Thursday, April 10

Last night we flew back to Maputo and checked into our trusty Holiday Inn. This morning started with a debrief back at the UNICEF office. Everyone was very pleased with the trip out into the field. They listened to our thoughts and offered some insight of their own. The meeting truly rounded out the week to bring everything back into a positive light. There are 130 people working in the Mozambican UNICEF office and only about 20 are from other countries. This shows the dedication of the people in the country to take care of their children. There is hope, there is progress, and UNICEF just asks of us to continue to spread the word. Talk about this program with your clients, friends, and colleagues. The more people who are aware, the more who get involved, and the closer the organization comes to its goals for the improvement of these children's lives. HIV/AIDS infection in children is virtually eradicated in the developed world, there is no reason, in this age of globablization, that the same can't be true for the rest of the world.

Wednesday, April 9 - Afternoon

This afternoon we visited the Chimoio Day Hospital. This visit really took a toll on all of us. We first spent time with the doctors as they explained what has been going on in the hospital and the new plans for an expanded wing. Next, they led us on a tour of the hospital. I think this tour was more difficult for a number of reasons, in that, the patients were more visibly sick and this really was the culminating experience. I know personally, I was getting frustrated that we weren't able to do more. I felt a bit like a voyeur. We were watching but not helping. With all the need out there is seemed like a waste to not be getting in there with both hands, ready to work. I wanted to clean something or hold someone, help file, basically just something tangible. All these thoughts and emotions were going through my head, when the doctor asked if we would like to walk through the Pediatric AIDS ward. At first, most of our group declined and the doctor looked upset. This appeared to be a case of mixed cultural signals. Those declining felt that was the proper thing to do so as not to disturb the patients. The doctor felt that they were declining because they didn't want to be bothered to see. After a few hesitating moments, it was decided that we would view the ward. Everyone was quiet and cautious as we walked through. The patients and parents simply stared at us. To the FTSE folks, it was a disheartening experience. It just seemed like we weren't doing enough. But the doctor, and later the UNICEF staff, tried to change our perception. The children we saw in the ward were the success story. As sick as they are, they are in the hospital receiving treatment. There are thousands more cases that are being left untreated in villages around the country. The education that FTSE is sponsoring will help bring more to treatment. They also couldn't stress how important it was for us to see, and be able to bring their stories back home. Deep awareness around the globe is what they are desperately hoping for, they believe the more that see and learn, the more who will help. As Patricia said on our last day, "There's hope in Mozambique, there's hope in Africa." And we are part of that change and that hope.

Wednesday, April 9 - Morning

Today was certainly a long day covering a range of emotions. We started out in the morning at the 1 de Maio Health Centre. This clinic, like the Manga-Mascarenhas Health Centre, provides a full range of health care services, but focuses on PMTCT. This treatment includes ARVs for the mother and baby, pyscho-social counseling and support, nutrition counseling for the mother and child, post-natal care including counseling on family planning and follow-up of the child in terms of vaccinations and growth monitoring. I am continually impressed by how they have all the bases covered, of course, the challenge now is getting mothers and families to take advantage of these services. It is difficult as some people have to walk as far as 10km to get to the centre and wait all day long. Mozambique is also still very much a patriarchal society and many women have to get permission from their husbands or fathers before they can even go to the health centre.
This centre was similar to the one from the day before. We met a woman who was walking out with her newborn child. She had just given birth the day before. Patricia asked her how it went, and she said, "It hurt". There is no pain medication for labor in Mozambique.
As we walked around the centre, we noticed little points of continuing education everywhere. They had a TV playing some of the same messages we'd seen the night before, a family planning poster outlining the different options, and another poster on water and sanitation hygiene. The learning never stops.

