When my friend came to visit me in Madagascar, she noticed how smiley everyone was. This surprised her. I think it would surprise most people. If you are going to be traveling for the first time to one of the poorest countries in the world with some of the worst health outcomes, you might think everyone should look miserable. But they don’t.
It is true: there was a lot of happiness that I shared with the Malagasy. But to be honest, their lives are really hard. One of my Malagasy friends had her two year old die by falling out of a window. Almost all women are likely to have at least one of their children die in childhood. If that is true, how can everyone be smiling so much?
There was an interesting article about a new intervention in India to provide psychotherapy through community health workers to help Indians with depression and anxiety. While depression is under-diagnosed and very stigmatized, the intervention has been very successful in putting people on treatment and helping them cope with these illnesses.
In the case of Madagascar, there must be a lot of depression. But I think that depression just hasn’t been given a name. Instead, it seems that the Malagasy just see their challenges and hardships as a part of life. My other Malagasy friend constantly feared that her husband would be unfairly taken to jail because a passenger was accidentally injured in the taxi he drives. My friend lives with that constant fear. She even confided to me that she wished, at times, that she wouldn’t wake up, so that all these problems would go away.
So behind those smiley faces, there must be a whole lot of hardship that has simply been accepted as the way life is.