Wednesday, February 26, 2014

Vovo Rachel

Vovo Rachel....and her goat joking around..

“Mana Colleen, esta na hora.” (Miss Colleen, it’s time).

It’s 4:00 a.m. last Wednesday morning.

Vovo (Grandma) Rachel had sent her grandchildren as a wake-up call.

After months of her inviting me to her machamba (farm/fields), I was finally going.

I grabbed my hat, a capulana (fabric cloth) and a bottle of water before heading out with them into the moonlight. I met up with Vovo at her house and she and I set off walking along the main road into the Limpopo River valley that reaches out to the provincial capital, Xai-Xai. She balanced a basket on her head as we walked. We met up with a friend of hers and then joined the other women who were making the journey on foot to the fields in the valley. The air was still, the lights of Xai-Xai were along the horizon, an occasional car would pass and there was a constant mumble of Changana, the local language.  It was about a 45-minute walk down into the valley and then we turned off the main road into the fields. From there it was about another ten minutes. When we got to her plot of land, I asked her how did she know that this was her land. She seemed to think it was quite the silly question responding that of course it was her land, she had planted it. But what I meant was where was any indication or separation from one plot to the next, there was no defining line, no sign, no nothing. But, I didn’t doubt it was her land.

She dropped her basket and pulled out her capulana. She instructed me how to tie it in order to use it as a sack to collect corn we were there to harvest. First, she wrapped it around her waist with the two ends in front. Then she tied the two corners on top together, then the two bottom corners together. Then she shifted it around so the tied part was in back. She then gave me a small wooden stick and showed me how to pull off the corn from the stalk, use the stick to split the top of the corn husk and then shuck the corn. Then insert it in the capulana sack tied around my waist. We were ready. And so we started.

We worked in a line together so as not to miss any corn. We worked our way down the field, filling our capulana sacks, then emptying them into a rice sack that we then emptied into a pile hidden in the middle of the field. She had arranged a truck to come the next day to transport all the corn to her house. We started working before the sun was even up and then watched a beautiful sunrise over the fields and the river valley.
Vovo was surprised at how quickly I picked up the process. The day before she had come by my house and said how going to the fields was no joke. She said it was hard work, almost doubting that I could actually work. This is after months of her telling me that I had to go to the fields with her. Months of her telling me, “If you want to eat, you have to work.” And that is the mantra here. She and her family are dependent on this corn. They will use it to make xima, the main staple food here for months, maybe even the whole year if she stores it well. As we worked side-by-side in the field she asked me about farms in America. I told her how my family just had vegetable gardens. But I told her how most of the midwest in America is cornfields just like the one we were in. The difference is that they are owned by companies that have lots of technology and machinery to harvest. 

“If you want to eat, you have to work.” She just kept repeating it. And it is true. This was the first day of my year and a half here that I made the trip out to the fields. But, for so many women this is the daily routine, daily struggle, just to put food on the table at the end of the day.

By 9 am, Vovo said that I had worked well and that I could go home. Her friend remarked how of course I worked well, I was a woman, not a man. Eek. But after all, it is usually the women here who are responsible for the fields. I told her I wanted to stay until she was going home. But, then around 10 am the sun emerged from the clouds and was beating down full force.  I realized I didn’t have any sunscreen on or with me and my Irish roots had nothing against the strength of the Mozambican sun. It was time for this Irish lassie to head home. By 11 am, I started making the trip back, my capulana sack slung over my shoulder with just about 10 husks of corn Vovo insisted I take home to cook. At that point, we were only about halfway through the field. She ended up staying well past 3 pm.  But, the work didn’t end there. She was back the next day at 4 am, this time with the truck in order to haul all the corn to her house. From there she then had to sort it and store it properly in order to be able to last the duration of the year. And she still has to care for the land in order to plant the next harvest.  I almost felt guilty. I didn’t even make it one whole day in the fields. While for me, this was some fun cultural exchange experience, this is the reality for Vovo and so many families I live with in Chicumbane. They are dependent on the land and what they harvest. Period.

Vovo and her family have been such an important part of my experience here in Chicumbane. I remember the first time I met her when I was on site visits still during training. She called out “Amiga” as I passed by with Vivienne, the volunteer I was visiting at the time. Vovo lives on the corner of the main road coming from the market to the hospital. I use this road just about every day so you could say I see her a lot. Our relationship started out as that, she would yell out, “Amiga” as I passed by. And we would exchange the usual “Tudo bem?” “Tudo bem obrigada” greetings. Then she learned my name and we would stop and talk a little longer. Soon after, her granddaughter, Lalina, six years old, joined the brigade of children who come by my house to color. Then she started sending Lalina over with pineapples. I was then invited to a party at her house and I was able to meet more of her family. When my family arrived in town, she greeted us with a bunch of avocados. And then after months of invitations, I finally went to church with her.

