Malaria Training in Fidel Castro

....Yes, that's the name of my friend's community located just north of Xai-Xai...

Welcome!

...and that is where we hosted a two-day malaria training last week. 

The group of community leaders and volunteers participating in our oral pre-test about malaria. Because we were not sure of the reading level of most, we did the test by a show of hands.

As part of transitioning into my new role as the Peace Corps National Malaria Activities Coordinator, I have been working with the current coordinator to learn all the in's and out's of my new position. As part of this handover, we hosted a malaria training of trainers in Fidel Castro with the Peace Corps Volunteer there, my friend, Dan Martin. Hannah and I planned out the training following models of trainings she had done in the past. We arrived in Fidel Castro early Wednesday morning and Dan's supervisor picked us up at the mini-bus stop. We then swung by Dan's house to pick him and all of the food and generator up before going to his organization. We arrived there just before 9 a.m., the exact time the training was supposed to start. But, it wasn't an issue as no one was there yet. And as we entered the building it became clear that the room we thought we would use was not in any way, state or form for a meeting. There was corn everywhere. Dan's supervisor tried to convince us that we could use one of the other smaller rooms, but we told him there was just not enough space. We then decided that we would set up outside.

We took the generator, the chairs and projector outside. The women cooking started setting up their kitchen. The kitchen being two fires and space for basins, water jugs, plates and all the ingredients including the chickens that would later become lunch. They were let to roam for just a little while longer. About 30 minutes later, our first participants started to arrive. It was not until about 10:30 a.m. that we realized we had better "tomar cha", serve our snack of tea and bread, as we continued to wait. It was not until 11 a.m. that we officially started our training with introductions and an ice breaker. Two hours late. But, so it goes. I have to admit, I wasn't stressed or even bothered by the fact that we were starting that late. I guess that's a sign I have adjusted to the Mozambican schedule.  Also, in typical fashion, Dan's supervisor, was there long enough to give a welcome and then he left. Chefes. So we were then left with our 10 participants. All of our participants were women, eight of them were volunteers from two different organizations that work in the community and two community leaders. We had a translator there as well to translate into Changana, the local language, and it ended up that he started participating more and forgetting to translate. After we went through our introductions, we did a pre-test orally and then started going through all of our themes for the day: transmission, prevention, symptoms and treatment. 

Hannah and I explaining the symptoms of malaria.

Throughout all of our sessions, we highlighted six essential actions:

1. Sleep under a mosquito net.

2. Allow PIDOM, the indoor spraying, into your home to spray for mosquitoes.

3. All pregnant women should take a prophylaxis called TIP.

4. Anyone showing symptoms of malaria should be taken to the hospital within 24 hours.

5. Do not leave stagnant water out in your yard or home.

6. When being treated for malaria, take all of the prescribed medication COARTEM.  

Hannah and some of the participants demonstrating how the parasite dies once Coartem, the treatment for malaria, starts working...

We finished the day with distributing manuals and storybooks, "Tatu, luta contra malaria". We told our participants that it was their homework to go home and read the books with someone. We then ate lunch of beans, rice, xima and chicken. From there, Hannah and I headed back to Chicumbane only to be back in Fidel Castro by 8:30 a.m. the next day. We told everyone that it was really important that we started on time the second day because we needed to finish early. We made up a rule together that if anyone arrives late, they would have to dance in front of the group. Also, if anyone's cell phone made noise, they too would have to dance. Throughout the two days we had a couple people dance. But, NO ONE had to dance that Thursday morning because they were late.

Reading story books about malaria. 

Some way, some how, everyone arrived before 9 a.m. and we started with tea and bread before starting our session at 9:30 a.m. Hannah and I were both amazed. That never happens. We started our session with reviewing the homework. And from there we did a little of Peace Corps Goal #2 and introduced them to Jeopardy reviewing all of the material from the previous day. They loved it.

