Having a baby in Madagascar

My partner’s step-sister had her 2nd baby today at Antsiranana hospital It has been interesting to see the similarities and differences between her Madagascar experience and my British one.

Complicated birth

We were all a little nervous leading up to this as she lost a healthy baby last year due to strangulation by the cord during the birth. She’d gone well past full term again this time and her belly was still very high and didn’t show any sign of the baby dropping into position.

It sounds like she had to take control of the situation herself. She waited until the day that ‘the good doctor’ was at the hospital and went with her bag and money (for treatment and medications) all packed. She took herself to the testing centre, in town not connected to the hospital, for another ultrasound which told her she still had a week to go.

Dissatisfied with this information she went back to the hospital for another ultrasound (remember she has to pay for all of these and they’re not cheap) and was told that there was only a little bit of amniotic fluid left in the womb and that her baby had probably been suffering for some time (not sure this was helpful information).

They wanted to induce her but she insisted on a caesarean, mindful of her experience last year when she was also induced. The surgeon agreed. She was offered epidural or general anaesthetic and opted for general – didn’t want to hear the clinking.

I went to visit her in the evening.

The maternity ward

Diego hospitalTo get into the maternity ward in England you had to get past the security coded doors, the disinfectant hand pumps and the reception desk staffed by midwives (in fact a host of different staff in different uniforms that I never worked out who they were).

In the Maternity ward at Diego General Hospital, you just walk in to a room with open windows to some regulation hospital beds and people sat around everywhere.

In Madagascar you have to supply your own food, linen and anything else that the mother or baby needs (this is the same for any hospital stay – or prison stay for that matter). So, by default nothing is sterile.

She’d been advised not to breastfeed until her milk came in, which is contrary to the emphasis that the UK midwives put on the importance of the baby breastfeeding the minute it pops out and getting that colustrum over the first 3 days. So, a friend of the mother was feeding the baby sugar water with an unsterilised spoon which she put in her mouth before giving to the baby.

As with many things in Madagascar my immediate reaction is horror and then you realise that the world doesn’t fall apart when things aren’t done the vazaha way. This isn’t to downplay the infant mortality rate here or what I suspect is a poorer rate of healthy outcomes from hospital stays but, in general, everybody stays alive. And, they’re not worried about our super hospital infections here – I’m not sure if that’s because they’re not here or because it’s more pressing to worry about cholera and amoebic dysentery.

I experienced more horror the next day when half eaten food on the bedside table was teeming with ants.

The Mum doesn’t have a nice electronic bed to raise her up so she’s lying prone unable to do much with her baby. He opens his eyes for the first time whilst I’m there so I raise him up for her to look at. She’s very slurry so I presume she’s still on some kick arse pain killers.

But despite the differences I was strongly reminded of being that new Mum with my own new little baby. As I heard the newborn cries and the mother turn her head away into the pillow a bit emotional, I felt tears well up in my eyes. And she looked so happy as the baby stopped crying just because he was laid next to her. And I felt myself falling in love with the little baby, just as I saw other experienced mothers do when I was out in public with a very small Fred. We really are programmed to love little babies.

You need family

There are nurses but the primary care of the mother and baby are done by friends and family. A woman has stayed with the new Mum all the time. Although I think that it would be great to have more midwife and nurse care, the system doesn’t work well in England either, due to the same shortage. I would have loved to have had a friend or family member with me who could help me out with all the little things. Pressing a button and waiting 40 minutes for a frazzled midwife to turn up once the need has passed didn’t provide me much support.


Small town / fish bowl life

Went to Diego airport today to see friends off.

Any visit to the airport means seeing familiar faces and them seeing you.

I realise I’m already getting used to the fact that this is a small town and your life is on show. In London people would know what I was doing because I told them, not because they saw me do it. So different people could know about my important professional milestones, drunken nights out, visits to the doctor, tripping over in the street, personal relationships etc.

In Diego, it’s always safest to assume that everybody knows everything.

An unsuspecting visitor, used to a cosmopolitan environment, may just see a sea of anonymous faces and not realise they’re all part of a closely linked net.

How are we all connected to each other?

Well, the fingers of large extended families reach far and wide, feeling deftly for information and gossip.

Also, the upstairs, downstairs phenomenon of domestic staff provides both the means of gaining inside knowledge and motivation for sharing it.

The itch to gossip about celebrities, so prevalent in the UK at the moment, is satisfied in Madagascar by gossiping about the better off – Vazaha or Gasy.

In a country where all regular forms of communication are mind-bogglingly ineffective (internet, post etc.) bush gossip, i.e. word of mouth, seems to race around Madagascar with death defying speed and accuracy.

Talking to myself – lonely expat behaviour?

I have started talking to myself in public again. The last two weeks have seen a resurgence of this habit, a behaviour I developed in Madagascar in 2006, but had lost during my stay in England.

I didn’t really notice I did it until I returned to England. I found myself doing it in shops and having to laugh it off when I got noticed.

It took about a month back in England to stop doing it.

So, why has it started again?

