Just when Malagasy health officials believed they were getting the upper hand against the plague epidemic that’s killed nearly 200, things just went from bad to much worse in Madagascar.
In an extensive report penned by Sally Hayden of The Irish Times, an unknown number of patients infected with the pneumonic plague (bubonic plague’s much deadlier cousin), have taken it upon themselves to “escape” from hospitals for fear of the stigma that comes attached to victims of the disease.
In the city of nearly nine million souls, Antananarivo is the largest and most populated metropolitan area in Madagascar, officially known as the Malagasy Republic. And within the city locally known simply as “Tana”, there are six separate hospitals that are treating those infected with a particular strain of the plague that from the moment of first contact can kill within 24-hours.
As reporter Hayden noted from the grounds of the city’s Central Anti-Plague Hospital Ambohimindra;
“This is the first time it’s an urban epidemic,” says Dr Marielle Zaramisy, the hospital’s chief of medicine, speaking in her small office from behind a cloth face mask. She’s been working in the hospital for just a month and a half, since the height of the crisis. Her family are worried about her safety. “As a human I’m afraid but I’m following all the precautions. It’s my job.”
Visitors must wear masks covering their mouths at all times. Before entering, shoe soles are sprayed with disinfectant and your temperature is taken with a handheld thermometer. The guards on the door oversee this process, but they also have a more important job to make sure patients don’t escape. At least one inmate got away in October, making it all the way home before doctors forced him back into an ambulance. There have been many other attempts, Zaramisy says. “Some escaped because they’re afraid of needles. People here are not used to the hospital.”
The Irish born, bred and educated Hayden also made note that due to the social stain that comes with a diagnosis of the plague, many victims very well may have not ever sought modern medical assistance from the numerous hospitals throughout the nation
“The problem of plague is not just a medical response. You can have hospitals but if people don’t come it isn’t enough,” said Jean Benoit Manhes, the deputy representative of Unicef.
Adding to public anxiety is a plague of rumours: that the outbreak is a government plot to get donations ahead of next year’s election; if you catch the plague it means you’re dirty; everyone who goes to hospital will die.
Zaramisy says it’s even hard to convince those who are infected of what they have. “It’s all about them not believing what they have despite having symptoms.”
In what may be an epidemiologist’s greatest nightmare, more than a few of those who’ve contracted the disease are going unreported and untreated;
“There’s been some resistance from the families,” says Dr Lalaina Randriamanantsoa, technical assistant at the ministry of health. “Some family members have gone into hiding.”
For each confirmed case of plague, as many as 20 more contacts have to be treated as a precaution. Those admitted to hospital are given the antibiotics streptomycin and co-trimoxazole, initially injected every three hours. Patients stop being contagious after five days of treatment.
After eight days they leave hospital healthy again, though victims are afflicted by stigma.
“Some people are ashamed once they get out of here. They don’t know can they go out at night, they don’t want to tell their boss because he won’t hug them anymore,” Zaramisy says.
Hayden also reported;
The plague has hit indiscriminately, but poverty has played a role in the death toll. Madagascar is one of the poorest countries in the world, with 92 per cent of the population earning under $2 a day. The average income is less than it was when the country gained independence in 1960.
It’s the uneducated that are least informed about the plague, meaning they won’t present themselves to a hospital if they experience symptoms. Though plague medication is free, the high cost of prescriptions for other ailments also means poor people aren’t used to going to doctors, preferring traditional healers instead.