The two policemen on duty, doubtless terrified themselves, ignored the inmates’ calls for help, even as a struggle broke out as the men jockeyed for position beneath two small openings near the roof that provided ventilation in the heat.
When at last they opened the door in the middle of the night, eleven men had suffocated to death inside. A twelfth stumbled out and took his last breaths in the courtyard of the police station. Thirteen men died in all.
As Juma Raimundo remembered it, word of the jailhouse deaths spread like a pall over the district, calming the nerves of the young angry men who had led the witch hunts over the previous several weeks. “From there,” he said, “the subject was closed.”
Both the officers on duty were ultimately sentenced to a year in prison on manslaughter charges; they served jail time alongside some of the prisoners who had survived.31 The legislature launched a commission of inquiry into the whole sordid episode in Mogincual, but the seams of the effort at fact-finding and reconciliation soon began to show. Frelimo politicians dusted off their standard argument over cholera-related violence and accused Renamo of spreading misinformation about the disease. However the tragedy came to pass, one Frelimo deputy charged, “Renamo is the moral author of the deaths in Mogincual.” Afonso Dhlakama, always one to embrace a poetic flourish, said Frelimo was trying “to hide the sun with a feather,” persecuting the opposition in order to deflect its own responsibility to protect people from cholera.32
When I asked later whether Frelimo and Renamo were using distress over cholera to do what the district administrator in Mogincual called “making politics,” he told me, “I can’t say yes or no, but I can say all politicians are opportunists.”
Others, though, pointed out basic shortcomings of governance that let the situation in Mogincual get so bad in the first place. As the columnist Mouzinho de Albuquerque wrote in the state newspaper two days after the jailhouse deaths, “The top brass of the PRM [Mozambique’s national police force], both nationally, and at the provincial level, knew the outlines of the unrest around cholera in Mogincual, but none of them went there in time to see for themselves. It was only after these twelve [sic] people died that the provincial commander, for instance, went to Mogincual.”33
Public officials, he suggested, seemed to have condemned Mogincual through sheer indifference.
Other questions surfaced from the report of a local human rights organization that conducted interviews with the police and focus groups in the field that very week. How could it be that police arrested more than thirty men but didn’t see the need for a contingency plan given that they had room for a fraction as many? Why were only two officers left on duty that night? Poor conditions and inadequate infrastructure, it noted, could be blamed for previous deaths in nearly every jail or prison in Mozambique.34 Why hadn’t something been done sooner?
Two weeks after the violence subsided, in timing that seemed too fortuitous to be accidental, a doctor showed up for work at the health clinic in Liupo—the first physician ever to be permanently stationed in the district.
* * *
The hospital in Liupo is a constellation of bright-white single-story buildings set in a large red-dirt courtyard and bounded by a row of massive mango trees. While I waited there one morning to meet Josué Chicara, who became Mogincual’s first resident physician in 2009, I struck up a conversation with a young male nurse entering the twenty-sixth hour of a forty-eight-hour shift.
Others had told me that the standard twenty-four-hour shifts—common for ER residents in the United States, though not for nurses—contributed to exhaustion and stress among health workers, exacerbating the difficulties posed by low wages, disdain for patients, and well-documented corruption throughout the health system.35 I hadn’t imagined what twenty-four-hour shifts would mean in rural clinics where no one was available to fill in for employees who couldn’t come in.
In this case, the nurse said he was covering for a colleague whom he imagined to be home with a fake illness, likely, he said, to be seen in one of Liupo’s kiosk-like bars in a few hours’ time. He looked weary to a point past physical exhaustion, standing in baggy hospital whites with his hands in his pockets, his blank expression disturbed only by the disorderly beginnings of a wiry mustache. “If I could amputate an arm and go back to Nampula city, I would,” he told me when I asked how he liked Liupo. Then, reconsidering, he added, “Or cut off a finger and go back.
“The countryside” he said, “is complicated.”
