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MOZAMBIQUE: Quiet Progress Against HIV/AIDS

Jessie Boylan

COBUE, Mozambique, Oct 31 2009 (IPS) - When Dorothy Kakongwe smiles, her creases tell stories no history book can recount. This elderly nurse can reflect on numerous changes in the landscape and people around her.

Nurse Dorothy Kakongwe is seeing the fruit of basic training and education in rural communities of Niassa province. Credit:  Jessie Boylan/IPS

Nurse Dorothy Kakongwe is seeing the fruit of basic training and education in rural communities of Niassa province. Credit: Jessie Boylan/IPS

"I've worked for 18 years in Cobue, and I’ve seen a lot of changes," said Kakongwe, who trained in Tanzania and is now working as a government nurse.

"During the war, everyone was living in the bush," she said. "It was very hard. The sick people would have to come to where we were hiding. Women would give birth in the bush."

With limited understanding of and education on health, many illnesses went undiagnosed and untreated, including AIDS.

"AIDS was there during the civil war," said Kakongwe, "but people didn't know anything about it. We know because people are going through the same experiences now as they were then."

In the years following the end of the civil war in 1992, people started to drift back into the region, bringing with them new knowledge from countries to which they had fled, like Malawi, South Africa, Zimbabwe and Tanzania. With this influx and new policy from the FRELIMO government, development and education slowly resumed.

But Niassa Province has seen significant advances in health education, training and treatment over the past five years.

The number of people dying from or infected with HIV/AIDS has dropped significantly; the reasons behind this are an inspiring example of how a region can successfully work towards the Millennium Development Goals (MDGs).

"Today a seven-year-old boy came in with his mother," said Kakongwe. "He has been feeling as if he has malaria for some time. We asked if we could take a blood test today, because he's been here a lot, and found that he is HIV-positive. His parents don't know yet. I have to go and tell them now."

It is a common story that children infected by the virus have parents who were afraid of or unaware of the implications of their own condition.

"I've been working here for five years," said Adriano Aidau, a volunteer nurse at the Cobue clinic, "since Dr Peg Cumberland started her programme here. I've never been to any school to study medicine. I've learnt all I know from Dr Peg."

Aidau is one of about 400 people trained by English doctor Peg Cumberland, who came to the region in 2004 after the Anglican Church told her of the severe lack of health education and services in the region.

"I've seen a big change in the understanding of HIV/AIDS in this area," Aidau continued. "I was born and grew up here, so I used to see the type of problems they had in the communities. There used to be a much higher death rate, from what we now know to be AIDS, and it has definitely changed."

The team of volunteers works in 43 communities, along 143 kilometres of the lakeshore, to deliver health services and counselling. Most of the villages can be reached only on foot or by boat.

Transport and access to health services are also huge factors for rural communities in getting tested and treated. Likoma Island in Malawi (a few hours' boat ride from Cobue) used to be the only reasonable health centre in the area.

"For people to come here (to Cobue) to get drugs or get treated from far-away villages is very difficult," said Aidau. "There was a man who came here from Ngofi, five hours' walk north from here. He was paralysed, and people had to carry him. We found he was HIV-positive and his immune system was very low. He had to stay here for three months for treatment, but now he can walk again and left just today."

In many communities there are health outposts which give basic medical care and counselling, and by the end of the year five of these outposts will be able to do HIV testing.

"A lot of people are HIV-positive due to promiscuity, but we have been doing a lot of training and education to widen the understanding, and we are seeing change," said Aidau. "Dr Peg's programme has helped a lot of people in this region, and made a huge impact."

Cumberland is held in high esteem throughout the region for her work: her approach has been simple, but required patience, perseverance and will. Some of the most obvious solutions to reduce the number of people affected by HIV are often the hardest to apply.

"What helped the huge turnaround," Cumberland said, "was just starting to talk about the issues, starting with the scientific facts. Also us identifying who is suffering from HIV, and the way that my colleagues have treated everybody – with acceptance, compassion and no discrimination. That's how we should treat this issue.

"As treatment has become available, people have realised there are huge advantages to getting tested and treated. And they see people able to be open about having HIV, yet still be respected and accepted members of the community."

Cumberland has always respected local customs and involved local chiefs in the processes, which has proved very useful and important.

"We had one situation where a woman found to be HIV-positive had been living in her mother's house, and her mother threw her out. We involved the chief and the health committee in sitting and discussing with the mother and other members of the family that it wasn't a necessary or appropriate way to act. The woman was welcomed back," said Cumberland.

Increasing knowledge and breaking down the stigma of HIV is a huge task which needs dedicated and consistent work. Mathias Hamouli and Maria Mcambula are two more Cumberland-trained volunteers working specifically with HIV/AIDS in the communities.

"At first there were many problems," said Mcambula, outside the training centre in Cobue, where many outpost volunteers have come for meetings. "People were getting sick and didn't know what was happening.

Although statistics are not precisely recorded, Hamouli and Mcambula have been keeping track of them. "In four years we have had a big drop [in HIV cases]. In 2005 we had 19 people die of AIDS, and in 2009 so far we've had four."

"The main cause is a lack of knowledge," Hamouli said. "But since we've done the training, people know about the ways they can contract the virus, which has helped."

Hamouli and Mcambula are clearly proud of their work, but believe more funding and volunteers are needed to further reduce HIV/AIDS infection rates.

Although the government provides test kits to the outposts and clinics, some people are still afraid to get tested. "If people say they haven't got the money for the tests or treatment, it's an excuse, because it's provided anyway," said Cumberland.

Perhaps the most important aspect of their success is that the infrastructure they've set up can be built upon. "It's having this infrastructure which gives people a way of accessing knowledge and services," said Dr Cumberland.

"I don't think we want to get a lot more sophisticated in terms of services that we have than we are already. It's more that about getting things working sustainably.

"I think the next challenge is how much can we move it out into other areas, and essentially without me being there. This is already happening – the volunteers do most of the training and treatment in the remote areas now, and that's great."

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