As you know, we went for a monitoring and observation visit to Marracuene district yesterday.

It was a great experience and I met some very interesting people as usually when visiting the field. We went around to different health posts in the district, making sure that the children were receiving the adequate dosage of vitamin A, polio vaccine and deworming tablets, checking the expiry dates on the vaccines, and seeing to that everything was in order. I took some time to walk around and speak to parents, health workers and children, which was very rewarding.

One case that struck me was that of a blind man that came to the health post with his two daughters, they had brought him there because they had heard (from the man with the megaphone, remember?) that it was important to get the vaccine. Every time I’m out I realize the importance of communication, of keeping the communities, community leaders, parents, teachers, traditional doctors etc. informed and involved. Letting them own the initiatives, activists feeling like they are contributing, young people understanding the importance and doing their best to get the younger one’s along. And this was happening, older children came with their younger siblings because their parents were out working in the fields, some of them out of their own initiative.

There was one thing that made me think though, and it was the omnipresent detail that the parents and health workers would say “open your mouth, it’s candy!” when giving the deworming tablets to the children. They are not sweet at all, but sure, it worked – this time.

Why not focus on educating and creating a positive picture of medicine as something that helps and cures, instead of infringing the trust of and directly disrespect your children?

Anyway, that was just a detail. But do you know what else I found? A small bear.

And of course, I wrote a story about it for the UNICEF website, here it is:

Marracuene, 27 November 2012 – On the second day of the National Health Week in Mozambique, women and children in the district of Marracuene in Maputo province gathered around health centers and mobile health posts. Led by the Ministry of Health, the campaign aims to improve the health of almost four million children by giving them polio vaccines, deworming tablets and vitamin A supplements. At the main health centers, family planning counseling is also available to all people of reproductive age.

“I am confident that we will reach our targets with the children here in Marracuene,” district director Isabel Menetiane proclaimed. “The numbers are already looking great. Yesterday we surpassed our goal of vaccinating four thousand children daily, and we know from experience that people here tend to come during the last days, so I am expecting a very good coverage”.

At the Marracuene health center, the preventive medicine technician, Rosalina Fumo, fills in the health cards and takes a moment to speak to each mother, giving advice and support. Sofia Cuco, 1 year and 10 months old, is hanging in the scale, it shows 9kg.

“Your girl has not gained any weight since September,” Rosalina tells the mother, 19 year old Zahora, while pointing at and explaining the graph in Sofia’s health card. “This is very bad and can be dangerous. At this age, your girl should be growing steadily. You need to change her diet and add some vegetable oil, milk, eggs or peanut butter to her porridge for her to grow healthy and strong”.

Zahora is thankful for the advice. “I am not happy that my girl has not gained weight, I want the best for her and will follow the advice of the health worker. But I am happy and feel more comfortable now when I know how to help her and knowing that she is vaccinated.”

A bit further away in the same district, a man wearing the white t-shirt and yellow cap for the campaign is standing by the mobile health post set up in a market named Guáva. He is holding a megaphone and shouts in Portuguese and the local language Shangana, urging people to bring their children to get their essential immunizations. Mothers and children are already standing in line facing the health workers, and more children are approaching. They have understood that somebody is giving out something good and some of them are looking curiously at the bright red pills containing the Vitamin A drops, they look almost like sweets.

Nationwide, the Ministry of Justice has joined the Health Week initiative, taking the opportunity to inform mothers about the importance of birth registrations. “It is very clever to use the fact that mothers gather in one place as an occasion to mobilize and advise them to register their children.” the chief medical doctor of Maputo province, Dr. Stélio Alfredo Dimande says.

Dr. Dimande is content with how the campaign is going. “This is a great initiative and we are really covering the entire district. The impact is much greater when we mobilize the communities and make sure that people actually participate. Unfortunately, people don’t come to the health centers for routine vaccinations and controls as often as they should, it would be a cheaper solution for the country – but it’s too difficult and expensive for some people to come, so we need to be the one’s reaching out to the communities.”

A visually impaired man approaches the health post with three children holding his hands, two girls and one boy. The girls are his 8 and 5-year-old daughters, Solange and Suza. As the immunization initiative is intended for children up to the age of 5, only one of them is standing in line.

“The girls came to me saying that they heard that there was something important going on in the market and that I had to take them there,” the father proudly explains. “I don’t see very much so they had to lead me here, but I am still here as their guardian to make sure that my Suza gets her protection and I will make sure that the boy’s parents also come here later with his health card. I am very happy that we found out about this campaign.”

Photos and story from the visit to the Health Center in Changara, Tete province. Published on the UNICEF Mozambique website.
© UNICEF Mozambique/2012/C.Bach

Ladies dressed in colourful traditional capulana fabrics are standing in a long line outside of the main health center in the district of Changara in Tete province in Mozambique. They are accompanied by their children and are today attending the monthly health control where their babies will be weighed, measured and checked for diseases.

Little Debora Inácio is four months old and is being held by her grandmother. The mother stands next to them, explaining why they have come today. “We come here once a month to check that everything is okay with the girl. It is very hot sometimes and we have to wait for a long time, but we are very thankful that the health centre takes care of us and our children,” she says, showing Debora’s health card with charts showing whether the girl has the weight adequate to her age.

Almost 200.000 people live in Changara and this is the only Health Center where a licensed medical doctor and admission facilities can be found. Dr. Fausto Muzila is the young doctor that is taking care of the entire district and supervising nurses and other health professionals. He has some support in his work from medical technicians and 12 smaller health clinics, but not even this main health center has advanced enough facilities to take care of some of the most acute and severe cases.

“We do what we can here in Changara, but when somebody needs a surgery after a car accident or when a mother is delivering a baby and acutely needs a caesarian, we simply cannot help them,” Dr. Muzila explains.

Patients in need of urgent medical attention that require surgery or x-ray are sent to Tete, the capital of the province, 100km away from Changara. “It takes more than one hour to reach Tete so it happens that patients die in transport just because they don’t reach the hospital on time, this is very sad,” Dr. Muzila says.

A bit further away, a team of health workers are showing young mothers how to prepare nutritious food for their children from locally grown ingredients such as corn, peanuts and moringa leaves, a very vitamin-rich plant that also contains magnesium and proteins. The mothers are informed that they only need to feed their babies with breast milk during the first six months, as it contains all nutrients the babies need, contrary to the belief in some of the communities.

Carmita, a 19 year old mother, is watching the presentation with her four month old baby, little Beyonce. “This is my first baby and now I will be able to cook food that is good and healthy for her,” she smiles, letting the girl taste some of the mash that the health workers have prepared.

HIV and AIDS related symptoms and diseases, malaria and diarrhea are the main reasons people come to the health centre. Lately however, after a large distribution of mosquito nets in all the communities, the numbers of cases of malaria are less than half of what they used to be.

“The mosquito nets have made a huge difference in the communities,” Dr. Fausto explains. “Now I only work 24 hours a day,” he jokes, smiling and pointing out that he has dedicated his entire life to working at the health center. “I don’t have my own family, I wouldn’t have time. Besides, the patients, the work I am doing here, it is all very rewarding. The health center is my home and family”.