Self talking situations

I do it to a certain extent in the house but I’m most aware of it when out of the house. A typical situation might be the market.

Much of it is harmless enough; reciting what I want to buy – a sort of memory aid.

“Right, I need to get potatoes, carrots and beans”

However, it also moves into expressing opinions:

“Ooo, those pineapples look nice. Bet they’re expensive though.”

And it’s often used around some interaction with another person.

“Hmm, she looks like she’s having a hard day.”
“Shouldn’t those boys be in school?”.
“Ah, it’s the man who always tries to rip me off. I know your game mister.”

And sometimes it’s me expressing opinions on Madagascar life in general as I walk through the market:

“Oh my word, could there be any more chaos?”
“As if life wasn’t difficult enough already, they have to make the umbrellas low enough to poke my eye out.”

Etc. etc.

Why do I talk to myself?

I imagine it must give me some feeling of protection and buffer against the stress of being out and about in another culture.

I probably feel less alone and different by doing it (though no doubt look like a fruitcake). By expressing opinions I know my friends would share, I bring my ‘normal’ into the situation. Whereas, in fact, I am the thing that is not normal.

It also gives me a sense of power because I am speaking in a language that they do not understand. So, they can talk about me and I can talk about them. I often do it if being stared at.

Sign of stress?

It would appear to be a coping mechanism which shows that there is something to cope with. This highlights the underlying stress that is part of being an ex-pat. In England, I can switch off because:

  • I blend in
  • I understand 95% of what is happening without having to think about it
  • I speak the same language
  • I know exactly how my behaviour is interpreted.

So I can think about what’s in my head or just the unusual things that happen.

The percentage of things that are becoming automatic and understood instead of confusing is increasing.

However, daily life is still far more tiring than back in my own familiar culture.

The last 2 weeks have also been stressful as I’ve been ill and thus feeling tired and fragile.

Now I am well again, we’ll see if I will stop or whether talking to myself is part of the ongoing stress of expat life.

Culture ain’t just about rice

I found this poster in the library in the Department of Anglo-American Studies at the University of Antsiranana.

I love it because not only does it remind us that we are the strange ones but also it shows how cultural difference goes much deeper than whether you eat rice every day or not. When you first arrive you think it’s all about learning about death ceremonies, how to cook rice and how to wear traditional clothing.

But, it doesn’t take much imagination to realise how I may have been perceived at times when I was acting very British.Working with anglophones

Are Malagasys racist?

One reason I chose to live in an ‘exotic’ country is because I enjoy getting to know people from different cultures. But I’ve found a society so obsessed with race and ethnicity that I often long for the interracial mixing of Britain (and if you disagree that races mix in Britain – you want to see it here!).

Economic, religious and social lives in Madagascar are all divided along fairly clear racial lines.

It’s an Indian!

Western tourists are often offended to be referred to and treated first and foremost as a Vazaha. But, what they don’t realise is that, in Diego, your race is the most important piece of information about you. When my partner was in England, we couldn’t see somebody of Indian origin without him commenting, “It’s an Indian.” Every single time. I tried to stop him doing it but it was an unstoppable reflex.

Race and status

In Britain we are aware of statistical differences in status between racial groups (the disadvantaged groups are probably more aware than the Whites). In Madagascar, as in much of Africa, it’s totally separate boxes – your race gives a fairly certain prediction of your lifestyle and status. I’m reminded of a white Zimbabwean friend of mine who said he was shocked to see white people driving buses and cleaning streets when he first arrived in the UK.

When I was back in England, taking a bus to my old house in Hackney, I was struck by how colour and class were not a correlation amongst my fellow passengers. I saw black professional people and poor white people, something you don’t see here.

I should qualify that there are some very well off Malagasy people and in the capital city, Antananarivo, great extremes of wealth can be seen. However, this only partly breaks the race rules as a closer look at Malagasy culture, especially on the plateau, reveals an ingrained ‘caste’ system where society has always been broken down between different ‘levels’ of society. Within Madagascar your ethnicity is also very important.

So, what race are the Malagasys?

When you stand back with a global and historical eye, the obsession with race in Madagascar is even more bizarre as they are such a racially mixed population. I often feel like I’m looking at a Benetton advert with 1000s of people, each one showing a slightly different shade and combination of features than the other.

For starters the original population is split genetically between African and Indonesian origin (see Research: Migration to Madagascar by the Wellcome Trust)

Research: Migration to Madagascar

Secondly, Madagascar has only been populated for 2000 years so any claim to be ‘pure Malagasy’ requires some explanation.

Lastly, there has been a considerable mixing of genes ever since humans arrived from all the foreign groups listed above through trade, piracy, war, colonisation and slavery. Some might say that the Coastal Malagasys reputation for being good hosts and for promiscuity has predisposed this island to racial mixing.

What about me?

I now define somebody’s race when I’m talking about them, and often ask for it if someone hasn’t described it. It’s partly that I’ve got over the hang up about asking but also because it does give a context to someone here. In England, finding out whether somebody is black or white doesn’t tell you very much.

Madagascar has a long way to go before there are enough opportunities for everybody that race is as unimportant.