many prices are quoted in FMg, you still pay in Ariary! Please note, it is quite difficult to get used to the currency because of the large numbers involved: eg 10 dollars = 20,000 Ariary (approx) Money Cheat Table (using easy, rather than accurate/up-to-date, exchange rates!) Malagasy Franc Ariary (Ar) (FMg) US Dollar

British Pound

Euro

2,000

3,000

2,500

100

500

0.05

0.03

0.04

200

1,000

0.10

0.06

0.07

500

2,500

0.25

0.20

0.18

1,000

5,000

0.50

0.40

0.35

2,000

10,000

1.00

0.60

0.50

5,000

25,000

2.50

1.50

2.00

10,000

50,000

5.00

3.00

3.50

50,000

250,000

25.00

15.00

18.00

100,000

500,000

50.00

30.00

35.00

Easy exchange rate

Be aware note that exchanging money in Madagascar can be extremely problematic and/or time consuming. Credit/Debit Cards are by far the easiest way to obtain cash in Madagascar (make sure than it has a microchip in order that it is accepted everywhere). MasterCard is almost never accepted and Maestro or American Express cannot be used at all. So it is highly recommended that you have a Visa card for your time here. There are many Automatic Teller Machine/Cashpoints in Tana or Diego (and one in Ambilobe), all of which give money in Ariary – up to 400,000 per day ($200). Whilst most banks do change Travellers Cheques, it is a VERY time consuming process. Bring Euros cheques only and try to avoid large denominations. Remember to bring your purchase receipt, as you will be unable to change the cheques without it. Alternatively, it is easier to change cash – again Euros only (not Dollars). Finally, there are plenty of Western Union offices in Diego for money to be sent to you in emergencies!

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5.4. Indicative prices Prices are cheap for local transport, basic hotels and local food. Prices for clothes and fuel are the same as the US/UK. Prices for domestic air travel and technology items are higher than in the US/UK. For personal spending money, we suggest you take $40/£25 per week for a budget trip or double that for a hassle-free, buy-everything, easy-going trip. Add more if you plan any extra flights or wish to stay in upmarket hotels.

The list below is a guide to help you when you first arrive in Madagascar. The prices will give you an idea of what you should be paying, but costs vary from place to place.

Item Bottled water (small) Bottled water (large) Coke/Sprite/Fanta (small) Coke/Sprite/Fanta (large) Large beer (THB) Rum (glass) Chocolate bar (Mars/Twix/Bounty) Carton Juice (small) Carton Juice (large) Bread (baguette) Croissant Street Food Samosas Fried bananas Glass of juice ‘sirop’ Filled whole bagette A bunch of bananas Internet (per half hour) Taxi journey (Diego) before 9pm Taxi journey (Diego) after 9pm Taxi (Tana/Nosy Be) – Airport to Hotel/City Lunch/dinner – Malgassy cuisine Dinner (Tana/Diego) – smart restaurant Hotel (Tana/Nosy Be) Hotel (Diego)

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Cost (Ariary) 700 1,500 1,000 2,000 2,500 3,000 2,000 1,000 3,500 300 800 100 100 100 1,000 400 2,000 800 per person 1,400 per person 30,000-60,000 2,000-5,000 25,000-40,000 40,000-200,000 20,000-140,000

Jan 2011

6. What to Bring May—October (Hot days/cool nights) November – April (Hot days/milder nights, rainy season)

6.1. Clothing Pack lightly and dark coloured clothing is best as things get dusty/dirty quickly O O O O O O O O O O O O O O O O O O O O

flip-flops/crocs (many volunteers find Crocs perfect for almost every situation) old sneakers/teva type sandals sturdy hiking shoes/boots (or sturdy training shoes) – suitable for a 2 hour uphill hike 2-3 pairs of shorts 1-2 pairs of light trousers/pants Warm pajamas (or a T-shirt, sweatshirt and PJ pants) 2 pairs of scrubs (optional) 4 t-shirts/polo shirts 1-2 long sleeved T-shirts/casual shirts 2-3 tank tops/vests (bra-tops are great for women) fleece jacket or heavy sweatshirt (for the cooler evenings) rain jacket (Breathable type) (optional save for November-April) 1 skirt & top or dress for women / business-casual trousers/pants & shirt for men 4-6 pairs of underwear (2-3 ‗easy to wash‘ bras for women) 3-4 pairs of socks (1-2 pairs of ―smart wool‖ socks are useful) sarong/wrap (useful as a spare blanket, skirt, towel etc light scarf (good for chilly mornings and evenings- optional) Sunglasses Hat/cap (essential) Lightweight sleeping bag (optional)