Just a month later, her 15-year-old granddaughter, Katia, arrived at her house with a baby just a few days old (born September 4th) and nowhere to go. Vovo accepted them both with open arms, and even gave the baby MY NAME.  I was more than surprised that afternoon I passed by her house and she passed me a baby telling me it was my “charra” (namesake). I told her I wanted to see how it was spelt. Turns out she is spelling it “Calita”, but I guess we won’t get too technical. Charras are very special here and people will talk about charras sharing the same names and then also being birthday charras if you have the same birthday as someone. Vovo likes to talk about my namesake and me as if we are the same person. When she sees me she’ll sometimes say, “You…you cried all night” or “Your mother didn’t feed you, you were so hungry.” I like to joke with her that my mother is very far away, she hardly knows when I eat. But, she’s referring to my 15-year-old mother. Unfortunately, however, the 15-year-old is hardly prepared to be a mother at all.
About a month ago, Vovo yelled across her yard as I passed by, “Your mother fled. She left.” Katia left the baby in the middle of the night crying, without saying anything. I, of course, had a hundred questions for Vovo. “Where did she go? Have you heard from her? Have you called any family members? Does this happen often here? What are we going to feed baby Calita?” She said she had gotten help from some neighbors in order to buy a can of formula. When I went to the hospital the next day, I started asking some of the nurses what to do. Enfermeira Suzete told me to go to Accao Social, Social Action, which is basically the social work department of the hospital. Of course, why didn’t I think of that?

The next day, Vovo arrived at the hospital to fill out a form requesting milk. She had to have the neighborhood leader sign it and bring it back to the hospital. From there, she was to wait a response. Since I work at the hospital, I told her I would check in on the status of the document once in a while. Every time I passed by, they said that there was still no response. About almost two weeks after Katia fled, she returned. Vovo threw her in jail for two nights on account of neglect. Katia never said where she was, why she went, how she went, how she came back, nothing. I refrained from drilling her with questions. And Vovo started calling her “crazy.” When she returned she had lost some weight and could no longer breastfeed the baby. So we left the papers at Accao Social, awaiting a response. About two weeks later, Vovo was at the hospital so we decided to stop in Accao Social. This time, the counselor said that we should fill out another document and take it to the city in order to make the request personally at the social action department instead of waiting for a response from the hospital. She said how it often took a long time through the hospital. So we filled out said document, waited about another week just for the doctor to sign it so we could bring it to the city. Within this week, Katia fled again in the middle of the night. She stole a cell phone, capulanas and money. I don’t think she will be coming back this time.  And finally, just last Friday Vovo was able to take the document and Calita to the city. She left with a box of formula that will hopefully last a month and then she can return to get another month’s supply.

When I went to her house later that day, I can’t tell you just how happy, appreciative and truly elated she was that her great-granddaughter now had formula. I was so happy to be able to help her out with the process, but also my heart ached. What happens to the people who have to make the same requests and don’t have a foreigner working at the hospital to help them? I didn’t know and still don’t know how many people they tell about the shortcut to fill out one more document and expedite the process by going yourself? How many requests are lost in the process because of all the formalities? I just remember how the counselor in the social action sector of the hospital, kept telling me how long the process would take if we waited for the hospital to process the request. Why is that? If one is making a request for milk it is because they have nothing else to feed their baby at the time, what are they supposed to give them in the meantime? Everything always seems to take so much longer here in Mozambique…but why is that?   Some things I don’t think I will ever understand.


Needless to say, Calita is now eating well and growing. She is lucky to have Vovo to take care of her. In fact, we both are. 

Vovo Rachel and Lalina

Meet Calita....She's my namesake, but they changed the spelling. Not too many Irish here in Moz. 

Lalina and Calita

Tuesday, February 11, 2014

The Pharmacy

My friends in the pharmacy.

I didn’t join the Peace Corps to file papers.

And yet, I have spent the better part of the last year filing papers. 

So it goes.

