Cumberland, Dr Margaret (Peg) - Mozambique

 

1 July 2005

The depth and force of the water make me intensely grateful to the person keeping a firm hold on my arm as he guides me, struggling against the current, across the rain-swollen river. “You know,” he says, “Someone was crossing at just this point when a crocodile touched him. We haven’t seen him since.” The tone of his voice conveys no sense of warning; he’s simply telling me a bit of local news about one of those things that happens here during the rainy season. The rains start, the river swells, crocodiles move down stream, people need to cross the river, a crocodile eats someone. That’s life (or rather death) here and you accept it because, until the government finds the money to build a bridge, it’s not going to change.

Or do you? 

And how about other health threats?

It is with the belief that God desires his people to reach out to others, not only with the message of salvation but also in the service of their physical needs, that I was invited to come here by the Niassa Diocese of the Mozambican Anglican Church. My role is to assist the Diocese in addressing some of the health needs of this remote and neglected area. I would be very grateful for your prayers that I might make a helpful contribution.

The Diocesan health project began in March of this year. It covers a 110km stretch of the shore of Lake Niassa (or Lake Malawi, depending on your perspective) extending up to the border with Tanzania. There are no proper roads along the lakeshore and the main means of transport are foot, dugout canoe and traditional sailing douw. In the north the mountains extend down to the lake edge and the track deteriorates to a narrow rocky path. Despite its’ inaccessibility there are about 15,000 people living in the area, almost all of whom are dependent on subsistence farming and fishing. 

In the late nineteenth and early twentieth centuries there were several British Anglican missionaries living here. They protected local people from slave traders and provided education and health care. During that era the great majority of the population came to regard themselves as Anglican Christians and they still hold on to that identity. During the war of independence against the Portuguese from 1965-‘75, the missionaries left, the services they’d established were largely destroyed, and the local population fled to the neighbouring countries of Malawi and Tanzania, leaving the area desolate. The war between Frelimo and Renamo from 1983-‘92 caused further disruption and it is only during the past 10 years that communities have properly begun to re-establish themselves.

The area has major health needs. Malaria, diarrhoea, child birth and increasingly AIDS are common causes of death, and young children and women account for a high proportion of the mortalities. The only government health facilities in the area are four small health posts, each with one nurse. Many people have to walk for more than two hours to reach a health post, and some must walk for more than four. Car travel is not an option. 

During the design phase of the project I spent a couple of months visiting communities and talking with local people and government personnel about what health improvements they wanted to see, and how they thought these could best be achieved, given the limited resources available. The project is based on ideas coming out of these discussions. We were delighted to learn in March that the Centro Cooperativo Suécia (a Swedish organisation whose main aim is to empower communities) had approved a 100% grant for the project to cover the first two years.

The project area covers 9 main communities, subdivided into a total of 33 smaller communities with a total population of around 15,000. Within the next two years we hope to:

  • open 5 community-run health posts, each staffed by 2 trained local volunteers and supplied with medicines by the government

  • establish a network of 30 trained traditional midwives working in close collaboration with government health staff

  • improve the government health facilities by building 3 small maternity units adjacent to the existing government health posts

  • raise the health knowledge of the local population and improve preventive health care through health education by community volunteers

  • alert communities to the threat of HIV/AIDS and assist them in implementing activities to reduce HIV-transmission, care for HIV infected individuals and their families, and provide for orphans

  • develop a community-operated health data system to record all births and deaths and enable the community to assess the impact of the project and advocate effectively for better services 

  • establish community health committees to oversee the various aspects of the project 

Nine years working on community health projects in Mozambique have convinced me that to improve health here most effectively it is necessary not only to increase health knowledge and make essential material resources available, but also to change attitudes and values to produce a more just and caring society. By providing opportunities for local people and government health staff to study the bible I hope that the project will be able to play a significant role in achieving this.

Since the project began in March the communities have responded enthusiastically. They have already selected their health volunteers and begun preliminary activities such as collecting sand and stone and making bricks to build the new health posts and maternity units. Training of the different categories of health volunteers commenced in April and will continue intensively until October. 

At present I'm mainly facilitating the project on my own but hope, within the next four months, to establish a team of local people to help me in training and following up all the community volunteers. My dream is that, after four years, this team will be able to replicate the project elsewhere with a minimum of external assistance.

Hiking from community to community, holding meetings, running training seminars and trying to keep up to date with administration and reports is often exhausting, but the beauty of the area, the pleasure of interacting with local people, and the thrill of seeing communities starting to work together to improve their lives serve as great encouragements to persist.

I would appreciate your prayers for:

  • the continued enthusiasm and active participation of the local church and communities

  • identification of the right people to recruit as members of the health team

  • energy to cope with the projects demands, and wisdom in allocating my time

  • good friends

And if there’s a civil engineer out there with a few weeks or months available and the inclination to help communities build small bridges using local materials, please get in touch.

Peg

(Dr Peg Cumberland)

peg@africa-online.net


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