Unfortunately, things are wrapping up on a sour note with a series of thefts: my camera, my i-phone, Phillips' camera, and quantities of cash ranging from about $50-150 have disappeared sequentially. It looks like someone is getting into our apartment, and taking small items on a continuing basis.
Though not entirely unexpected event when travelling in places like this, it is disheartening. Most people here are desperately poor, and though most are honest, I am sure that to some we seem like fair targets. it is nevertheless unsettling and leaves me with a bad feeling, like I have been violated. Though the camera can be replaced, the photographs on the memory card cannot. And the iphone I had hoped to use as my backup camera, as well as calling home using Skype, and of course the many other things I use it for. One consolation is that I have nothing else of value left to be stolen.
There is plenty more I had hoped to write about: The medical students I’ve been working with, the “Medicina Verde” (green medicine) project which makes traditional herbal medications which we prescribe in the clinic (things like eucalyptus cough syrup, pepper based salves for joint pains). The severity of some of the illnesses I’ve seen people with here, and how long they go before they seek medical attention, the many wasted, broken bodies ravaged by HIV, tuberculosis, and cervical cancer, among others. How stoic and accepting of their fate many are. These will have to wait for another time.
Tomorrow I leave for South Africa: As I write this, Tia is flying south from Paris to meet me in Johannesburg tomorrow. We will travel for a couple of weeks, in Kwa Zulu Natal, and Capetown, before meeting Danny and Anelise in Boston.
Monday, August 9, 2010
Dinner with Arlindo and Joaqina and Emerson in his new house
Arlindo invited Peter and I over for dinner at his new house yesterday. (Arlindo is the medical student-minister-teacher-new father who I wrote about in an earlier posting) This is the house that we both gave him money so he could build it. It consists of two rooms and a bathroom, about 200 ft sq total. Cinder blocks, concrete floor, plumbing, lights, bathroom. It is basically an upgraded shed, in the corner of a lot on which sits a three story apartment building. He lives there with his wife, Joaqina, son Emerson, and currently his niece, Palmira is sleeping on a mattress on the floor.
Interestingly, they do have a maid, even though they had to borrow and beg money to complete the house, and there are only the three of them.
They splurged on sodas and beer for us, and we sat and chatted, playing with the baby while Joaquina and Palmira cooked dinner. They washed and shredded Kale into a big pile on a woven platter. They cracked open coconuts and used a little stool outfitted with a scraper to scrape out the white meet inside, and then proceeded to start cooking a curry with Kale, coconut and tangerine. It looked great, but it turned out to be for tomorrows dinner. Tonight we had chicken, salad, and rice. The rice was from Joaquin’s family machamba- they grow rice outside of town.
For desert: yogurt with cashews and tangerine.
Interestingly, they do have a maid, even though they had to borrow and beg money to complete the house, and there are only the three of them.
They splurged on sodas and beer for us, and we sat and chatted, playing with the baby while Joaquina and Palmira cooked dinner. They washed and shredded Kale into a big pile on a woven platter. They cracked open coconuts and used a little stool outfitted with a scraper to scrape out the white meet inside, and then proceeded to start cooking a curry with Kale, coconut and tangerine. It looked great, but it turned out to be for tomorrows dinner. Tonight we had chicken, salad, and rice. The rice was from Joaquin’s family machamba- they grow rice outside of town.
For desert: yogurt with cashews and tangerine.
Tuesday, July 13, 2010
Zimbabwe-A police state in shambles, but with warm people, and fine geography. PLUS, special bonus feature - Golf, and world cup soccer
Since I arrived in Beira, I’ve been hearing about Zimbabwe- the warmth of the people , the beautiful of the country, and the screwed up-ness of the government. Last weekend, I took an extra day, folded myself into a chapa, and headed west to see what all the excitement was about.
It took about 7 hours of sitting with my knose between my knees, squeezed in 4 across between fragrant unwashed bodies, in a narrow, rickety minivan, travelling way too fast, passing on curves and swerving to avoid potholes. The only way to survive such an ordeal is to put yourself into a Zen-like trance, breath in and out through the hole in the top of your head, repeat your mantra slowly to yourself while telling yourself that the pain you are feeling is not your own. (It helps if you can position yourself over one of the many holes in the exhaust.) There are compensations however, which require rousing from the trance- fine scenery, free Portuguese lessons from your neighbors, fresh tangerines and roasted cashews purchased through the windows from vendors that crowd the van as we passed through towns.