Tuesday, April 8 - Afternoon

This afternoon we visited GESOM, the Social Education Group in Manica that works closely with UNICEF. Our entire team was very impressed with GESOM's work. This NGO is working on education and awareness of issues across the community, and HIV/AIDS is an obvious focus. The facility includes a radio station, internet cafe, and a rec hall for children's programmes. The most amazing part is that most of these programmes are run by children. We met a group that was working on a programme, the 10 children were ages 11 to 17. They all work at the radio station in all capacities from interviewing, broadcasting, and even the technical side of constructing the equipment. These young people are bringing to light and starting discussions/debate on such issues as HIV/AIDS, cholera prevention, child rights, girl's education, birth registration, promotion of Child-Friendly School initiatives and the Youth-Friendly Health Services. Mozambique has typically had a culture that did not speak openly about these topics, but this practice will no longer work. Knowledge is power. These young people are not only spreading valuable information, but are honing professional skills that can allow them to get better paying jobs in the capital (journalism, business, health work, and more) and continue to spread the knowledge around the country and Mozambique's story around the world. GESOM is also one of the partners that is creating the mobile multimedia units that are bringing these messages to the most isolated parts of the country. After leaving GESOM, we headed to another part of Chimoio where a mobile unit was just beginning their presentation. Apparently the town had been told we were coming and they had an extra large turnout of a few hundred people, and a lot of really young children were allowed to attend as there was a school holiday the next day. (The units will drive through town during the day with a bull horn to drive up attendance) As we walked toward the crowd a huge cheer went up, you really would have thought that we were rock stars. I've never seen so many happy, excited young faces. They had set up folding chairs for us along the inner circle of the crowd and we were immediately surrounded by children. They wanted to get as close as possible, and many were touching and hanging all over us. At one point I had enough children leaning on me that I was almost falling off my chair! I desperately wanted to pull one of the young ones up into my lap, but figured that might have started a bit of chaos. As excited as they were, as soon as the video started the entire crowd fell silent. Most of them had never seen any sort of electronic media and they were riveted. We saw two stories that they told as parables. It was all in Portuguese, but we could understand the messages clearly. The first showed a wife asking her husband to pick up a cocunut for dinner. At the market, the man shakes the cocunut and it sounds like there's milk inside, he brings the cocunut home. When they crack it open there is no milk, and the moral of the story is that just like the cocunut, the face of AIDS may not be visible from the outside. You may look and feel fine, but you should still be tested and have your partner tested as well. The second story had two men breaking down rocks. One man thought he was very clever and picked the smallest rock thinking it would be the easiest to crack and it ended up being the most difficult. The same moral applied. The best part of this presentation was watching the kids. They were laughing, they were engaged, they really got it. It was just so encouraging to see the education being received. It gives you hope. There is a small window of time from about 10-14 years of age, where UNICEF and the other partners are hoping to reach the kids before they become sexually active. Statistics show that girls begin sexual relationships on average by 16.1 years and boys are only slightly later at 17.8 years. The program is focused on HIV/AIDS knowledge, family planning, and child's rights, particulary the right to education where there is a large gender gap right now. Only 48% of girls attend primary school compared to 56% of boys. All in all, the mobile unit was a very refreshing positive experience. They told us of a unit a few weeks back, that had half the group lined up to receive HIV/AIDS counseling and testing in the tents after the presentation. That is a huge improvement for a country that is still battling the stigma of HIV/AIDS.

Tuesday, April 8 - Morning

This morning we woke up to another sunny day. We loaded into the trucks and drove to Manga-Mascarenhas Health Centre. It is mostly an outdoor facility with consultation and examining rooms around the side. There were easily 200 people waiting to be seen and many of them had been there since 5 AM. The health workers said that they will usually stay until 3 PM but never leave until every patient has been seen for the day. There is actually only one doctor in the area that services 35,000 people. This centre is primarily used to treat malnourished children, but of course come across children with HIV as well. It is difficult to treat a child for both malnurtion and HIV. ARVs are difficult to take on an empty stomach, are not well tolerated by a severely malnourished person and are less effective. At the same time, a malnourished patient living with AIDS does not respond to the usual treatment for malnutrition with the therapuetic milk or food as effectively as an HIV-negative patient. We saw many many children and several newborns. One family was off in another area and we had a chance to speak with them. The young girl's name is Mother. She is five years old, and certainly acts like a mother by carrying her younger sibling who is almost half her size. Some of the children came right up to us to say hello, but most would simply look on with curious, solemn faces. From the Nutrition Centre in Beira we drove to Chimoio. A rural town due west in the province of Manica. In the afternoon, Shazanna, Saim, and I took a walk down the street and happened upon another NGO that focuses on HIV and AIDS. We walked up to the porch to take a look at their bulletins and were invited in for a briefing. They have a very similar strategy to UNICEF. (UNICEF mentioned that many smaller organizations will piggyback off their efforts) It works quite well as UNICEF will discover the programs that work and then other organizations initiate them. It was interesting to see the other end of the spectrum as this NGO had very little funding. They are still very committed to battling the challenges of HIV and AIDS in Mozambique.

