Friday, January 13, 2012

The Health System...Part 2

Healthy Mozambique – The Health Care System (Part  2)…

(Note to Our  Faitihful Readers: Your author recently lost ( misplaced?, had stolen?) his camera. So, unfortunately for now, you’ll have to follow along without the benefit of pictures. We hope to have a replacement on board soon!)

Let’s continue our brief look at the Mozambican health care system -  this time focusing on the impressive volunteer workforce that  keeps the system running.

Civil society in Mozambique comprises literally thousands of organizations, mostly small and  not for profit, that tackle a wide variety of social issues: education, agriculture, the environment and , especially, health care. Many of these organizations deploy their volunteers to address specifically the HIV/AIDs crisis. These volunteers contribute their time, and some receive nominal stipends of a few hundred dollars a month from their sponsoring organization. With high unemployment and underemployment in Mozambique there is no dearth of volunteers with time to offer.

Health care volunteers are typically known by the somewhat-quaint socialistic title, “activistas”. Activistas are involved in providing direct care services to patients at local hospitals and health centers. And, in educating their communities on disease prevention, screening and treatment. With only 1 Medical Doctor per 20,000 citizens in Mozambique, the very-lightly-trained activistas play a key role in maintaining the public health. For sure their  lack of formal training can limit the quality and breadth of care activistas provide.  However, most Mozambicans would agree that such assistance is better than the alternative – no care at all.

The most visible and perhaps important role for activistas is in the delivery of home-based care (“visitas domicilias”). In the starkly huge and rural country that is Mozambique, home-based care is often the difference between life and death for many who live far from any town or health care center. Activistas visit patients  several times a month check to check their health status (vital signs and blood pressure are taken) and remind them of scheduled medical appointments. A case load of 10 to 20 patients per activista is typical. Most patients are referred to the activistas’ organizations from local health care centers  For home-bound patients under treatment, activistas also serve as an essential courier service for delivering  much-needed medications and supplies.

 The activistas work force is truly impressive. Until more senior health professionals can be trained to service the needs of Mozambicans, it’s the activistas who will continue to make the daily life and death differences for millions.

Until Next Time (Ate Ja!)

Wednesday, December 21, 2011

The Health System (Part 1)

Healthy Mozambique – The Health System (Part 1)….

(Note to Our Readers: Your author recently lost (misplaced?, had stolen?) his camera. So, unfortunately for now, you’ll have to follow along without the benefit of pictures. Hope to have a replacement on board soon!)

Let’s take a brief look at the Mozambican health care system -  we can start from the top down.

Health programs in Moz are directed by the state Ministry of Health. There is a minimal private sector: the Ministry controls, in one way or another, all the health programs in the country. Health care delivery is organized at a provincial level. Here in Xai Xai , the provincial capital, we have a rather large (300 bed), somewhat-modern hospital, with a new, well-equipped surgical suite. For higher-level services, patients can be  air lifted or driven to the capital, Maputo. Is care of high quality? Probably not like back  in the states. For this reason, ex-pats, and volunteers, such as we Peace Corps volunteers, are typically referred out to facilities in South Africa for most acute care.

On the next level are ambulatory care centers, or Centros de Saude. These are the key public health facilities from which most residents receive preventive care (immunizations, prenatal care, testing (e.g., HIV)  and treatment of minor illnesses. In Xai Xai we have 7 such centers, most staffed by but a single doctor.  Sophisticated services are few (e.g., no radiology). But, hereabouts there is no private health care system, so the Centros are the only choice for residents. Waiting times are long, and many patients lack the money to pay for transportation to the Centros from their homes. However, once there, they receive most services free of charge.

 Most striking to the foreign visitor are the relatively few physicians. There are two medical schools in Maputo, with two more in the works. And, a few foreign-trained physicians practice here and there. . But, the rate of approximately one physician to 20,000 citizens is pretty grim. Nonetheless, Mozambique seems to make the most of  it. Considerable support is provided by developed countries, such as the hundreds of millions of dollars provided by the USA in recent years to fight HIV/AIDS.

