Antananarivo’s Hospitals: Where the Power Outage Isn’t the Biggest Risk

i showed up in antananarivo thinking i’d ride bikes, drink 90-cent coffee, and maybe get a tattoo that said ‘i survived the climb.’ instead, i got a cyst the size of a small tangerine on my knee and ended up in a hospital that smelled like burnt rice and disinfectant. it was ian m randsa & nina, the gov’t hospital near rokomby, and honestly? it was fine. until the lights went out.

here’s the truth: antananarivo’s healthcare isn’t sexy. it’s not polished. but it’s alive. bleeding, sighing, occasionally dancing to somewhere’s phone speaker playing tambourine-heavy malagasy pop-and somehow getting the job done.


*mafia of the morphine

i asked a nurse, straight-faced, why the iv bag was taped to a chair. she shrugged: “when the grid drops, we tape.” hard truth: staffing gaps are real. a 2022 WHO report says there’s 0.2 physicians per 1,000 people here. that’s less than half of gambia’s ratio. but here’s the twist: the people who work here? they’re ghosts in white coats who show up anyway. i saw a guy hand-squeeze a syringe for three hours because the pump died. no one complained.


overheard gossip (aka drunk advice from a guy named jules)

“if you need antibiotics after a tuk-tuk accident? go to site. if you’re pregnant? go to hatapaka. if you’re not malagasy? they’ll give you the nicest medicine… then charge you double. but hey-that’s the difference between the public hospital and the private one off av. de l’indépendance.”

“they got real ct scans now at tana private. i saw a guy get scanned for his dog’s rupture. yeah. dog. took 20 minutes. bill was 1.2 million ariary. i cried.”


the clinic that felt like therapy

tana private hospital. walk in. no queue. the cesium-blue chairs are clean. nurses speak french and english without flinching. they gave me a tissue with my ibuprofen. that’s… startling here. the downside? cost. a basic consultation? approx. 45,000 ariary ($10). breakfast at the cafe next door? 15,000. the hospital’s probably breaking even on the coffee sales.

i didn’t feel safe in the public one. i felt respected*. in private? i felt like i’d stolen service. there’s a moral dissonance here, and i’m not sure who’s at fault: the system, the greed, the colonial ghosts, or me for expecting perfectly white hospitals in a city where the electricity’s run on leftovers.


the weather today? dry, gray, and airborne like crushed cigarette ash. there’s a wind that blows dust from the hills into your socks as you walk. it takes four hours to get to anjanahary. that’s where the forests grow thick and the healers use rosemary and rattan. they don’t have ct scans. they have silence.


i’m still here. because a dude in a rasta hat told me: “kids in ambatolampy get diagnosed by community elders before they even see a nurse. sometimes that’s better.”


read the last 32 reviews of tana private - most are in french. all are real.
the reddit thread where someone got an ultrasound with no appointment
the smallest clinic on the internet - a one-room building with a woman inside who fixed my burn with plant sap and a prayer.
world health review with actual stats (avoids the word ‘vibrant’)

last night, i woke up to a nurse humming in the hallway. i didn’t know if she was praying or just remembering her son. i didn’t ask. i don’t need to. everyone here knows: healthcare here isn’t about zip codes or insurance. it’s about who stayed awake when the power broke.

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