Zimbabwe is a noticeably richer country than Mozambique- no more houses with cane walls and thatched roofs, the people were noticeably plumper, and all wore shoes, nobody in rags. But while Mozambique’s trajectory is steadily upwards, Zimbabwe’s , has been tracking steadily downwards for the past 30 years due to the destruction of the economy by Robert Mugabe and the ruling party, ZANU-PF. Mugabe came to power in 1980, and initially showed promise. Since then he has morphed into a dictator and the political situation has deteriorated such that it is essentially a one party police state. The economy has been in a downward spiral, with hyperinflation (after introducing a 100 trillion dollar note, worth about $4 US) only recently abated after they switched to the US dollar as the official currency (the smallest currency they have is a $1 note- no coins, so if you purchase something, you get your change in candy or soda). Although the political situation was a constant presence during my visit, Zimbabwe is still a wonderful country full of warm, effusive people and beautiful landscape.
I was travelling with another American, Phil. We found our way to a small guest house run by Ann Bruce, an elderly white Zimbabawean and her employee Emma, along with Emmas extended family. Although shabby, with lumpy beds, it was clean, safe, and friendly (and cheap - $10 per night). We felt immediately at home, and during our stay we had many pleasant conversations and shared meals with them. We noticed that whenever politics came up, everybody glanced around to see who was there, and then spoke very quietly- It is a crime to badmouth the government and President Mugabe. I’ve been reading a book about Mugabe, the liberation struggle, and ZANU. It’s a pretty discouraging story. ( the claims that you have to support the ruling party or be deemed a traitor sounded frighteningly similar to the Bush administrations claims during the recent war.)
Mutare is a small city situated in a high valley surrounded by mountains. High and dry, like the highlands of Guatemala in winter, or the American west, aka Boise with tropical trees. We found lunch at a nearby restaurant- it was a walled compound with a nice garden and a veranda bordered by flame trees and jacarandas. The garden was full of fashionably- dressed Zimbabwean kids and parents there for a birthday party. We’re talking Sarah Palin eyewear, Rolex watches, fine leather shoes,etc. There was a guy following the kids around with a huge movie camera documenting the event. It was pretty packed, but the owner, a friendly Zambian-born man of Irish descent named Patrick, found us a table on the edge of the action. It turns out that wealthy black Zimbabweans are either from the ruling party, or in the diamond business. A few years ago, diamonds were discovered nearby, and the gold rush has been on since then. Local kids who were parking cars or selling bananas suddenly found themselves fabulously wealthy & driving Mercedes. Patrick told us a hilarious story of how he was approached in the plaza by a kid who wanted to sell him a barrel of rocks that he claimed were diamonds. Patrick hadn’t heard of the discovery, and told him to “Get Lost”, assuming it was a scam. “I missed the bus on that one” he said and nearly fell over laughing.
We asked Patrick how we might make our way out to the Bvumba mountains- we wanted to see the area, but it is impossible to rent a car in Mutare, and there were no busses. He thought about it, then suggested negotiating with a taxi driver before saying good bye and wandering off. Fifteen minutes (and a succulent steak in mushroom sherry sauce) later, he came back, and suggested we talk to his friend “Otie” , who was sitting nearby. “ He has about 30 cars, and if you go talk to him, he’ll probably let you use one”. Otie was an African man of about 40, slightly overweight, and diving into his own steak while nursing a beer. We were introduced, made some small talk, and then Otie offered to show us around town. What proceeded was then a bizarre tour of Odies’ riches- we saw an assortment of cars in various states of repair, the shop for his well drilling business, both of his houses, and one of his two wives. He took us up to a viewpoint in the mountains above town, then back to the market in the middle of town, where he drove down the pedestrian alley between stalls (honking to part the seas of shoppers), stopping in front of the CD booth where he wanted to buy music. He launched into a diatribe about foreign media was misrepresenting the political situation in Zimbabwe, how none of the beatings, killings and land thefts had actually occurred, and how everyone ought to just support the ruling party and everything would be fine. Things were getting a little weird, so at that point, Phil and I decided that it was time to bail out. We would figure out another way to get to the mountains.
