Discovering New Ways of Learning in Madagascar

Sophie Weiner

CCP | Communications Specialist
A group of children from the remote village of Antaralava in Ranomafana National Park, Madagascar await health consultations from the Centre ValBio mobile health clinic.

A group of children from the remote village of Antaralava in Ranomafana National Park, Madagascar await health consultations from the Centre ValBio mobile health clinic. (Photo credit: Sophie Weiner)

During my very first week at K4Health, I learned I would be travelling to Madagascar to help train members of the local Population-Health-Environment (PHE) network on storytelling techniques, and to conduct interviews with PHE-focused health care providers, recipients, and policy makers as part of K4Health’s Family Planning Voices initiative. New to the world of global health, this would be my first assignment in a low- or middle-income country. I was excited for the trip—an opportunity to feel a deeper connection to our work outside the office, but also slightly anxious about the unknown and overwhelmed by all the new information to learn.

To prepare, I used every freshly acquired knowledge management tool and technique at my disposal: I scoured the K4Health website for materials and resources related to PHE, I searched Basecamp – our primary project management web application – for content adaptation opportunities when developing my training session presentation, and I met with seasoned co-workers for tips, advice, and lessons learned from their own travels.

As a result of this pre-trip planning, I became much more aware of my own process for acquiring knowledge. Having previously worked for an educational publisher, I was familiar with the theory of Universal Design for Learning, an evidence-based framework that aims to accommodate various learning styles in the classroom. However, it wasn’t until entering a brand new field and attempting to familiarize myself with all the customs, terminology, and cultural norms that go along with it that I began to reflect upon my own preferred learning methods.

Once in Madagascar, I started noticing many different forms of learning in action, three of which I’ll call:

  1. Learning by tradition
  2. Learning by demonstration
  3. Learning by oral storytelling 

Learning by tradition

Fara Rakotoarison is a midwife with the Centre ValBio mobile health clinic. She and her team travel throughout the Ranomafana rainforest in Madagascar to provide medical consultations and treatments to villagers living in remote areas.

Fara Rakotoarison is a midwife with the Centre ValBio mobile health clinic. She and her team travel throughout the Ranomafana rainforest in Madagascar to provide medical consultations and treatments to villagers living in remote areas. (Photo credit: David Alexander).

On a visit to the remote village of Antaralava in Ranomafana National Park—a beautiful rainforest home to a variety of unique plants and animals—I interviewed Fara Rakotoarison, a midwife working with the Centre ValBio mobile health clinic. She explained how the biggest challenge in her work is overcoming villagers’ dependence on traditional healers (mpanavanana in Malagasy) who do not have formal medical training. Knowledge and skills are not acquired in medical school, but rather passed down from generation to generation.

Fara went on to tell me a story about the loss of a child who was born in a breech position. The traditional healer who was delivering the babies (the woman in labor was having twins) did not have the proper training to save the second child. And so by the time the healer called the mobile team for assistance, it was too late. “The woman in labor was extremely tired, she was in pain all over—her stomach hurt, her back hurt, her feet hurt. We did all that we could do.”

Fara stressed that the reliance on tradition is especially trying in family planning as it is difficult to break habits that have been taught by trusted community and family members. One potential solution to this challenge could be to pair a traditional healer with a skilled birth attendant—much like how some American women are now opting to use a doula when they give birth in a hospital.

Learning by demonstration

Outside Antsirabe, Madagascar, a driver replaces the damaged tires of his vehicle following a car accident as a group of passersby gather to observe.

Outside Antsirabe, Madagascar, a driver replaces the damaged tires of his vehicle following a car accident as a group of passersby gather to observe. (Photo credit: Sophie Weiner)

On our 10-hour-long trek back to Madagascar’s capital, Antananarivo, following the site visit, our team got into a car accident—a reckless motorcyclist illegally weaved between our 4x4 and an oncoming truck, forcing our driver to swerve off the winding road and into a trench. Within moments of the accident, a crowd of onlookers began to form, some of whom offered to help, while others simply enjoyed the free entertainment. Several young boys and girls were among the group of observers. While the kids may have initially come for the spectacle, I realized this was actually a knowledge-acquiring opportunity for them. As our driver and his Good Samaritan helpers fashioned an impromptu ramp out of a pile of nearby stones and changed the busted tires of his car, the young people were learning new car repair skills.

Research actually suggests that demonstrating knowledge (the show-don’t-tell approach) is one of the most powerful ways to change behavior. For instance, showing anti-vaxxers the dangerous outcomes of denying their children disease preventives is much more effective than presenting counter-research to myths and misinformation.

Learning by oral storytelling

Two members of Madagascar's Population, Health, Environment network practice new photography techniques during a K4Health-led storytelling workshop in Antananarivo, Madagascar.

Two members of Madagascar's Population, Health, Environment network practice new photography techniques during a K4Health-led storytelling workshop in Antananarivo, Madagascar. (Photo credit: David Alexander)

During our storytelling training workshop with the local PHE network in Antananarivo, several participants noted the strong role that oral storytelling as a knowledge-sharing tradition plays in their communities. The notion of fady—a Malagasy term meaning forbidden or taboo—was a reoccurring theme throughout our trip. One workshop participant explained that fady concepts are often taught to kids by their parents, usually in connection with a story that has a lesson on morals or social norms.

Back at our Baltimore office, I am inspired to adapt these three forms of knowledge-sharing into my own work routine. That could mean attending a center-led professional development session on basic writing tips, asking a co-worker to demo an unfamiliar web platform, or opening a meeting with an engaging yet agenda-relevant story.

Each of these types of learning has a place in global health and if applied strategically, can give health care providers and program managers the opportunity to improve health knowledge and services, and, ultimately, outcomes.