UNICEF Madagascar: Hard Times in Tana

Hard times in Tana Madagascar’s political and economic crisis has hit the urban poor of the capital Antananarivo, or ‘Tana’, particularly hard. Many have lost their jobs and new jobs are hard to find. After Nambinina Rakotonirina joined the ranks of the unemployed several months ago he and his wife Julie and their baby, Nambinitsoa, had to make do with less. They didn’t fully realize the impact this was having until the day a neighbor came to their door...

05:35 The service has already started when Nambinina Rakotonirina, 26, slips quietly into an uninhabited pew at the back of the church and opens his Bible. The pastor’s voice echoes thin and distant off the cold concrete walls. This morning’s sermon is about hope. About Madagascar’s abundant resources and the poor’s lack of access to them. About how the political situation in the country has only made a bad situation worse. “Hope is what’s left,” the pastor says. “Hope and prayer.“ Since Nambinina lost his job three months ago these are the currency that sustain him -- only he puts it a little differently: “Praying to have hope.”

Nambinina’s nickname -- Nambin -— means ‘lucky’, but that isn’t something he has felt lately. Several months ago government budget cuts resulted in the loss of his salaried job on a government construction project. Nambin spent two months looking for whatever work he could find. Every day he went out early in the morning and every day he returned home in the evening with nothing.

He and his wife Julie, 19, and their then ten-month-old daughter Nambinitsoa lived for as long as they could on their meagre savings while looking for ways to economise. Beyond using candles instead of their single electric light, all they could cut was the cost of food. “For two months we didn’t have any money at all,” Nambin says, “and we didn’t have enough to eat.”

During this time a neighbor who is also a community nutrition worker came to their door and asked to take the baby’s arm measurement. When she told the couple their daughter was malnourished, Nambin was stunned.

“I really thought our daughter was healthy and normal,” he says.

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06:18 When Nambin returns from church, Julie, with Nambinitsoa on her hip, opens the door and greets him with a smile. Behind her, rice porridge bubbles on the charcoal stove in the blackened hallway.

The couple rent a single room in a small gabled house accessible only by the footpaths and narrow alleyways that make up the interior of densely populated Antananarivo. Entering their room, Nambin sets his Bible on the dresser and looks around. Despite the stains on the walls and the housecoat that doubles as a curtain, it is a tidy room. The bed is neatly made, the dishes clean and stacked. When breakfast is ready, the three of them sit together on the bed to share a bowl of steaming rice porridge.

Julie recalls how after their neighbor measured Nambinitsoa’s upper arm, she accompanied them to the local health centre, where a nurse weighed and measured the baby and confirmed that she was malnourished. “They told us she was really underweight and gave us some special food for her,” she says. “I felt so bad. I kept thinking how it was our fault.

It was our choice to have her and she was malnourished because we didn’t have enough money to give her the food she needed.”

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07:30 Over the last few weeks Nambin’s luck seems to have changed. A friend told him about a temporary job at a small construction site nearby. For 3000 Ariary (US $1.50) a day he “carries bricks, cleans up, and whatever else they need me to do.” It is only half of what he used to make. “But at least it allows us to buy some rice,” he says.

Nambin’s situation is by no means unique. Since Madagascar’s political crisis began in 2009, life for Madagascar’s working poor has become increasingly difficult. The imposition of sanctions and an uncertain investment climate have brought the country’s economy to a virtual standstill. Tens of thousands have lost their jobs. With so many people unemployed even daily labour is hard to come by. The streets and alleyways are full of people selling whatever they can think to sell. Poverty, food insecurity, criminality, and corruption are on the rise.

“Those two months when I didn’t have a job were really difficult,” Nambin says. “But I think they were hardest on my wife. I would go out looking for work every day while she stayed at home with all the problems -- no food in the house and no money.”

Times are still hard. “I never know from one day to the next if I will have work,” he says. “But I know there are others who are even more affected by all of this than we are. I know people who haven’t had work for a long time -— people who only live on whatever they can steal.”

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08:12 While Julie washes the breakfast dishes then bathes and dresses Nambinitsoa she talks about how they arrived in this unexpected situation.

“Nambin and I got married two years ago,” she says. “He had finished grade ten and then earned a certificate in ceramics. I had just finished grade nine when I was forced to leave school.” Julie’s parents were among the tens of thousands of workers in Madagascar’s export processing zones who lost their jobs when, as a result of the crisis, the US suspended duty-free agreements with Madagascar. Without an income they could no longer afford to pay her school fees. “After I’d been out of school for six months, it seemed like a good time for us to get married,” she says. “I imagined a good life for us -— having a family, having things in our house, having enough food to eat. I never imagined that we would live in need.”

“After Nambin lost his job every day was a struggle to find something to eat. Now that he has work at least there is a little money to buy food.

