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#424
Madagascar
Keymaster

For many rural people, initiation into modern life takes place in the hospital. This is in any case what Odéon Theophile Andrianaivo thinks in his study on “The role of the Malagasy hospital in health education” (Bulletin de Madagascar, December 1967). They see what a bed, a mattress, a shower, a toilet or a lamp, etc. They are so quickly impressed by the environment that a fear and a complex settle “that many people mistakenly refuse to enter into modern life”.
Indeed, “despised silently by the city dweller or by a circle believing himself to be more evolved”
(See previous note), the rural community feels a latent fear of doing wrong, of ridiculing oneself, of displeasing the caregivers “whom he fears with respect like the village healer”. According to O. T. Andrianaivo, like the city dweller, the peasant flows to the hospital every time a relative is sick. Despite the rigors of hospital discipline, he settled in a group somewhere during the hospital stay to be within reach of the call and to come quickly to visit him at the prescribed hours. The group brings its rice, its bundle of wood, its mat, often sleeping under the stars, increasing the number of the floating population of the city. Some towns, such as Moramanga, have set up shelters to accommodate these people in the margins of hospitals. These centers, placed under the authority of the hospital’s medical director, are considered as hospital obligations and places of learning for urban uses and hygiene.
Between the evolved urban and the rural real is the “urban proletariat” which is closer to the second group by its habits. In search of a job, it settles itself as well as badly and rather badly than well – on the outskirts of the cities. Located between two civilizations, he tries to appear city dweller whereas he lives in conditions sometimes less good than those of rural.
Thus, its geographical location only influences the traditional structures it brings from the countryside. “For him, there are agonizing problems: the under-equipment in urban planning and overpopulation. In the absence of an immediate solution, the hospital and the dispensary must, in particular during the rainy season, be able to provide accommodation and care in large quantities, forcing caregivers to practice both collective and individual medicine. “
In the hospital, caregivers (doctors, nurses, midwives, nurses, pharmacists) are honored to belong to the privileged world of the hospital. It contributes through various activities to give care to the sick. “The struggles they fight against diseases and death classify them, in the eyes of the public, in a world apart. Their power, which many still believe is magical, is personified by their blouses and their functions, hence a “reverential fear” that persists even among city dwellers.
“Some caregivers – I set aside doctors and pharmacists – exploiting the notoriety of their hospital function, become healers to modern medicine. Most people divide into two sexes people in medical blouses: Radoko or doctor and Rasazy or midwife. “Thus a doctor often receives the title of Rasazy and a nurse will be given the name of Radoko. Receiving the title of Doctor for many years, some hospital nurses or clinics allow themselves to provide home care by establishing diagnoses and prescriptions themselves, and sometimes by supplying medicines from hospital wardrobes. “
Cases may be rare, but the fact that this new category of healers is sheltered by the walls of hospitals “could give a great impetus to this dangerous practice. Modern medicine ought to deserve the total confidence of our patients, and so at all costs we must combat this new and very modern formula of charlatanism. But caregiver-sick contact is often difficult because the latter, diminished physically and morally, sees in the former a force which, by creating a half fear, more or less eliminates confidence in the encounter. “The nature of human contact is a matter of personality and temperament. “

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