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Madagascar Cholera Epidemic Marred

February 25, 2000

ANTANANARIVO, Madagascar (AP) _ Madagascar’s battle against a cholera epidemic is being complicated by a spat between the government of one of the world’s poorest countries and an acclaimed international aid agency.

More than 1,000 Malagasies _ as residents of this Indian Ocean island are called _ have died since the epidemic erupted a year ago, according to official figures. Most health officials believe the death toll is higher, even as the government said Wednesday the epidemic is ``diminishing.″

In a battle on the sidelines, the Swiss section of Doctors Without Borders announced Tuesday it was abandoning its cholera-fighting operations in the country because the government refused it access to victims.

``The reason they gave (was) `We the people of Madagascar can care for our own population,‴ said Thomas Nierle, a Doctors Without Borders official. ``I think it’s a question of sovereignty. It’s a lot of pride. It’s almost arrogant.″

The government, for its part, made a similar accusation against Doctors Without Borders, which won the Nobel Peace Prize last year for bringing medical aid to conflict areas worldwide.

″(Doctors Without Borders) has treated us like a war-torn country with no ability to conduct its own health initiatives, dictating what we do,″ Armand Ralaidovy, the Health Ministry’s coordinator for combating cholera, said in an interview. ``Their statement was derogatory.″

``We have more than 2,000 doctors. We have the health infrastructure,″ he said.

Ralaidovy said the government was ably handling the epidemic. But some of the criticism has come from Madagascar’s own doctors.

On Tuesday, a local association of doctors known by its French acronym SEDODIA called for Heath Minister Henriette Rahantalalao to resign, saying she was bungling the handling of the epidemic.

Soon after the epidemic broke out, the Ministry of Defense erected roadblocks on major highways. All travelers were required to take heavy doses of oral antibiotics in a move many critics said was ineffective and even dangerous. Giving antibiotics to those without cholera serves no purpose, and raises the general population’s resistance to the drugs.

The roadblocks were taken down on Nov. 26, but were put back up a few weeks ago and only travelers complaining of diarrhea were then given the antibiotics.

This Texas-sized island off southeast Africa is known to the 100,000-plus tourists who visit annually for its unspoiled beaches, virgin rain forests and sightings of lemurs and humpback whales. But behind the pristine attractions lie poverty and unsanitary living conditions _ a breeding ground for cholera.

Only one in three people have access to clean water in Madagascar, the 13th poorest nation on the planet. Only 3 percent have access to flush toilets. Most even lack the money to buy charcoal to boil water, a critical step in preventing cholera, an acute intestinal infection that causes copious diarrhea, which can quickly lead to dehydration and death.

On Wednesday, 16 patients with severe diarrhea checked into the dim, run-down Befelatanana Hospital in Antananarivo. A crowded roomful of listless men, women and children were laid out on cots with IV cords dangling above them.

A notice in an office around the corner reminded medical personnel to require relatives to take special precautions in burying the bodies of cholera victims, to prevent more infections.

Doctors said about 50 cholera patients were in the hospital, down from more than 100 in recent weeks.

The Health Ministry said Wednesday the worst of the epidemic was over.

``The outbreak has peaked and now is diminishing because of our interventions,″ Ralaidovy said in an interview.

But Nierle, who recently completed a 13-month tour of duty in Madagascar and was interviewed by phone from Geneva, said there were no signs the epidemic was slowing.

A total of 18,809 suspected cholera cases have been identified in the past year in Madagascar, the government said. A reported 1,070 people have died.

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