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Caring without exception

By Kate Thompson, Safina Center “Kalpana Chawla ‘Launchpad’ Fellow”

We are in the bustling beach-side city of Morondava buying food and other supplies, when I notice one of our porters is wearing a White Star t-shirt. American cast-off clothing often ends up in markets here, and it takes me a few minutes to make the connection. The shirt is navy with a crisp, white ocean liner cruising across the chest. When he turns to heave a bag of rice onto his shoulders, I see “R.M.S. Titanic Crew” emblazoned across the back of his shirt. It’s cruelly apt, I think to myself, because sometimes this island does feel like a sinking ship.

A village in Western Madagascar, which, like many, depends on local natural resources for their livelihoods. Photo: Kate Thompson

Field work, especially in global aid and conservation, can often be a breeding ground of cynicism. It’s hard to resist the negativity at times, the pessimism that swarms like malarial mosquitos at dusk. Madagascar is both home to a fifth of the world’s primate species, many of which are in imminent threat of extinction, and to a unique, culturally diverse population of people, whom are experiencing a recent famine and high rates of malnutrition. It is one of the poorest and most food insecure places in the world, with 92% of Malagasy living on less than the equivalent of $2 per day. It is difficult to take on a single piece of this fractal crisis and not feel overwhelmed, disheartened and flat-out-angry at all the chaos that remains. The soaring occurrences of childhood malnutrition and stunting, the rapid depletion of slow-growing forests, the dwindling numbers of endangered primates, the rampant and poorly regulated strip-mining, the outbreaks of plague, tuberculous and malaria that settle like a feverish stupor on the heart.

Even within the protected forests, logging is rampant. Here are canoes being carved within the forest to be carefully and discretely brought home later. Photo: Kate Thompson

In the beginning of my project our village, an earth-and-tree-hewn settlement on the outskirts of the forests and the fringe of Martian-looking salt-flats, was frustrated with us. Day after day, people came to ask us for medicine, and day after day we turn them away. People gathered on our porch: itchy-skinned toddlers, the elderly with ash-fueled coughing fits and the fishermen with pus-bulging-wounds from stepping on broken shells and fish hooks. When I introduced myself as studying health, they thought medicine. When I introduced myself as a doctoral student, they heard doctor. They heard hope. It is true that two of my translators are registered nurses and I am a first responder. I’m licensed to put right your garden-variety dislocated shoulders and broken limbs and I’m confident doing so, having successfully patched up my own severed leg in college with duct tape and a pad until I could reach a doctor two days later. None of us, however, are permitted to prescribe medicine. Legally and ethically, it’s out of our medical scope. Scope of practice, however, is a hard thing to explain to hopeful people in dire need.

Our village was supposed to have a clinic built here years ago, but cement husk of the building stands half-finished in the center of town, adorned with children’s graffiti and torn political posters. The community even tried to build an earthen traditional house to function as a doctor’s office, but gave up when do to remoteness, lack of governmental funding, and worsening regional security, no doctor ever came. Research suggests that human health, especially that of children, is significantly correlated to wildmeat hunting and consumption. It may be that investing in clinics and community health might be the most effective way to counter illegal resource exploitation, but few have taken up this approach. Where we are the nearest doctor is a four hour’s walk away – a nearly impossible journey for a new mother fever-dizzy and too weak to walk. The nearest dentist is 6 hours away—by car.

Forests surrounding developed areas in western Madagascar are often devoid of larger tree. Photo: Kate Thompson

And so it went on, like this: Can I have free medicine? No. Can I have free medicine? No. Can I have free medicine? No. Can I have free medicine? No. We can give advice. We can listen. We can treat external wounds galore. But we cannot give medicine, and that’s what people want.

Two months into the project, I hit a low point. “NO” I snapped at Marie*, a woman about my mother’s age, sitting on the woven mat floor of our house. She has a headache, with some probing admits she hasn’t drunk any water since the day before. You just need water and I know you have some at home, I think. The iPads we use to collect data aren’t working. The surveys aren’t translated right. I haven’t slept well in at least three days, it’s 122 degrees outside this afternoon and someone stole my t-shirts and “NO. We don’t give medicine. We are not doctors. We cannot help you.” Without a word, she walks out.

I flip through my emergency medicine handbook, trying to see if there are any non-medical headache remedies beyond drinking more water I could (and should) have recommended. I pause on a page of notes. In big letters, I had copied the words of my instructor: “Do exceptional care. Always.” In this moment, I had slipped into a sharp and jagged mood that hindered attentive care. Let alone exceptional care. I felt deeply ashamed and deeply exhausted.

In the coming months, I came to realize that draining infected abscesses and irrigating sand-encrusted gashes was simultaneously the least and most I could do for the people around me. Although I hope my research eventually contributes to public health and conservation policy that benefits this community, they are hungry now. Jeanne’s children have measles now (a massive outbreak swept through Madagascar during my time there). Germaine’s best friend has infected blisters on her ankle from a tumbled pot of water that needs cleaning now. Just like any of us, it’s hard to think about conservation and reforestation with an empty stomach and aching forehead.  

I took great joy in cleaning and bandaging wounds, as it felt like the most direct contribution I could make to the well-being of the village. Photo courtesy: Kate Thompson

My dissertation work has convinced me that, on the front lines of in-situ conservation, the needs of indigenous populations must be heard and addressed before conservation aims can be achieved. The physical health of human populations is deeply intertwined with that of the surrounding ecosystem, and likewise until people have a baseline level of food- and economic-security, they cannot realistically stop practices like poaching, logging, or slash-and-burn agriculture. It will be a while before my dissertation work is finished, longer before it’s published, and even longer before it hopefully helps shape policies to the benefit of the village I advocate for. However, in the gap between horizonal hope and immediate need, I can at least listen to the story of how Georges sliced his hand cutting brush for his cattle, I can clean and bandage the mangled flesh, and I can share his smile weeks later when I shake his hand in the market, for now healed and whole. Small, concrete kindnesses (and a lot of Neosporin) are perhaps the most meaningful broader impacts my dissertation can offer.

*all names are fictionalized to protect the identities of research subjects

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