Chicara walked out a few minutes later, extending a strong handshake and a broad smile, and invited me to sit on a plastic patio chair outside the pharmacy. When he’d first come to visit Mogincual, he explained, he’d only agreed to stay when he saw that there was cell phone service. Broadly speaking, Chicara was optimistic about the direction of public health in the district, though, he added, “Mogincual is known for having a difficult population.”
There had been a handful of cholera cases in 2010, he said, but only isolated instances of unrest since the “events” of 2009. In one incident, a group of men in the town of Namige had burned down the home of a Save the Children volunteer working with the Ministry of Health, and attacked a nurse while they vandalized the health post there. In another, this time in the town of Liupo itself, a schoolteacher woke up to find a ring of white flour on the ground outside her home, a kind of warning that she was bringing cholera to the area.
In 2011, a year when there was no cholera in the whole district, one neighborhood simmered with rumors that a Frelimo party official was spreading cholera in the dead of night, and he was ultimately threatened with a crude note tacked to his front door: “Marcos Prata—distributor of cholera. Attention: If anyone gets sick and dies, you’ll be killed with a machete.”
Nevertheless, nurses who had had to steer clear of parts of the region following the unrest in 2009 had recently resumed visits to Quinga and elsewhere. In 2010, Chicara himself had gone to Curuhama as part of a childhood vaccination campaign and found the community eager to participate.
Sidestepping politics, Chicara framed all this in the context of a broader national struggle to reconcile Western-style medicine with the care offered by Mozambique’s curandeiros, or traditional healers. Since 2009, he said, the Ministry of Health had started to embrace collaboration with traditional health practitioners: a nurse in each district had been assigned to act as a liaison for traditional medicine, meeting with curandeiros monthly to try to coax them to refer patients to the government health system.
Mozambique has made undeniable strides in public health in recent years. There have been sharp decreases in child and maternal mortality and a steady uptick in child vaccinations.36 Although HIV/AIDS remains the leading cause of death, access to antiretroviral treatment has expanded dramatically.37 At the same time, UNICEF estimates that more than 40 percent of children in Mozambique are chronically malnourished.38 According to the World Health Organization, nearly one in three women aged fifteen to forty-nine dies from maternal causes.39
Fully 45 percent of Mozambique’s population is younger than fifteen.40 It will be hard for growth of the medical system to keep up. In 2009, Mozambique had one doctor for every 33,000 people, and one nurse for 5,000.41 It has one practitioner of traditional medicine for every 200.42 Accordingly, the Ministry of Health estimates that more than two-thirds of Mozambicans are their patients.43 Yet the relationship between traditional healing and so-called biomedicine has been fraught for a long time.44
“The state ignores traditional doctors while civil servants frequently resort to them,” writes the Portuguese anthropologist Maria Paula Meneses. The institutions, she argues, operate in strictly rational terms; their employees are more practical. Meneses relays a story from a patient from the professional class who’s visited curandeiros for serious ailments: “Anything goes. You never know if they will work, but one certainly will; we can’t risk not trying.”45
In 2010, the Ministry of Health created the Institute for Trad
itional Medicine to build ties with traditional healers and conduct research on herbal and plant-based remedies. It created a national registration system to get some account of the number of curandeiros operating around the country and to give them a modicum of recognition from the government. The ministry has conducted a series of tailored trainings for traditional healers on recognizing symptoms of HIV/AIDS, malaria, and tuberculosis.46 It’s largely a one-way street: “The knowledge of the traditional doctor is only seen to be valid as a complement to biomedicine,” Meneses observes. “The traditional doctor is seen as one who needs to be trained, but who does not participate in the training of biomedical doctors.”47
Mistrust remains a challenge on the other side too. Two weeks before we met, explained Josué Chicara, the doctor in Liupo, a seventy-year-old cook had died in his care, having arrived at the hospital in the terminal stages of tuberculosis. Over the two preceding months, the man had been admitted to the hospital and fled treatment a total of seven times, dragged to the health center by family members or neighbors, weakened, groggy, in the midst of a crisis of symptoms, only to run home on his own when he began to get his strength back.
