unicef madagascar: hard times in tana

Hard times in TanaMadagascar’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 hardto 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. Theydidn’t fully realize the impact this was having until the day a neighbor came to their door...

2 UNICEF Madagascar Hope for the future

05:35

The service has already started when Nambinina Rakotonirina, 26, slipsquietly into an uninhabited pew at the back of the church and opens hisBible. The pastor’s voice echoes thin and distant off the cold concretewalls. This morning’s sermon is about hope. About Madagascar’s abundantresources and the poor’s lack of access to them. About how the politicalsituation in the country has only made a bad situation worse. “Hope iswhat’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 havehope.” Nambinina’s nickname -- Nambin -— means ‘lucky’, but that isn’t something

he has felt lately. Several months ago government budget cuts resulted inthe loss of his salaried job on a government construction project. Nambinspent two months looking for whatever work he could find. Every day hewent out early in the morning and every day he returned home in theevening 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 whilelooking for ways to economise. Beyond using candles instead of their singleelectric 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 enoughto 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. Whenshe told the couple their daughter was malnourished, Nambin was stunned.“I really thought our daughter was healthy and normal,” he says.

Hard times in Tana 3


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 porridgebubbles 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 denselypopulated Antananarivo. Entering their room, Nambin sets his Bible on thedresser and looks around. Despite the stains on the walls and thehousecoat that doubles as a curtain, it is a tidy room. The bed is neatlymade, 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 weighedand measured the baby and confirmed that she was malnourished. “Theytold us she was really underweight and gave us some special food forher,” 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.”


07:30

Over the last few weeks Nambin’s luck seems to have changed. A friendtold him about a temporary job at a small construction site nearby. For3000 Ariary (US $1.50) a day he “carries bricks, cleans up, and whateverelse they need me to do.” It is only half of what he used to make. “Butat 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 becomeincreasingly difficult. The imposition of sanctions and an uncertaininvestment climate have brought the country’s economy to a virtualstandstill. Tens of thousands have lost their jobs. With so many peopleunemployed even daily labour is hard to come by. The streets and alleywaysare full of people selling whatever they can think to sell. Poverty, foodinsecurity, 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 outlooking 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 moreaffected by all of this than we are. I know people who haven’t had workfor a long time -— people who only live on whatever they can steal.”


08:12

While Julie washes the breakfast dishes then bathes and dressesNambinitsoa 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 finishedgrade nine when I was forced to leave school.” Julie’s parents were amongthe tens of thousands of workers in Madagascar’s export processing zoneswho lost their jobs when, as a result of the crisis, the US suspendedduty-free agreements with Madagascar. Without an income they could nolonger afford to pay her school fees. “After I’d been out of school for sixmonths, it seemed like a good time for us to get married,” she says. “Iimagined 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 incharge of the family’s budget. She explains that even if Nambin works sixdays a week, he can only earn 72,000 Ariary a month (US $36). But everymonth the couple’s expenses —- rent, food, candles and charcoal —- add up toalmost 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 expenseswherever we can. For example, in the past we used to eat rice three timesa day,” Julie says. “Now we only cook it at breakfast and then share theleftovers for lunch and dinner.”


09:43

Every Wednesday morning for the last two months Julie has joined mothersand children as they line up to have their malnourished children weighedand measured. Dr. Alice Raselanivo, who is in charge of the CRENAS(Outpatient Centre for the Nutritional Rehabilitation of SeverelyMalnourished 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 moremalnourished children here. Many, like Nambinitsoa, are here because theirfathers don’t have work so the family is eating less. Others are herebecause there are a lot of children in the family and when the food isdivided 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 behealthy and normal. This is why the community-level nutrition screeningthat takes place throughout the country twice a year during UNICEF-sponsored Mother and Child Health Weeks is so important. “I always seespikes in the number of malnourished children at the CRENAS in Octoberand April,” says Dr. Raselanivo. “That is because every child in the countryfrom 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 isjust 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 13-month-old only weighs the equivalent of a healthy three month old. “Thiscase is quite severe because her weight keeps fluctuating,” the doctorsays. “We have to continue to follow up every week.”

Name: Nambinitsoa

Age: 13 months

Weight: 6.5 kg

Diagnosis:malnourished


09:39

Julie leaves with a one-week supply of therapeutic food for Nambinitsoaand is told to return the following week for more. Supplied by UNICEF,this highly nutritious food provides Nambinitsoa with the calories andnutrients 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 forthem. Long term malnutrition, which now affects half of all children underfive in Madagascar, can result in stunting, reduced intellectual capacity,illness and even death. “That is why the work we do here at the CRENASis so important,” says Dr. Raselanivo. “By treating children early andfollowing their progress we can limit the complications of malnutrition, sothere 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 theCRENI (Inpatient Centre for Nutritional Rehabilitation for Severely Mal-nourished Children with Complications). But I also know that when a familyhas 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 Ican’t do anything to change that, so I do what I can: I treat them, Igive them therapeutic food, and if they have complications such as a lackof appetite, or severe anemia resulting from malaria or pneumonia, I referthem to the CRENI.”


4:46

This afternoon, like most, when Julie goes to the market to buy food forher family she returns with a little bit less. The price of rice, the staplefood in Madagascar, has increased by 20 per cent since the beginning ofthe crisis. Other basic foodstuffs have also become more expensive.Julie tries to follow the doctor’s advice on what to feed Nambinitsoa soshe will be healthy. “I am supposed to feed her soup with rice, carrotsand other vegetables, and also make sure she eats cheese and drinks cow’smilk,” 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 alittle meat, some noodles and rice. Always rice. Then we all share it. I amso grateful that the food she receives at the CRENAS makes up for whatwe 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 nodsJulie 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 countryas well.”

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

UNICEF is working with local health authorities to screen and treatmalnourished children and to support them with nutrition interventionsthat will safeguard their long-term health and wellbeing.

unicef madagascar: hard times in tana

Documents

unicef madagascar hope

hope iswhats

wife julie

nambinina rakotonirina

futurehard times

single room

tidy room

day hewent