6.2. Personal Items O O O O O O O O O O O O O O O O O O O

soap shampoo/conditioner razors toilet paper – 1 or 2 rolls bath towel/ wash cloth toothbrush/ toothpaste hand sanitizer (optional) soap powder feminine hygiene products Snacks / Treats - individually wrapped Tea bags(if you prefer it to local coffee) and/or hot chocolate, powdered milk, Headlamp and/or flashlight/torch that converts to a lantern (spare batteries or wind-up) Sturdy water bottle/metal thermos Journal and/ or reading books French/English dictionary Money belt Camera (you will have the capability of charging a battery if necessary) Umbrella (only needed during rainy season, November-April) Stethoscope (do not buy one if you do not have one already)

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6.3. Medical Kit Whilst we have some of these items at the Clinic, it is best to bring your own O Anti- malaria tablets O Anti-mosquito repellent (strong) O Sunscreen (>30spf) and after-sun cream O Diarrhea medications (eg Ciprofloxacin) (+/- laxatives) O Anti-fungal cream O Antiseptic/Antibiotic cream O Analgesics – Paracetamol/Tylenol & Ibuprofen O Band-aids/plasters – assorted & roll tape

6.4. Communications If you have an unlocked telephone, feel free to bring it or you can buy a local phone for under USD20. You can buy an Orange SIM card for the equivalent of USD8-10 and then top-up cards at many shops. Orange reception at the clinic can be good, but it is unpredictable. However text messages always eventually get through! Therefore, a phone is useful to send/receive SMS text messages home. Overseas calls are very expensive but you might be able (on a good day!) to receive international calls. A laptop is useful only if you are staying for a good length of time. Please note that we do not have internet access at the village, and a laptop can only run off its battery (same with ipods/iphones/ipads etc). There is no main electricity at the village. We do however have a 240 volt generator which (if working!) we run every few days and it is possible to charge phones and cameras at that time. But please do not rely upon this – as is often the case in Madagascar, it may not be working, so always expect the worst. Internet cafes are not laptop friendly, so a laptop is not necessary to check your emails whilst you are in town. If you so wish, it is possible to buy a wi-fi ‗dongle‘ for your laptop from Orange for about USD100, which gives you a slow/sporadic connection about USD50 per month.

7. Useful Contact Numbers/email addresses Mada Clinics - Madagascar personnel Vice-President: Ben Shipley –261 (0)33 03 486 15 (may change as Ben is always losing his phone!) ben.shipley@madclinics.org Local representative/Nurse Didier: 261 (0)32 61 697 95 operations@madaclinics.org Mada Clinics - UK Medical Director: Dr Philip Trangmar – 44 (0)208 133 0226 philip.trangmar@madaclinics.org or philip_trangmar@hotmail.com skype: philip.trangmar

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8. Volunteer Health The clinic has basic facilities and a qualified nurse, as well as a selection of prescription drugs. If you need additional care, we also use an English speaking (private) Doctor in Diego if our volunteers have any problems beyond the capabilities of our nurse: Dr. Anante – Tel : 032 070 9805. Diego has two hospitals – a principal (government run) one and a military (private) one. The ‗Hôpital Be‘ (Big Hospital) is able to perform basic operations, stabilise patients in critical conditions, and provide other basic care facilities. The majority of doctors speak French and the director of the hospital speaks English. Hôpital Be – Tel : 020 82 219 90. Hôpital Militaire – Tel : 020 82 210 61. There is also a nearer smaller hospital at Anavarano. The doctor is French and partly English speaking and is called Dr. Ginette – Tel : 033 112 2434 For severe illness or injury, it is possible to arrange medical evacuation using: Espace Medical, Antsahabe – 65 rue Pasteur Rabary, Tana . They can supply a simple ambulance, an ambulance with equipment and doctor, or a helicopter if needed. Tel: 22-625-66, 22-219-72, or 032-02-088-16 (cellular).email: esmed@wanadoo.mg. Ambulance services are available within Antananarivo with Polyclinique Ilafy at 22-425-66/69 or 033 11 458 48 / 032 07 409 38; CDU (Centre de Diagnostic Medical d‘Urgences) at 22 329 56 or 032 07 822 28 or 033 11 822 28. Malaria and Medical Vaccinations: The following advice is only for guidance only, and is taken, in part, from the Center for Disease Control in the US (www.cdc.gov). We recommend that you seek advice from your own doctor at least one month prior to traveling. We recommended that all volunteers take Malaria Prophylaxis tablets. Whilst nets are provided and there are few mosquitoes up at the Clinic, Malaria is rife in Madagascar. Please ask your own doctor for advice (most people take Doxycycline). You should be up-to-date with your ‗routine‘ shots such as, measles/mumps/rubella (MMR) vaccine, diphtheria/pertussis/tetanus (DPT) vaccine, and poliovirus vaccine. Tetanus is particularly important. The Hepatitis B vaccine is highly recommended for all those who intend to spend some time working in the clinic. Vaccination against Hepatitis A is recommended although not absolutely necessary. We recommend that all volunteers should be vaccinated against Typhoid. Rabies is a difficult subject to address. Yes, the Clinic is in a rural area, but most guide books do not recommend it unless you are going to have direct contact with Lemurs. If you are coming to work with us on the ecology side and therefore will be spending more time in the woods looking at flora and fauna, then it might be a good idea. Remember that the anti-rabies injections still means that you may need treatment if bitten.