When I visited Mogincual for the first time, in 2012, I was anxious to see what scars had been left by the outbreak and ensuing violence. Similar if less widespread unrest has followed cholera around the region every year since 1998. Usually, as in Angoche and Mogincual, unrest moved in concert with the scale of the outbreak, though sometimes it arose in places with no cholera cases at all.
“Ironically, there were no cases of cholera reported in Alto-Maganha,” reads a 2010 story describing cholera riots that destroyed a newly constructed health center in a town along the coast of Zambezia Province.48 “But there were outbreaks elsewhere in the province, and in neighbouring Nampula. So the Pebane district health authorities embarked on an education campaign, telling people how to avoid cholera.”
Within days, “a mob marched on the health centre, smashed all the windows, tore off the roof, and destroyed the medical equipment.”
When the governor visited the town two months later, residents apologized for destroying the clinic and asked him to rebuild it. “You used to complain that there were no health services here,” the governor, Francisco Itai Meque, replied. “When it was thought that the problem had been solved, you fell for the wave of disinformation and rose up against your own interests.”
Did anyone in Mogincual feel contrite, or somehow wiser for the tragic events of 2009? What, at bottom, had driven the resentment and suspicion that boiled over into such rage?
I got a ride to Curuhama on the back of a Chinese motorcycle belonging to Hermínio Alexandre, a community court judge in Liupo who had agreed to drive and translate. It was a luminous, cloudy day. A sprinkling of rain left the road a bright brick red, majestic mahogany trees rising on either side with a tangle of vines and underbrush below.
Past the crossroads leading to Quinga, Hermínio and I took one hopelessly zigzagging shortcut between cassava fields and gnarled cashew trees and nearly fell repeatedly. But we soon emerged in a wide lane of small matopi, or thatch-roofed shops, where we found the home of the líder comunitario, Gregorio Passarinho, at the bottom of a slender wooden flagpole.
Hermínio Alexandre, a community court judge in Liupo, was a witness to the aftermath of the cholera outbreak in 2009 and acted as a guide and translator on visits to villages affected by the violence.
Passarinho is in his fifties, lean and muscular and, at our meeting, circumspect, with a creeping hint of a smile that suggested a lingering expectation of my saying something impolitic or treading on precarious ground—which, of course, I was. Passarinho has a gray beard, hollow cheeks, and a long, refined nose that gives him the look of Jules Verne or some other nineteenth-century baron of ink sketches in profile.
That Passarinho was still living in Curuhama was remarkable to me. Less than three years earlier, he’d been rounded up and beaten alongside Cassiano Muquinone, the Red Cross volunteer who was ultimately killed, and left bound by the wrists for forty-four hours as his neighbors set fire to the houses all around him. Afterward, he’d spent three months recovering in the hospital.
Passarinho suggested speaking to a few people in the market. Was it necessary to gather them? he wondered. No, I explained, I found it easier to talk to small groups. Even so, he led me, my government credential letter folded between weathered fingers, to the steps of the fishmonger’s and proceeded to read the contents out loud in Makua for a crowd of fifty young men who had gathered to learn the purpose of a foreigner’s visit.
Anxious to keep a mellow mood, I said a few things myself: that I had no secrets, that I didn’t come to muck anything up, that I found it hard to do an interview with so many people at once, and I proposed to Passarinho that we begin by chatting on his verandah one-on-one.
“If the government didn’t have any power here,” he said, “the whole area would have been destroyed.”
Still, he’d returned to Curuhama to reclaim his neglected fields and resume his humble duties as líder comunitario, being a liaison to the district government and a first port of call for visitors.