 Next time we’ll look at the remarkable volunteers on the ground that help make the whole system work.

Until Next Time (Ate Ja!)

Wednesday, December 14, 2011

A Few Numbers...

Like the United States, Mozambique requires health care providers to report occurrences of selected contagious and high-profile diseases. The country’s local public health departments compile reports of these data, and submit them to the national ministry of health. Which, in turn, publishes a monthly  Boletim Epidemiologico Mensal (Monthly Epidemiological Report)..

Here are some numbers, as reported and published in the Boletim for this past September. (N.B.: As a point of reference Mozambique has approximately 20,000,000 citizens, in a country roughly the size of west coast of the US.)

Malaria is very rare in the states, about 1,100 cases per year, mostly occurring in people who have carried the infection with them from a foreign country. That’s a rate of  1:300 individuals. But, here in Mozambique, malaria dwarfs even HIV as a killer. In September, the health department reported 171,640 cases of Malaria and 89 deaths/ compared with 171,846 cases and 133 deaths in August. All in a population 1/15th of the United States.

Meningitis  is another disease that has been successfully controlled in developed countries. Here in Mozambique we’ve reported 59 cases and 7 deaths in September. The Centers for Disease control reports about 4,100 cases annually in the states, with about 500 deaths. Not great, but, about half as many (on a per capita basis) as in Mozambique.

For more information on public health here in Mozambique, check out the department’s webside:

Until Next Time (Ate Ja!)

Tuesday, December 6, 2011

Societal Odds and Sods

My Local Primary School

St. John Baptist Catholic Church


In this edition I’ll share some information (and quasi-information, otherwise known as ”my opinions”) on a variety of topics. Hope this gives you a context for Mozambican society and daily life…it’s not all about health and HIV, for heaven’s sake!


Moz officials and society give strong support to education. Programs generally follow those with which we are familiar in the states – primary school, secondary school and college. Instruction is very structured, however, without much of the give, take and participation we find in American classrooms.

Others features include the pressure for social promotion to higher grades. And, a sizable number of  older high school grads who may have taken some time off to work before completing their high school degree. One insidious practice:  trading grades for sex between high school teachers and students…officially, forbidden; unofficially tolerated.

One huge problem faced by society is that, while many students are graduated, relatively few find jobs in their chosen fields.  For example, the state spends a lot of  money on teachers’ colleges and the quality of instruction and resources there are quite high. But, there are few teacher jobs to go around and, thus, many grads are left without the opportunity to actually teach after graduation.


To understand Moz it is essential to recognize that it is a very young country. The country won independence from stubborn Portugal in the 1970’s long after just about every other African country. After independence, the Portuguese cleared out quickly and left few resources behind. Almost immediately, the nation’s civil war commenced, pitting the Mozambican majority against a South African-supported minority (RENAMO). Suffice it to say, all this fighting was not resolved until the 1990”s and its toll on society has been significant.


FRELIMO , the political party of the revolution and civil war, continues to dominate political discussion. Its candidates win most elective offices throughout the country.. While other parties, including a rejuvenated RENAMO,  surface occasionally, FRELIMO’s grasp on the levers of power is very strong. As the party of the revolution, FRELIMO resonates strongly with Mozambicans. Regardless of the party’s blatant corruption it will be many years before a credible opposition emerges.


The Portguese left a deep Catholic heritage. Evangelical Christian groups grow and thrive, as in many other countries in the developing world. There is a sizable Muslim population, particularly in the country’s north. And,  the country’s Indian population is primarily Hindi.


Soccer (Football) is the sport of choice for men, though, frankly, we are not very good, even by the rather low standards of small African nations. Women’s basketball is  a very popular sport, as are volleyball and boxing. Alas, track and field…not so much.

