The thrice-daily planes from Maputo to Nampula always carry several missionaries and nuns, which begs the question why none of them come here to what is arguably the most important church in Mozambique. When I put on my tourist developer hat, I see this as a place for pilgrims. The church is said to be the oldest in the southern hemisphere that was built as such. Earlier churches were converted (usually from mosques).
The roof is leaking, the walls are covered in green slime and the ceiling is starting to rot. For once, it is not for the government to deal with a case of neglect, it is for that far richer body, the Vatican. Probably unbeknown to anyone in those Roman corridors of power, a jewel in the Indian Ocean has been thrown away. Elsewhere, worldwide, Roman Catholics are losing their faith, while here, a tiny hub of the faithful are struggling unaided to keep theirs. It seems as though Our Lady of the Cures has forgotten this village and taken her miraculous cures away with her.
In the absence of miracles and holy balm, and where the local curandeiros fail, all cures are in the hands of the medical authorities. In a tropical country like Mozambique, children sicken and die in the arc of a day unless they receive emergency treatment; Nampula is just too far away. For the adult sick, it is even more difficult to get out of the village because carrying a grown man to Chocas is difficult and transportation thereafter is unviable.
A simple solution for many local health problems would be to lure a doctor to Cabaceira Grande, upgrade the health post there, and ask him or her to care for both the villages. One of the reasons why there is no doctor is, I think, because the Albert Schweitzers of this world are few and far between, and few fully qualified doctors can survive in the bush. Where would they live? What would they eat? In the days of missionaries, medical teams went out and battled with disease in the most isolated places. Today, some backup is both needed and wanted.
For the past thirty years, a doctor in the village might have found it very hard to stay, whereas now the college can provide accommodation, three meals a day, laundry facilities and, maybe as importantly, some kind of social back-up. Due to the lack of facilities, there are no teachers living in the village. The teachers stay in Chocas and walk in through the bush every day to teach. Most teachers don’t want to come to the Cabaceiras either. Having struggled to get an education to grade ten B and paid to qualify as a teacher, nurse, doctor, social worker, health worker or whatever else, the last thing most people want is to be relegated to a backwater with no running water, no electricity, no transport, no proper back-up, an almost total lack of materials to work with and to be forced to live in a mud hut.
It will be hard for a Mozambican doctor to take up the Cabaceira challenge. Mozambican doctors are in very short supply and most have just emerged from their own poverty and are supporting extended families on their meagre incomes. Nor have I come across the foreign doctor who will rally to the cause, but I feel sure he or she is out there. The experience would be invaluable for any graduate of tropical medicine. Furthermore, as the fight against AIDS/ HIV has become a worldwide campaign, these villages offer a unique opportunity for research.
To date, statistics of HIV-positive cases have been based on limited tests. Certain fairly small groups of people are tested, such as mothers who give birth in particular clinics, prisoners, selected groups of schoolchildren, workers from a given factory. The final statistics tend to be based on non-representative or incomplete groups. To find out how many people are really infected, entire villages need to be tested. In the Cabaceiras, there are two entire villages willing to co-operate with such a survey. Over seven thousand people are here waiting to help.
There is more, and this second point is one I have tried in vain to bring to the attention of aid workers. The presence of HIV/AIDS infection seems to be substantially lower in the Cabaceiras than elsewhere, not just in Mozambique, but in Africa. The local communities are willing to help combat this disease, which has only just begun to show itself here. Because of its extreme isolation, hardly anyone has come in or gone out of this area. Tests that could have been done earlier elsewhere to establish base lines weren’t done because nobody knew then how serious the AIDS epidemic would become. Here in this forgotten village there is a chance to step back in time and establish base lines from which the spread of the disease can be studied.
On the one hand, we want a doctor and AIDS researchers to come to the village. On the other hand, those researchers should come. They should be here in force. A unique opportunity is being missed. With millions of dollars a year being spent to combat AIDS, a tiny part of it would be better spent here than maybe anywhere else in the continent. So far, the HIV present would appear to be imported from villagers who left to live and work in Nacala and Nampula and who came home, terminally ill, to die in one or other of the Cabaceiras.
Last, but not least, there is malaria. On a World Health Organization map, Mossuril District, which includes the twin villages, is shaded as a ‘low-to-no malaria’ zone. By so doing, it has condemned the local people to receive ‘low to no help’ with what is an ongoing plague. Malaria-prevention methods have not been explained here. No one told the villagers that puddles and pools and uncovered wells help spread the disease. No one explained the importance of mosquito nets and of covering up at night. No one has come to teach local families how to recognize the early symptoms. The villagers did not know they had to rush for treatment, nor how to nurse malaria patients at home. A recent report showed that of a US government fund of 95 million dollars given to eradicate malaria, 90 million dollars was spent on consultants. The retail cost of a mosquito net is four dollars. Approximately four children can sleep under one single net.
The seven-thousand-plus villagers are scattered over as many kilometres. We do what we can, but we need help. The local health centres do what they can, but they need help. The district health authorities do what they can, but they need help. Each entity is struggling to keep up with its own overload. There is no time, money or personnel to tackle this extra problem. The organizations that help elsewhere draw a line before the Cabaceiras. It is an invisible line, but none cross it.