There hadn’t been any trouble since. As Juma Raimundo put it, “The people who spent time in prison are the ones who keep everyone else calm.” When I asked Passarinho whether his neighbors’ views of cholera had shifted in the intervening years, he broke out laughing. Where do people think diarrhea comes from? I asked. “Even today,” he said, “people think diarrhea comes from the government, that only Frelimo knows. That’s exactly what they say: ‘Frelimo knows where it comes from!’”
Outreach and education work around hygiene has continued in Curuhama, he said, albeit with some careful parameters. “The government comes and talks about latrines, about cleaning wells, about hygiene, but they never say the word ‘cholera,’” Passarinho said.49
After Passarinho and I spoke, I said I wanted to walk around the village to try to speak with people one-on-one, but I soon found myself on the porch of the fishmonger’s surrounded by a crowd. Once again, I explained that I was a reporter, not a politician, and that I’d like to just walk around and chat with people one-on-one or in small groups. But in Passarinho’s translation from the Makua, at least, everyone was too uneasy to do things that way: it would cause suspicion and gossip for me to have private interviews, they said. At an impasse, I proceeded to ask my questions of the group.
How have things here been since 2009? Has your relationship with health workers changed? After a stirring silence, a man in a blue knit cap with a long goatee spoke up: “From 2009 up through today, we have been living happily, because things have changed.” What has changed? “From that time until now, that illness hasn’t returned.”
Where does that illness come from? Murmurs, nervous chuckles. “They want to know which illness you’re talking about,” Passarinho explained. The illness they call cholera, I said. “They are saying some people know where the illness comes from, but they’re afraid to say.”
How had the outbreak in 2009 affected life here? A volley of translations moved through the crowd, as the group churned in consideration of the question. I rephrased: in 2009, some very serious things happened here. Some people died, others were badly hurt, and others went to jail. That kind of thing doesn’t usually happen in a village. Has it changed what it is like to live here? More murmurs. Finally, if this illness were to return, do you think that your reaction here in Curuhama would be the same? This elicited a much firmer response. A man in Muslim dress in the back row spoke for his companions: “That depends on the spirit that enters the population at the time, whether it will provoke us to react a lot or a little.” What do you mean the spirit? “Whether we’ll be inclined to accelerate or remain calm.”
Will you go to the health center if you get diarrhea? The reaction was unanimous: “No! If you go to the health center, you’ll get worse and die.” Watching my expression strain the edges of earnest belief, someone mad
e a comment Passarinho tactfully neglected to translate. Bit by bit, I and the crowd descended into a contagious fit of belly laughs. When it finally subsided, I forged ahead: would you go to the health center for other diseases? “Yes, we do, and you usually get better.”
How is it that the hospital would make you sicker for some things and less sick for others? “Perhaps the medicine for that illness does not exist. Perhaps they only have medicine for fever and headache.”
A young man piped up to say they would take up armas brancas—or “shiny weapons” like knives and spears—to fight those responsible if and when cholera returned to Curuhama. “If it’s the water, we’ll fight the water, if it’s wood, we’ll fight the wood, and if it’s a person we’ll fight them.” But how will you know? “We’re grown up,” he said. “We know how to tell who is evil.”
* * *
The only one-on-one interview I managed to secure with a perpetrator of Curuhama’s cholera violence was with Momade Mutumuara, a fifty-one-year-old farmer who invited me to sit on a straw mat outside his home surrounded by tall grasses and rows of fleshy cassava plants. Mutumuara had spent three months in jail in Angoche after the riots. He did not deny taking part in vandalism but said he hadn’t been convicted of participating in any actual violence and wouldn’t say exactly what he had done.
Even so, Mutumuara’s gripe with the Red Cross seemed deeply personal, a vendetta over a long record of neighborly grievances.
Mutumuara described Cassiano Muquinone, the Red Cross volunteer who was killed, as “showing off” when he came to the village in a Red Cross jeep, asking for credit at Mutumuara’s barraca, or bar, and making jocular threats about bringing ill health on people in town. “At your barraca, he’d come in and say, ‘If you don’t give me what I need—patience, careful, watch out. You’ll get diarrhea.’”
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