Sharing knowhow and joining forces towards Health for All
Contribution to the Annual Report 2016 of the MMI Network

28 Months as project manager with the Brigada Móvel in Morrumbene, Mozambique

28 Months as project manager with the Brigada Móvel in Morrumbene, Mozambique

Mozambique, one of the South Eastern-African Countries, actually ranks 181st among the 189 countries in the Human Development Index 2016. Since 2007 Medicus Mundi Italy (MMI) is working for the empowerment of the Mozambican National Health System in Morrumbene, a rural district populated by 150.000 inhabitants situated in the Inhambane Province in Southern Mozambique. MMI supports education courses and training-on-the-job of local health workers in the field of Maternal and Child Health (especially nutritional rehabilitation), Tuberculosis Control and HIV/AIDS management, and offers supervision of supported activities. The focal activity is called Brigada Móvel, a public mobile clinic that provides primary health care to the rural communities living in the most remote areas, far from the traditional Health Centers. Since 2011 the Brigada Móvel reach every community in the district at least once every three months, but often more frequently as needed. During 2016 a total of 164 visits were realized.

My collaboration with Medicus Mundi Italy (MMI) started in October 2014. For me it was enough to set foot on the reddish soil of Mozambique to perceive the first sharp contrast. On one hand, the enthusiasm of a young physician for having received such an important task: be the health project manager. On the other hand, the huge responsibility for the whole project. I decided not to let myself be impressed by the amount of work to do, but to focus on the implementation of a basic service, trying in the best “MMI spirit” to deliver my share of “health for all” to the Morrumbene population. No time to know the details of the local context and here I am launched on an ambulance of the Brigada Móvel (BM) that day after day provides, to the most remote communities of the District, essential health services such as vaccination for children, ante-natal care, treatment of malaria, and management of the many cases of HIV, not to forget acute and often severe malnutrition.

I spent my first six months coming around with eyes and ears wide open, to know the communities’ needs and the colleagues’ habits. After that we began the education and training courses plus the supervision to the National Health Program in the 11 Health Centers of Morrumbene.

The MMI operated support to the National Health services in the area of nutrition is included in a larger project that involves two other Italian non-governative organizations, namely Servizio Volontario Internazionale (SVI) e Servizio Collaborazione Assistenza Internazionale Piamartino (SCAIP), which support the agricultural sector and the micro-economy in order to reach higher levels of food security in the Morrumbene district. Despite the fact that the National Health System is totally free of charge, in Mozambique many children with malnutrition are not hospitalized and often not cured at all, because “thin bodies” are considered as the normality by families and health workers (in fact 44% of the Mozambican children suffer from chronic malnutrition). Other local barriers, both cultural and distance related, may also contribute to the undertreatment of childhood undernutrition.

Thanks to the BM service, we were finally able to reach the most rural communities and to implement there a comprehensive nutrition program. Starting from the screening of acute malnutrition via the management of Marasma and Kwashiokor to nutritional education, where through cooking sessions we encouraged families to take advantage of the locally available products to fight food insecurity effectively. Encountering the communities gave us the chance to discuss some other essential points in which people are still dependent on traditional authorities and healing practices such as “traditional health practitioners” and “traditional midwifes”: for example, in the Morrumbene district almost 60% of pregnant women deliver at home without skilled birth attendance. During 2016 I also worked in the pediatric ward (I should say room, as there is no ward) of the Morrumbene Health Center, focusing on improving management of hospitalized children with severe and often complicated acute malnutrition. Applying the local protocol strictly, we were able to treat 25% of all the pediatric inpatients with SAM of the Inhambane Province!

But during my 28 months in Morrumbene I also had to face difficulties in many areas, such as:

  • Training: Working on the motivation of the local health workers was quite a difficult task, as they often showed reluctance in adopting the national health policies and protocols.
  • Language: Despite of Portuguese being the national language, in these remote rural districts most people have not received even primary school education and thus only speak the local dialect. So, working through the local health workers is absolutely necessary.
  • Tradition. Working in Mozambique could put you in front of some difficulties linked to “cultural differences”. For example, in rural villages often acute malnutrition is seen as a kind of damnation, in which the spirit of wild animals impedes a good development of the children. Such a curse than needs a traditional ritual of purification – which often worsens the health of the child!

But as time went by, I felt myself increasingly part of something stronger than the tropical heat in January: something rooted in the imperturbability of Morrumbene, in sharing objectives with the local group of volunteers, in the mission of Medicus Mundi. We worked a lot in these 28 months. But despite everything, as one of the many Mozambican mysteries, fatigue weighed less than the desire to think about doing even more, to direct efforts to improve the project further and offer ever more to our beneficiaries.

On the 15th of February, the day after my return from Mozambique, a tropical cyclone called Dineo–17 made landfall in Southern Mozambique, Inhambane Province, carrying strong winds exceeding 130 km/h, rough sea and torrential rain. The most affected area was exactly the district of Morrumbene where many health centers and schools I visited during my stay had their roof uprooted or were totally destroyed and the entire population suffered severe damage. Years of work were strongly struck, but fortunately none of my colleagues was killed and everyone started to help with the reconstruction.

This is what I'll bring back with: it’s mandatory to accept that not all events can be controlled. But it’s good to struggle together to change those you can!

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