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9. Nearby Places of Interest At the weekends or in your free time it is definitely worth exploring the local areas surrounding the clinic. The following will give you a rough idea of what there is to see:

9.1. Ankarana National Park/Mahasima Village Just 5 miles down the road from the Clinic lies the 18,225 hectare Ankarana Special Reserve and if wildlife (either flora or fauna) is your thing, this is not to be missed. To visit the park is to enter a magical world of thick green forest, the trees, complete with their sinister, twisting creepers, house many sportive lemurs which cheekily poke their heads from holes in the trunks to watch passers-by. The forest is interspersed with the famous Ankarana ‗tsingy‘, impressive rock formations, resembling a giant‘s pin cushion, made up from thousands of spiky limestone natural pinnacles. Also within this wonderland are eerie but intriguing bat grottos and beautiful lakes and canyons. To visit Ankarana it is possible to catch a taxi-brousse from the road at the bottom of Maventibao‘s mountain. The journey to the parks entrance is then just twenty minutes away (3,000Ar). On arrival you will pay a park entrance fee of 25-37,000Ar and also have to hire a guide for your time in the park. The price of guides varies depending on which routes you choose to take and the length of time you wish to stay (from 15,000-40,000 Ar). Please note you must take all the food and water (or water purification) you will need into the park with you. An easier alternative to camping (especially as scorpions are reportedly a problem) are nice clean bungalows (10,000Ar) at the entrance with bedsheet, candle, mosquito net, good bed, cold showers and (shared) toilets. Official web site: http://www.parcs-madagascar.com/fiche-aire-protegee_en.php?Ap=6

9.2. Anivorano/The Sacred Lake The last town of note along National Route 6 before the Clinic is Anivorano and a pleasant day can be spent visiting the hospital (meeting the local doctor, Dr Ginette) and strolling around the food market, absorbing a bit of Malagasy life. The Taxi brousse costs about 4,000Ar. You could also combine this visit with a trip to the nearby sacred lake, 2 k down the road from Anivorano. Legend tells of a witch doctor who once came upon a village located where the lake is now. Being dry season, the man was thirsty from his travels and asked the locals for a cup of water, but was refused by the people who were unwilling to help a suspicious looking soul. In retaliation to their parsimony, he cast a spell to flood the village, turning it into a lake and the locals into crocodiles! To this day, those living nearby still visit the site to pay respect to their ancestors with gifts of zebu meat. On hearing their chants the crocodiles will come right up onto the banks of the lake, a fascinating, albeit scary, sight!

9.3. Ambilobe Further south dwn the road from the Clinic turn off is Ambilobe, a town of quite substantial size, which is 40 minutes by taxi-brousse. It is the nearest place to come if you feel you need to make contact with the ‗real‘ world. Amilobe has one internet café: note, like all such cafés in Madagascar, the connection is extremely temperamental and sometimes it does not work at all! Ambilobe also offers interesting clothes and food markets and a handful of nice eateries (complete with ice cold drinks which can be sorely missed up on the clinic hill!). It can also be the drop of place if you are coming by Taxi-brouuse from Nosy Be. There is one OK hotel, called the National Hotel, in case you need to spend a night.

