Paciencia

 One of my PCV friends who is finishing up her two years of service named her cat Paciencia. Patience. And I can definitely already understand why. I have only been at site six weeks, but already patience has taken on a whole new meaning, especially when it comes to my role at the Rural Hospital of Chicumbane with the Elizabeth Glaser AIDS Foundation (EGPAF). I have felt extremely welcomed by all the hospital staff. They are usually quick to greet me with a “Bom dia”, “Ola amiga” or “Ola filha”. I think in general my name becomes “Amiga” because they do not remember my name or cannot pronounce it. It’s also the easiest greeting since I am one of two white people who frequent the hospital. I spent my first few weeks at the hospital either waiting for my counterpart or sitting with Ricardo, one of the nurses, as he did consultations. He is in charge of the GAAC program. GAAC stands for Grupo de Apoio e Adeseo Comunitario and is a program where groups of six people living with HIV on TARV (antiretroviral) are formed in the community. Then once a month, just one member of the group has to go pick up everyone’s medication from the hospital instead of everyone from the group having to go each month. This way, each person saves time and money in only having to go to the hospital once every six months, instead of once a month. I met Ricardo in my initial introductions at the hospital and through Vivienne. He is also in secondary school learning English so he likes to practice his English with us. Yes, he has already completed his nursing training, but is still finishing secondary school. Figure that one out. So often if I was waiting for my counterpart to arrive, I would just go and sit with Ricardo as he did his consultations. He once asked me if I was waiting for something because he said I was so patient just sitting there. I think that day I sat with him for about 3.5 hours.

When I last met with Louis, my counterpart with EGPAF, we decided our current routine of me getting to the hospital at 8 am and then waiting around until he got there to just follow him wasn’t exactly working out well. We devised a new plan. We decided that I would shadow each sector of the hospital to get a feel for what goes on. I decided to start by following one of the nurses, Enfermeira Minda, who works in the CCR or Children at Risk department. Enfermeira Minda lives in my neighborhood and sometimes we have walked home from the hospital together. CCR is for all children from infancy to 18 months who have been exposed to HIV, are twins or are malnourished. These children are supposed to come to the hospital once a month. I spent the first few days of the week just sitting and watching each consultation. Women arrived wrapped capalanas toting their baby on their back. I sat patiently as Enfermeira Minda started going through her questions. Often the consultation began in Portuguese and then would turn to Changana. I quickly learned that there was absolutely no comparison to HIPAA here in Moz, let alone any real sense of privacy. Aside from a simple “Licenca” upon entering a room, I could sit in on just about any consultation and often there were other patients in the same room as well. And despite the masses of patients waiting there is often no real sense of urgency. The nurses will enter in the middle of consultations and proceed to ask questions of the attending nurse. And often nurses will just get up and go get lanche (snack) down the sand road at the market stand. The women waiting to be seen have an amazing sense of patience. They are often all sitting outside on the wooden benches or straw mats on the ground just waiting to be seen. No magazines in the waiting room, hardly anyone is on a cell phone, but everyone has a baby.

On Wednesday, Enfermeira Minda asked me to collect everyone’s health cards and write down all of their names in the order that they arrived and will be seen. No problem. Only most of the women speak Changana so they hardly understood my Portuguese and then I could hardly pronounce, let alone spell most of the names. By the time she returned from getting some Fanta and biscotes, I had the list and cards all set. She then proceeded to do consultations with all the patients and I observed. She explained to me what she was doing as she administered a number of HIV rapid tests. Luckily all of the ones were negative. It was amazing how one of the babies she tested did not even flinch. She also gave a lot of mothers their HIV test results which had been sent away. Again, all of the consultations I observed were negative. One mother of twins broke into tears when she found out the results were both negative. During the consultations, Enfermeira Minda rarely touches the child aside from administering the test. Consultations are down at office desks and gloves are rarely worn. She has a list of questions to ask of each mother. There are no computers and no electronic records. So everything is written in books. There is a book to keep track of who has a consultation, a book to record who is HIV tested and the results, another for the PCR HIV  tests which are sent away to be read and another for  who is given a mosquito net, etc. A book for everything so the majority of the consultation is spent recording all of the information in each appropriate book.

On Thursday, when Enfermeira Minda arrived she said she forgot her glasses at home so I would have to help her. She handed me the consultation book and told me exactly what I had to fill in for all the blanks. She would ask the appropriate questions usually in Changana and then in Portuguese she would tell me what to write. She would then sign off on it. She kept saying that in no time I could do consultations on my own. I reminded her that I was just a Peace Corps Volunteer and not a formally trained nurse like she is. I had to remind her several times throughout the day. I explained to her that I am studying social work in graduate school so she took me over and introduced me to the Accao Social, Social Action, department of the hospital, which is the closest thing to social work at the hospital.

On Friday, I went to a meeting in Xai-Xai at the EGPAF office. All of the Peace Corps Volunteers working with EGPAF were invited. The meeting started with an overview of the work EGPAF does. It then quickly moved into reporting statistics and data. I think we were all definitely questioning why we needed to be at this meeting. And again I found myself just sitting patiently, my mind wandering. About halfway through the meeting, Louis, my counterpart, sent me a text: “As you can see, there’s a lot of work to be done.” He speaks English and often likes to practice with me. I remind him that I need to practice my Portuguese, so usually he will speak in English and I will speak in Portuguese. I agreed with his text, some of the statistics were startling. He continues to tell me how I need to be the link to the community for the hospital, but I am not exactly sure how I am supposed to do that just yet. Right now, I am just working on learning about each sector of the hospital and building relationships with the staff. Hopefully, I will be able to more clearly define my role in the weeks and months ahead. Until then I just have to relax and be patient. Paciencia.

Five hours later that Friday…the meeting was still going. Paciencia. At about 2 pm, all of Peace Corps Volunteers were released. We went out and sat in the lobby where lunch was ready, but not having permission to eat yet, we were again waiting patiently, but this time for lunch. Paciencia.