Stories From the Field
November 10, 2010:
Ocua Health Center, Chiure District, Cabo Delgado Province
Tina Goncalvez is the mother of four children. Her youngest is 4-months old. Today Tina arrived at the Ocua health center for a check-up, which includes evaluating the baby for its growth, administering vaccines, and vitamin A as needed.
Tina lives 5 miles from the health center in the village of Napopo. Tina and her husband are subsistence farmers. They have no transportation. The trip to the health center took her two hours to walk from her home. Today she arrived at 7 am to ensure she could return home early enough in the day to care for the rest of her children.
November 1, 2010:
Typical Day in the Field:
Field coordinators are responsible for the supporting health centers across a number of districts in a province. During a typical day they travel from one health center to another, delivering medical commodities and recording inventory in the health centers. A Field Coordinator may drive as much as 100 miles a day on rough dirt roads. Each health center is visited once each month.
Field Coordinators typically starts their day at 5am, especially if they have to drive to a different district, which may be hundreds of miles away. They start by checking their vehicles – 4 x 4 pick-up trucks – to ensure they have sufficient fuel and are fully maintained for the journey. The coordinators check their existing supplies of vaccines and purchase fuel and water and bread – sometimes a can of sardines - they will need for the trip.
If they are already in the district where they will be distributing medical supplies, then they arrive at the district hospital by 7 a.m. At the hospital they will meet the regional PAV chief and the district director and collect any additional necessary supplies needed for the rural health centers. The field coordinators will review what issues are of priority in the district, and ask what they should be paying attention to in the health units. At the hospitals the field coordinators will check the operations of refrigerators – used to maintain cooler temperature levels for vaccines – confirm available stocks of supplies, and check to see if data on inventory and equipment maintenance is being properly recorded.
Throughout Mozambique there are thousands of remote health centers. In Cabo Delgado, the population of 1.7 million is supported by 118 health centers covering 16 districts. It may take several hours to reach the most remote health centers.
The trip is hot and dusty and the roads are extremely rough. The trucks can rarely drive more than 25 mph. The truck is constantly dodging potholes and swerving left and right. The driving is extremely physically demanding.
When the field coordinators arrive, they typically require an hour to record inventory levels, deliver supplies, including vaccines, medicines, medical equipment and propane.
But the time required to complete the support for a health center can take much longer than an hour … there are often problems with staff being busy or absent. Field Coordinators are also tasked with reviewing data records for each health center. Because of the many activities the health workers are tasked with, data may not be recorded properly, requiring the Field Coordinators to spend more time at the health center to determine an accurate evaluation of consumption of supplies.
Outside the health center, long lines of patients are common. Mothers sit on the ground waiting with their children that are often half dressed because they have to be weighed naked. Often by 11am under 5 patient visits have concluded.
After visiting the health centers, the Field Coordinators return to the district and report on their findings, giving recommendations of what needs to be addressed.
They generally return to their hotel at 7pm. The “hotels” are generally without running water, although some have generators.
Most days the Field Coordinators are covered with dust. They will clean up, eat dinner, and go to bed.
Alfredo Durão Sahate Nunleque (Durão)
Cabo Delgado Field Officer