Doctor's Review: Medicine on the Move

December 14, 2017
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Off the map in Madagascar

Hit the back roads to find the heart of this East African island

Like the chameleons that live in its lush forests, Madagascar presents an ever-changing face to the visitor. One moment you can be driving in mountains with terraced rice paddies, convinced you are in Southeast Asia, the next, crossing rocky desert lifted from the Australian outback. The island offers cloud forests that might as well be in Central America and beaches with the fine white sands of Pacific atolls.

The fantastic range of scenery is less surprising when you consider that Madagascar is the world's fourth largest island, more than twice the size of Great Britain. It is also one of the world's poorest countries, listed 141 out of 174 countries last year on the UN's human development index which ranks countries by such factors as life expectancy and education and salary levels.

Most visitors ignore the poverty by barricading themselves in seaside resorts that cater to package tours, such as Nosy Be or Île Ste. Marie. Those who take the time to explore Madagascar will have to confront the reality of poverty, but will find a country with rich local culture, friendly residents, breathtaking landscapes and incredible fauna. Touring Tana

Every trip to this former French colony begins in the capital, Antananarivo. Madagascar's tongue-twisting place names are usually given nicknames and the capital is no exception. Tana, as it's known to the locals, is a sprawling city that straddles several hills, although few visitors stray far from downtown. There are a few colonial-era buildings worth seeing, but for the most part the city is a series of identical neighbourhoods.

The highlight for most travellers is Friday's Zoma, one of the world's largest open-air markets where you can buy just about anything -- it's the best place to pick up Malagasy crafts before leaving for home. Be prepared to bargain, but more importantly, be prepared for pickpockets. One of the by-products of the country's poverty is its high crime rate, and visitors are warned to stay off Tana's streets at night. Rare Breeds

To travel all the way to Madagascar without exploring its national parks would be missing out on a unique opportunity. The country has a vast network of parks and some of the world's most unusual flora and fauna. If you're not going beyond Tana, the closest you'll come to seeing the island's fascinating wildlife is at the Tsimbazaza Zoo and Botanical Garden. A visit offers a pleasant respite from the busy downtown and you can observe lemurs, chameleons and other animals among the orchids, periwinkle and various exotic plants.

Although it sits in the Indian Ocean just off the coast of Africa, Madagascar shares little in the way of animal and plant life with the rest of the continent. The island split off from the African landmass 165 million years ago and most of its species evolved in isolation. About 80 percent of its plants and animals are found nowhere else on Earth; among them are the quirky-looking, round-eyed lemurs, a family of primates that are synonymous with Madagascar.

Lemurs live in every region of the country. There are several different varieties, virtually all of them endangered. That's because three-quarters of the island's original forests have disappeared since it was settled a mere 2000 years ago. Luckily, the country is taking great strides to preserve wild areas for lemurs and other species. Conservationists believe visits to these sites, and eco-travel in the country, are the key to improving the conservation efforts of the government and local population.

One of the best places to spot lemurs is Andasibe-Mantadia National Park, also known as PÄrinet Reserve. It's a day's drive from Tana and home to the Indri, the largest of the lemurs. These giant black-and-white teddy bears move languorously through the forest and make such a racket, you don't even need a guide to spot them. However, all visitors to the country's national parks must have an official guide accompany them. Guides not only help visitors understand what they are seeing and keep them from getting lost, they also stop tourists from poaching. Incredibly, plenty of people pocket lizards, tree frogs and orchids to keep for themselves or to sell in Europe.

While visiting the park I stayed at the nearby two-star Hôtel Buffet de la Gare, a train station that's also a hotel. Built in 1938, it's a charming throwback to the country's colonial past. The rooms are unimpressive, but the dining room is a formal affair with vast ceilings and waiters in starched white uniforms. Like most hotels catering to foreigners, the restaurant served French dishes rather than local specialities. Rice is the staple of Malagasy meals -- in fact travellers joke that the Malagasy word for rice may be vary, but that part of the meal never does. Most meals also include beef or pork, and variations on Indian and Chinese dishes are fairly common. Especially tasty is the soupe chinoise, which can be found on just about any restaurant's menu. And no meal is complete without the national dessert, banane flambé.

The train station was built at a time when train travel in the area was still a possibility. Only a few tracks left from the colonial era are in working order and most of the running stock is ready for the museum, although guidebooks and tour operators can point you to memorable trips for rail lovers. A few scenic routes have near-regular service, but there's no guarantee that trains are running, so make inquiries before planning your trip. Especially recommended are the Antananarivo-Toamasina and Fianarantsoa-Manakara trips, through steep mountains, rainforests and quaint villages. Rough Riding

Apart from a few paved highways, the country's roads are mostly rutted dirt tracks that become mired in gumbo when it rains. The major form of transport on the island is the bush taxi, known in French as taxi-brousse. These are generally small pickup trucks that run from town to town. The open back has a pair of benches protected by a canvas covering. Taxi-brousses don't run on any sort of schedule, they just leave when they're full, or more precisely, overflowing.

 

Taxi operators maximize their profits by cramming as many people into the back as possible and when that's full, filling the cabin in front. If passengers want to hang off the back, then that's fine too. My first taxi-brousse ride was actually in a Jeep Cherokee. The driver managed to fit 18 people into the car along with any belongings that couldn't be lashed to the roof. Admittedly, some of the passengers were small children, but things were a bit cramped for my six-foot frame.

