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...

Medicine in Mozambique: Obstetrics and Gynecology

Yet another week in my medical clerkship here in Mozambique, and this time I was in the little town of Chiure. Not too far from Pemba this place, just a 2hr drive or so. What is interesting with Chiure is that although it may only have 2 paved roads, it is quite a populous place. In fact, the district of Chiure happens to be the most populous in the Cabo Delgado province. Thus Chiure hospital sees quite the number of patients, all coming in from the surrounding towns and villages. Also, alternatively, some medical teams go out to the health posts on the country side and provide care more locally. I did a bit of both this week, working in the hospital and going out to the remote health posts. My hosts for the week were a lovely British/Brazilian family in which the mother was the OB/GYN I was working with for the majority of the week.

There is a real need for proper maternal health care in Mozambique, since a lot of women in this part of the world still die from pregnancy related problems. Such things like regular ante-natal checkups that one is used to in the developed world simply are not that common in northern Mozambique. The result is that problems that could be avoided early on in pregnancy are left undetected and can eventually become life-threatening. Thus the work within maternal health care in Mozambique involves both solving the grave cases that do occur, and also working on preventing them by getting mothers to do regular check ups. It is a interesting field of medicine to be sure, and I have been glad to have experienced it for this week. Now for some pictures!

On the road to Katapua, a remote health post.

Katapua Health Post

Doing Consults with Patients in Katapua

Getting ready for surgery in Chiure. Lots of C-sections (including twins) some hysterectomies, sterilizations and one case of a unicornuate uterus. Also a quite tragic case of a woman with a massive placental abrubtion, yet another example of how early intervention can be the difference between life and death.

An interesting week and lots of new things seen and learned. Next week I fly off to Gurue, (of drinking water fame) the more mountainous region of Mozambique not far from Malawi. Look out for a post on that at the end the coming week. Till then, cheers.

Medicine in Mozambique: A Flying Start

As many of you know, last summer I did my medical clerkship in Olsztyn. It was an experience filled with russian toilets, electrocution and random crazy patients. This time around, I am in the jungles of Mozambique, a rather stark contrast to the Polish wilderness. Just last week I was in the small town of Topuito, which, although remote, is the location of the world's largest titanium ore mine. Using the mine as a base, we would drive out into the surrounding villages each day to provide medical care to people who sorely need it. Thought I'd share some of my experience. Right, let's start from the beginning.

 The first part of the journey was flying from Pemba to Nampula, a 40 min journey which easily trumps the alternative 6hr drive there. A small Cessna plane, courtesy of the MAF, then took the medical team from Nampula to Topuito. The medical team being me the medical student, the Dutch doctor I was shadowing, a Dutch nurse and a Portuguese dentist. That was my very first time in such a small plane, and after the 45 min in the air I was both amazed and slightly nauseous. It really is the real deal as far as aviation is concerned, but the ride can be rather bumpy from time to time.

The little Cessna plane.

The Doc and I getting ready for take-off.

View from the plane.

Getting out into the surrounding villages was different from day to day. Sometimes it was a drive of various lengths in the Land Rover, other times it would involve crossing a river in a boat powered by a man with a bamboo stick. Upon arrival, we would each set up our stations and see the patients one by one. People came with various problems, ranging from complaints of headaches to faces filled with massive boils.

During the days I learned the details of proper history taking, i.e. how to ask a patient what their problem is. I also learned a bit of auscultation, and how to do chest and abdominal exams. To me it really feels like the core of primary medicine, being able to hear and feel what is wrong with a patient. It is a skill I think I will need to practice quite a bit over the years. One thing that I would do on a regular basis was to give HIV tests to patients we suspected had the virus. The region we worked in has been hard hit by the virus, and more than once we had to give the bad news to patients. Some would break down and cry, but the majority would just shrug it off as just bad news. One wonders if they have a superior way to cope with their struggles, or don't fully understand the implications of the disease.

At the clinic in Topuito

The clinic in Topuito, just a short drive from the mining complex where we stayed, is a newly built medical center. It has a maternity ward and a wing for the general consults. In maternity we did quite a few ultrasound checks on ladies with complaints of abdominal pain, as well as some pregnancy check ups. The morning consults were usually dominated by kids with fungal infections, HIV patients, and patients suffering from hypertension.

Strained selfie at Topuito clinic.

Clinic in Briganha

The clinic in Briganha was about an hours drive away from the mine, so pretty much smack in the middle of nowhere. Here the nurse turned ambulance driver as a critically ill lady had to be rushed to the nearest proper hospital, which was about another hour and away on a poor excuse for a road. Good thing we had Land Rover. Here there were quite a few exotic disease, including elephantiasis due to lymphatic filiarisis (caused by the wuchereria bancrofti, for my fellow Parasitology survivors) more intense fungal infections, eyes destroyed by bacterial infections, and many weird skin conditions. Of course you had your usual HIV and hypertension patients here as well.

Clinic in Larde

Larde was a special place. It was quite a big town, giving the circumstances, but we had to use a boat to get there. Once the boat had crossed the river, the medical equipment was carried by a couple bikes and mopeds to the clinic itself. In fact, I believe train and hot air balloon were the sole modes of transportation not used on this trip, all in all.
                                     

Crossing the Larde river.

Medical Supplies in "safe" hands.

The boats likewise safe.

Much learned from this first week, and I have really grown to appreciate the need for medical care in the remote reaches of Mozambique. Next week I'm off to Chiure, which is a medium sized town not to far from Pemba, to continue my medical clerkship at the hospital there. Will try to write up something about it next week. Until then.