»ACTIVITIES
The project aimed to ensure free access to healthcare for groups most severely affected by this disaster. This took the form of supporting 16 health facilities in the area, through general medical consultations and ante-natal care, supplying medicines and medical supplies, improving the physical stability of some health facilities, and implementing a surveillance system to monitor potential epidemic diseases and nutritional status of children under five.
»OUTLOOK
This operation is a response to the needs of an already vulnerable population following Cyclone Ivan. In order to anticipate the impact of such natural disasters and to improve the response, MdM is rolling out a disaster-preparedness programme financed by ECHO.

»ACTIVITIES
The disaster risk management programme supports community services in four at-risk zones in the district with the aim of improving the preparation for, and response to, unforeseen events and to reduce the risks of vulnerability. Since the programme started, we have supported the training of health centre managers in epidemiological surveillance and the production of an evacuation plan by the district health services. We have also organised a workshop on mapping the vulnerabilities in each of the four target zones and have begun to identify a series of actions to take in relation to the shelters and health centres.
»OUTLOOK
In 2009, we plan to set up facilities to treat acutely malnourished people within the zones (training and supervision); to monitor the basic health centres in the four target zones (epidemiology and malnutrition); to refurbish the shelters and the health centres; to train emergency workers in the communes; to introduce the evacuation plan and accompany the communities in a participative process of disaster risk management.

»ACTIVITIES
The programme has enabled the prisons where we work to be upgraded and the conditions for detainees to be improved. Specific improvements include functioning infirmaries, trained nurses, provision of more latrines, improved hygiene due to whitewashing, insecticide treatment and treatment for severe and moderate malnutrition. MdM will therefore be able to withdraw from some prisons in 2009 for this component of the project. The work on respecting prisoners’ rights is a longer process and will be continued for several more years.
»OUTLOOK
In 2009, the project will be extended to new prisons in the north of Madagascar. It will focus on improving the project and ensuring its long-term sustainability, by strengthening the capacity of the prison administration to meet its responsibilities in relation to health, hygiene, nutrition and prisoners’ rights. A network of Madagascan associations working in prisons and international actors specialising in incarceration issues will be established.

»ACTIVITIES
Two visiting medical teams from Reunion carried out cardiac surgery activities. There were three components to the work: approximately 250 cardiology consultations (with echocardiograms and surgical indications) per visit; 17 closed heart surgery operations in Antananarivo hospital and four open heart operations at St Denis hospital; mentoring the teams and providing theoretical and practical training during each visit.
Two visiting medico-surgical teams carried out week-long child surgery programmes. Their work comprised 240 consultations by expatriate surgeons, 36 on-site surgical interventions (urological, digestive and plastic surgery) and three transfers to Reunion.
»OUTLOOK
We plan to continue these activities and to re-evaluate our work in 2009. A five-year project plan is in preparation with a view to skills transfer and provision of medical equipment to enable more cases to be treated on-site by an increasingly autonomous specialist surgery service. The current political difficulties are not hindering collaboration between the MdM teams and the hospital’s medical personnel.