The next day, armed with new information and accompanied by Andreas and Caspar (two Danish travelers we had met), we walked out of town to the Total gasoline station on the edge of town . There we joined a motley assortment of others looking for transportation to the Mountains. We joined up with a local women, and negotiated transport “ala family dog” crammed into the back of 30 year old pickup with a too-low cap and bad springs. And, oh yeah, exhaust leaks, which once again helped to dull the pain of my contortionist position.
We rose up into the Bvumba mountains on a gourgeous winding road, with expansive views down into Mozambique that we could glimpse through the windows. At the end of the road was the Leopord’s Rock Hotel, a relic from the Rhodesian days, and a favorite resting spot for Queen Elizabeth and Princess Diana. That was before the collapse of the economy and the rise of Mugabe. Now it is still an elegant, though fading, place, but we had it nearly to ourselves. There is a famous golf course there, which Caspar and Andreas wanted to try, so we played the good colonialists, rented clubs, hired a caddy (required), and played 9 holes ($25 apiece). It was a pretty tough course. We lost 12 balls, spent about half the time looking for them in the jungle, and it took us 4 hours. Luckily, there was no one else playing to get annoyed, and Benjamin, our caddy, and the other workers seemed happy to overlook the fact that we didn’t meet the dress code, or have much of a clue about golf. Even the monkeys in the trees seemed amused. No matter though, as the scenery was phenomenal. We then decompressed over late lunch on the veranda, and started a long walk back towards town.
That night was the night of the World Cup Final game between Netherlands and Spain. Eight of us Mzungu’s (white people) crowded in with the locals in a pub to watch the last in a long series of soccer matches. World Cup fever abated a bit here, when the last African country, Ghana, failed to progress, but the final was enough of an event to pack the pub. (Included in our group of Mzungus, were Luke and Cathy, who are friends with my niece Shannon at Xavier University in Cincinnati.) Then the next day, it was Zen time again, and after an eight hour return trip in the fetal position, we made it home. Beira never looked so good.
It took about 7 hours of sitting with my knose between my knees, squeezed in 4 across between fragrant unwashed bodies, in a narrow, rickety minivan, travelling way too fast, passing on curves and swerving to avoid potholes. The only way to survive such an ordeal is to put yourself into a Zen-like trance, breath in and out through the hole in the top of your head, repeat your mantra slowly to yourself while telling yourself that the pain you are feeling is not your own. (It helps if you can position yourself over one of the many holes in the exhaust.) There are compensations however, which require rousing from the trance- fine scenery, free Portuguese lessons from your neighbors, fresh tangerines and roasted cashews purchased through the windows from vendors that crowd the van as we passed through towns.
Zimbabwe is a noticeably richer country than Mozambique- no more houses with cane walls and thatched roofs, the people were noticeably plumper, and all wore shoes, nobody in rags. But while Mozambique’s trajectory is steadily upwards, Zimbabwe’s , has been tracking steadily downwards for the past 30 years due to the destruction of the economy by Robert Mugabe and the ruling party, ZANU-PF. Mugabe came to power in 1980, and initially showed promise. Since then he has morphed into a dictator and the political situation has deteriorated such that it is essentially a one party police state. The economy has been in a downward spiral, with hyperinflation (after introducing a 100 trillion dollar note, worth about $4 US) only recently abated after they switched to the US dollar as the official currency (the smallest currency they have is a $1 note- no coins, so if you purchase something, you get your change in candy or soda). Although the political situation was a constant presence during my visit, Zimbabwe is still a wonderful country full of warm, effusive people and beautiful landscape.
I was travelling with another American, Phil. We found our way to a small guest house run by Ann Bruce, an elderly white Zimbabawean and her employee Emma, along with Emmas extended family. Although shabby, with lumpy beds, it was clean, safe, and friendly (and cheap - $10 per night). We felt immediately at home, and during our stay we had many pleasant conversations and shared meals with them. We noticed that whenever politics came up, everybody glanced around to see who was there, and then spoke very quietly- It is a crime to badmouth the government and President Mugabe. I’ve been reading a book about Mugabe, the liberation struggle, and ZANU. It’s a pretty discouraging story. ( the claims that you have to support the ruling party or be deemed a traitor sounded frighteningly similar to the Bush administrations claims during the recent war.)
