The medicine In Tamatave

We spent the first 2 weeks of our stay here working in a clinic on the outskirts of Tamatave. A majority of the work load was for children mainly who had infections of one sort or another. Unlike the UK all the children are treated as if the infection is bacterial and a whole random assortment are dealt out; All children with a cough get cotrimoxazole. In addition all of the children are treted for worms every 3 months as they have a big problem with it here.
All medications have to be paid for although they seem quite cheap by western standards: 1 antibiotic tablt costs 0.5 pence. Despite this there are many people who cannot afford the medication.

The second set of 2 weeks we have been in the local hospital, mainly in the paediatrics department. It is quite sad as there is usually at least 1 death per day. The treatments and investigations here are very limited which doesnt help. However the single most common problem is that people dont bring there kids in till they are very very sick because they are worried about the cost since many cannot afford to pay. For example 1 child was taken to their GP in january and diagnosed with meningitis, given a prescription for antibiotics but the parents couldnt afford the antibiotics. 6 months on the child has the most enourmous hydrocephalus (water on the brain). The child needs to go to tana to have a shunt put in to drain it but the parents cannot afford the 4000 arary bus cost of getting there (3500 arary = 1 pound). So we are currently giving it antibiotics and draining 50 ml of fluid off its brain every few days knowing full well that its not going to cure the problem, confounded by the fact the parents have now run out of money for antibiotics. Thats a pretty standard example of medicine here.
All patients have to provide someone to stay with them and look after them, as well as providing all the sheets for the bed and implements to eat with and out of. the relatives then fetch rice in their own saucepans from the hospital canteen.
In addition its not helped by malagasy beliefs - if the parents dont think the newborn children will survive they dont buy it clothes, medicines etc etc.