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!)

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 1/15^th 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: http://www.misau.gov.mz/pt/epidemias_endemias/vigilancia_epidemiologica

Until Next Time (Ate Ja!)

Societal Odds and Sods

My Local Primary School

St. John Baptist Catholic Church

FRELIMO HQ, Xai Xai

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!

Education

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.

History

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.

Politics

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.

Religion

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.

Sports

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!)

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!

CACHES…

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 !

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.

Climate….

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!

Agriculture…

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!)

My Daily Routine

Before trekking into the labyrinth of the  Mozambican health care system, I’ll post a few

(? Interesting?) unrelated entries on a variety of topics: the environment, food, gender roles, politics, the work place, education, language,and, below, My Daily Routine. If you find this more like homework than an “entertaining and informative”blog – LET ME KNOW!

Daybreak…. Usually, I’m up by 5 a.m., a mere one hour after the sun. We have strange hours here – no daylight savings time! And, the whole country is in the same time zone, for better or worse, lighter or darker. Daybreak is really the best part of the day, before the sun of southern summer has a chance to deplete our energy. My front yard is graced with many trees, and trees mean birds in a wide variety of colors, sizes and voices. (Note to self: find a book on the birds of Moz!) Trees include coconut, orange and cashew. Right now, mangos are entering their season – with two trees on my property, they are a sweet (free) deal.

At home, it’s the usual routine I’d follow anywhere –I’ll spare the details. I do try to grab a few minutes of the BBC radio broadcast, test myself with a few exercises in my Portuguese dictionary and read a few pages of  whatever book I’m wading through at the time.

Then, it’s off to my workplace: a good 20 minute walk, followed by a 15 minute bus ride crammed into a chapa with 15 other commuters…all for the low, low price of only 20 cents.

Mid-Day…The heat has set in by now. Were I Greene, Kipling, Orwell or any other British ex-pat it would be about time for a gin and tonic. However, being the still-rather- industrious American, I usually settle for juice and bread, along with my fellow Mozambicans. With all the stores closed for mid-day break (roughly, Noon til 1:30) there is not much to do except “passear” (walk) through the crowded streets of downtown Xai Xai, observing the street life.

End of Day…Around 3 or 4 p.m. I’ll leave my office and do some shopping, picking up some food for dinner or other necessities… and, then, head home. Occasionally, I’ll meet someone for dinner, but, as the city (“cidade”) is far from my neighborhood (“biarro”) this is usually difficult to arrange logistically.

Boa Noite! I usually take a 4 or 5 mile run before dinner. Though my fitness is nowhere near where it used to be back in the states, I can muster enough energy to make the run a worthwhile effort. Sure attracts attention, though. Mostly unwanted, save for the many children (“criancas”) along the route. Afterwards, it’s time to bathe (“tomar banho”), eat (“jantar”) and retire around 7 or 8 p.m. I try to fit in some reading to close the day, a book or the daily Moz newspaper, Noticias.

Kinda boring, huh? Well, sort of, but it works well for me right now.

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

A New Beginning....

Bem Vindo! Welcome! To the much-delayed debut of my blog, Healthy Mozambique.

After 6+ months on the ground in Mozambique, I’d say it’s a bit overdue.

 I hope you will enjoy my reports from the field as much as I will enjoy sending them.

By now, many of you know that I arrived in Mozambique on May 31 to begin my 27 month Peace Corps assignment, as a volunteer working in the health care field.  After 10 weeks of training in the border town of Naamacha, I was placed here in Gaza Province, in the provincial capital of Xai Xai. More on my town, training and  work at a later date.

For now, here are some of the top 10 cultural differences I’ve noticed in my few months here in country. Take them for what they’re worth….I’d say that’s about 5 Metacais (“Mets”), the local currency, which runs about 27 Mets for One U.S. Dollar.

Here goes……

Driving. That would be on the left hand side, please. No speed limits, no stopping for pedestrians…hey, it’s like NASCAR, without rules. In the dark, you’d be wise to  proceed at your own risk, as drinking while driving is a national pastime. Dim those headlights, deflate those tires, crack the windshield  and you’re ready to roll, Mozambican style!

Language. Well, some folks speak English,  but not many. There’s the old colonial language Portuguese - I’m getting the hang of it. Some try harder to master it than others. To wit, the Indian shopkeeper whose store I visited the other day welcomed me with a hearty “Buenos Dias!”…er, uh, wrong part of the Iberian peninsula, Senhor!