In addition to training all of our participants about malaria, the second component of our two-day training was to write up an action plan to eradicate, or at least diminish, malaria in the community. We divided our participants into two groups and they had a serious brainstorm "chuva de ideias". We then wrote up a plan together and designated responsibilities. With the information they learned in the training, they said they would go to talk at churches every Sunday, give talks at the local schools and meet with the people responsible for the neighborhood wells in the community to ensure that each well has a good cover and everyone in their neighborhood understands the importance of covering it. (Stagnant water is where Anopheles mosquitoes, the ones that transmit malaria, breed.) 

At the end of the second day, after going over malaria prevention, treatment, symptoms, transmission and developing an action plan with the group, Hortencia led giving the post-test to all the participants. 

When I talked with Dan today, he said the group plans to meet on Wednesday to start putting their plan into action. Fingers crossed.

I am hopeful. The day after our two-day training I had a meeting at the EGPAF office in Xai-Xai. As I entered the room, Amelia, one of the volunteers I had just met in Fidel Castro, shouted out my name. I was so surprised to see her there. But then as I realized that the meeting was about how community organizations can work more with EGPAF at the hospitals, it was not such a surprise. I sat down next to Amelia and she told me how she "beep"ed me ("to beep" someone is to call that person only to have it ring long enough so they can see you called and then use their credit to call you back) last night with some questions she had.

"When does malaria become cerebral?"

That was her question.

I was impressed. And embarrassed. I had to admit, I did not know the answer. I told her, as I was still in the process of taking over the position, I am still learning. So I told her I would do my research and get back to her.    

Hannah and I were pleased with how the training went and hope to have similar trainings to this one throughout the country over the next year.  Stomp out Malaria.

Hannah, Dan and the group of newly trained malaria trainers!

Check out this music video of a group of teenagers who worked my friend Alden and Positivo, an organization that creates music with health messages, to write and create music about malaria.

The Great Northern Adventure

Six cities in Mozambique (Pemba, Ilha de Mozambique, Nampula, Cuamba, Gurue, Quelimane)

Five different modes of transportation (Plane, train, car, bike, boat)

Four Peace Corps Volunteer houses along the way

Three friends out exploring

Two weeks of an exciting, yet relaxing vacation

ONE Great Northern Adventure.

Sunrise over Maputo the morning we flew out

Upon arrival in Pemba, the first stop along our tour.

The beach in Pemba, we happened to stumble upon a Vodacom dance party...

Ilha de Mozambique

Alden with all his new friends he made on our bike tour around the island.

Alden and Adela in front of the hospital on Ilha, just one of the many stops on our bike tour. 

The view from the Garden of Memories.
During the slave trade, most of the slaves exported from Mozambique left from this dock. 

Sunset over Ilha.

Sunrise on Ilha. 

The oldest building in the Southern Hemisphere (the white church above which was part of the Portuguese fort)  is located on Ilha.

Exploring the old Portuguese fort. 

We did an overnight camping trip to Island of the Snakes. This was our campsite. Yes, we saw snakes.  

Boarding the train from Nampula to Cuamba. It was an 11-hour ride. 

The view from the train. 

Moz 18 Reunion in Cuamba.

Colin and Alden outside Colin's organization where an old tank is left from the country's civil war. 

Hiking in Gurue!

Gurue in its glory!

An all-day hike to the waterfalls.

The tea plantations in Gurue

Just hanging in Gurue

The tea plantations in Gurue...

The bustling fish market at the beach just outside of Quelimane. 

Decisions...Decisions...Decisions

As the seasons are changing in Mozambique, my plans have also been changing.

