Originally written and published in September 2019.

Northern Madagascar from above

Resting off the coast of southern Africa, about 250 miles east of Mozambique, the island nation of Madagascar is a juxtaposition of rich biodiversity and extreme poverty. The capitol city of Antananarivo is one of the most dangerous cities in the world, but chaotic streets give way to lush green hills and endless rice paddies and small rural communities dot the countryside. Contrary to the animated children’s movie, lemurs are not everywhere. Instead, the rare creatures exist only in small areas of intact rainforest scattered sporadically across the island. These pockets of biodiversity attract visitors from around the world and tourism and mining are the country’s largest sources of revenue. Still, 75% of Madagascar citizens, known colloquially as Malagasy, live under the International Poverty line of $1.90/day[1]

To make ends meet, many Malagasy keep small farms to feed themselves and their family. Rice is cultivated widely and, as a whole, Malagasy citizens eat more rice per person per day than any other country in the world. Although rice is rich in carbohydrates, it lacks fat, vitamins, and iron. Dietary iron generally comes from protein and thus a lack of protein often results in a lack of iron, which is an essential component of healthy red blood cells. Iron deficiencies make oxygen transport difficult and can lead to anemia (sub-normal numbers of healthy red blood cells). Signs of anemia include fatigue, shortness of breath, headache, dizziness, difficulty concentrating, and general malaise.  

Rice drying on mats in the streets of Antaravato, Madagascar

For many Malagasy, hunting is the most practical way to access protein. Given this connection, it is hardly surprising that those who consume large quantities of bushmeat or wild game have lower rates of anemia, while those who eat less bushmeat face higher rates of anemia, as documented by researcher Christopher Golden. In a country with so many natural resources, endangered species, and protected areas, much of the hunting is not legal and disrupts fragile ecosystems. Hunters are also at high risk of contracting and spreading infectious diseases from the animal blood and body fluids they come into close contact with. Yet, if faced with the choice to protect the environment or to feed my family, I would undoubtedly choose the second. As humans, we are wired to do what we must to protect those we love.

Evening light in Vinanibe, a remote village in the highlands

Food scarcity isn’t a new problem for humans. In the United States, we rely heavily on agriculture for sustenance. But even here, a cow is a big investment. And it takes time to grow. In Madagascar, poultry is a logical alternative protein source to bushmeat: there are no taboos against it and people generally like the taste. It is common for people to keep a few chickens, but most are unable to count on either their eggs or their meat for protein. Newcastle Disease Virus, an avian respiratory virus, circulates regularly throughout the island. It spreads quickly through the air, and carries a mortality rate over 80%, killing most of the chickens that it infects.

To address food insecurity and protein access, the Madagascar-based non-profit MAHERY (Madagascar Health and Environmental Research, also “strength” in Malagasy) has started a vaccination campaign against the virus that causes Newcastle Disease. The locally developed vaccine is administered as an eyedrop three times per year and costs farmers $0.03 per dose. In addition, vaccinators offer farmers education on best practices for chicken rearing.

Prior to 2017, my knowledge of Madagascar had been limited to the PBS show Zoboomafoo that I watched as a child. Yet, as part of my graduate degree in public health, I found myself buying a ticket to the former French colony to work with MAHERY on their chicken vaccination project. I have long been interested in systemic solutions that address multiple problems at once. When it comes to health, many of these solutions fall under the umbrella of “One Health”: a way of thinking that asserts that human, animal, and environmental health are connected and that professionals in each of these areas should work together to improve health outcomes for all. Although directly impacting poultry health, the MAHERY project is aimed at preserving the environment and improving human health by providing more protein and decreasing hunters’ risk of contracting infectious disease. Additionally, the project empowers women: men hunt, but chickens are seen as a women’s asset. By viewing the system as a whole rather than the sum of its parts, MAHERY is working to create sustainable health improvements for all of its occupants. 

Bamboo lemurs, one of the more than 100 lemur species that call Madagascar home

This undertaking is not the first of its kind. Local examples of One Health include everything from WisCARES – a low-cost veterinary clinic for low-income pet owners that partners with social workers and pharmacists – to clean air initiatives that subsequently improve the health of humans, wildlife, and pets in the vicinity. In a world of ever-increasing challenges, cooperative and systemic solutions like these are imperative. The health of the human race is entwined intricately with the health of the environment and of the creatures that surround us. Without them, we will also cease to exist. 

You don’t need to be a member of the medical field or to know a lot about the natural world to contribute. Expertise from all areas is required – artists, musicians, farmers, urban planners, business owners, finance specialists and everyone in between. You don’t have to take a trip to Madagascar or administer a chicken vaccine. Systemic solutions that improve health come from every discipline and change will come if more people view the world, human systems, and health holistically. The power of a conversation or the value of a vote should not be undersold and we can all work together to protect ourselves and the world around us.