But what he is earning now is not enough for us to survive.” Julie is in charge of the family’s budget. She explains that even if Nambin works six days a week, he can only earn 72,000 Ariary a month (US $36). But every month the couple’s expenses —- rent, food, candles and charcoal —- add up to almost 120,000 Ariary ($60).

To cover some of what remains Julie washes people’s clothes or fetches water for them. “In a week I can earn about 5000 Ariary (US $2.50) doing this,” she says. “But we are still short so we decrease our expenses wherever we can. For example, in the past we used to eat rice three times a day,” Julie says. “Now we only cook it at breakfast and then share the leftovers for lunch and dinner.”

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09:43 Every Wednesday morning for the last two months Julie has joined mothers and children as they line up to have their malnourished children weighed and measured. Dr. Alice Raselanivo, who is in charge of the CRENAS (Outpatient Centre for the Nutritional Rehabilitation of Severely Malnourished Children without Complications) at the local health centre, then reviews each case and talks with the mothers.

“Unfortunately, cases like this are common these days,” she says. “Since the beginning of the political crisis we have seen more and more malnourished children here. Many, like Nambinitsoa, are here because their fathers don’t have work so the family is eating less. Others are here because there are a lot of children in the family and when the food is divided between all of them they don’t get enough.”

With two out of three families in Madagascar living in poverty, many parents, like Nambin and Julie, may consider their malnourished child to be healthy and normal. This is why the community-level nutrition screening that takes place throughout the country twice a year during UNICEFsponsored Mother and Child Health Weeks is so important. “I always see spikes in the number of malnourished children at the CRENAS in October and April,” says Dr. Raselanivo. “That is because every child in the country from six months to five years of age is being screened and, if necessary, sent to us for treatment. But malnutrition is out there all the time. It is just a matter of detecting it and telling people to come.”

When the examination is finished Dr Raselanivo tells Julie that Nambinitsoa is doing better this week -— though at just 6.5 kg the 13month-old only weighs the equivalent of a healthy three month old. “This case is quite severe because her weight keeps fluctuating,” the doctor says. “We have to continue to follow up every week.”

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binitso Name: Nam onths Age: 13 m .5 kg Weight: 6

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ish : malnour Diagnosis

09:39 Julie leaves with a one-week supply of therapeutic food for Nambinitsoa and is told to return the following week for more. Supplied by UNICEF, this highly nutritious food provides Nambinitsoa with the calories and nutrients she needs to return to good health.

Because young children and babies are growing more than they will at any other time in their lives the consequences of malnutrition are worst for them. Long term malnutrition, which now affects half of all children under five in Madagascar, can result in stunting, reduced intellectual capacity, illness and even death. “That is why the work we do here at the CRENAS is so important,” says Dr. Raselanivo. “By treating children early and following their progress we can limit the complications of malnutrition, so there are fewer hospitalisations and fewer deaths.

“Am I hopeful about this case? The good thing is that Julie wants her daughter to get better so that she doesn’t need to be hospitalised in the CRENI (Inpatient Centre for Nutritional Rehabilitation for Severely Malnourished Children with Complications). But I also know that when a family has unresolved economic problems, the child will almost certainly be back.

“It is frustrating to think that we are really just treating the symptoms when the real reason children are suffering is economic. But I can’t do anything to change that, so I do what I can: I treat them, I give them therapeutic food, and if they have complications such as a lack of appetite, or severe anemia resulting from malaria or pneumonia, I refer them to the CRENI.” 12 UNICEF Madagascar Hope for the future

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4:46 This afternoon, like most, when Julie goes to the market to buy food for her family she returns with a little bit less. The price of rice, the staple food in Madagascar, has increased by 20 per cent since the beginning of the crisis. Other basic foodstuffs have also become more expensive.

Julie tries to follow the doctor’s advice on what to feed Nambinitsoa so she will be healthy. “I am supposed to feed her soup with rice, carrots and other vegetables, and also make sure she eats cheese and drinks cow’s milk,” Julie says.

“I wish we could afford all of that, but we can’t. I buy whatever I can afford. Some days I make a soup with potatoes, carrots, maybe a little meat, some noodles and rice. Always rice. Then we all share it. I am so grateful that the food she receives at the CRENAS makes up for what we cannot provide.”

By the time Julie and Nambinitsoa return from the market, Nambin is home. “Will you have work tomorrow?” Julie asks him. When Nambin nods Julie sighs with relief.

“I am going to keep trying to make things better,” he says. “I have hope that we will get out of this situation —- my family and the country as well.”

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Families like the Rakotonirinas will continue to suffer until a resolution to the crisis is found. In the meantime, children like Nambinitsoa need proper nutrition to ensure that they grow up healthy and are able to reach their full potential.

UNICEF is working with local health authorities to screen and treat malnourished children and to support them with nutrition interventions that will safeguard their long-term health and wellbeing.