Driving towards better health in Madagascar

Prof. Ahmad Ahmad stepped up onto the podium and surveyed the crowd in front of him. All the seats were filled; others watched from the back of the small tent, or stood just outside its shade, peering in.

“I hope that the use of this mobile unit will contribute to screening, prevention and treatment of diabetes in our population,” said the Director of Cabinet in the Madagascar Ministry of Health. “I hope it will effectively reduce the number of diabetes cases we discover, and deaths because of diabetes. There’s still much to do.”

The applause was enthusiastic – and with good reason. An estimated 600,000 people in Madagascar are diabetic, but only about half of them know it. Finding the other half presents a major challenge for this large, island nation in which 80 percent of the population live in rural areas. There is, indeed, much to be done.

That’s why he and about 100 guests gathered on 12 September at the Madagascan Diabetes Association (A.MA.DIA) clinic in Antananarivo. They had come to welcome a new tool to the island’s fight against diabetes: a white Toyota Hiace High Roof van, custom-built in Madagascar filled with equipment for diagnosing diabetes-related eye complications.

Inside, the van contained high tech equipment for diabetes treatment and diagnosis, with a special emphasis on eye exams. Outside, it had decals explaining diabetes symptoms and preventive measures, to educate patients waiting for consultations.  And underneath, it had good shock absorbers, to manage the island’s notoriously rough roads.

The van is the result of a joint project between Madagascar’s diabetes association A.MA.DIA and the World Diabetes Foundation. Employees of the pharmaceutical company Novo Nordisk A/S contributed 99,000 euros to the project via a series of fundraisers in 2013. Running costs will be covered by A.MA.DIA.

Mission: prevent complications

After the speeches in the tent, it was time for the unveiling. Representatives of the Madagascar Ministry of Health, A.MA.DIA, WDF and Novo Nordisk lifted the white and blue sheet covering the van, and opened its sliding door to the eager crowd.

Inside, Dr. Ranto Rajaona, an eye expert who will travel with the van, showed guests how the equipment works and offered demonstration screenings.

Outside, Dr Haja Ramamonjisoa, Médecin Chef for A.MA.DIA, explained the project to journalists in French and Malagasy, the island’s local language.

“The problem with diabetes in Madagascar is late diagnosis, accessibility to care, and complications after diagnosis,” he said. These complications, which include blindness, amputation, cardiovascular problems and kidney failure, can be devastating.

“Therefore, AMA.DIA has started a project for prevention and treatment of diabetes complications, financed by WDF and in partnership with Novo Nordisk,” he said.  “This is the second mobile diabetes care van in Africa, and the first in Madagascar.”

The inauguration was a success for several reasons, said Astrid Hasselbalch, programme coordinator for the World Diabetes Foundation, who spoke at the event.

“It was the first time a Ministry of Health representative visited the main A.MA.DIA clinic,” she said. “Also - the NGO community working in diabetes and social work was well-represented, opening new opportunities for collaboration. And the press attendance was good, hopefully resulting in a lot of media attention.”

Just days after the inauguration, the new van hit the road. The first stop was Antsirabe, where a mass screening of the population took place to detect diabetes-related eye complications.

From there, the van is scheduled to travel on to Toamasina, Mahajunga, Antsiranana, Morondava, Toilara, and Fianarantsoa. It will travel non-stop, according to A.MA.DIA, visiting all of the country’s accessible districts with brief breaks for maintenance.

See a short film from the inauguration.(2 mins)