Monday, April 7

As mentioned, today is Women's Day in Mozambique. It is a day to honor the nation's women who fought for independence from Portugal. The women of our group have decided a nationally recognized Women's Day is needed in our respective countries as well! Despite the holiday, the dedicated staff of UNICEF was willing to come into the office to brief us on the Country Programme for 2007 - 2009. The focus was on the PMTCT and the mobile units' activities as this is where FTSE's donation is being allocated. The UNICEF Country Representative, Leila Pakkala, briefed us on the program, and introduced us to the UNICEF members who would be accompanying us in the field:
Patricia Portela de Souza, UNICEF Programme Communication Specialist
Dezi Mahotas, UNICEF Health Specialist
Gabriel Pereira, UNICEF Communication Officer
The most compelling piece of the briefing that I took away was the comprehensiveness of the programme. Yes there is an HIV/AIDS component but as UNICEF pointed out, one can't work on this issue without looking at the others surrounding it: health and nutrition, water sanitation and hygiene, basic education, and child protection. All of these areas have an HIV/AIDs component. Once a child is born free of HIV, it is important to keep them that way, and enable them to receive an education, have access to clean water, and avoid the other deadly diseases that can inflict young in the area.
Leila ran us through a very thorough presentation that outlined all of the work that UNICEF is embarking on in Mozambique. She gave us some staggering statistics:
- 50% of the country's population is under the age of 18
- HIV is hitting women 3 times more than men
- Mozambique was the poorest country in the world in 1992 but has experienced positive economic growth of 7-9% each year to pull itself up 7 spaces in the world's GDP ranking in just 15 short years
These facts highlight how important UNICEF's work is in this country. The government is strong, growing, and eager to help their population, but the children first have to survive to receive these benefits and continue to develop the nation into the future.
With women contracting HIV at a much high rate, this was the logical choice to focus HIV prevention efforts. When women go to a clinic for pre-natal care, it is a prime time to start prevention. Health workers have the mother's attention so they can receive counseling on family planning, vaccinations, HIV testing, and if positive, PMTCT services that can drop the chances of transferring the virus from 25%down to just 5%. By having these services integrated into one clinic helps the women feel more comfortable and alleviates the stigma associated with HIV/AIDS.

I could probably write a whole report on the information that we received in the briefing, but I will stop for now. There is an excellent PowerPoint presentation, in case anyone is interested. After leaving the UNICEF offices, our group took a tour of Maputo to learn a little about its history and culture. After that it was off to the airport for the next leg of our journey to Beira.

Beria is the second largest city in Mozambique. We arrived late in the evening and while driving to the hotel noticed a strong difference to Maputo. Patricia noticed our stares and remarked, "This is the real Mozambique". The city is significantly poorer with no tourist dollars coming in, the dirt roads and crumbling housing structures were evidence to that fact. After checking in we walked down the street for a quick dinner where a restaurant stayed open just to serve us. Tomorrow we visit the first clinic, Manga-Mascarenhas Health Centre.

Sunday, April 6

The team met at the airport in Johannesburg for our short flight to Maputo, Mozambique. For a quick introduction to the team:
Sandra Steel, FTSE based London, Head of External Relations
Shazanna Safdar-Karim, FTSE based London, Legal Counsel
Saim Ghouse, FTSE based London, Data Analyst, Operations
Charlene Low, FTSE Asia Pacific, Senior Sales Manager
Meghan Watts, FTSE Americas, Marketing Associate
My first impression of Maputo was its similarity to a Carribbean island with colorful houses and the close proximity to the beach. The following day was a bank holiday in Mozambique and as we drove to dinner the beach was lined with people enjoying the evening with barbeques, music, and dance.