Unfortunately, my counterpart and I decided to cancel the agriculture and nutrition project we had been working on since September. There were various reasons we decided to cancel the project including: a lack of volunteer participation, problems with seeds, an abandoned garden, lack of organizational support and a lack of community support. It was not the community-led, community-driven project that we had imagined. Instead it felt more like I was trying to run the project almost single-handedly, which is not sustainable nor what should have been happening with the project. So it was the responsible and necessary decision to terminate the project. In the end, the money we did not spend, can be applied to other worthwhile Peace Corps projects. As I have experienced before in Peace Corps, not everything works out as planned. I have learned countless lessons along the way. But, as I told my counterpart, there were unfortunately too many forces working against us. So we will take what we have learned and hopefully he can apply this experience to a project in the future. We still successfully educated eight volunteers in the area of perma-gardening and conservative agriculture. We also will continue to offer our nutrition classes through May 2nd. We are just cancelling the project before the volunteers go out and teach conservative agriculture to families in the community and host health fairs. Even though, we are cancelling the project at this point, I still think that they may be able to teach families in the community and even host the health fairs in the future someday. All of the volunteers involved in our project now have agriculture and nutrition manuals so the information is in their hands to use as they wish. As the president of my organization told me when we decided to cancel the project, "Paciencia" (Patience). Similar to my own mantra, so it goes...As I said, it was a tough, but necessary decision.

That wasn't the only big decision I made recently. After countless pro-con lists, phone calls home and long walks working it all out in my head, I accepted an offer with Peace Corps to serve as the National Malaria Activities Coordinator in Maputo for the next year. I will be working as part of the Peace Corps Stomp Out Malaria Initiative.  Additionally, I will be working with Peace Corps as a PCV Tech Trainer for the new group of Moz 22 volunteers expected to arrive at the end of May.

Last weekend, my Peace Corps friends visiting my house made a game out of killing the mosquitoes against the walls of my home. These little pesks carry the evil killer: malaria. Malaria is a big issue not only in Chicumbane, but continent-wide.  Malaria is the number one killer in Sub-Saharan Africa. In Mozambique, malaria is responsible for 45% of deaths in children under 5 years old. However, malaria is a very preventable disease if people sleep with mosquito nets, stay inside at night, use repellent and are aware about prevention and treatment. As the national coordinator, I will be responsible for ensuring that Peace Corps Volunteers are informed and educated about malaria nationwide and are sharing this information with their communities through projects and activities. While I have worked some with malaria in Chicumbane, I am excited about this opportunity to work more closely with this preventable disease, eradicating malaria one mosquito at a time.

It is going to be a busy next couple of months. I am leaving tomorrow on vacation in Northern Mozambique for the next two weeks. From there I will be going to my Closure of Service Conference April 27-30, the last time Moz 18 will all be together in country. I will then go back to Chicumbane for two weeks before going to Namaacha to plan out Moz 22 training May 14-30. During June and July, I will be back and forth between Chicumbane and Namaacha, wrapping up projects at site in addition to helping out with training for Moz 22. The last week in July, I will go down to Maputo to "COS", which basically means have my yearly medical check-up and then move into my new house in Maputo, complete with flushing toilet and shower, just a few of the serious upgrades I can look forward to. September 9-20th I will go to Senegal for Stomp Out Malaria Boot Camp, a ten-day intensive hands-on malaria training. From there, I hope to fly to AMERICA for the one month trip home Peace Corps includes as part of my year-long extension.

So... see you in September or October?  

In honor of Dia de Mulher Mozambicana...

In Mozambique, every Friday is considered “Dia de Homen”. The first time I heard someone refer to this tradition, I was slightly shocked and a little confused. What exactly did that mean, “Man’s day”? And then, I realized that so called “Man’s day” really just gave men the liberty to go to the bar and drink, free of responsibilities or obligations. Well, what about Women’s Day? Yes, women have a day too. But, just one. April 7^th. Dia de Mulher Mozambicana. There is a day once a week in order to celebrate men, but women just have one day a year. What is wrong with this picture? As you can see, while there has been a lot of recent improvement with gender equality, there is still a long way to go. However, in honor of Dia de Mulher Mozambicana just around the corner, I wanted to honor just seven of the amazing women I have met throughout my service here in Moz. Who knows where I would be without them?  

