Mozambique: Where health is more than pills and vaccines

Jul 172014

From the preventable tragedy of newborn deaths to the thrill of cutting edge technology for same-day viral load testing of young babies, from a rural hospital without an incubator to the enthusiasm of HIV positive activists, this was a whirlwind, knowledge-packed media trip to see maternal and newborn health in Mozambique.

From the preventable tragedy of newborn deaths to the thrill of cutting edge technology for same-day viral load testing of young babies, from a rural hospital without an incubator to the enthusiasm of HIV positive activists, this was a whirlwind, knowledge-packed media trip to see maternal and newborn health in Mozambique.

Nine international health journalists took part in this fellowship, sponsored by the United Nations Foundation and organized by ICFJ. Mercedes Sayagues, former Knight Health Fellow in Mozambique, coordinated the tour.

Here are some highlights from her diary:

Thursday 3 July, AM - Only six out of ten Mozambicans have access to health services, national health director Francisco Mbofana tells us at a briefing.

AM - At the Polana Caniço clinic in a modest neighbourhood of Maputo, we see the new German-made Alere viral load counting machine being tested and refined. It can detect HIV in weeks-old babies within one hour. The current method of dry blood spot collection analyzed at a central lab takes a month or more, leading to a big loss of babies to follow-up. An estimated 14,000 new HIV infections among children occurred in 2012, down from 26,000 in 2009, according to UNAIDS.

Friday 4, AM - At the Manhiça Health Research Centre, 90 kms north of Maputo, researcher Elisa Lopez Varela tells us that only half of people with TB in Mozambique are on treatment. Their studies show that local people believe that the incorrect performance of burial rituals (known as kuchinga in the Shangaan language) brings TB.

PM - At the maternity ward of the hospital in Chokwe, 200 kms north of Maputo, we meet one woman who lost her baby to eclampsia, one with a fetal death, two healthy newborns, and a woman whose baby needs to be resuscitated during five minutes, with an old suction machine. Director Inacio Chichango Junior says that first on his wish list is an incubator: they have none.

Saturday 5, AM – We meet TB and HIV patients at a WHO-funded project near Xai-Xai. One woman, 55, diagnosed with TB two years ago, takes her pills daily, yet she is adamant that TB is caused by flawed kuchinga, burial rites that include widow cleansing through sex with the late husband’s brother. This underpins what we heard at Manhica centre yesterday.

Monday 6, AM – Back in Maputo, at the DREAM centre for antiretroviral treatment, activists Sifronia Filipe Maotsa tells us that stigma is a huge barrier. Often women don’t tell their husbands they tested positive, fearing divorce or expulsion from the family home. Some wives convince the husbands to test together at Dream, and ask the nurses to pretend this is their first visit, and the positive diagnosis, a surprise.

At the farewell briefing at the United Nations, Daniel Kertesz, WHO representative, concludes: “We know what works, the evidence-based research, and the successful interventions. The challenge and frustration is getting these to the people who need it. There is so much more to health than the pills and the vaccines and the state of hospitals. The social determinants of health are a critical factor in keeping people healthy.”

And with these wise words in our minds, we head to the airport.

FAST FACTS ABOUT HEALTH IN MOZAMBIQUE

Pop: 24 m National HIV prevalence: 11.5%

Infant mortality rate: 92 per 1,000 live births

Maternal mortality rate: 500 per 100,000 live births

Total maternal deaths: 4,000 per year

55% of births with skilled attendant

27% of pregnancy-related deaths are due to HIV

56,000 women newly infected with HIV in 2012

7 out of 10 eligible children are not receiving HIV treatment

45% of rural children suffer chronic malnutrition and stunting

Source: UNAIDS, UNICEF, COUNTDOWN TO 2015, DHS 2011