Mutare is a small city situated in a high valley surrounded by mountains. High and dry, like the highlands of Guatemala in winter, or the American west, aka Boise with tropical trees. We found lunch at a nearby restaurant- it was a walled compound with a nice garden and a veranda bordered by flame trees and jacarandas. The garden was full of fashionably- dressed Zimbabwean kids and parents there for a birthday party. We’re talking Sarah Palin eyewear, Rolex watches, fine leather shoes,etc. There was a guy following the kids around with a huge movie camera documenting the event. It was pretty packed, but the owner, a friendly Zambian-born man of Irish descent named Patrick, found us a table on the edge of the action. It turns out that wealthy black Zimbabweans are either from the ruling party, or in the diamond business. A few years ago, diamonds were discovered nearby, and the gold rush has been on since then. Local kids who were parking cars or selling bananas suddenly found themselves fabulously wealthy & driving Mercedes. Patrick told us a hilarious story of how he was approached in the plaza by a kid who wanted to sell him a barrel of rocks that he claimed were diamonds. Patrick hadn’t heard of the discovery, and told him to “Get Lost”, assuming it was a scam. “I missed the bus on that one” he said and nearly fell over laughing.
We asked Patrick how we might make our way out to the Bvumba mountains- we wanted to see the area, but it is impossible to rent a car in Mutare, and there were no busses. He thought about it, then suggested negotiating with a taxi driver before saying good bye and wandering off. Fifteen minutes (and a succulent steak in mushroom sherry sauce) later, he came back, and suggested we talk to his friend “Otie” , who was sitting nearby. “ He has about 30 cars, and if you go talk to him, he’ll probably let you use one”. Otie was an African man of about 40, slightly overweight, and diving into his own steak while nursing a beer. We were introduced, made some small talk, and then Otie offered to show us around town. What proceeded was then a bizarre tour of Odies’ riches- we saw an assortment of cars in various states of repair, the shop for his well drilling business, both of his houses, and one of his two wives. He took us up to a viewpoint in the mountains above town, then back to the market in the middle of town, where he drove down the pedestrian alley between stalls (honking to part the seas of shoppers), stopping in front of the CD booth where he wanted to buy music. He launched into a diatribe about foreign media was misrepresenting the political situation in Zimbabwe, how none of the beatings, killings and land thefts had actually occurred, and how everyone ought to just support the ruling party and everything would be fine. Things were getting a little weird, so at that point, Phil and I decided that it was time to bail out. We would figure out another way to get to the mountains.
The next day, armed with new information and accompanied by Andreas and Caspar (two Danish travelers we had met), we walked out of town to the Total gasoline station on the edge of town . There we joined a motley assortment of others looking for transportation to the Mountains. We joined up with a local women, and negotiated transport “ala family dog” crammed into the back of 30 year old pickup with a too-low cap and bad springs. And, oh yeah, exhaust leaks, which once again helped to dull the pain of my contortionist position.
We rose up into the Bvumba mountains on a gourgeous winding road, with expansive views down into Mozambique that we could glimpse through the windows. At the end of the road was the Leopord’s Rock Hotel, a relic from the Rhodesian days, and a favorite resting spot for Queen Elizabeth and Princess Diana. That was before the collapse of the economy and the rise of Mugabe. Now it is still an elegant, though fading, place, but we had it nearly to ourselves. There is a famous golf course there, which Caspar and Andreas wanted to try, so we played the good colonialists, rented clubs, hired a caddy (required), and played 9 holes ($25 apiece). It was a pretty tough course. We lost 12 balls, spent about half the time looking for them in the jungle, and it took us 4 hours. Luckily, there was no one else playing to get annoyed, and Benjamin, our caddy, and the other workers seemed happy to overlook the fact that we didn’t meet the dress code, or have much of a clue about golf. Even the monkeys in the trees seemed amused. No matter though, as the scenery was phenomenal. We then decompressed over late lunch on the veranda, and started a long walk back towards town.
That night was the night of the World Cup Final game between Netherlands and Spain. Eight of us Mzungu’s (white people) crowded in with the locals in a pub to watch the last in a long series of soccer matches. World Cup fever abated a bit here, when the last African country, Ghana, failed to progress, but the final was enough of an event to pack the pub. (Included in our group of Mzungus, were Luke and Cathy, who are friends with my niece Shannon at Xavier University in Cincinnati.) Then the next day, it was Zen time again, and after an eight hour return trip in the fetal position, we made it home. Beira never looked so good.