Enia

I first met Enia just over a year ago at a Gender Based Violence training that the Elizabeth Glaser Pediatrics AIDS Foundation (EGPAF) hosted for Peace Corps Volunteers and new fellows they were dispersing into the Gaza districts. The fellows were students from Eduardo Mondlane University, Mozambique’s biggest university.  Enia was the psychology fellow assigned to Xai Xai district and would be coming to work in Chicumbane. I remember being impressed by her caring, friendly disposition and her chic wardrobe. She wore a beautiful capalana tunic, had a matching headpiece, beaded necklace and earrings as well. We started talking and I felt my lack of Portuguese at the time as a hindrance. She spoke so fast and eloquently. She was so patient with me taking the time to slow down and explain what I did not understand at first. We have been working together ever since.

As the psychology fellow working at the hospital, Enia and I have been working together to organize Maes Para Maes, a support group for HIV+ pregnant women, and a pediatrics support group. We have experienced several setbacks and frustrations in organizing Maes Para Maes; however, we have a mutual understanding that we are in this together. We share many of the same frustrations working with the hospital staff. They say they are too busy to support patients more or do not follow through with ideas. I always tell her that I am glad to see her frustrated. I don’t really mean that, I just mean that it is nice to see that I am not the only one experiencing difficulties or frustrations. I used to sometimes think it was just me being the foreigner. Enia is punctual and works hard. She has an empathetic manner and she cares for all the patients she interacts with. I always enjoy sitting with Enia as she counsels patients before and after HIV tests because she really takes the time and consideration necessary to counsel people on such a sensitive topic. She also has a unique way of getting people to open up and really share with her what is going on.

We run a pediatric support group together every Thursday morning at the hospital for children who are taking ARV’s. In addition, we wrote and submitted a proposal together to create a Children’s Corner at the hospital. We are still waiting for the hospital to determine the appropriate space to use.

Enia and I are more than just colleagues. Over the past year working together, we have become friends as well. She invited me to her graduation party last November. She graduated with her psychology degree from Eduardo Mondlane University. I met her whole family and her father even dragged me out onto the dance floor. She has two kids and another one on the way. To me, Enia embraces a positive, confident, ambitious spirit that is often hard to find in women here.

Vovo Minda

“On a scale of 1-20 (the grading system used in Mozambique), I’d give you a 30,” Vovo Minda once told me. She then told me that I work too hard.  She reminds me of my deceased grandmother, Grandma Huysman. I think it is a combination of her stature, her “take charge” attitude and her almost brutally honest, but yet compassionate nature. “Oh Colleen, what is going on with your face? You have pimples all over it.” Thanks Vovo Minda, I know. But, she means well. She does.

Vovo Minda is the head nurse in Consults of Children at Risk (CCR). She sees all babies up to 18 months who have an HIV+ mother, are malnourished or are twins. She actually retired a few years ago, but the hospital asked her to come back to work. She’s that good. In my first few months shadowing at the hospital, I spent a few weeks with Vovo Minda in CCR. I remember how she wanted to teach me everything. She wanted me to fill out the paperwork while she talked with the mother and child she was attending. She even wanted me to give HIV tests. I explained to her how I was not a nurse. We eventually started making papas, porridge, together to teach mothers how to make it for their malnourished children. This time last year, every Wednesday we worked with a volunteer to make porridge. I loved doing this with Vovo Minda. I loved watching how she would explain to the mothers what they needed to do for their children. We had a good program going until the hospital ran out of ingredients and we have yet to start up again. We are currently waiting on charcoal.

I brought Vovo Minda with me to a Peace Corps conference on project design and management last April. I was hoping this would give us an opportunity to plan out the papas activities a little more and shape them into more support groups. The conference gave us the opportunity to sit and really discuss some ideas, but it has been difficult to get the ideas going since then. The conference was held at a conference center just outside of Maputo, pretty isolated and not really close to anything. When we got there, Vovo Minda said, “Colleen, I thought you were taking me to stroll around Maputo.” And that’s Vovo Minda for ya.  She dreams of someday having a cresh, a center just for babies who are sick and malnourished.   In the meantime, her home serves as such. She cares for her grandchildren and some of the neighborhood kids who are HIV+ and do not have anywhere else to go. She is 64 years old, but has the spitfire of a teenager.

