One problem in Mueda district and throughout Mozambique is the inability of husbands to provide blood for transfusions to their wives, whether directly to them or to replace stocks at the blood bank. Deep-seated beliefs prevent it.

In the event of a divorce or separation, the husband cannot leave his blood behind. He wants to take it back, lest the wife engages in witchcraft against him using the blood. Community tribunals often hear divorce cases where husbands demand their blood back.

In Mueda, if a patient is evacuated by ambulance from a rural clinic to a district capital’s hospital, the choice of who travels with her depends on who can donate blood. The patient’s mother usually steps forward, but if she is old, frail, thin or anemic she is not a suitable donor. And with an HIV prevalence of 9 percent in the district, any young, sexually active donors must be screened for the virus.

The director of the hospital in Mueda district, Carlos Alberto Sitoe, who is also the only technician skilled in surgery for three districts with half a million people, knows this problem all too well. The hospital’s blood bank can only stock a small amount of blood due to irregular power supply and small capacity. Before starting a surgery that requires transfusion, Sitoe must make sure a family member can replace the blood.

Last week, the patient scheduled for surgery had a life-threatening hemoglobin count of 1. Hemoglobin is the oxygen-carrying protein molecule in red blood cells. An adult woman should have a count of 12. Asked for a blood donation, her husband, a healthy, robust man, brought two old and frail aunties, both unsuitable donors. The hospital told him to return with younger, healthier relatives.

Sitoe is simultaneously bemused, annoyed and resigned. “This is rural Mozambique,” he says, with a frown and a hint of a smile.

Editor’s note: Mercedes Sayagues is a Knight International Journalism Fellow in Mozambique. She recently journeyed to the most remote region of the country with a rookie reporter to investigate conditions at the health posts and hold a training session for radio reporters there. She discovered a struggling health care system further compromised by the prevalence of strong beliefs.