Just as Rabobank Foundation has stepped in to help the community to farm (of which, more later), so others could follow suit and step in to help combat malaria and monitor and prevent the spread of AIDS.
The tradição, so effective in many fields with its medicinal herbs administered by curandeiros, is ineffectual against malaria. The tradição treats local illnesses with local remedies. To date, most ailments that occur in any given area will also have a natural cure available within that same area. Knowledge of what that cure is and how to prepare and use it has been the business of witches and witchdoctors since time immemorial. Plants that can cure can often kill so it takes great skill to work with them. The local curandeiros are mystified as to why their indubitable powers and expertise fail so miserably to combat malaria.
With the morass of mysteries that come from the village to me, this is one mystery that a little-known theory can explain. There is evidence of malaria in Europe for two thousand years, but there is no evidence for it having existed in Africa prior to the arrival of Europeans. Thus, the theory claims, malaria is not a local disease – not here, not in Mozambique and not in Africa. It has long been the bane of the continent and it decimates the population, but it didn’t originate here: it was imported from Europe. The tradição is handed down from generation to generation and adheres to the knowledge of ancestors from the time when the Macua settled here. That was over a thousand years ago. Malaria was imported here after Vasco da Gama by the Conquistadores. It was imported from Europe, where, until Columbus took it to South America, and the British to Asia, it was an exclusively European disease. In England, it was finally eradicated from the Norfolk Fens as late as the 1930s. In Italy, it weakened the entire Roman Empire.
For centuries after unwittingly exporting malaria, European colonizers then suffered its scourge. The tropical climate was a paradise to anopheles mosquitoes
, they were in mosquito paradise. Unchecked by European winters, they multiplied and spread. The reason why there are no traditional cures to be found locally is because there is nothing traditional about the mosquito.
Malaria killed more soldiers and sailors in military campaigns than the enemy did. Africa, in particular, came to be known as the White Man’s Cemetery. The one and only cure that emerged was quinine, and the one and only place it was found was in the bark of the cinchona tree in Peru. For the British, the fact that Peru was Catholic made quinine seem like a Jesuitical anathema. It was called the Devil’s Bark and the average upstanding Englishman stubbornly preferred to die than to take it. The average poor British soldier would most likely have preferred to risk eternal hellfire and have taken the cure, but it was very expensive and not made available to him.
In the past, beating malaria meant making money. Beating malaria meant being able to colonize and rape more tropical countries. It is both the good fortune and the misfortune of several large ethnic groups in West Africa to be genetically immune to malaria. While they remained safe from the disease, they became the perfect slaves for the colonizers. West Africans could be sent with impunity to the Americas and work the ever-expanding sugar plantations without succumbing to the fever that killed off everyone else.
Meanwhile, malaria spread, and wherever else it spread to, it was no respecter of persons. It is still killing millions of people a year. And in the summer of 2005, malaria cut a swathe through the village. Master plasterer Mestre Tauacal was one of those who died. His fellow workers grieved doubly for him. They grieved because his time had come in his prime and because he died before he could see the better life his children will have. He died before the college project was completed, even though every wall of the palaceu bears his mark.
Day by day during this crisis, people queued outside the college gates for anti-malaria pills. I use the term ‘college gates’ as though there were such a thing, but we have no gates. We have a gateway, where long ago there must have been gates. For us, to begin with, the courtyard was entered via a gaping hole where several metres of wall and one of the gateposts had fallen down. In those early days, people came to a pile of rubble and called for a guard. Then Ramon and the workers mended the wall and built a new gatepost. After that, a sisal rope with a small stop sign was slung across the opening. Now Adamji has built a bamboo bar, which he and his fellow guard Daniel take great pleasure in letting rise and fall.
I always used to travel to Mozambique with a stock of Malarone, a relatively new anti-malarial drug which does not have the harsh side effects of others on the market, such as Lariam and Chloroquine. Everyone coming out took Malarone and it seemed to work very well. The drawback is the price: each pill costs over one dollar. We took them as malaria prevention. We handed them out as an actual treatment: at the rate of four pills a day per person. It was hard not to keep doing this; people died without them. Yet there came a time when neither we, nor friends of the college, could afford to keep up with the demand.
In the summer of 2005 there was a health crisis in the whole of Mossuril. The drugs that the district urgently needed were not being supplied. Health centres like the ones in the Cabaceiras had no malaria treatment. In the case of Cabaceira Pequena, nor did it have even basic supplies to treat such problems as wounds and eye infections.
The summer of 2005 was the first time I had spent more than a few weeks in the village. It was my first opportunity to really see how dire the healthcare situation was. Back in the Venezuelan Andes, we didn’t have much healthcare either. During the years I spent there, I became reasonably expert as the district nurse. So I knew how to treat wounds and lower fevers, to treat vomiting and diarrhoea, bronchitis, ringworm, scabies, conjunctivitis and some other basic tropical maladies. In the Andes, with a similar scarcity of pharmaceuticals, I learnt many herbal remedies.