Thursday, July 8, 2010
Malaria:
Malaria is the “influenza” of Africa, and Beira is a hotspot. I imagine it has something to do with the fact that city is built on a sandbar, on the edge of a vast swamp. Malaria kills several million people yearly, primarily children in sub-saharan africa. Prior to coming to Mozambique, I´d diagnosed a grand total of one case of malaria (a patient who had just flown from the Dominican Republic to Kodiak, and got off the plane with typical symptoms). I´ve been hesitant to write about the disease until I had more experience, but since we are seeing 5 or 6 cases a day, and I´ve been here 7 weeks, I think I´m getting there. I am getting to the point where I think I can diagnose a case from across the room.
It is an impressive disease, especially in kids. A typical story is the sudden onset of severe headache, muscle and joint aches, recurrent fevers with shaking rigors. But it can masquerade like many other illnesses, sometimes causing a cough, and other times vomiting and diarrhea. Cerebral malaria looks like meningitis, and is just as deadly in kids. I´ve also seen patients with what looked like hepatitis, and also glomerulonephritis with anasarca (kidney disease with total body edema) due to malaria. I´ve felt more enlarged spleens and livers (from malaria) in the past 7 weeks, than in the previous 20 years of medical practice.
People with malaria are listless, eyes dull, suffering. Like victims of dementors in Harry Potter, they look like they´ve had all the joy sucked out of them. Though the picture often seems pretty typical, we try to do a rapid blood test to check for the presence of the plasmodium falciparum parasite before treating: we did a study, and found that only 20% of the patients from the clinic overall, that looked like they had malaria, actually tested positive for it. (I am going to brag, and tell you that I get it right over 50% of the time). The tests are not perfect: there is an Austrian ex-pat here who came down with typical symptoms, but two sequential tests were negative. He developed what looked like hepatitis, decided to go home (to Austria), where he ended up in the ICU, gravely ill for two weeks. A subsequent test for malaria was positive. (He´s getting better, and coming back soon).
Just as victims of the dementors respond to chocolate, there is still a prompt and effective treatment for malaria. Co-Artem is a combination of two medications (to prevent resistence from developing) that brings rapid relief, usually within a day or two, although some effects linger for weeks.
A historical tidbit: before antibiotics, it was found that patients with syphilis could be treated by intentionally infecting them with malaria. The resulting fever would kill the spirochete that causes syphilis, and the malaria could then be treated with quinine. (Just thought you´d like to know).
)
Tuesday, July 6, 2010
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.
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.
Thursday, July 1, 2010
Mt Gorongosa
The first Sylvester I have ever met (other than in Loony-Toons) was a 56 year old polygamist with 20 children, and 3 wives. Wiry,& fit, he clutched only a nylon bag in his hands as he walked up the path to join us where we sat. I later peaked in his bag, and saw that all he carried was a blanket and a piece of plastic. His only other piece of equipment was a pair of leather boots, but no water bottle, food, knife, map or compass. As we started walking, we traded small talk, which is how I learned about his family. And yes, he could name all twenty of his children (I forgot to ask for the names of his wives).
Our goal this past weekend was to climb Mt Gorongosa, 6000 feet high, and the 4th highest peak in the country. Although there is a trail to the top, you need to hire a¨ guide¨ to help you find which of the numerous paths that crisscross the area will take you there. We had driven to the nearest town, Villa Gorongosa, and arranged to be dropped off in a little hamlet at the base of the mountain. There we connected with Sylvester, who agreed to take us up and down the mountain for a fee of about $15.
Our gear was somewhat marginal. We had scraped together a few tents, but had only a stack of blankets to take the place of sleeping bags and pads. These we loaded up into one monstrous backpack which found its way onto my back.
Te rolling agricultural fields at the base of the mountain where reminiscent of the highlands of Guatemala. We passed isolated compounds of small grass huts, and small hamlets. We encountered women carrying baskets on their heads,and families working small farming plots. They were invariably friendly, would stop working and wave, but we couldn´t talk as they spoke a local language rather than Portuguese.
About an hour into the hike, we stopped at a small waterfall with pools for bathing (and cold water); a great place to hang out
With great hesitation, we left paradise, and continued on. Coming over a knoll, we surprised a late morning festa, powered by a solar-panel powered boombox and fueled by the local moonshine.
