239: What continent is this?

For the last three years, the World Council of Churches had been planning a regional meeting in Madagascar to support the efforts of local churches dealing with HIV and AIDS. Finally, it happened. Our small plane left Johannesburg, crossed over Mozambique and the Indian Ocean, and graced over rocky outcrops and luscious green rice fields until it landed in Antananarivo, Madagascar’s capital. Very few tourists have come to this island since last year’s military coup, so in February the country cancelled all visa fees and now gives every new visitor an informational booklet on the history of Madagascar’s lunar calendar (which is Arabic in origin). Does the government really think these gestures will persuade tourists to start coming again?

An international city – in a time warp

Unfortunately, I could only stay less than one week. But what an amazing experience! Antananarivo is one of very few historic capitals that lie neither on the ocean nor on a major river. Instead, it is located in the middle of the country, perched on hilly outcrops about a mile above sea level. There are 2 million inhabitants and not a single traffic light. Not one!

The traffic is terrible, as you can imagine. But I enjoyed looking at the proliferation of cars from the 1950s, which gives a feel of Old Havana – albeit with a French overlay. Most cars are rattling Renault 4s and 2-horsepower Citroens, which are used as taxis.

Old buildings line the streets, with sloping tiled roofs, tiny wood-shuttered windows and small balconies where people hang out their laundry to dry. None of the structures seemed quite straight, least of all the narrow outdoor staircases that lead one to the second floor or up the steep hillsides of the city. Looking at these scenes, I was reminded of old Moldova or parts of Eastern Europe fifty years ago. Yet the street signs are all in Malagasy and French. And, given Madagascar’s history as a former French Colony, our meals invariably included croissants every morning and French wines at night.

Perhaps because I knew so little about Madagascar, I never expected the city’s residential and business areas to be so crowded. People’s homes and shops are squeezed into tiny spaces in between flower-potted gardens, polluted canals and sour-smelling garbage heaps. Most surprisingly, however, the flat areas that surround the city’s hills consist mostly of rice paddies. In the middle of the city! Sadly, however, the paddies are becoming less productive every year, as an epidemic of hyacinths choke out the oxygen in the stagnant water. Seemingly, no one knows how to get rid of this invasive plant. (The same has happened in the Chesapeake River outside Washington, I understand.) A number of local farmers try to induce their cattle into the water to eat the hyacinths, but with little success.

These scenes and my interactions with the Malagasy people transported me even farther afield -- to Asia. Most people look Polynesian and they speak a local language that resembles a Papua New Guinea dialect. (The photo of me is with Rev. Vololona Randriamanantena – a descendent of Malagasy royalty and coordinator of the World Council of Churches’ efforts in the country.) What little you see of new construction is almost entirely financed by Chinese banks using Chinese labor, and in my Chinese hotel nobody even bothered to translate the instructions from Chinese on how to operate the TV or telephone. Over and over during this trip, I kept pinching my arm to remember what continent I was in.

The two sides of HIV in Madagascar

But of course, we came to focus on the HIV situation. Coming from other southern-African countries that have the highest HIV-prevalence rates in the world (for example, Namibia’s adult population is 18% HIV-positive ), once again Madagascar blew me away. The national prevalence rate in Madagascar is less than a half-a-percent – far less than in Washington D.C. (at 3%) or the United States as a whole (close to 1%).

What is Madagascar’s secret to success?

If you answered “its isolation” you are probably correct. But it’s not only that Madagascar is an island, far away from Africa’s mainland. Even within the country people don’t move around a lot due to the country’s miserable road network. So the normal patterns by which disease is spread don’t apply here.

Moreover, when people do travel, it often means that they are looking for work outside Madagascar and, because of language issues, that usually means going to Mauritius or France or West Africa where the HIV prevalence is much lower. Finally, you may be aware that male circumcision reduces the likelihood for HIV infection by 60%. And, despite the fact that Madagascar is mostly Christian, virtually all Malagasy boys get circumcised by the age of two. It’s not a foolproof solution (as Jewish and Muslim men with HIV can sadly testify), but it certainly helps.

Unfortunately, the downside to this low prevalence rate is that for those Malagasy citizens who do happen to be HIV positive, the stigma and discrimination issues are awful and overwhelming. Most people living with HIV are afraid to tell their employers or even their family members that they carry the HIV virus for fear that they will be thrown of their jobs and homes. Clinics and support organizations for HIV-positive people are few and far between, and also very difficult to find. (The desire for anonymity keeps them hidden, without any public outreach.) The churches have a big role to play in breaking down stigma and discrimination, and from what we could see many are trying their best.

We visited a number of HIV/AIDS clinics and support groups. Interestingly most of the people living with HIV whom we met were men, while worldwide the disease predominantly affects women. Is this because of the relatively more-accepted practice of men-having-sex-with-men in Madagascar? I can only guess. So much on this island remains a mystery – and not only to me.

Lemurs are best!

Of course, no trip to Madagascar is complete without taking in some other unique aspects – specifically, some of the country’s 16 surviving species of lemur. Our natural history guide was named “Good-smelling,” which I thought bode well for our adventure.

Lemurs are the world’s earliest prehensile mammals, maternal in their social structure, and generally living in groups. They are primarily vegetarian and females always eat first. A night, lemurs sleep in a circle, with the males forming a protective ring around the females. They are naturally curious creatures, their round eyes staring at you intensely like Namibian bush-babies. Tragically, a loss of habitat has endangered many lemur species (15 are already extinct). We saw them in the zoo, in an open reserve. I would have loved to visit their natural habitat. Yet even here, I could have watched them for hours.

Madagascar is not on our world-trip itinerary but I hope I can come back one day. To end, here is a wonderful local proverb that I learned during my stay:

Let your love be like the misty rain,

coming softly but flooding the river.

...............(Madagascar)