A more comfortable option for getting around the country is to hire your own taxi driver in Tana. A lot of them hang out at the airport but you could also have your hotel arrange for one, which is probably best way to avoid being overcharged. You can negotiate a set price for the time and distance you are travelling and they will whisk you around the country in relative comfort. Taxis are obviously more expensive but can be worth it since you control the pace of travel and stop wherever and whenever you like. The downside is that unlike the taxi-brousse, which is a fantastic way to meet ordinary Malagasy people and learn about their country and culture, private taxis keep you isolated.

It is possible to rent a car but most agencies will make you pay for a driver, whether you want one or not. Even if you are tempted to do the driving yourself, you should consider having a local person behind the wheel as Madagascar's roads are pretty chaotic. If time is short and money is not a problem, you could consider flying Air Madagascar between cities. Known as Air Mad, it is actually a reliable carrier with a decent network to 60 cities, though not immune to the vagaries of travel in a developing country. On the trail of the ring-tailed

Hikers will not be disappointed visiting Isalo National Park, a gorgeous region of Jurassic-era sandstone. The park is a short taxi-brousse ride from the town of Ranohira, 400 kilometres southwest of Tana. There are rocky mesas and sculpted canyons to explore with stunning waterfalls and forests filled with ring-tailed lemurs.

The misty jungle of Ranomafana National Park is home to hot springs, rare lemurs, dozens of exotic birds and orchids, all a short distance from Fianarantsoa in the centre of the island. I got up at dawn to catch a taxi-brousse so I could get to the park early. I had forgotten that nothing in Madagscar leaves quite on time; it was hours before one actually left the station. When I finally arrived it was mid afternoon and pouring rain, but I wasn't about to turn back.

I went to the park headquarters, paid my fee and a guide was roused from his siesta. He wasn't too pleased to see me. The two of us set out along trails of red mud that ran through the park, contending with leeches that fell from the trees and painlessly latched onto our arms, necks and ankles. We soon spotted our first lemurs of the day and my guide regained his enthusiasm. They were the most common species, the Brown Lemur, but in short order we were lucky to find a group of Golden Bamboo Lemurs. Discovered only in 1985, these are the rarest of the species and one of the reasons the park was created. They were fascinating to watch in their original habitat, quite a change from the zoo in Tana. The slow glide

If you are hoping for a glimpse of life in the backlands, you should consider a pirogue ride down the Tsiribihana River, a wide, slow-moving, brown waterway that bisects the middle of the country. Larger boats will take you down the river in greater comfort, but it's more fun to travel by pirogue, which is a sort of dugout canoe. I travelled for three days with a pair of Frenchman and our two guides and the experience was unforgettable. After meeting the mayor of the small town of Miandrivazo, who signed our departure permits, we sailed down the river. Along the way, we sang Malagasy songs with our guides and stopped at small farms and villages to meet warm, welcoming locals. At night, we camped along the river on sand banks and looked at the glittering night skies with its unfamiliar southern constellations.

If you love scuba diving, then venture to unspoiled Ifaty on the southwestern coast. Guidebooks will tell you that the diving there rivals that of the Red Sea, and they aren't wrong. When you aren't diving, you can walk along fine, white-sand beaches that stretch on for kilometres. The village of Ifaty is small with only simple accommodations, but offers a glimpse of small town Malagasy life. My fondest memory is of the night half the village gathered to watch French- dubbed action movies in an outdoor theatre that was nothing more than a fenced-off yard with a large television. The volume was cranked up to cover the chugging of the gas-powered generator and above us were those gorgeous southern stars. Meeting the Malagasy

As compelling as Madagascar's unique fauna is, its tribal lore and warm inhabitants are even more interesting. Not only did the country's wildlife develop separately from Africa, so did much of its culture. The island was an uninhabited wilderness until Malay-Polynesian explorers settled it about 2000 years ago. Their descendants are the country's largest ethnic group, the Merina, who live mostly in the central highlands. Over time other groups came to the island to add to the mix. Tribes descended from East African arrivals dominate the coastline, and generations of Arab and Indian traders have also settled the country. More recently, Portuguese and French colonists have also left their marks. French is still widely spoken on the island and a working knowledge of the language is useful for getting around since English is rarely used.

The 18 tribes that inhabit the island have developed diverse and rich folklore, music and art which are worth exploring. One of the most notable features of Malagasy culture is fady, a system of taboos and rituals that permeates daily life. Just about anything can be taboo and every tribe has its own beliefs. One village may hold a tree sacred while another frowns on eating pork. Foreigners aren't expected to be aware of these taboos, but you should be mindful of local beliefs, as some of them may be very strong.

This is especially true around burial sites. The Malagasy hold their dead in very high regard and much of the fady revolves around funeral rights. Tombs can be very elaborate and colourful, often decorated with intricate carvings or zebu cattle skulls. Famdihana, literally the turning of the bones, is a common Malagasy ritual. Every five to 10 years, the dead are disintered, fêted and sung to, then wrapped in new shrouds and reburied with gifts. Cemeteries are worth a visit, but always ask about the local fady before venturing among the dead.

 

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