The first year on the Great Island

Cap Anamur provides health care support for the rural population of Madagascar at two locations. In the Southwest the team, consisting of a nurse, a physician and a technician, works in the region Atsimo Andrefana. Here, we support the hospital in Bezaha and five rural health care stations medically and technically and thereby improve the medical care for approximately 65.000 people.

The medium-sized city Bezaha is located about 700 km south of our second facility in Fandriana, in the so-called “Zone Rouge” (see background information below). As the region is dry and not very fertile, the inhabitants of this region focus their lives mainly on owning Zebu cattle. In this area life is much more burdensome as compared to the very fertile high plateau of Madagascar. The institution supported by Cap Anamur is the referral hospital for the entire district and has its only surgical facility. Our team will implement structural improvements in the surgical- and birth wards and revive the departments for internal medicine and pediatrics. Disinterest and mismanagement on the part of the head of the hospital as well as corrupt employees among the care staff have even aggravated the situation in the past years.

Apart from purchasing the necessary medical goods and the hands-on efforts of the physicians, the focus is mainly on the exchange of knowledge and on practical further education and training. Thus, in the past year, significant improvements regarding hygiene could be implemented. The hospital is frequented more often than before our arrival. Especially the surgical ward is occupied with many patients, injured or ill, some of them seriously, who here can be helped very well.

Specific construction measures could further improve the hygienic situation, structural defects could be repaired. Thus, the operation room, the only one in the area within a three-hour drive, was reorganized and refurbished. In addition, we renovated other buildings, built new sanitary facilities, refurbished and reorganized the pharmacy and repaired the ambulance car.

The second site is located in the center of the island, in the province Amoron’I Mania. The city Fandriana is about six driving hours away from the capital Antananarivo. Fandriana is a medium-sized city in the central, fertile highlands. Approximately 100.000 Malagasies live in the catchment area of our hospital. The project was aimed at implementing a surgical unit, including a rather well functioning birth ward so that a competent caesarean section can be carried out in the future.

As there had not been a ward building for surgical patients we constructed a new building with the support of our architect Andreas Tsukalas from the project in Bezaha. At the moment we are working on the completion of the surgical inpatient ward. To ensure a smooth operation we also put the laboratory back into operation. The entire necessary equipment and the furnishing of the OR-unit were ordered and are available since the end of May. By the end of June we will have set up a functioning surgical ward in Fandriana. With this there now exists an alternative to the regional hospital in Ambositra for the 250.000 inhabitants of the district, which is too far away for many patients and also too expensive.

Our local physicians, Dr. Friederike Hunstig and Dr. Lothar Winkler already introduced the sonography and implemented important improvements in the surgical ward. In the months to come we will set up the operation service. In addition, the opening of an X-ray department is planned. This will most probably be completed by the end of July due to the long delivery times. Then, orthopedic operations can be performed. Things are progressing at the location in Fandriana.


In February, relatively peaceful elections were held in Madagascar. The new president has appointed a physician as Prime Minister who,  at the same time, is the head of the Ministry of Health. A cautious wait-and-see attitude prevails among the population – probably because things cannot get much worse – especially in the health care sector. The stately health care system is free, theoretically but in daily life patients have to pay. It is hard to see through this complicated and corrupt system, especially in the South.

The overall security situation seems to be unchanged and quite stable after the elections: Driving after dark is not advisable as the streets are partly not paved and are in total darkness. The situation is a bit more tense in the south of the country, in the so-called “Zone Rouge”, location of our project in Bezaha. This is a prohibited area for foreigners. Several times patients with severe wounds from gunshots were brought to our hospital. In most cases regional conflicts are the reason as cattle-rustling is quite common in this area.