Going forward, I hope to focus this blog on a variety of health issues here in Mozambique. Where possible I’ll try to borrow (?steal?, ?expropriate?) information  from other sources, to help shed some light on the situation here on the ground. I hope that  you’ll also tolerate the occasional diversion to talk about my daily life and experiences. Hope you stay with it!

Until Next Time (Ate Ja!)

Sunday, December 4, 2011

World AIDS Day 2011

Mural, Fidel Castro

Observance, Xai Xai

Observance, Xai Xai

CACHES Celebration

CACHES Celebration

Mural, Fidel Castro

Another diversion from our overview of Mozambique to report on our recent activities and festivities in observation of World AIDS Day, December 1!

HIV continues to be a huge problem throughout southern Africa, in Mozambique and, especially, in my neighborhood in Xai Xai. In Mozambique, about 11.5% of adults are estimated to be HIV +. This is very high, in contrast to most other parts of the world, where the prevalence rate is much less than 1%. There are a myriad of reasons posited for this high rate, but, the bottom line is, no one really knows why the rate is particularly so high hereabouts. Nor, how to reduce it dramatically.  Let’s just say that, millions of dollars have been invested in the effort and changing a society’s sexual mores and behavior is not for those with faint hearts or shallow pockets.

Fidel Castro Mural Project... On Tuesday, I helped 4 other PC volunteers in the neighboring town of Fidel Castro. They’d enlisted their young girls’ social action groups (REDES) to paint a mural on a building in the town’s central square. Murals are a common sight throughout Mozambique, painted to honor a variety of people and causes, HIV prevention among them. We had a great time and much support from local painters and  painter wanna-be’s. It was a challenge to allow the 30+ girls to express themselves artistically, while also producing a “quality”” mural. Pictures below of the close-to-finished product… you be the judge!

Xai Xai Observance…Back here in my home town, we held a nice observance of the Day.
A Health Fair is a staple of all these events, and this one was no exception. Booths included blood pressure checks, family planning information and the obligatory disbursal-of-free-condoms-to-one-and-all. The observance had an interesting kick off at the town’s Catholic Cathedral…not sure how this squares with Rome’s position on use of birth control, but I’ll leave others to ponder the paradox.  Our 200 man (and woman) march then proceeded to the town’s “plaza of heroes”…every town in Moz has one, honoring the war dead and serving as a spiritual gathering place for many of the innumerable celebrations. Once there, we lay wreathes in honor of those who have died from AIDS. We were treated to much speech-ifying about HIV, our successes and challenges…would that the spirit of the people was always up to the rhetoric. But, that’s a story for another day. There was a lot of singing and dancing too, to take folks’ minds off the seriousness of the occasion and the heat of the summer sun. Some pix below!


Last but not least, on Saturday, December 3 I attended another AIDS Day observance, this one in the town of Chicambane, near Xai Xai. A Peace Corps Volunteer works with the site, a program run by a local association, CACHES (roughly, “Child Artists Against HIV and AIDS”). This is a wonderful organization that offers programs to local children in many of the arts including painting, music, dance and theatre. We were treated to many excellent performances by the students and their mentors, The program also included a “palestra” on HIV/AIDS. Palestras are round-table discussions on a particular topic. They are very popular here in Mozambique, as a great way of imparting information to a large group of people (e.g., about risky health behaviors). A couple group leaders facilitated our discussion with the 100 or so folks in attendance Saturday.

 Well, that’s my AIDS day report…hope next year we can report that we’ve made a lot of progress in the fight against AIDS.

Until next time !

Monday, November 28, 2011

Thanksgiving 2011

A diversion from our overview of Mozambique to report on our recent Thanksgiving trip and celebration !

The Trip…. Friday, the day after Thanksgiving, began and continued gloomy, with a light rain. Prospects did not look good for “bolea”-ing (hitchhiking) with 3 other volunteers north 150 miles to meet our fellow volunteers for a three day Thanksgiving Weekend. Nonetheless, despite the weather, the 5 hour journey was pleasant enough. We managed to negotiate the journey in only 3 truck rides on the lovely, palm-fringed EN1 (National Highway 1), with occasional glimpses of the Indian Ocean. Without event,  we took our final leg – a pretty shabby ferry boat across the bay from the highway to Inhambane city to meet up with our colleagues.