I have been working on and off in the pharmacy at the hospital since last May. I never thought I would work in that sector because it is the busiest, most stressful part of the hospital, or at least I think so. One day last May I went to the pharmacy hoping to find out how many people had faulted on their treatment over the previous month to include this information in a proposal. I was told that I could look at the FILAs, documents that are used to record each time a patient picks up their ARVs.  I was directed to a large filing cabinet. It quickly became obvious that the FILAs were quite unorganized. The drawers hardly shut, the hanging folders were ripped and said FILAs were in disarray. Quiteria, the pharmacy staff responsible for the FILAs, explained to me the multiple-step process she went through just to locate and fill out the FILAs, and how she was not always successful. I told her I was willing to help with the organization and potential re-organization. I quickly became her “amiga.” At that point, I didn’t realize I’d still be working in the pharmacy eight months later and that we’d still be “amigas”.

When I went back to the pharmacy the next day, Quiteria once again explained what was expected to happen and what was actually happening. She said how usually if they couldn’t locate the FILA they would just create a new one so now there were many duplicates. I had my work cut out for me. I spent pretty much all of May through August, working to eliminate these duplicates. I would find the duplicates, put them aside and then Quiteria recorded the information from both FILAs on just one of the documents. Upon eliminating all of the duplicates, we discussed how there needed to be a better way to organize all of the FILAs. We started to brainstorm. It was time for a change.

In November, we received information from the Elizabeth Glaser Pediatrics AIDS Foundation that they would be starting a study in 2014 called SMSaude, in which they would be sending out text messages to patients in the hopes of increasing adherence to treatment. With this study, they expected all hospital paperwork to be in order, including the pharmacy FILAs. They provided a layout of exactly how the FILAs had to be organized. There needed to be two filing cabinets, one labeled “current month” and the other “following month”. The four drawers were to be marked “first week”, “second week”, “third week” and “fourth week”. Within each drawer the FILAs were to be put in alphabetical order. We now had a plan to follow. EGPAF provided the new filing cabinets, folders, labels and FILAs. Tecnico Vladimir, responsible for the pharmacy, said that it wasn’t worth it to try and find the old FILAs (the ones I had been working with from May-August) as patients arrived during the month of January, but rather to open new FILAs for all patients. I try not to think about how much time I spent/wasted organizing all those old FILAs. Eek.  
According to the Ministry of Health, the hospital calendar year starts on December 21. So starting Monday, December 23, we opened a new FILA for each patient doing treatment. Mind you, over 6,000 patients are doing treatment at my hospital.  Throughout the month of January, every day I arrived in the pharmacy collected the receipts from the day before and then used them to open new FILAs. It was a long process. Quiteria was working on it with me, but she took her vacation for most of January so I was left with Sitoe. Sitoe is a character. He works hard, but loved to inquire about our potential relationship asking if I would go to the beach with him, if he could come back to America with me and when our wedding would be. Despite the countless marriage proposals, we finished opening all the FILAs.  

Starting January 23, we were able to start the new process for filling out FILAs. It goes something like this: when the patient doing treatment arrives at the pharmacy window, he/she hands in his/her hospital identification card, then Quiteria searches through the current month filing cabinet to find the patient’s FILA. The pharmacy technician then fills out the FILA when giving the patient his/her medication. At the end of the day, all of the FILAs are to be registered in the pharmacy book and then passed to the database sector of the hospital where they are typed into the system. They are then returned to the pharmacy and filed under the first name but this time in the coming month filing cabinet. That is our goal, but so far, this exact flux is still a work in progress.

 The first couple days with the new system were rough. I was really nervous because while EGPAF was demanding the change, I was the face there in the pharmacy working to change the system. The very first day I stayed at the hospital until 17h when I usually leave at 12h. The pharmacy technicians were not entirely thrilled by the new process, even though they admitted to the benefits. The wait time is already ridiculously long at the pharmacy and now we were adding an extra step to the process. The noise of patients waiting outside definitely has become more audible. But, I am always amazed by how calm and collected Tecnico Vladimir stays. I can’t say the same for the other pharmacy technician…but that’s beside the point. Tecnico Vladimir never lets the line, the noise, the number of patients get to him.

Now, three weeks into the new system, I am trying to phase out my role. I am working more directly with Quiteria to make sure that she keeps up with locating FILAs when patients arrive and that the filing cabinets stay organized. I am working to make sure the flux is in place so that the FILAs once updated are passed to the pharmacy book, the database and then filed back in the filing cabinet for next month. On February 20, we will unroll the last part of the process because this date marks the end of the month. At the end of the month, the FILAs that are left in the folders of the current month faulted/missed their treatment and need to be located. I am going to go through this process with Quiteria for the next few months to make sure the patients who have missed treatment are identified and contacted. The primary reason I first stepped foot in the pharmacy eight months ago.

Wow. Thanks for staying with me. 

I didn’t know I could write so much just about filing papers.