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#425
Madagascar
Keymaster

Prior to the arrival of the Europeans in Madagascar, the care or accommodation centers do not exist. The sick are treated at home or are placed away on the orders of the king. Andrianampoinimerina isolates the smallpox in individual holes dug out of the villages during an epidemic. His successors act similarly. Towards the middle of the 19th century, philanthropic religious works created hospitals and clinics in certain parts of the island, especially in Antananarivo.
But the true hospitable history begins with the French expeditionary force which is endowed with a highly mobile ambulance. After the pacification, the infirmary settles down and becomes a military hospital that receives in special premises. General Gallieni subsequently created dispensary hospitals everywhere, and the public’s spirit “which hurt a distinction between hospital and dispensary, called hospitals’ any health center” (Odéon Théophile Andrianaivo, study On The Role of the Malagasy Hospital in Health Education, Madagascar Bulletin, December 1967).
The Europeans give above all a definite importance to the medicine of care, to the hospital. “But housing was a serious problem: the break between family life and hospital life, the isolation of a member (in the broad sense) was felt to be an evil. “
O. T. Andrianaivo explains: “The patient who is hospitalized who does not have an escort or who is not visited, is considered by the entourage with a feeling of commiseration sometimes ironic and disdainful. This is why, he adds, the family makes it a duty to permanently place at least one member next to the patient, to recreate in the hospital the spirit “tsy misara-mianakavy” strongly anchored in each ethnic group. Family cohesion requires that no member move away from the family. “So the hospital becomes a meeting place for everyone, a grouping center where public relations play a full role. “
According to O.T. Andrianaivo, the hospital is truly a world apart, a place where various groups can be together and a place where different customs manifest themselves simultaneously. “Each patient brings home his way of thinking, expressing himself and living: each one brings his folklore. “
The citizen is favored for a long time because very great facilities are offered to him in social matters. The first hospitals were built in the big cities, and in the 1960s only major centers were serviced by main hospitals. Teaching centers are also located there. At the same time, urban concentration is only about 15% of the population, but for the urban dweller, the use of a doctor is very easy, both in dispensaries and hospitals and in private practices. In general, however, he goes to the hospital only in very serious cases, since “an illness that begins, is often treated at home, consultation is made by relatives or friends”.
However, for a sick child, the dispensary is always used. And to visit a sick relative or friend, it is also a duty to go to the hospital. Thus visiting a member of the hospitalized family is an obligation both social and family, especially dominicale. Because professional obligations mean that Sunday only allows for an afternoon long enough for visits. “A flash tour is socially badly seen. It is also an opportunity to show his material situation, which in the 1960s is fairly easy. The city dweller can afford a lot of food, clothing and furniture. Based on his possibilities, he believes that the hospital can provide them only in quantity and not in quality.
Thus, “starting from a prejudice, he affirms that everything that is for collective use can only be of low quality”. Each family tries to do this, to give its patients hospitalized products from outside: linen, food, tidbits and reading. Better, always suspicious and afraid of having an unwanted neighbor, the citizen usually enters a private room (1st category) or a twin room previously reserved for the Vazaha. “Despising the peasant manners he describes as rude, the city dweller does not mingle with the rural community, who, unable to afford it, is still in medical care (category 4). “