Ravao’s Story: A Health and Environment Champion From Madagascar’s Mikea ForestNovember 21, 2012 By Vik Mohan
I recently spent a hectic and intense couple of weeks in the village of Andavadoaka, where Blue Ventures’ community health project is based, during my annual visit to Madagascar. Although I founded our Safidy (meaning “choice”) health program several years ago, each return visit brings new and inspiring stories and lessons from our team on the ground.
This particular visit was quite eventful, to say the least. We celebrated the fifth anniversary of the launch of our community health projects; held the inauguration of our new reproductive health center and environmental education buildings; opened the doors to our very first antenatal education clinic in the region; held a community-led “total sanitation” festival in Andavadoaka; had a successful visit from our partner, Marie Stopes Madagascar; trained all 30 of our community-based distributors of reproductive services how to counsel women on the use of long acting contraception; and visited some of the poorest and most isolated communities we serve in the neighboring Mikea Forest.
As someone who spends much of my time working remotely, away from our project site, it was incredibly valuable and rewarding to see our program in action and the fruits of our labors. No words can quite explain the joy of seeing the value of our work firsthand: watching a pregnant woman get the opportunity to receive antenatal education for the first time, or a young mother make an informed choice about how long she waits before she has another baby; witnessing the gratitude people feel because we’ve taken the trouble to provide services to their remote community; and watching the Malagasy regional medical inspector join us as we dance to a song about Safidy that was written and performed by our community-based distributors.
One thing that hasn’t changed over the years is transport; it sure doesn’t get any easier!
Our home base, Andavadoaka, is eight hours travel across sand and through the Spiny Forest in a 4×4 from Toliara, the closest big town. To get from Andavadoaka to the Mikea Forest is even harder; the sand is too deep for even our 4×4 to manage. In order to visit some of the forest communities there, Caroline, our Safidy project manager, and I took a cart pulled by zebu (cows) for two hours to Befandefa, another village, then walked three or four hours in deep, hot sand to get to the first village in the forest, Ankililaly.
The following day was just as strenuous: seven hours in a zebu cart traveling between villages and finally back to Andavadoaka. It was worth the effort, though. The reception we received from Ravao, the lovely community-based distributor in Ankililaly, moved myself and Caroline to tears. She gave up her hut for us to sleep in, made us dinner, sang and danced for us with her family by moonlight, and tried to give us one of her precious chickens as a gift to say thank you for coming to visit. These Mikea Forest communities are some of the poorest people I’ve ever seen, and I felt truly humbled by their generosity.
Ravao’s story is truly amazing. She is about 40 years old (she does not know exactly) and has 12 children; the oldest is 24, the youngest is 2. Until Blue Ventures introduced Safidy in Ankililaly, Ravao had no access to family planning. As soon as our program reached her village, however, she availed herself of our services and is now a regular client. When we were recruiting women to become community-based distributors for our family planning program, she felt so strongly that women in her region should have access to contraceptive options that she volunteered her services. Being an intelligent and highly respected member of her community (and one of only a few literate women in the region) she was an obvious candidate for this role.
Dr. Vik Mohan on Integrating Family Planning and Conservation in Madagascar
Now fully trained, she tirelessly champions the cause of universal access to family planning, using her knowledge of the people of the Mikea Forest and their semi-nomadic lifestyle to reach as many women as possible with much needed family planning services and basic health education. She walks over five hours to Andavadoaka to attend any training we offer, such as the quarterly update training for our community-based distributors, and is grateful for the opportunity to develop her knowledge and skills. Her commitment to her work, and the fact that she is part of and has the full respect of her community makes her more effective at providing services to this community than any of us from the outside could ever be.
It has been great to witness the impact of our work. I get a definite sense that people understand issues relating to health and sanitation far better than they did at the launch of Safidy five years ago and its link to the environment and their livelihoods.
While it is difficult to quantify, it seems that the women I met were more empowered and more willing to take control of their health and other aspects of their lives. The contraceptive prevalence rate has gone up from less than 10 percent to 40 percent in the time since we started, and we have witnessed a huge reduction in birth rate as a result. Quite apart from the huge health and social benefits to individuals, couples and the community, it’s worth noting that the population of the region would be six percent higher than it is now, if Safidy had not been started.
The slowing in the growth rate of the population means that our community-based conservation and coastal resource management program is likely to be more effective, and providing much needed health services to the community ensures better buy in from the communities we partner with. I feel so excited to know that our work impacts so positively on Ravao and the thousands of women like her living in this isolated and underserved part of Madagascar.
Dr. Vik Mohan is director of sexual and reproductive health programming for Blue Ventures, a London-based non-government organization that works to promote health and conservation goals in Madagascar alongside eco-tourism.
Photo Credit: The Mikea Forest, Madagascar, used with permission courtesy of Al Harris/Blue Ventures.