Mozambique: mosquitos and medicine
By Rachel Sloane in Africa
I visited Mozambique in order to report for BBC Radio Suffolk on the work of a Suffolk doctor who was leaving Ipswich to help train doctors in the developing world.
Everywhere I went I faced two questions “Had I been to Africa before?” and “Had I visited the hospital yet?” The response to the first question was no – and that met with gasps of astonishment that my first experience of this vast continent wasn’t a cosseted wildlife-spotting safari holiday with other western tourists.
I was on a trip to Beira, the second city of Mozambique - one of the poorest countries in the world. As for Beira General Hospital, well, it was on my list of planned visits and an essential place to go if I was to understand why a medical school was so important that European doctors and nurses would put their successful careers on hold for a couple of weeks, or a couple of years, to go and train the next generation of Mozambican doctors.
The Ipswich NHS Hospital Trust had been involved with the Universidade Catolica de Mocambique since it opened in 2000, and Dr John Day, a consultant physician running their diabetes centre was asked to become Professor of Internal Medicine of the Medical Faculty upon his retirement from the NHS.
The scheme aims to benefit the student doctors in Mozambique and give the British doctors a wider range of experience to take back to the NHS. Rather than use NHS money, the Ipswich-Beira Health Initiative charity was set-up.
I'm a trustee of the charity and went out to look at the work they do, see what was needed and why people from across Europe were responding to the appeal for help.
With Dr John Day and Dr Hadi Manji, consultant neurologist from Ipswich Hospital and the National Hospital of Neurology in London respectively, I was to stay at a guest house of the medical faculty. Although clean and comfortable, fears about crime meant the front veranda was protected by locked ornamental wrought iron grills and a houseboy, Ashmal, was there every time you left or returned, to lock up behind you. We were told never to walk alone anywhere and always used a university minibus.
The only other medical school in Mozambique is in the capital, Maputo. Once a Portugese colony, Beira was a thriving city, but problems came when the Portuguese rulers left, almost overnight, in 1975 after a long War of Independence.
The country was left with 97% of the population illiterate, without a trained and educated leadership and no infrastructure. It rapidly disintegrated into civil war. A drought then left many Mozambicans dying and the future looked bleak.
Then, in 1999 , we saw on our TV screens the impressive sight of millions of Mozambicans queuing in the heat to place their vote in a democratic election. Although the country still has a long way to go in beating poverty and disease, the situation is improving.
The wide boulevards of Beira have many large pot-holes and are almost empty of vehicles, apart from alarmingly fast mini-buses. Most of the offices and hotels stand empty with gaping black holes for windows and doors. Most local people live either in the run-down villas the Portuguese left behind, or in local villages in huts made from palms, plastic and corrugated iron, linked by muddy pathways.
As part of their studies, the medical students go into the “village” of Inhamdina where 25,000 people live with no running water or electricity and only communal toilet facilities. Assigned to a few families each, they offer basic hygiene and health advice.
Along with Bramble, the local mediator, I went with student doctor, Wilma, and tutor nurse, Monique Korver, into the village and met one of the families. They proudly showed me the neatly swept dirt floor and the cooking and washing pots hygienically stored off the floor, on a hand-made table.
The Beira medical students had also worked to improve the open drainage system, that ran alongside the market stalls selling fruit and dried fish.
Mozambiques has very high rates of infant, child, maternal and adult mortality. There are only 800 doctors for a population of 17 million people.
42% of the population have HIV or AIDs while tuberculosis and malaria are also major problems. As Dr Hadi Manji from Ipswich, discovered, there is no neurologist in the whole country, so his advice on the medical ward was needed, as well as his teaching skills at the university.
Children attend school in shifts for two hours a day. Visiting Escola Joao XXIII, a well-run catholic school, with Dr John Day, I was struck by the large grassy playing fields and welcoming teachers – but the classrooms seemed very plain and empty of equipment, pictures and colour to my western eyes. Singing for us, the children were happy and excited, but, it was a sobering thought when Dr Day pointed out, as we left, that many would have died of Aids or malaria before they were 16 years old, unless medical facilities were improved.
Back at the university the students all spend twenty hours a week learning English in their first year of study. Their Zimbabwean teacher is Farisai Gamariel: “Most of the students know very, very little English when they arrive – their knowledge is very basic. In medicine, if you don't know English you have problem."
Although ward assistants are regularly sweeping the floors, the smell is overpowering as the rat-infested toilets are unable to cope with the combination of large numbers of people and poor plumbing. On the medical ward one set of rat-infested bathrooms and toilets have been refurbished and piped water has been laid costing $8000 – money raised in Suffolk by groups such Playford Church.
Babies on the children’s ward sleep two to a bed with no mosquito net, alongside their resigned mothers. Most of the ward sinks have taps that do not work, and Dr Hadi Manji had to resort to cotton wool and a bottle of alcohol when he wanted to wash his hands.
Paediatricians Dr Annette Phieffer and Dr Ermalinda Gomez say it's difficult: “What we really need is more doctors and nurses and more space, so that we can treat the patients in single beds in a more dignified way. There is some improvement in the south of the country and Maputo. Here in the centre of the country, in Sofala, it has not improved so much.”
“We have more departments, such as pathology, but the AIDS epidemic is giving us many more problems, and the number of patients is always more than improvement in staff numbers."
At the university, there's an impressive mural painted by students, portraying how their childhood education led them to college and how they will return to their communities as qualified doctors.
The first doctors will graduate next year, and they have all had to make a commitment to stay and work in the Beira area of Mozambique for at least three years. The hope is that these students will return to the college to train future generations of doctors.
last updated: 16/07/2008 at 11:09