Young Explorer Cara Brook is in Madagascar studying the impact of human land development on biodiversity and how it could potentially spread infectious diseases that are transmitted from animals to people. Cara will focus on bubonic plague in small mammals and henipaviruses and lyssaviruses (two strains of viruses) in bats.
Malagasy currency is measured in Ariary, and it takes 2,000 Ariary to equal one US dollar. The largest bill in circulation is a 10,000 Ariary note—read $5 US—which I think rather underscores Madagascar’s rank among the ten poorest countries on the planet. As in much of the developing world, there are multiple faces to Madagascar, and I find myself curiously navigating them all, threading my way amongst ex-pat researchers, University of Antananarivo professors, local vendors, and scientific research assistants. One evening, I spend 10,000 Ariary on a taxi ride to meet colleagues at one of Tana’s finest French restaurants, where entrees average out at 15,000 Ariary (still a steal by American standards). The next night, I spend 400 Ariary (yes, that is 20 US cents) on a taxi-be ride across the city to join some Peace Corps volunteers for a meal that cashes in at 3,000 Ariary, or $1.50 US. Upon later reflection, I decide that the second meal tasted better, though my insides might regret it tomorrow.
In spite of the tropical locale, winter is fast approaching at this high latitude in the southern hemisphere, and there is a creeping chill in the air when night falls dark and fast. Come four o’clock, I begin to feel my old Africa anxiety—it is time to lock the doors and settle in; these streets are not safe to wander at night. The pain and the suffering are rampant, even in light of the optimism and possibility that shines from Centre Valbio. I walk across Tana in the company of a fellow PhD student, and children with sticky hair and tattered clothing hold out their hands. “Should we give them something?” my companion wonders, but I know that such an offer will only make matters worse; a thousand more hands will follow the first that is filled. “I think there are too many to help in that way,” I say, and I feel heartless and cruel.
In the city center of Antananarivo, a pack of boys swarms me and grabs at my pockets. They steal my chapstick—it’s all I have on me—and they snatch and break the chain around my neck. I fight them off and recover the pendant that hung from the chain, a stainless steel Peace sign from my parents’ college days. It all seems so pointless, for that pendant is not even valuable, only sentimental and that only to me. I am deeply shaken and I wonder…How do you break the cycle that drives such desperation?
In the daylight, I journey across the Haute Plateau, Madagascar’s central highlands, in the company of my research partner, Malagasy PhD student Christian Hafaliana. An old man walks along the road, head bent against the locust plague that glitters all around him. The Malagasy call them valala, Christian informs me. “They destroy the crops,” he says. “Especially the rice.” And rice is the staple food of Madagascar. It is the worst locust plague the country has seen in sixty years, and we stand in the middle and watch it swirl. “It is not so bad today,” says Christian. “Sometimes the whole sky goes dark.”
At Centre ValBio, representatives and dignitaries from the surrounding countryside gather together with scientists and doctors and public health administrators in Namanabe (‘Friendship’) Hall to discuss threats to human livelihood in the region. In addition to locusts, people talk of plague and dengue fever and chikungunya, of malaria, typhoid, tuberculosis, and intestinal worms. Madagascar is a rough place to live.
Matthew Bonds and Michael Rich from Harvard Medical School and Partners-in-Health (PIH) relate plans to bring a new healthcare NGO to Madagascar and specifically to Ranomafana. Modeled after PIH projects in Haiti and Rwanda, this NGO will deliver more than simply healthcare—I remember so clearly Paul Farmer telling my freshman class at Stanford University that, “the best cure for malnutrition is food.” Break time at the community meeting finds Matt staring out the window of Namanabe Hall with powerpoint in hand—he had intended to close with a lecture on poverty traps, neoclassical economics, and infectious disease dynamics, but it all seems very abstract now. “I can’t give a talk here,” he says to Professor Tom Gillespie of Emory Rollins School of Public Health and the CDC—another of the Ranomafana health and disease team. “It’s just not appropriate.” “Yes, you can,” says Tom. “It just doesn’t have to be this talk.”
So Matt scraps the theoretical modeling and the powerpoint presentation and talks instead about the vision for the future—the union of infectious disease research with real-world healthcare delivery. We know that we can learn about the interface between ecology and human livelihood in Madagascar, but the true test will be whether we can employ that knowledge for the good of both humans and environment alike. It’s an ambitious goal in a very challenging place, but there are no illusions about the difficulties ahead. It’s an inspiring group to have landed amongst in the first year of my PhD, and I could not be more honored or excited to watch it all unfold.