IRPfellows, Mozambique — Oct 29, 2014

The logistical nightmare of providing health care in rural areas

If you fall ill in rural Mozambique, your options are devastatingly limited. If you had the chance to pick a place from the bad options, however, I have a feeling you couldn’t do much better than Moamba, a village in Maputo province near the border with South Africa.

We visited a clinic there that serves the local community. They can treat the most common afflictions – diarrhea, chronic malnutrition, malaria, and HIV/AIDS – but face numerous problems common to all rural hospitals. Clinics are understaffed, the pharmacy does not have a reliable supply of drugs, and patients must walk or commute long distances from home to arrive. A handful of people are entirely unreachable.

Maputo province.

Maputo province.

Still, I can’t help but feel we saw the crown jewel of health care in rural Mozambique. A plaque commemorated its establishment in 2010 in response to the HIV/AIDS crisis as well as specified it receives funding from the U.S. Centers for Disease Control.

Most of the action on Tuesday took place at the maternity ward, where dozens of women sat in a row outside waiting for their turn. Doctors weighed children to check for signs of malnutrition by swaddling babies in a cloth swing and attaching them to what looked like an oversized luggage scale. They vaccinated for common diseases such as TB and polio, treated malnutrition, and distributed anti-retroviral treatment to prevent mother-to-child transmission of HIV.

A mother waits outside to have her child weighed with about thirty other women.

A mother waits outside for her turn to weigh her baby.

The doctors and medical technicians we met were young – many in their 20s – and all had less training than in Western systems. In Mozambique it takes four years of training to become a doctor after completing secondary education and 30 months to become a medical technician. The staff we met were passionate about helping their communities, proud of their work, and hoped for a better future for health care in their country.

A 20-year-old medical technician stands with the scale used to weigh babies.

A 20-year-old medical technician stands with the scale used to weigh babies.

A few moments sent my eyebrows shooting up my forehead, such as learning that the most commonly treated problem in the psychiatry ward was… epilepsy. The fact that this clinic had a psychiatrist in the first place was an immediate giveaway that it was not very representative of the general state of healthcare, since treatment for mental illness is practically unheard of. (They also said they had drugs for schizophrenia.)

The room for sterilizing equipment, housed under a thatched roof.

The room for sterilizing equipment, housed under a thatched roof.

We saw a mother who had given birth just 30 minutes before and a woman having a birth control implant removed from her upper arm.

Beds for recovering patients.

Beds for recovering patients.

In theory health care in Mozambique is free for patients. Expecting mothers who live far from the clinic and are at risk of home deliveries are even offered free accommodation on the hospital grounds for the last two weeks of their pregnancies. I saw a few posters urging readers to report any attempts at eliciting payment or corruption to a central line.

A notice urging readers to report irregularities.

“Combat corruption by reporting charges and bribes, etc.”

This is a village in the wealthy south of the country and near South Africa, where more healthcare options are available. It will be interesting to see how it differs from other clinics further north, where we’re headed today.