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9.4. Diego Suarez If you have a few days spare at a weekend or at the end of your stay, you can spend time in the largest town in the North of Madagascar. It has many colonial buildings (albeit run down) and a huge market. This is the best place for souvenirs, including the aromatic vanilla pods. It has several internet cafés and if you want a guaranteed internet connection (albeit slow), this is your best bet. Most shops and banks in Diego shut between 12 pm and 3 pm Monday to Friday and are open in the afternoon until 5:30 pm. At weekends, shops only open on Saturday mornings. Restaurants are generally open all day. There is also a fantastic French patisserie at the largest hotel in town, The Grand. Eating at street stalls is a cheap option, but does require a strong stomach! If you want to give it a go, make sure you begin with trying small quantities and gradually increasing them if you are sure you are fine. Note that juice ‗sirop‘ at stalls and Malagasy restaurants normally comes from concentrate that is diluted with untreated water.

9.5. Ramena Beach An interesting day trip from Diego, or if you fancy a spot of R & R, you can spend a couple of lazy hours (or days) on the beach at Ramena. The immaculate white sands stretch a length which includes a busier end with hotels and bars and a quieter part where it is possible to watch fishermen go about their day‘s tasks. Snorkelling at Ramena is good and it is possible to hire a fishing boat to take you to the Mer D‘Emeraude, where it is even better! There is also a dive centre at Ramena.

10. Other useful info, web addresses & airline information Best Guidebook: Bradt‘s Guide to Madagascar (latest edition 9th) National Parks: http://www.parcs-madagascar.com/ Air Mada – online booking: www.airmadagascar.com Air Mada – overseas offices: www.airmadagascarna.com/MDcontact.htm Air Mada – pdf list of flights: www.airmadagascar.com/offres-plan.html (CDG – NOS operates out on Wednesdays and back on Thursdays) Air France: Paris to Tana daily: www.airfrance.com Air Austral (via Renuion): http://www.air-austral.com/accueil.php Air Italy: Milan to Nosy Be (Mondays out Tuesdays Home): www.airitaly.eu CorsAir: Paris to Nosy Be and Tana: www.corsairfly.com/corsair/index.do (NB Not operating to Nosy Be as of Jan 2011) N.B. If you fly into Madagascar using Air Mada you are entitled to 30% discount on internal flights.

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11. Terms By accepting to come to Madagascar with Mada Clinics you confirm that: O

You do not have any ongoing or occasional medical or psychological condition which precludes you from living or working in a rural setting;

You are aware of the current political situation in Madagascar and travel at your own risk;

You have adequate travel insurance to cover medical emergencies, evacuation, and your personal belongings;

You hold a passport of at least 6 months validity;

Whilst in Madagascar you will agree to abide by the laws of Madagascar.

ÂŠ Mada Clinics

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Jan 2011

12. Useful Malagasy Phrases Pronunciation guide: Ah—like a in ‗father‘; Eh—like e in ‗they‘; Ee—like i in ‗machine‘; Oh—like o in ‗so‘; Oo—like u in ‗used‘; Ng—like ng in ‗morning‘ General: English Hello What‘s the News? (usual greeting) There is no news! (usual response) Yes No Thanks! Please/Excuse/Sorry Good-bye!

Sambitsara/Veloma/Au-revoir

Water

Rano

Useful for the Clinic: English

Malagasy Mbôlatsara

Pronounciation Mboh-laht-sah-rah

Ino vaovao?

EE-noo Voh-voh?

Tsisy vaovao!

Tsee-see Voh-voh!

Eka/Ia/Oui/Eny Aha or Ehe/Non Misaotra!/Merci! Aza fady

Eh-kah/Ee-ah/Wee/Eh-nee Ah-hah or Eh-heh/Noh Mee-soh-trah/Mer-cee Ahzah-fah-dee Sahm-beet-sah-rah Veh-loo-mah/Ohr-vwahr Rah-noo

Malagasy

What is your name?

Azôvy añaranao?

Where do you live?

Aïa mipetraka anao?

How old are you?

Firy taoño anao?

How many days have you been sick?

Firy andra marary anao?

Where is your pain?

Aïa marary nianao?

Is there a fever?

Misy fièvre?

Is there coughing?

Misy mikohaka?

Is there diarrhea

Misy mivalaña?

Blood Pregnant

Lio Bevohoka

Pronounciation Ah-zoh-vee ahngah-rah-noh? Ah-ee-ah mee-peh-trah-kah ah-noh? Fee-ree toh-ngoh ah-noh? Fee-ree ahdrah mah-rah-ree ah-noh? Ah-ee-ah mah-rah-ree nee-ah-noh? Mee-see fee-eh-vreh? Mee-see mee-koo-ah-kah? Mee-see mee-vah-lah-ngah? Lee-oo Beh-voo-hoo-kah

In the Clinic, we have posted a more complete list of helpful phrases and pronunciation.

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