Bill Frist. MD
Today was our last day in Mozambique. The last time I was in this country I led a large bipartisan Senate delegation introducing my colleagues to five countries in Southern Africa. That was four years ago. We spent a couple of nights in Maputo then, but on this trip we have made a point to travel outside of the capital city to different parts of the country. This is possible because of the single-engine Caravan plane and the dedicated missionary pilots of AIM AIR who have flown us places that would have been impossible to visit.
On the current trip we first traveled to Chimoio, just adjacent to the Zimbabwe border in central Mozambique, then to the capitol city Maputo, and then we flew north about four hours (it’s a long country) to Nampula where we were yesterday, reviewing the Millennium Challenge Corporation compact, which will begin to be implemented in mid-September.
We left Nampula early this morning and went to the airport for our one hour flight to Nacala. Nacala is on the eastern coast of Mozambique, and it has a huge natural port that is extraordinarily deep. There is no commercial traffic yet because the town is so remote, but I predict in 10 years it will be a significant port. Flying in, one could see that with the deep waters and inviting shape and large size, it will be inevitable that with appropriate roads coming in, it will be a popular port.
We spent the day in Nacala, and a remarkable day it was. Save the Children has been active for a number of years in the Nacala region and it shows. We first went to the Matalane community, where the community leaders showed us what all Save had done. From an educational session on family planning and respect for women, to a lively cooking demonstration in which women are instructed how to make a nutritious and healthy (enriching with peanuts, greens, a bit of oil (vitamin A)) porridge for the young children (for growth and healthier immune systems), to, my favorite, a household visit with a community health worker, we witnessed the pride and hope that comes from empowering people to help themselves. This is what Save the Children is all about. We also visited a school for young children; Save built three extra rooms for the community which permitted expansion of the total population from 500 to 800 children, with most of the additional 300 being young girls. We visited a birthing clinic and saw the education for prenatal moms to care for their babies. This included keeping the newborns warm with baby caps. Save the Children in the United States has started a wonderful tradition of women knitters around the country making baby caps that can be worn to combat hypothermia (yes, even in hot climates these caps are life-saving).
Save the Children focuses on the community health worker – a member of the community who is trained to help look after others in the community. A single community health worker, which by the way costs only about $100 to totally train, can care for hundreds in his community and save an estimated 20 lives over the time of his or her service. What a return on investment!
Just one story that puts it all together for me:
We traveled with Sam, a community health worker, to a home. Sam wore a white coat and carried a simple canvas bag with low-tech, inexpensive health supplies. He was known by the household because he grew up near and now lives in the same community. When we arrived at the one room, mud brick house with a thatched roof that you had to duck under the overhanging to get inside, just outside and adjacent the door (which was a blanket) was a beautiful woman, a mother, sitting on the ground next to her three young boys, probably about 4, 6 and 8 years old.
As I approached with Richard Dixon, the regional program manager for Save, and John Grabowski, Save’s articulate Mozambique director, I heard a hacking cough coming from the four huddled together out front. I couldn’t tell which one was coughing because of the bright sun in my eyes, but I heard Sam introduce himself to the family and immediately reach out and touch the 6 year old boy, whose cough pierced the conversation every 10 seconds or so.
After learning that the mother was the head of this single parent household, Sam asked what the problem was. He asked the mom for the child’s vaccination card, and mom went back in the small home and returned a minute later with the bright yellow card. Sam looking at the card found all vaccinations were up to date. Sam took the boy’s pulse, using a watch with second hand, provided by Save. He then, after having the boy remove his shirt, counted the boy’s respirations over a minute, a simple procedure he was taught to do (and a powerful one diagnostically) and said that the boy needed to go to the local health facility to be treated with antibiotics. Mom smiled with relief realizing her son would get better.
Of the 27,000 children who die every day in the world, pneumonia is the number one killer. Sam knew that this child could be cured with 20 cents worth of antibiotics! He sent word for transportation and very soon a “bicycle-ambulance” arrived (a bicycle pulling a stretcher on wheels). Before loading the boy, Sam asked mom if she had the ingredients to make a home-remedy cough syrup to take to give him some relief for the journey to the hospital. I couldn’t understand the recipe (all conversations took two translators to finally get to English for me to understand--- the local language into Mozambique language and then to English), but mom went in again and came back with an elixir of some sort and an onion. She did not have whatever Sam had requested as ingredients. So Sam said the best thing to do was just get to the clinic, miles away.
The boy was loaded on the stretcher. Mom gathered her belongings in a huge clear, what looked like, garbage bag, and off the family went to the clinic for antibiotics. Sam may have just saved the little boy’s life.
This tells it all. Someone back in the U.S. probably contributed to Save the Children, which in turn hired country director, John Grabowski, who saw to it that community health workers like Sam were trained. The Sams of the world are not American; they are trusted and respected members within their community, and they are equipped with the knowledge and the necessary supplies (total cost $25 of supplies). The community health worker can diagnose the “big” killers in children (pneumonia, diarrhea, and malaria) and can arrange for treatment – which literally saves lives.
So here I am in Mozambique, a heart and lung transplant surgeon, who is accustomed to saving lives, but doing so at a cost of about $100,000 each. What amazes me is that, of the 10 million children who die every year under the age of 5, more than 2/3 can be saved by inexpensive, proven measures like antibiotics, caps for newborns to wear to prevent hypothermia, Vitamin A, and vaccines. Pretty inexpensive treatments to save a life.
When I get home in a few weeks, I need to figure out how to tell this message so everyone in America understands it. There is something you can do to save a child; maybe you can help me spread the word.