Hospital Central do Beira

Nadia is a 25 year old medical student from the Capital City of Maputo, who is just finishing her training at the Universidad Catolico de Mozambique, here In Beira. She is married, with a 2 year old son. She has a few weeks off before graduation, and since she is one of the better students, she was offered a chance to moonlight in the clinic to earn a little extra money. She is as smart and motivated as any US medical student. I asked her if she could show me around the main government hospital, and she took me to see it this afternoon.



I waited for her at the bus stop in front of the hospital. She arrived early, by local standards, which was 20 minutes late by ours, and I spent that time watching the comings and goings: Chapa´s trying to collect a few more passengers, hospital employees dressed in white or other uniforms ( the type you would see in childrens books when I was growing up in the 60´s; orderly´s, maids, etc), and patients family members coming and going for visits. Overall, it was a pretty mellow scene.

The hospital is located on a moderately large campus with a single large main hospital building and a cluster of smaller outlying buildings. Most look like they were built in the 30´s or 40´s, with few alterations, and less maintenance, since. It is all located across the street from the beach, in a nicer end of town about 2 blocks from where I am living.

First stop was the malnutrition ward, where kids with murasmus or kwashiokor receive the best known treatment for hunger, which is food. Next door was the diarrhea ward for kids where they are rehydrated orally. It was fairly quiet today, but during the rainy season there are often 4 or 5 children, plus a parent, for each bed!



Then on to the main building: five grim stories of chipped concrete, narrow hallways, and silent suffering. As we came into the building we met a patient with Leprosy who Nadia knew. He was a man of about 60 who hobbled around with a crutch, carrying a radio tucked under an arm , left foot wrapped in gauze. She said he had been living in the hospital for 2 years, and, since she last saw him he had lost all of his toes. He was heading into the dermatology ward, which mostly housed patients with kaposi´s sarcoma, and HIV-related maligancy.

There were separate wards for internal medicine, surgery, pediatrics, orthopedics, obstetrics, and gynecology patients. All were pretty much full to the brim, with 5 beds per room, which left about a foot between beds and two feet along one wall. Over each bed was a mosquito net, and there was only one bathroom off the hallway for all the patients in a ward. Patients were laying around, huddled under blankets, or visiting with family members. Some had casts or obvious wound dressings, but few had any apparent ongoing treatments. In many of the wards, the hallways were lined with beds too. At the head of each bed was a thin paper chart. There were few hospital personnel visible: an occasional nurse or ward clerk. Family members seemed to delivering much of the assistance.

The internal medicine ward was the grimmest of them all. 99% of the patients have end-stage AIDS. It smelled of urine, and each bed was occupied by a gaunt, crumpled human being, most sitting silently, and alone. It was noticeably more crowded than the other wards, with hardly any room to walk down the hall, and it was filthy.

There was one unique ward, called the “model hospital ward”, which turns out to be the place that you get to go to if you have connections. It obviously made Nadia´s blood boil that there existed a second tier of care. There are only 3 patients per room, none in the hallways. It was noticeably cleaner and brighter than the rest of the hospital. Still, by western standards, it was desperate.

There is a separate pediatric and adult emergency departments, both crowded with forlorn looking patients. The hospital has an ultrasound machine, an Xray machine, and a CT scanner (the only one in the province). An Xray cost 20 Meticais (65 cents), a CT scan ; 1000 Meticais ($30). There is also a lab, a pathology department, a morgue (very busy), and a psychiatric ward.

What impressed me most about my visit, however, was not the deplorable state of the facility, but Nadia´s upbeat attitude. She greeted staff and patients in a very pleasant and comforting way. She told me she enjoys working in the hospital. After graduation, she will complete 2 years of required government service in a remote clinic, and unlike many other students, she looks forward to this as an exciting opportunity. She hopes to get further training in pediatrics after that, and to work in a hospital, such as in Beira, in the future.