From May to July, it was these herbal cures, my Dutch-stocked medical bag and Malarone that were called upon daily to assist the villagers. ‘Dr’ Rocha still had some medicines at his health post and he was treating Cabaceira Grande’s wounded beyond the college gates. But Cabaceira Pequena is the cut-off place. The tide keeps it to itself. When the tide is low, you can walk to it in an hour across the sandy mangrove fields from the college. When the tide is rising, that walk becomes a two-hour wade. When the tide is high, it is out of bounds and anyone attempting to cross will drown.
The college has no car, no 4x4, no truck or lorry. It has a recalcitrant motorbike which guzzles spare parts and dumps its driver in the bush with monotonous regularity. During the summer, the motorbike spent most of its time out of action and leaning against a tree. So our means of transport were the chapas (squeezed in with between twenty and once a record of thirty-five other passengers), the dhows, bicycles and on foot.
It was Marufo, one of the first and best students, who asked me to go with him to Cabaceira Pequena to help the sick. Because Marufo was captain of the Varanda football team, I had more to do with him than some of the other students. He is also the one who speaks the best English and the one who borrows books to read.
He is twenty-two, strong and handsome, with the proud bearing of the Macua. He had spiked his foot on a cone shell while commuting to the college and had a major infection which he asked me to treat. A week later, cured, he asked if I could treat some of his village. ‘There are no medicines at the post. There is a wounded boy. We have no dressings. The tide is still out; if I guide you there and back, can you come after school?’
That was the first of what became a daily visit to his village. Each day, more people came to be treated. Deep cuts tied up with dirty rags were presented to me for treatment. Some of them were truly disgusting. None of them had had the benefit of either disinfectant or clean dressings. The concept of the latter was so obviously a novelty that it brought home how deep the lack of basic education ran there. Every day, the local people walk in the sea. Every day, saltwater acted as a natural disinfectant. When a fisherman cut himself, the sea washed and cleaned his cut. If it was a bad one, it was tied up with a strip of old capulana. Beyond that, no medical knowledge had seeped in.
In the planning stage, the college project aimed to send its volunteers out into the villages to teach basic healthcare and to gather data on local maladies. Some of the volunteers were chosen for their experience in these fields. This part of the plan didn’t happen. The qualified volunteers who were there lacked guidance; and in the absence of it, they also lacked the initiative to teach even basic hygiene. So no one knew about cleaning wounds or covering them with boiled cloths, no one knew they were supposed to wash their hands. As to disinfectant: what was that?
At the end of every visit, a queue formed for anti-malaria pills. Within a fortnight, I had run out. Ilha had none. In fact, Ilha had no malaria treatment at all in its one pharmacy. I took the three chapas to Nampula, setting off at 3.30am and reaching the city just before noon (just before the shops closed). I caught the main chemist and bought up his stock of Malarone. I asked when more would be becoming in. The chemist raised his eyebrows and shrugged: probably not for a few months.
Those were early days and I had not learned not to rush around in Nampula, so I rushed, trying to do and buy dozens of things and got hot, tired and frustrated.
Back in the village, I reassessed what we were doing and, realistically, how much more we could do. Alone, on the health front, I was trying to plough the sea. We needed help, we needed a lot of volunteers to come and help but we also needed a powerful partner with qualified medical personnel.
Meanwhile, Marufo and I kept commuting to Cabaceira Pequena and with my limited knowledge and expertise I was able to help a bit. I also took medical supplies to the health post there and spoke at length to the forlorn lone male nurse. I explained that more help would be on its way but it would take time. I promised to bring a few more supplies myself when I next visited Holland, including a medical chart to adorn his bare walls. He perked up a lot, then he
showed me a few things that would make an immediate improvement and we made a list. They were embarrassing things he asked for, like a bucket for water and a plastic cup, some mosquito netting for the window and a rush mat to lay across the bare iron grid of the bed on which local women gave birth. The total value of these things that made such a difference to his work was five dollars.
We are not supposed to donate things to the health centres. They are supposed to run on government money. The nurse should be paid by the government and all supplies are supposed to be sent to him on request. That is the theory. I had been warned by the previous owners of Varanda not to interfere with this system as to do so would relegate the new health post to governmental neglect. Yet when a nurse has no water container and no cup for patients to take the pills he prescribes, and when, as he rightly pointed out, so many of his patients don’t know how to take pills because they have never had to before, and when the government doesn’t even send down the pills, small necessities have to come from somewhere.
Being the official nurse in Cabaceira Pequena is a pretty thankless task. The pay is non-existent, the facilities are almost permanently undersupplied; there is nothing to do for an outsider and nowhere decent to live. Having received a modicum of attention, he took the initiative of walking to Mossuril to draw attention in person to the fact that Cabaceira Pequena had no medical supplies. I went on the back of Morripa’s motorbike to Mossuril to inform the District Administrator of the health crisis in the Cabaceiras. It was he who informed me of the much bigger scale of the problem, that the whole of Mossuril was lacking supplies, that every health post in his district was being run by nurses.
Mozambique Mysteries Page 29