Professora Tereza

“You have to change your shirt. You can’t wear that.” Tereza had just arrived at my house for my Portuguese/Changana lessons. But, as she arrived, she informed me that instead of having lessons, we had to go to my neighbor’s house because my neighbor’s baby had died that morning. So I wrapped a capalana around my waist, changed my shirt and we went to my neighbor’s house to sit on the straw mats and pay our respects. The next hour was spent listening to all the women gathered at the house singing in Changana. They hugged and embraced the grieving mother. Since that day over a year and a half ago, Tereza has continued to be a culture guide, if you will.

Professora Tereza and her daughter Kaka on Christmas Day. 

Professora Tereza started out as just my Portuguese and Changana tutor just two months after I arrived at site. After asking around for a tutor, one of the nurses I work with, Patricia, put me in touch with Tereza, a second grade school teacher. Maybe she thought my Portuguese was at a second grade level? I don’t know. Either way, it was a great match. Tereza started coming over my house two days a week for about an hour and a half. For the first hour, we practiced Portuguese and the last 30 minutes was Changana. The Changana usually ended up as her just yelling things at me and I would have to repeat it. I still remember, “Fula Matilu, Fala Matilu” (Open your eyes, shut your eyes). We practiced that one a lot.  Just before the holiday season 2012, I stopped tutoring. I was more confident with my Portuguese and I had decided that I wasn’t getting much of the Changana, I needed to do more practice on my own.

So we stopped having tutoring, but our friendship didn’t end there. I started going by her house either to or fro the hospital and we would have tea or lunch. Tereza lives with her two daughters, Magida (10) and Kaka (2). Kaka has an irrational fear of me and cries just about every time I enter into their yard. And I am now helping Magida with her English homework each week. The tables have turned and I am now the language tutor.

Tereza and her family have been so warm, generous and welcoming to me throughout my service. I went to a spiritual ceremony at her house last Easter, Tereza introduced me at the local Presbyterian church, I celebrated Christmas with her family in Xai-Xai and she always keeps me informed of gatherings or activities in the neighborhood.

What I appreciate most about Tereza is how she never treats me like a “mulungo” (white person). She expects the same from me as she does of her neighbors, friends and own family. I have been to a number of Mozambican parties where I am told to just sit in a chair with the men (women usually sit on straw mats), while everyone else I know will be running around preparing things. Tereza doesn’t do that. She hands me the soap and tells me to wash all the dishes in preparation for serving a meal, or passes me a knife to peel a 12.5 kg bag of potatoes. She then also makes sure I never miss when it is time to eat or rest. On Christmas, we made that 12.5 kg bag of potatoes into a vat of French fries. She was impressed how I seemed to know what I was doing. I told her how French fries here or “la” (there in America) are made the same way. Since then she has been telling me how I need to bring cassava, peanuts, pineapple, leaves of cassava home so I can make Mozambican food when I get back. We are still trying to figure out how I could get it all in my suitcase and through border control, but we have some time to figure that out.

Dona Rachel

I never imagined myself having a maid in Peace Corps. During training when visiting volunteers talked about their “empregadas” (maids) I always said I didn’t think I wanted to have one. Especially not in Peace Corps. And then I met Dona Rachel. She had been working for Peace Corps Volunteers for 12 years when I arrived in Chicumbane. In the past, she would cook and clean for volunteers. I wasn’t going to be the one to cut her off. So she started working as my maid. I still don’t like to think of her as a maid, but rather a neighbor/friend who just helps me out from time to time. She usually comes once a week to cart water from my neighbor’s yard to my house and wash my clothes. She then also takes care of Mel when I go away. She also helps me out with transporting my gas tank when I need to get that filled and with carrying a 25 kg bag of flour to make Mel’s food. She has never cooked for me, but recently we have talked about making some Mozambican dishes together, she said so I would know how to make them when I get back to America.

