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 !