Inhambane…And so, to our final destination. A small, pleasant colonial city reminiscent of Mexico or central America. And, a fair quota of well-fed, well-housed South African tourists and NGO-employed ex-pats…a bit different from my home city of Xai Xai, for sure. Inhambane is also the gateway to a few (reportedly) beautiful beach towns, Bara and Tofu. Hope to make it to them some time and answer the age-old question: is t he Tofu hard, soft or spicy?

 The Food… We prepared a large Thanksgiving dinner for our 15 attendees. We were able to make a mostly traditional menu, thanks to the local market (Chinese, large) and a well-stocked supermarket, The Bull. Included many traditional dishes to make it feel like home: cranberry sauce, sweet potatoes, apple pie and chicken (tastes like turkey).
Plenty to go around – the only thing missing was football !.

Our journey home was managed under blue skies, in the back of a couple flat bed trucks, shared with bags of charcoal, and one very quiet goat owned by one very drunk passenger.

Until next time…”Ate Ja” (See you soon!)

Food, Glorious Food !

In this episode, we touch on the Climate and Food options of my new home town, Xai Xai.


Like just about all of Mozambique, Xai Xai has a tropical climate year round. Temps in winter hover around the 70’s while summer can push the thermometer over 100 F, nao problema. Temperatures are well-moderated, though, by the long coast line with the Indian Ocean. Rain is plentiful, but the “rainy season” is a bit different. In many other tropical climes (Central America, Southeast Asia) the rainy season begets a day with monsoon-like downpours, followed by intense sun and heat all in the same day. Hereabouts, we seem to get a stretch of 4 or 5 hot, rainless days, followed by 3 or 4 overcast and wet ones. kind of a good mixture, I think, though the rain can be quite intense and accompanied by high winds. Floods are not uncommon and my home neighborhood is on higher ground, to where many Xai-Xaiáns moved after an especially bad storm a few years back. Report that, Willard Scott!


At heart Mozambique is predominately a rural, agricultural economy and my home town and province are no exception. Xai Xai has access to a huge variety of plants, vegetables and fruits. Unfortunately, the soil is very sandy and takes a lot of work for local gardens (“machambas”) to produce crops, many of which are of low quality. Better crops can be imported at higher cost from other provinces, or, most frequently, from South Africa (e.g., apples, and strawberries and pears, oh my).

For one of my Peace Corps projects I visited the local branch of the federal Department of Agriculture. With the help of Sra. Francisca Joaquicene, the Department’s agronomist (with a specialty in Cashews!) we prepared a graph of all the growing seasons for the major crops in the area. Among the notable crops hereabouts, harvest seasons are:

All year: Rice, sweet potatoes, banana, papaya
November: Mango
December: Coconuts.
January thru March: Oranges
August: Garlic, tomatoes, potatoes, lettuce, carrots, onions, and peppers.

P.S. I forgot to ask her about her specialty cashews, but I think we’re pretty much talkin’ May and June is cashew season. (About the same time as pineapples…delicious, but rather scarce round here.)

Availability…There is a terrific mercado grande here in town. It has just about everything you’d ever (or, never!) need – clothes, electronics and, of course, food. If the big market is too overwhelming there are plenty of street vendors, small shops and a few “supermercados” with a variety of western goods. I use ém all, including a local youth who stops by my house (a little too) regularly to vend his onions and tomatoes…gotta keep the money in the ‘hood and the local youth happy!
We’ll touch more on food and nutrition in a future entry. As we’ll see, the planting, harvesting and consumption of nutritious crops is of critical importance to all Mozambicans, but especially to those with HIV and related disorders.

So, until next time…”Ate Ja” (See you soon!)