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Madagascar: malagasy dispensary in rural area. Economic decline has led to a deterioration in medical services. The country has only one physician per 17,000 people. Important regional differences also exist: in some provinces the ratio was as low as one physician for 35,000 persons. For the entire island, a total of 234 medical centers were under the direction of one doctor, and the remaining 1,728 centers were under the direction of paramedics, midwives, nurses, health aides, or sanitarians. For those unable to obtain modern medical treatment, traditional medicine, the use of herbs or the exorcism of malicious spirits, remains popular.