The local population lives by subsistence farming, frequently disrupted by the droughts and natural disasters which plague the island. The hospital was founded in 1954 by an American Lutheran mission. As is often the case with SALFA (Lutheran) hospitals, years of wear and tear, lack of maintenance and funding have left their mark. The hospital has nearly closed several times in recent years.

Due to poor health care in the area, many patients arrive at the hospital with illnesses already far advanced. The hospital, predictably, lacks funds and equipment. Any number of problems need to be faced daily. Due to a shortage of surgical gloves, disposal gloves are sterilized and reused. Medicines are rationed, the x-ray unit is defective and cracks make disinfection of the floor difficult.

But things are looking up: In March 2015, Dr. Heuric Rakotomalala took over and now manages the hospital with his wife, Mireille, also a doctor, reconstructing and expanding it. With the help of donations - also from other charitable organisations - a new water supply with filters for decontamination and a solar power plant for the hospital and the surrounding buildings were installed.

Despite the enormous challenges, the couple have done well in balancing hospital management and medicine, thanks to the right mix of competence and human kindness, seriousness and humour. Despite frequent feelings of being caught in a losing battle, they have in no time at all transformed a desolate bush hospital into a functioning one. Word has spread; the number of patients has increased steadily. The development of basic health care provides an impetus for improving regional infrastructure, like the construction of a paved road to the hospital and the provision of electrical power as far as the village - positive steps towards mitigating poverty in southern Madagascar.