Flooding
Latest Challenge for Chicuque Rural Hospital
by Beth Ferrell
A lone highway -- Highway 1 -- provides access to Chicuque Rural Hospital, a United Methodist mission in Maxixe, Mozambique, from that nation’s capital city of Maputo. In early 1999, two months of rain damaged bridges along the highway, making travel and transport of supplies to the hospital, which is 300 miles north of Maputo, difficult. Record-breaking floods early this year further damaged the highway making it impassable for weeks.
At the same time, the need for supplies at the hospital skyrocketed as flood waters forced people from homes and sparked the spread of disease.
As Response went to press, the situation was desperate as food, fuel and medical supplies had been exhausted. Electricity and water pumps require fuel, and there was little fuel, which meant limited if any electricity and portable water.
Since Highway 1 is the only road that transverses the lower one third of Mozambique, the only alternative way to Maxixe is by airplane to a small airport at Inhambane, which is across a bay from Maxixe. Supplies had to be brought into Inhambane Harbor by medium-size ocean-going ships. Although this helped, it was not adequate to meet the needs.
The need for portable water was significant as most of the water in the area is obtained from shallow wells, which are easily contaminated during heavy rains. Diseases such as cholera, diarrhea and malaria are an ever-present danger in such a situation.
A second danger threatens the people of Mozambique in the wake of the floods -- the danger of land mines that were displaced by flood waters. Areas that had been demined can no longer be considered safe because no one knows where the land mines are now.
The threat of land mines will long impact the people of Mozambique because they survive by subsidence gardening, which is impossible in the aftermath of the floods that washed land mines into their fields. Malnutrition and subsequent disease, plus land-mine injuries, will be part of life in Mozambique for the foreseeable future.
Housing for most people in the area is constructed out of bamboo with coconut branches for roofs. These houses do not stand up well in rain. Many families have lost their homes.
Unrepaired erosion damage from the 1999 rains was compounded by this year’s floods. Chicuque Rural Hospital was saved from erosion by construction of drainage ditches on both sides of the hospital, but a police station/warehouse across the road from the hospital could not be saved. A bakery and a fish shop down the road from the hospital are in danger of eroding away.
Hope is seen in construction of a new road, which winds its way through the houses and palm trees of Maxixe to Highway 1. And hope is seen in the fact that in the midst of this disaster, Chicuque Rural Hospital -- a 180-bed facility -- has continued to serve the health needs of the local population and serves as a reference hospital for the 1.5 million people in Inhambane Province.
Two Stories
A woman who was injured by a land mine provides an example of how the hospital is helping people deal with the current disaster and the aftermath of war. The woman was hand plowing her garden plot when a land mine exploded injuring both her legs. She thought plowing the plot was safe because she had cultivated it last year, but the 1999 rains had moved land mines.
Staff at Chicuque were able to save one of her legs but had to amputate the other. After four months of treatment, she was fitted with a leg prosthesis by Handicap International, a service provided across the bay in Inhambane.
Even with the prosthesis, life will be difficult for the woman in a community where firewood is gathered daily by hand, water is carried long distances and food is grown in family gardens.
The story of a second patient -- an 8-year-old boy who fell from a mango tree in which he was playing -- further tells the hospital’s story. His injury was not attended to immediately so by the time he got to the hospital, his leg was so badly infected it had to be amputated to save his life.
Subdued for a few days after surgery, his sparkling personality soon emerged as he raced around the surgical ward in his wheelchair and later on his crutches. As the time for his discharge approached, hospital staff learned he had nowhere to go. His mother had died in the civil war and his father had psychiatric problems so was not competent to care for him.
God provides answers even in challenging times. In 1991, United Methodist Women, in conjunction with Chicuque Rural Hospital, had started an orphanage at Teles, a town six miles from the hospital.
The boy moved there.
The story of this boy and the woman who lost her leg to a land mine are stories of just two of approximately 5,000 in-patients served by the hospital each year through surgery, maternity and pediatric services and dispensing of medicine. Chicuque Rural Hospital also offers extensive out-patient services.
Outpatient services
Such services provided by the emergency department include a laboratory; blood bank; radiology; physical therapy; maternal and child-health programs, including a well-baby clinic; a failure-to-thrive clinic; an immunization program; prenatal and postnatal care; family planning; socially-transmitted disease clinic; and clinics for surgery, medicine, pediatrics, gynecology, psychiatry, ophthalmology, dental, and sexually-transmitted diseases. More than 100,000 out-patients are seen annually in the out-patient clinics.
Outreach programs to train people in fundamental health practices such as sanitation, hygiene, proper nutrition, making and using oral rehydration solution, and how to prepare safe drinking water have been developed locally and nationally.
Locally, hospital staff go into neighborhoods where the highest incidence of health problems such as malnutrition, anemia and low birth-weight babies have been identified. Because this program depends on staffing and transportation, it is sporadic because of the lack of staff, vehicles and fuel.
The national outreach program, known as the Community Development and Health Project, was initiated in 1995 at Cambine United Methodist Mission, 18 miles inland from Maxixe. Housing for participants is available at a United Methodist guesthouse. The Cambine Health Center provides classroom space.
The project focuses on participatory education in basic sanitation and hygiene, nutrition, community development, methods of preparing safe drinking water, family relationships and family planning, measures to reduce common diseases, and the importance of oral rehydration to counter diarrhea.
Participants, called promotoras when they complete the course, are lay people, usually women from throughout Mozambique. They spend a month in training with two coordinators, Celestina Zacarias Malate and Anastacia da Esperanca Perieta, both members of United Methodist Women in Mozambique.
More than 100 promotoras have been trained and have returned home to share what they have learned with their neighbors and church groups. Their efforts are helping combat serious health problems in Mozambique, such as malnutrition, anemia, diarrhea, malaria, a 1.1 percent maternal mortality rate, and a 25 percent mortality rate for children under 5 years old.
Key to the promotoras’ success is establishment of community-development committees.
Celestina Zacarias Malate, now one of the coordinators of the training program, learned first-hand how valuable the training is. Initially skeptical about the necessity to treat drinking water, she tried it. No one in her family has had diarrhea since.
Hospital improvements
Inspite of the recent flooding, improvements have been made to Chicuque Rural Hospital over the past 11 years that have expanded its outreach:
Hospital’s history
Chicuque Rural Hospital has been an important resource to the people since its founding in 1913. During Mozambique’s civil-war years -- 1976-1992 -- it served despite the conflict all around. Now the hospital serves a nation severely damaged by weather.
The hospital was established as part of the Methodist Mission in Chicuque, which began in 1890, to do two things:
These goals remain today.
From 1975-1986, the hospital was nationalized and was under the direction of the Mozambique Ministry of Health. In 1986, an accord was signed that has allowed it to function as a joint venture between the Mozambique Conference of The United Methodist Church and the national health ministry.
Once run by missionaries from outside Africa, leadership today is indigenous. Jeremias Franca, a Mozambican, will become a administrator of the hospital this June after he completes the hospital-administration course at Southwest Texas State University in San Marcos, Texas.
Beth Ferrell is a missionary with the United Methodist General Board of Global Ministries who served 10 years in Mozambique. A nurse, she is currently on study leave at the University of Arizona in Tucson, Ariz