Manhiça: A Love Story

How could I have known, when I first visited the Centro de Investigação em Saúde de Manhiça (CISM) in Mozambique in the summer of 1998, that it would be the start of a fantastic lifelong love story? At the time, I was a scatter-brained fifth-year medical student. My only clear ideas were my vocation and my interest in everything having to do with what was then known as “tropical medicine”. In the summer between my fifth and sixth years of medical school—the last summer I would be free to do something voluntary before hunkering down to prepare for my speciality entrance exam—I wanted to have my first experience at a centre in a low-income country.

How could I have known, when I first visited theManhiça Health Research Centre (CISM) in Mozambique in the summer of 1998, that it would be the start of a fantastic lifelong love story?

After much searching and little success firming up any plans, I had the immense good fortune of crossing paths with Pedro Alonso, who, without hesitation—and I will never be able to thank him enough for this—offered me the chance to visit Manhiça, Mozambique. Not only would I be able to spend two months there, but I would do so at the same time as Pedro and his family.

It was a unique opportunity. In fact, this first encounter with medicine and research in Africa convinced me that this was what I wanted to do with the rest of my life.

It was a unique opportunity. In fact, this first encounter with medicine and research in Africa convinced me that this was what I wanted to do with the rest of my life

Back then, CISM was a very young centre, with just a few dozen workers and a shared computer. The entire staff received electronic correspondence via a single email account.

I occupied a room inside the centre that would later become Pedro’s office. I spent most of the day in the hospital, tagging along behind Madalena Ripinga, who was entrusted with the task of training me in everything I didn’t know (which was practically everything!).

Thanks to Madalena, I attended my first births, saw countless paediatric patients, treated children with malaria—so many, it was never-ending—and most importantly, I came to understand the operational dynamics of a hospital with limited resources.

I attended my first births, saw countless paediatric patients, treated children with malaria —so many, it was never-ending—and most importantly, I came to understand the operational dynamics of a hospital with limited resources

I fondly remember meeting the centre’s first training fellows, Francisco Saúte and Abu Saifodine, as well as researchers like Anna Roca.

Opening My Eyes to an Unknown World

Beyond paediatric care, I was lucky enough to get my first taste of research fieldwork. My mission was to obtain nasopharyngeal swabs to screen for respiratory syncytial virus and pneumococcal disease. I spent the last few weeks accompanying the field team on their visits to the community.

Manhiça opened my eyes to a world I knew nothing about. As I came to see how relevant and useful applied research and public health were, I was disabused of my mistaken belief that research essentially took place at the laboratory bench.

Manhiça opened my eyes to a world I knew nothing about. As I came to see how relevant and useful applied research and public health were, I was disabused of my mistaken belief that research essentially took place at the laboratory bench

By the end of that brief stay, I was sure that this would be my future professional life—so much so that I asked Pedro to help me return to Africa as soon as possible. Pedro, as always, kept his promise, arranging for me to do a rotation in Ifakara, Tanzania, where I once again confirmed my passion for Africa, but he tempered my overenthusiasm by advising me to postpone my return to the continent until after I had completed my specialisation.

An Unprecedented Opportunity

And so I returned to Barcelona to train as a paediatrician, a field in which I would have no shortage of work when I finally returned to Africa. Just as I was finishing my third year of specialisation, Pedro—once again—offered me an unprecedented opportunity. He urgently needed a paediatrician for the initial follow-up of nearly 2,000 children participating in a phase IIb trial of the RTS,S malaria vaccine, which was about to start in Manhiça.

I threw caution to the wind and managed to convince the clinical management of the hospital where I was doing my residency to let me go as a “voluntary rotation” and keep paying my salary while I spent four months in Mozambique. And what a four months it was! It was perhaps the most intense four months of my career, with interminable workdays, huge responsibilities, and the best possible environment and trial to really delve into the world of research.

Together with Caterina Guinovart, Eusebio Macete, John Aponte, Clara Menéndez and many others, we achieved extraordinary results. It was a true baptism by fire. It was also the experience that convinced me once and for all that Manhiça had to become my home as soon as possible. And so, in October 2004, I arrived on the scene for a three-year stay.

Manhiça opened doors for me as a paediatrician and as a PhD student . I started participating in studies of malaria and other paediatric infectious diseases and was joined a few months later by Maria Maixenchs. Those were always years of happiness, tireless work and constant learning alongside my Mozambican colleagues. Pedro Aide, Tacilta Nhampossa, Sozinho Acácio, Inácio Mandomado, Sonia Machevo, Khatia Munguambe...—how young we all were, and how much we have grown!

Manhiça opened doors for me as a paediatrician and as a PhD student. I started participating in studies of malaria and other paediatric infectious diseases

I will always remember a brief exchange I had with Ariel Nhacolo in September 2007, a few days before I left for London, where I was going to study for a master’s degree in epidemiology. Wise Ariel, then the coordinator of the centre, openly reproached me, saying that we, the mulungus, always took advantage of CISM for our own training but never returned to Manhiça. When I came back to live in Manhiça a few years later, this time with my wife and one-year-old twins in tow, I reminded Ariel about that conversation and confirmed that my love for the centre remained solid and unshakable.

As a health and biomedical research professional, CISM has given me everything. As a person, CISM and Manhiça introduced me to many of my best friends. I always feel welcome here in my second home. Thank you for everything you have given me. I hope to continue repaying my debt to CISM in the years to come.