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Tending the garden: Parish Nursing in Madagascar.

"Till the soil:" Uncover what is happening

There are three nurses working as Parish Nurses in Namahora and Morondava. One has worked 3 days a week primarily at the prison with its 500 inmates. She has offered, "counseling and given spiritual advice, treatment regarding transmissible diseases such as HIVAIDS, [as well as] vaccination and nutritional programs for the undernourished prisoners and room disinfection."

The other two nurses have worked in the large Cathedral Parish of Maria Manjaka. We met with them, listened to what they had been doing, problems their clients had, and their instructions to them. They are doing assessments, recommending care and follow-up, encouraging the clients to get better medical care, supporting their spirituality, giving emotional and social support, referring them to available limited resources, and advocating for them, by going with them to get help, or talking with the government health care supervisor to get more specialists to come to town, etc. They felt like social workers, and they love their work.

"Pull the weeds:" Find problems and clarify

Clients wanted meds from the nurses, since they do not have money for them. Others do not yet value what the Parish Nurses offer. We reminded the Parish Nurses often that they are not the Dispensary, clinic or hospital, but they can offer support, information and referral to appropriate resources. Clients often will not go to the doctor when referred as they do not have the money; and some clients do not want to make the changes necessary to become healthier. The Parish Nurses felt that church leaders had not always been supportive. Some church volunteers thought that they would be paid, and no longer wanted to help; others have moved. Parish Nurses don't have enough resource information in their native language, Malagasy. Our translator, Hortense, had just finished her social work degree in the spring, and knew of resources via internet and other places that she had had to look up for her program. She shared these with them. Communication with us is difficult--no computers for them to use. We worked out a plan using the cybercafe.


"Water the ground:" Offer encouragement and support Before we left, we met with church leaders. We reviewed all the concerns and plan that we had discussed. They will be translated into Malagasy and given to all.

"Fertilize:" Establish plan for next steps, other meetings A male nurse who runs the Dispensary in Namahora is very interested in Parish Nursing; he sat in on the meetings with the nurses. He already does health programs on the radio station an hour a week. He will take the course next year.

In the capital, I met with Mme. Claudine R--, the Chief Nurse for Madagascar. We discussed what nursing is like there, what Parish Nursing is and how it works, what our vision for the work there and future connections and plans. Nurses in Madagascar study for 3 years, then take an exam given by the government to receive their diploma. The government has just started their first Master's level program for nurses. The salary for an RN is about $100-150 a month. They do receive some public health classes, along with mental health, but there are none working directly in these fields. She told us that nurses who serve in rural areas serve as doctors, doing simple surgeries and such. She asked about our plans for the program, and I told her we hoped to expand if there was interest. She asked to find nurses for us. I agreed, but stated that they do need to be connected to their faith communities. I explained that we also hoped to find an English-speaking nurse one day to train as a Parish Nurse Educator there, and she expressed interest in that idea, as well.

"Let the garden grow:" Their brochure sums up their perspective, taken from their brochure: (translated by Fr. Jack Nuelle MS) "We give special thanks to Mme. Maureen Daniels of St. Louis, and Mme. Thandiwe Dlamini from Swaziland, because they were like God's messengers who accomplished this course among us. Insofar as Parish Nursing is concerned, just a few words--they woke us up here in Morondava. There has never been anything like this on our island. And we here were the ones who benefitted and may it grow stronger among us."

We continue to pray for them as they implement the things we recommended, and continue to minister to the Malagasy people's needs for health and wholeness.

Maureen Daniels, RN, MN, who serves as the International Program Coordinator at the IPNRC, went to Madagascar with her husband, Al Daniels, August 16 to September 6, 2008, to follow-up on the work of the Parish Nurses taught last year in order to offer support and encouragement. They travelled to Morondava, where the Parish Nurse program is located. They were assisted by Madagascan friends, Hortense Rabetsara and Roger Ralahotsy, who translated for them. This is a summary of their journey.
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Author:Daniels, Maureen
Publication:Parish Nurse Perspectives
Geographic Code:6MADA
Date:Jan 1, 2009
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