I will never forget the first day I moved into my house. Dona Rachel had come by at 5 a.m. to say good-bye to Vivienne and as Vivienne’s chapa drove away, Dona Rachel jumped right into helping me move my things into the house and rearranging them. We cleaned the entire house from floor to ceiling inside and out. She helped me make the house my house. Dona Rachel is so physically strong and works extremely hard. She is dedicated and knows what she has to do in order to feed her family at the end of the day.

Since November, Dona Rachel has also been working in the city so instead of her regular schedule of coming on Tuesday mornings, she has been coming once a week whenever she has a chance. Usually it is late afternoon Friday or Saturday. But, she still likes to keep tabs on me to see how I am doing. She will usually give me a call or just stop by on her way to or from the city just to say hi and chat for a bit. That is one thing I love about Mozambique. You never need a plan or invite to visit someone. It is accepted and even expected just to stop by people’s houses to check in, visit and bater papo (just chat).

Adelaide

I first met Adelaide last year when another volunteer told me about a lady in the market who had beans for just 25 mets. That’s less than a dollar. We had been in the routine of going to another lady in another market and getting beans for 40 mets, but now we had to check out the lady with 25 met beans. Nowhere in America can you get this much food for under a dollar. What a steal.

Adelaide, Maecina and Joana making peanut butter at her stand in the market. 

Meet Adelaide. She is a caring, generous mother from South Africa running a stand in the busy Xai-Xai market. She only speaks English and the local language Changana. So after our first lunch to check out the new place, we were hooked. Adelaide has the best beans in the Xai-Xai market. She does. The other day when I was there, she had already run out of beans by 1:30 p.m. Her beans are in high demand. And I have become one of her loyal customers. I usually try to make a trip at least once a week, but if I don’t show up for a while, Adelaide will text to check in. She runs the stand with her niece, who she took in after she lost her parents, and usually her two kids, Joana and Luis, are running around as well. Adelaide took in one of Mel’s puppies from the last litter. Unfortunately, it has since disappeared. I felt so bad when Adelaide called to tell me because she too was so upset about losing the dog. Last year, two other volunteers and I taught Adelaide how to make peanut butter right there in the market after we had eaten lunch. People in the market definitely got a kick out of the three white people using an alguidar (clay pot in picture) to mash up peanuts. Adelaide loved it and we have plans to make peanut butter again next weekend. Adelaide is such a genuine, caring and open woman. We will often talk about what is going on with her family or at home and just about life in general. And in return, she asks about my life and always likes to keep tabs on former volunteers who have already left. She has definitely gotten used to the volunteer invasions at her little stand in the market. It’s no wonder she runs out of beans.

Dona Persina

Dona Persina is my landlady. She also runs a charcoal stand in the market area of Chicumbane. And she sells corn. And she collects bottles to return for a deposit. Dona Persina knows how to make a buck or two. She is what I like to call a “chefe”, meaning that she knows what she wants and how to get it done. Here, that is sometimes a rare quality to see in women. She lives with her husband and their grandson Antonio, who lost both of his parents. The house I live in was actually owned by Antonio’s father so someday when he is older, it will hopefully be his.

Throughout the end of last year, Dona Persina was hurt her back and could not work. She could hardly walk and mainly stayed on a straw mat all day.  As you can imagine, this period was very frustrating for her, someone used to keeping busy and working her various jobs. So I got into the pattern of stopping by their house and visiting. I would sit and chat with her and her husband, have tea and some days even eat lunch together. Her husband, by the way, reminds me of my grandfather P-Pop. I don’t know if it is the way he tests me, always asking what I think about different things going on in the world that he has heard on the news; or the way he moseys around the neighborhood; or his eagerness to learn about anything and everything, especially English words, but something about him always reminds me of P-Pop. So I guess that is also why I always like to visit them. I love hearing their stories. About ‘how back in their day’, you were told who you would marry by your parents, or how Dona Persina used to walk all the way down to the river to wash her clothes or how a monkey came right up to a baby and took its food when they lived out in the bush.  Some stories I take with a grain of salt, but regardless, it is always a good laugh.

