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Madagascar: Akanin’ny Marary does quality work for people with physical disabilities

The Akanin'ny Marary ("Home for the Sick") Centre in Madagascar is located in Ambositra, a town in the Amoron'i Mania region, Fianarantsoa province. It treats people with leprosy, tuberculosis and mental-health problems and is also a major prosthetic rehabilitation facility that receives support from the ICRC Special Fund for the Disabled.

Meticulous attention to detail

Most people who go to the Centre for prosthetic rehabilitation have some type of deformity of the lower limbs. "In Malagasy society, the body's lower limbs are viewed as more important than its upper limbs, which is why fewer people make appointments for their arms and hands," explained Christian Rafamatanantsoa, who is the senior prosthetic/orthotic technician at the Centre. "All too often, unfortunately, people wait too long to seek treatment and their limbs can't be saved. Most of our adult patients are diabetic and have had their feet amputated, whereas the majority of the children we see have clubfoot."

Shoes for clubfoot and people suffering from polio and leprosy are specially designed and made in the workshop. Since patients with leprosy can no longer feel pain, the inside of the sandals are lined with a soft foam material called plastazote. Julien Andrianaivo, who had leprosy when he was three years old and was treated at the Centre, is now one of those in charge of the shoemaking workshop. CC BY-NC-ND/ICRC/Krista Armstrong/mg-e-00254
 

The work done by prosthetic/orthotic technicians requires utmost precision: "Even when two patients have had thigh amputations, each is unique," explained Christian. "The prosthesis is designed to perfectly fit each individual's body and disability. A multidisciplinary team made up of a physiotherapist, a social worker, a prosthetic technician and a doctor then works with the patient." The technical side and the physical rehabilitation have to come together for the sake of the patient's physical and mental well-being and social reintegration. The Centre is unique in Madagascar for its specialized equipment and trained staff.

 Technicians make prostheses (artificial limbs) and orthoses (braces and devices to support weak limbs) in the limb-fitting workshop. They make unique prosthetic limbs for each patient from plaster moulds that are perfect replicas of patients' stumps. CC BY-NC-ND/ICRC/Narindra Rakotonananahary
 
 Technicians make prostheses (artificial limbs) and orthoses (braces and devices to support weak limbs) in the limb-fitting workshop. They make unique prosthetic limbs for each patient from plaster moulds that are perfect replicas of patients’ stumps. CC BY-NC-ND/ICRC/Narindra Rakotonananahary

Just happy to help

"Seeing a patient who couldn't even stand when he came to the centre now able to walk, seeing the smile lighting up his face – that's what gives me the greatest satisfaction," said Christian.

 "I'm still a bit scared to stand on my new leg but I'll get used to it," said Hansel Rajaonarivony, a 14-year-old boy who lost his leg in a motorcycle accident in 2012. It was the first time that an entire prosthetic leg was made in Madagascar using various techniques. CC BY-NC-ND/ICRC/Krista Armstrong
 
 Françoise Fanampisoa, aged 16, was born with one hand and one leg. “I had always dreamt of being able to walk on two feet like everyone else. And in two days, the Centre allowed me to do just that!” Françoise, who was fitted with a prosthetic leg three years ago, has just received an aesthetic hand prosthesis. CC BY-NC-ND/ICRC/Krista Armstrong
 

See also: website of the ICRC Special Fund for the Disabled