Sometimes in my sleep deprived state I feel as though I am walking around in a dream and I am snapped back into reality when we are conducting interviews and talking to staff at sites. It was busy this past week in Moz. Not a lot of sleep happened. The intense heat, while very welcomed coming from Boston, is best enjoyed lying on a beach, not necessarily in a very small and cramped health facility. This heat induces an instant sleep state whenever we have a moment to ourselves and especially any time we are in motion, such as on long car rides. During these rides, I awake to some of the most beautiful, vast, and open scenery imaginable, straw huts dot the horizon and women bent over damp rice paddies remind me of what hard work really means. We stop to take a photo and are instantly greeted by a local man selling a bag full of roasted/burnt cashews that do not necessarily look all that appetizing but our 80 cent purchase brings so much joy to his face we could care less whether or not there is a chance of diarrhea in the morning.
In Mozambique, 90% of people live off of $2/day. This statistic is hard to swallow at times when a meal can be equivalent to a week’s worth of wages. Accommodation and food are not cheap in Mozambican cities. Most of the tourists to Moz are here on business and many include Chinese investors. The locals are not thrilled about this influx of Chinese funded infrastructure, which comes at a great cost, handing over mining, timber, and fishing rights. The truth is many are stealing resources, such as timber, from the country illegally. This is creating severe deforestation and exploiting Mozambicans to do the work of cutting down trees, which affects not only global warming, but the amount of rainfall in a region already plagued with droughts and flooding. Driving from Namacurra to Quelimane, I notice so many trucks full of logs, such an important resource of this country, being stolen in broad daylight. In May of last year, about a ton and a half of elephant tusks and rhino horns were seized by the Mozambican police, found in a Chinese citizen’s apartment. Mozambique has lost over 50% of their elephants due to illegal poaching and much of the ivory is being sent to China. The University in Maputo now offers a course in Chinese and a brand new Chinatown with a hotel the size of MGM in Vegas is being constructed in Beira, where we are now.
For many years, the people of Mozambique have experienced hardships inflicted upon them by outside powers. Beginning in the 18th century, Arab slave trading shipped more than one million Africans out of the ports of Mozambique. Portuguese colonization left 95% of the population illiterate when they won independence in 1975 and left the country in socioeconomic ruin, setting the stage for the 15-year civil war that began two years later, from 1975-1992.
This apartheid sponsored war waged by the rebel group, RENAMO, left 40% of Mozambicans internally displaced and killed over 1 million. RENAMO was funded to inhibit Mozambique from gaining economic independence from South Africa and did so by targeting their transport corridors, which link the surrounding land locked countries to the ports of Mozambique. Thousands of Zimbabwean soldiers were brought into these areas to protect them. Women and children were kidnapped by RENAMO and rape was used as a tool of war. These factors, along with the health care system becoming a prime military target, created a unique situation in Mozambique in which high prevalence rates of HIV emerged in the central region along these transport corridors as opposed to peaking first in the capital city as was the case in other African countries. The long lasting effects of this treacherous civil war, including the return of many refugees that fled, as well as the continuation of a migrant labor system that disrupts stable family units, foster conditions that make Moz exceptionally vulnerable to the spread of HIV.
The prevalence of HIV in Mozambique is 11.5%, and can reach up to 25% in some districts. Women are 4 times more likely to become infected as their male counterparts. PEPFAR is now focusing efforts on “micro-epidemics” or areas within countries that have the highest number of PLWHA (Persons Living with HIV/AIDS), many of which still include these transport corridors.
Kevin and I are here collecting data on behalf of CDC and PEPFAR on how money is being used through implementing partners. These organizations are awarded PEPFAR funds and are responsible for distributing them to sites in their designated province. Our job is to visit the IPs and sites they support to gain a better understanding of how funds are used. This is down to the level of detail of the cost of providing cotton wool to personnel salary to blood transport, and so on. Blood transport in these regions involve a man on a motorbike and a long dusty road.
We are assigned the Zambezia, Sofala, and Xai Xai provinces and visit 6 sites total. We just finished up in Zambezia and were a bit disappointed we were not sent to the site on the other side of the river that required us to traverse crocodile and hippo infested waters on a small fishing boat. We appreciate a good adventure. It is difficult to keep foreign staff at that site for some reason. A doctor stationed there just resigned so there is an opening for those interested.
We are currently at a beach in Beira, the second largest city in Moz. This weekend we finally have some time to explore a bit on our own. We rode a txopela (rickshaw) today to get to the beach and reveled in its openness to this bustling city, only an arms length from pedestrians, stray animals and cars, feeling every bump and hole of the unpaved roads, hearing the music blasting from people ready for the weekend, and smelling all the smells. At some point though, we really need to sleep.