Continuing up the mountain, we entered a thick tropical rainforest, and then climbed steeply for the next 3 hours. It was a tough, rocky, and narrow trail. It did not help that the huge pack on my back continually got hung up low hanging branches. I remember thinking that it was better than elk hunting (but just barely), which we do for “fun”, so this must be fun too.
Eventually, we made it up to a large meadow near the top, where we camped for the night. I continued on to the very top with Sylvester, but everyone else stayed behind, saying they were too tired, and would do it in the morning. That was unfortunate, because by then it had clouded up and they had no view, so I showed them my pictures from the top.
The way out was a replay of the way in, except that gravity was on our side. We made it back in time to hit the road and arrive back in Beira before dark, which is at 6 PM. (After that, the vehicle-swallowing potholes become hard to see, and roadside robberies more common.)
Our goal this past weekend was to climb Mt Gorongosa, 6000 feet high, and the 4th highest peak in the country. Although there is a trail to the top, you need to hire a¨ guide¨ to help you find which of the numerous paths that crisscross the area will take you there. We had driven to the nearest town, Villa Gorongosa, and arranged to be dropped off in a little hamlet at the base of the mountain. There we connected with Sylvester, who agreed to take us up and down the mountain for a fee of about $15.
Our gear was somewhat marginal. We had scraped together a few tents, but had only a stack of blankets to take the place of sleeping bags and pads. These we loaded up into one monstrous backpack which found its way onto my back.
Te rolling agricultural fields at the base of the mountain where reminiscent of the highlands of Guatemala. We passed isolated compounds of small grass huts, and small hamlets. We encountered women carrying baskets on their heads,and families working small farming plots. They were invariably friendly, would stop working and wave, but we couldn´t talk as they spoke a local language rather than Portuguese.
About an hour into the hike, we stopped at a small waterfall with pools for bathing (and cold water); a great place to hang out
With great hesitation, we left paradise, and continued on. Coming over a knoll, we surprised a late morning festa, powered by a solar-panel powered boombox and fueled by the local moonshine.
Continuing up the mountain, we entered a thick tropical rainforest, and then climbed steeply for the next 3 hours. It was a tough, rocky, and narrow trail. It did not help that the huge pack on my back continually got hung up low hanging branches. I remember thinking that it was better than elk hunting (but just barely), which we do for “fun”, so this must be fun too.
Eventually, we made it up to a large meadow near the top, where we camped for the night. I continued on to the very top with Sylvester, but everyone else stayed behind, saying they were too tired, and would do it in the morning. That was unfortunate, because by then it had clouded up and they had no view, so I showed them my pictures from the top.
The way out was a replay of the way in, except that gravity was on our side. We made it back in time to hit the road and arrive back in Beira before dark, which is at 6 PM. (After that, the vehicle-swallowing potholes become hard to see, and roadside robberies more common.)
Monday, June 28, 2010
The Hospital at Nhamatama
I visited a small rural hospital last week: Nhamatanda is in a town of about 10,000 (my guess) , and the hospital serves a district of about 500,000. There are two doctors, and six ¨technico´s¨, who are more or less like PA´s, but trained to do specific procedures like C-Sections. Currently there are also 6 medical students, which is (or is not?), a good thing, since both of the doctors are gone right now. The first photo is of a lab tech showing us their new CD4 counter, a piece of equipment which is essential for treating AIDS patients. It was purchased for the hospital by the Clinton Foundation.
The HIV rate in this area is 29%. About 10% of HIV(+) individuals are on anti-retrovirals (provided through funding from the US at a cost of about $100 per year per person).
The second picture shows family members of patients cooking food for themselves and the patients in an area set aside for this.
The most common reasons for hospitalization are malaria and childbirth . They do about 250 deliveries a month, and have a 3% C-section rate. (Maybe that should be a little bit higher, since Mozambique is tied with Sierra Leon for the highest neonatal mortality in the world!). There is also about a 1% incidence of uterine rupture, for unclear reasons (a study is in progress). The third photo shows pregnant women at a hostel on the hospital grounds where they come and stay when they are close to delivery. May live too far away to wait at home, especially during the rainy season.
The two most common surgeries are 1) hernia repair and 2) intestinal obstruction due to ascaris (pork tapeworm) infection. The fourth photo is of one of the medical students showing us around.
In addition to surgical, obstetrical, pediatric and general medicine wards, this hospital has separate wards for TB, leprosy, and malaria, and a tent for cholera patients. The last photo is the cholera tent.
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