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This article is concerned with the training and curing practices of Betsileo ombiasa (‘healers-diviners’), and their relationships with biomedical practitioners and Christian healers, in particular Fifohazana exorcists. We first give an account of what we think is characteristic in the process of becoming an ombiasa, highlighting in particular the role of ancestors and other spiritual entities. We then give a brief description of the ombiasa’s healing practices and the kind of remuneration they usually ask for. In the last part of the article we discuss their collaboration and conflicts with other health practitioners, showing how ombiasa are constantly adapting their practice to avoid open confrontations with their competitors, accommodate their patients’ expectations and continue to carve out a niche for themselves within Betsileo medical pluralism.