[This post was written by Sílvia Brugueras Torrella and Marta Encuentra Romero]
A country of contrasts—that was the impression that stayed with us after two and a half months in Mozambique doing practical field work with the Spanish NGO Farmacéuticos Sin Fronteras (pharmacists without borders) after we completed the ISGlobal-University of Barcelona Master of Global Health. Our visit began in Pemba, the capital of Cabo Delgado province in northern Mozambique, where we landed at a provisional airport that was built mostly of plastic sheeting and had no services. More contrasts awaited us in the town of Pemba, where the old colonial centre of brick and cement houses interspersed with a few paved although potholed streets is surrounded by the areas that are home to most of the population, who live in houses made of logs, mud and stones thatched with a material similar to straw. In the middle of all this, we could see the first signs of an emerging class of more affluent people, those who have benefited from the arrival in Pemba of companies that have come to exploit the area’s oil and gas reserves. Although Mozambique is still one of the poorest countries in the world, its economy has experienced annual growth of over 7% for the last ten years.
One of our goals for this trip was to improve the operation and management of a private pharmacy in Pemba by setting up a computerised system. We also undertook a study to identify possible future projects and provided training in basic health and hygiene in Silva Macua, a town 80 kilometres from Pemba.
On several trips we used small minibuses called chapas, the country’s main form of transportation, although you will never see more affluent Mozambicans travelling in chapas. On one trip, we counted 50 people in the small van and the 120-km trip took 6 hours. What for us was just another little adventure, for most people in Mozambique is one of the everyday hardships they face whenever they have to travel, for example to visit the nearest health care centre.
In Silva Macua, a town of about 4000 inhabitants, we saw how difficult it is for people to meet even their basic needs. In this area of scant rainfall and high temperatures, water is a scarce and precious resource and people must choose whether to use it for drinking, cooking, washing or growing food. These extreme living conditions favour diseases such as diarrhoea, skin disorders, and infections, and these in turn reduce the inhabitants’ productivity, diminishing their chances of survival and hindering development. When we add the fact that the nearest health centre is located at a distance of 12 km and that the cost of transport is beyond the means of a section of the population, we are looking at a high-risk situation for the health of the community.
The training we received on the master course proved useful during our stay in Mozambique and we drew on what we had learned about management, infectious and chronic diseases, qualitative and quantitative methodologies, and health anthropology. Furthermore, the concepts so often discussed in the classroom, such as "barriers to health", "vulnerable populations" and "low-income country" certainly took on a new meaning for us.
Our work in Mozambique afforded us an opportunity to see the operation of the public health system. Common problems include the lack of specialists in hospitals and health centres, constant stock shortages and supply interruptions in hospital pharmacies, as well as a lack of capacity in health centres to respond to emergencies and complications.
We could not leave the country without visiting the Manhiça Health Research Centre (CISM), a facility based on a model in which biomedical research is a tool for cooperation.
After our experience, we are more aware of what has been achieved so far and how much still remains to be done before the people of Mozambique and many other countries will be able to exercise their right to a decent and healthy life.