Medicine in Mozambique: In the Hall of the Mountain Queen

Back from the last week of my medical clerkship, which I spent in and around the town of Gurue. Here in the southern most part of the Rift Valley I got to encounter a new culture, the Lomwe, and marvel at a magnificent nature. Far from the flat coastal grasslands, the area around Gurue is mountainous and filled with rivers and forests. The area is still quite isolated and the remoteness and wilderness does add to the overall charm. From a medical perspective, however, the isolation bodes ill for those who get ill and find themselves several hours from the nearest health posts. It has been a privilege to be able to travel out to this area to learn firsthand about the way medical treatment can be given in remote settings. It has been interesting to see how the balance between emergent care and sustainable development is met, and the different struggles a "jungle doctor" is met with.

The view from the backyard at the house where I stayed. Decent.

Panorama of the hills outside Gurue.

This beautiful panorama shot is taken behind one of the clinics we helped do consults for. Unfortunately, the clinic is overseen by an old man who fancies himself a nurse, without any real training. The doctor I was shadowing made it a priority to try to give this old man some proper medical knowledge, but unfortunately only so much sticks with a stubborn old man. Meanwhile, his clinic was filled with medical kits charitably given by aid organizations such as UNICEF. A common thread in my medical clerkship was seeing the need for sustainable development within the Mozambican health sector, rather than quick fixes. Here is a perfect example, UNICEF and the thousand of people who donated money are surely thinking "great, we have been able to send X amounts of medical kits to remote clinics in Mozambique, changing the world!". Unfortunately, sustainable development is never that easy, it requires time and patience, and ambitious locals willing to learn and bring their country forward; along with the proper supplies. Tragically, it is quite difficult to meet these requirements at once, and thus remote medicine can often be a frustrating balance of scant resources. 

Idyllic Eucalyptus-lined road up into the remote hills.

A makeshift clinic deep in the hills. In fact, this place is so "exotic" that they have their very own queen, who we were honored guests of. Maybe not quite as pompous as Elizabeth II, but I can with full truth state that I have checked the blood pressure of a proper Queen. From the exotic to the horrifying, in this little clinic in the hills a mother came to us with her two small children. Twins they were, but one wouldn't have guessed it. See the thing was, this so-called-mother had only been breastfeeding one of the twins, and had left the other one to fend for himself. The result was one healthy 3-year old, and one scrawly creature that made the Darfur children look fortunate. That is not an exaggeration. I will not show the picture due to patient privacy, but it is one of the scariest thing I have seen. One wonders how a mother can be that cruel, to starve one's own child.... Shudders. 

"Where There is no Electricity"

Invinha, a more proper health post, with proper being a very relative term in this context.

Mualacala, a magnificently named village with stunning views. When we arrived in the morning the nurse on station had just the previous night delivered a baby. No midwife at the clinic, and the nurse just fresh out of nursing school, I say that is quite an achievement. In Mozambique the need for educated nurses and health staff is so great that fresh out of school this young nurse had been sent off to work on his own. A measure more of dire need than efficient planning. The doctor I was working with makes it a priority to teach the local nurses and further their medical knowledge. Yet another step in trying to make health care more sustainable in Mozambique. 

Picture taken out the window of an old Portuguese Tea factory. Keeping with the golden word sustainability, this factory is now used by the doctors who fly out here to educate a group of so called activists. These activists are taught about basic health, malaria, bilharzia, HIV  etc. They then go home to their respective villages and teach the population at home about these things. Might seem like a small thing, but preventative medicine and education could be the difference between life and death in millions of cases.

After a week out in Gurue it was time to fly home again. This young lady flew us quite a bit of the way as well! Not everyone who can say they have been piloted by a 13-something year old, and survived!

After a couple weeks out and about in the African bush my medical clerkship comes to an end. I have learned a lot over these past weeks, and have gotten a deeper understanding of what medicine in the remote really entails. I know this knowledge will serve as ambition and inspiration as I continue my education in Poland this autumn. Not making any promises, but this may not be the last time that I jump into a little Cessna and head off into the wilderness. Vamos ver, vamos ver...