Antonieta

Antoineta is probably one of the strongest, most caring, empathetic women I have met here. She works as a volunteer for Tsembeka, one of the community based organizations here in Chicumbane. The organization is made up of volunteers, some HIV positive, who look after vulnerable children and orphans in the community and patients who have missed or abandoned treatment through home visits and searches. At the moment, Tsembeka does not have funding, but that is no barrier for Antoineta. I think if she could, single-handedly, she would make sure that no one in the area missed their treatment.

Antoineta and her puppy.

She lives in Chiconela, which is a 20 met chapa ride from Chicumbane, but that does not stop Antoineta from accompanying people to the hospital regularly to pick up their medication or just going to the hospital for them. She gives and gives and gives, when she herself lives on very little. Antoineta lives with her two sons and one of Mel’s puppies from the first litter. Her husband died a few years ago and now most of her family lives in South Africa. While I do not work directly with Tsembeka, last year I worked with Antonieta to organize teaching some of the volunteers how to make peanut butter. Since then, Antoineta has continued to make peanut butter at home and for the kids of her neighborhood.

She is motivated and willing to do so much for others. She also has an amazing optimistic spirit. She is infamous for always saying, “Tudo bem, nada mau” (Meaning all is well, nothing wrong). And I always believe her, but really she might be going through much more than you and I will ever experience. But, she would never lead you to believe that. She is always too busy looking out for everyone else. And everyone else knows to go to her for whatever they may need. She will find a will and a way to do what she can to help out.

I have been so lucky to have been able to get to know these amazing women throughout my service. They hardly receive any recognition for the things they do on a regular basis; for just being who they are. They are strong and genuine, selfless and intelligent, warm and compassionate. They have been an inspiration to me in so many ways. So on this April 7^th, Dia de Mulher Mozambicana here’s to them! To Enia, Vovo Minda, Professora Tereza, Dona Rachel, Dona Persina, Adelaide and Antoineta,  THANK YOU.  

Carnavale in Chicumbane

Sam and I at the first weekend of Carnavale

For almost the past month, Chicumbane has been celebrating Carnavale.

For a while I was trying to figure out the cultural roots or significance, but when asking around, I have just been told that the first one in town was last year after a group of young people decided to start it.  I think the Brazilian soap operas might have played a role in the idea as well. There are other carnavale celebrations across Mozambique, but I have only participated in the ones in my own town.

Carnavale 2013 with Nelio and Dario. 

The first Saturday of Carnavale (photo above) was in the main market area of Chicumbane. It included a march of lots of people cross-dressing and then transitioned into a talent show on a stage in the market area. After seeing how people were dressed up during the march, I decided to go home and get my mask (see above). As I went home, a couple of the kids I know from CACHES asked if they could make masks as well. When we got home, I brought out cardboard I had been saving, glitter and foam stickers. It was only a matter of minutes before my entire veranda was sparkling.

Making Carnavale masks at my house with the kiddos!

A variety of groups dancing and singing all competed in the show that followed the march. The winner, to be announced the third and final week of Carnavale would win 5,000 meticais ($166). A few of the dance groups who competed were kids and teenagers I knew from CACHES.

Some of the kids I know from CACHES dancing in the dance competition.

I am friends with a group of young guys who are part of a group, Chicumbane Entertainment. They actually won the competition at last year's Carnavale. They have written their own music, even recorded some and perform quite frequently at the local bar in town. So I spent the night with them. I felt like such a groupie, running over to the stage when they performed and then hanging out with them when they were off-stage drinking canu, a traditional drink made from the fruit canu. I had never seen that many people flooding the market and out into the street.

