Pilot's Logbook: The Doctor is... In

Crowd that gathered at the airport while we were waiting for the plane to arrive

The week before last, I had the opportunity to fly out to the District of Gurué with one of the doctors that MAF flies on a regular basis. Located west of Nampula in the Zambezia Province (about an hour and fifteen minute flight in the Cessna 206), the area is characterized by beautiful mountains, tea and macadamia tree plantations, and huge stands of eucalyptus trees.

We were scheduled to take off at 6:30am. While Dave prepped the plane, Dr. Hanneke Dekker went to the hospital to pick up the patient that had been brought to Nampula on the previous return trip from Gurué. As Dave went through his run-up, he discovered a problem with the plane. Fortunately, the Cessna 210 was available, so off we went, leaving Dave with wrench in hand to work out the problem on the 206. Although I didn’t get to fly with my Dave that morning, I did get to be “co-pilot” with the veteran Dave, our Program Manager, and he even let me take the controls for a bit :)!

Upon arrival, we were picked up in the medical team’s Land Rover and the first stop was the hospital in town of Gurué. Here Hanneke does ultrasounds with her portable equipment each visit because the hospital does not have ultrasound equipment. We also picked up plastic boxes of medicines that are stored at the hospital’s pharmacy that she would use at the various clinics throughout the week. We also met up with José, a Mozambican who knows the local language and assists quite a bit with the patients.

The doctors rotate between 12 villages where one afternoon they will make house calls, visiting patients who are too ill to travel to the clinic. Each village has a volunteer (Activista de Saude) who help locate which patients need visits in their village. This week, the Activista organized a town-hall style meeting where they discussed the methods of preventing diarrhea and the importance of building latrines and afterwards Hanneke examined several patients.

Folks gathered from the village for the meeting

The next day we headed out through the mountains to a remote area that is approximately a 2 hour walk from the nearest clinic. On our way, we hit a muddy spot in the road and got the Land Rover stuck. An hour and half later and with the help of a dozen folks who wandered out to watch and help, we were “un-stuck” and back on the road.

Does this really need a caption?

As we neared the make-shift clinic, we met up with the queen of the village, who rode with us to the clinic along with another patient. Our delay was unfortunate because the doctors are only here one afternoon twice a month so you can imagine the number of people that wait for a turn to see the doctor. Because we arrived late, we stayed late, and as dusk was approaching Hanneke and José quickly administered malaria tests to babies, knowing that if they didn’t get the meds, the outlook might not be good.

Arrival at the remote clinic

Queen of the village

The following day, on our way to another clinic, we dropped off letters at a couple of schools in the area to find out if they would like to have a visit from the dentists to talk about good dental health. When we arrived at the clinic, we saw that a tree had fallen on the building and collapsed a corner of the building since the last visit, but fortunately the examining room was still usable. Again, there were more patients waiting for a turn with the doctor than there was time.

Dropping off a letter at the school

Clinic hit by the tree

People waiting their turn to see the doctor (tea plantation in background)

That afternoon, the Activistas from the various villages traveled to the old tea factory for a training session. The topic of the day was nutrition and diarrhea prevention. Afterwards, they took a test so the doctors could see how effective the training sessions have been. A t-shirt and cap was given to each volunteer so they could be identified in their village as they go back to encourage others to have healthier lifestyles.


Activista and her daughter sporting her new cap

Activistas with their new shirts and hats

The last morning before leaving, we visited one more clinic. This clinic has a medical assistant available and can see patients even when the doctors aren’t in town. But even this isn’t without problems as the assistant told us that they had already run out of malaria medicine earlier that week.

Examining room at one of the clinics

After several days just being a fly on the wall, watching Hanneke diagnose patients (occasionally I counted out pills or carried equipment), I gained a new understanding of the culture and the challenges of practicing medicine in rural Mozambique. Sometimes people come to see the doctor much too late and at other times for almost no reason at all. One man had a burn wound that was several years old and the skin had healed in such a fashion that he could no longer bend his arm at the elbow or shoulder. Some are hopeful for a magical cure (as evidenced by the scars left behind by the traditional healers) for problems that have no simple cure. I watched a man learn he tested positive for HIV but couldn’t discern if he really understood the gravity of the disease. Will he find a way to get to the hospital in Gurué for treatment when it is over an hour’s drive away? Multiple people came in with aches and pains making me realize how much I take my bottle of Ibuprofen for granted. A simple sore knee is not so simple when you walk everywhere you need to go, often carrying heavy loads of water and supplies. Many folks suffered headaches solely because of dehydration or had sick babies only because of malnutrition. But did they understand the simple advice of the doctor or would they go back to the witch doctor for a “better cure”? I watched the emotion on a woman’s face as she learned she was pregnant (her only other child was 18) and couldn’t tell if she was happy or sad, amazed or shocked. I saw parents bringing in children with mental disorders hopeful that the doctor could make them normal again. An older gentleman came in with his Bible in hand, hoping for some reading glasses, and he left smiling knowing that he could once again read God’s Word. One woman brought in a baby with a severely infected eye that was not responding to the antibiotics. Will that baby end up losing its sight? One woman and her four year old daughter came in each carrying one of her twin infants. She had walked to a different clinic the day before only to find they were out of the malaria tests so she had walked several hours that day to the clinic we were at. Listening to Hanneke ask the patients questions, I was shocked at some of the answers. Many mothers don’t know how many months old their babies are, many children don’t know how many years old they are (often the parent would make a guess), and sometimes the symptoms were blamed on evil spirits.

Hanneke and Jose administering malaria tests

The clinics are simple, just an examining room with a table and a place for the patient to lie down to be examined. No running water, just a bucket of water and some soap in the corner. The pharmacy consisted of the plastic boxes of common medications that the doctor would sort through, hopefully finding the right one. The next time you visit your sterile, fully equipped doctor’s office, say a prayer for Dr. Hanneke and Dr. Pim as they practice medicine under these challenging circumstances. The next time you complain about sitting in the air conditioned waiting room watching TV, instead pray for patients here who walk for hours and would wait the day to see the doctor. And the next time you grab for that bottle in your medicine cabinet, remember those who can’t just run to the drug store to soothe their aches and pains. I know I will!