The most prevalent lingua is our local language, Changan. Every region of Mo has at least one local language, often two. It’s quite easy to ingratiate yourself with passers-by with only a few simple words of Changan. Which is about all I’m capable of, at present. Lixile: Good Morning!, Canimambo: Thanks! And Ripilile: Good Evening. So much for my Changan.

Lines. Forget ém. Don’t have ‘em. Sharp elbows are required. No gender differences recognized here, it’s every person for him or herself. In particular, children are not given preference. Brian Urlacher, where are you when I need you?

Cha. That’s literally “tea” , served at the ungodly hour of 10 a.m. A bit early for the Brits, but a nice custom, nonetheless. Unfortunately, as served in the office setting, it tends to disrupt what ever work is supposedly being done: “Sorry, that open heart surgery will just have to wait…”. Usually served with bread (“Pao”)..sorta better than what passes for bread in the states, but the French would be appalled.

Change Money. Thank God for ATMs. The alternative? Camping at the bank for half the day waiting for the completion of endless paperwork and red tape. Not for the faint of heart or short of time.There are also change agencies: less waiting, lousy exchange rates and they don’t take bills under $10 or printed before 2007!

Holidays! Plenty of ém. I count 8 since mid-August. And, on these days just about everything shuts down completely, save for a few restaurants. The celebrations themselves are pretty uniform: a trip to the local war memorial for some solemn words, supplemented with lots of guns and roses. Being a young nation (at peace only since 1992), Moz celebrates just about anything that was of some historical significance in the fight for independence. Kinda like if we were still celebrating as national holidays Paul Revere’s Ride, Washington Crossing the Delaware, or the signing of the Constitution…come to think of it, hey, why DON’T we get those days off from school and work?

Lunchtime. See Holidays above. All businesses shut down usually between Noon and 1:30 p.m.. This makes it a bit difficult to pick up that needed roll of toilet paper or bag of rice on the lunch hour. Oh yeah, ditto on Saturday after noon and all day Sunday: shopping verboten.

Chapa. The local bus transport. Indispensable, cheap and dangerous.  Picture enclosed!. Formula: cram 15 passengers into a beat-up Japanese-model mini-van, add chickens and sacks of potatoes, mix and serve. Really, they are the only way to get around Moz and, though not safe, they cost a measly 20 cents per ride. Alternative? REAL buses, donated by the Chinese, guess they have enuf of them. These run infrequently, cost less but stop very few places. And, my favorite, “boleia”-ing, otherwise known as the good old American pastime of hitch-hiking…actually works well in Moz, though I don’t recommend it after dark.

White People. Like me. But, also let’s include Chinese and Indians. We are all “Mlunga” or “whites”. Actually, a pretty offensive term, but you have to role with it. “Who you callin’honky?”is probably a dangerous response, though useful in making me feel better for the moment.

Television. Omnipresent and rather useless for keeping up with what’s going on in the world. (Thank God for BBC radio!) A tip of the hat, though, to several Brazilian soap operas (“telenovelas”) that are great for watching to hear the Portuguese language, at least as spoken in Brazil by bad actors impersonating sexually-precocious teenagers.

Churches. Plenty of ém. Ya got your Catholics, ya got your evangelical Christians. And ya got yer smattering of mosques and Hindu temples. Mozambicans are a pretty religious lot, though, and spend a lot of  Sunday getting ready for church, being in church and convening after church. God is in her heaven and all is right with the world, leastwise this corner of it.

Greetings. They’re long, polite, elaborate and absolutely required.  And, IMHO, a bit pointless, but, hey, that’s just me. We’re talking about 180 degrees from our good ol’American non-greeting..a mumbled g’day, no eye contact, no touching, by all means, keep moving!. Here’s the standard sequence here in Moz, accompanied with a lot of hand shaking that I can’t begin to verbally replicate, you’’ll have to take my word for it.

Good Morning/Afternoon/Night: Bom dia / Boa Tarde / Boa Noite

How Goes it?: Como esta?    

Fine, and you? Tudo bem, e tu?

Fine. Ta Bom.

No matter what, things are always “Ta Bom”. As Oscar Wilde, or someone of his ilk once said, the definition of a boorish person is one who, when you ask him how he is doing, actually tells you. No boors here in Moz!

So, until next time…Ta Bom, y’all !

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