Chicumbane Entertainment

The second Saturday of Carnavale was held at Primavera, the only real bar just a 10-minute walk outside of town. The talent show continued with groups performing their dancing and singing routines. And even more kids came to my house that morning to make masks. Word had gotten out that Mana Colleen had glitter.

Glitter EVERYWHERE!!!

Honecio rocking his mask.

The third Saturday of Carnavale was postponed a week due to lack of money on the behalf of the organizers. But, the extra week gave us time to add a little something to Carnavale. One of the guys from Chicumbane Entertainment, Afro, called me early in the week asking if I could help him get an HIV test at the hospital. Yes, of course. So he came to the hospital the next day and I brought him to my friend Enia, one of the counselors who does HIV testing. After the test, he, Enia and I were sitting talking. I got an idea...since he is kind of like a little celebrity in town. . .when he gets up on stage that next Saturday he should make an announcement about getting tested and encourage others to do the same. We kind of laughed and joked about it, but I made sure he knew I was also kind of serious.

Later that night he called me asking if we could plan out what he could say at Carnavale. From there the idea expanded to asking the hospital to donate condoms to distribute and including a little health talk in the middle of the show. We made a plan and divided up what each of us would do before we would meet again. We asked some of the volunteers from CACHES if they would help distribute and maybe do a little talk or skit as well. When I asked the hospital about donating condoms, they were thrilled and wanted to give me three boxes--that's 15,000 condoms.  I only took 10,000. And 1,000 female condoms. I then started asking some of the nurses if they would be interested in giving a talk at the event. When they were a little hesitant about working on a Saturday night, I went and asked some of the nursing students I know. They were more enthusiastic about the idea. So it was set. We would distribute condoms at the march part of Carnavale and then at the actual event at Libote, the disco about a 40-minute walk outside of town. The nursing students would give a little talk about condom usage and getting HIV tested at the hospital. Afro would sing his music about HIV and encourage others to do the same. We would also include little announcements about using condoms and getting tested throughout the show. It went more or less according to plan. But, so it goes.

Paulo and Rafaela. Paulo and I made condom crowns to promote the condoms we were distributing at Carnavale. And Rafaela danced in the dance competition. 

I spent most of that Saturday waiting to hear from Afro about what time everything would get started. But, while we waited, some of the CACHES volunteers and I wrote health messages on the condoms we would distribute. We also made condoms crowns (See picture above). I learned how to make them in college during my FYSOP days. For a little while that Saturday I couldn't decide if it was appropriate or not. But, then decided, why not? Let's do it. And they were a hit.

We ended up not distributing condoms at the march. But, once we got to Libote at about 19h, we set up condoms at the bar, in the bathrooms and at the entrance and exit. Then around 22h, Rui and Cosme, the nursing students, gave a brief talk about condom usage and HIV testing. They then walked through the crowd distributing condoms.

Rui and Cosme, two nursing students, gave a short informational talk about condoms and going to the hospital to take an HIV test. 

Afro then followed their talk by singing his music about HIV. The emcee included reminders for the audience to be sure to pick up condoms at one of the various locations. Mission accomplished. We successfully included health messages and condoms at Carnavale. While of course, it could of been a little more organized, I have found that will always be the case. So best not to think about what could have been, but what we did accomplish. We distributed about 2,000 male condoms and 250 female condoms. And the rest...the plan is to go back to Primavera and Libote and ask them to keep their bathrooms stocked with condoms. We also hope to plan another show with Chicumbane Entertainment and other groups to distribute the rest and include more health messages.

We'll see if that happens. For now they are waiting in my house.

You know you are a health volunteer when....you have over 8,000 condoms sitting in your living room.

Big night out.
Carnavale at Libote, the disco just outside of town.

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 4^th) 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

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.