No time for grief - Volunteering with the nurses at the Vilanculos hospital

[I originally wrote this post in September 2015 and kept it private. I am posting now for your review].

The first thing you always noticed when walking through the double doors and into the darkened hallway was the smell. The sickeningly sweet wash of formaldehyde, the slight bite of antiseptic, and a weighty, warm, sour aroma I eventually realized was the smell of rotting flesh.  It was a smell that embedded itself into your clothing, into your hair – so pungent and domineering that upon arriving back home after my first shift, I in a frenzy and on the verge of tears, stripped off my clothes and threw myself into the shower. My white lab coat, crumpled dejectedly on the floor, glowered, accusingly in silence as I scrubbed my naked, sunburned, sweaty body and scalp with such ferocity I imagined the molecules of disease, death, and heartbreak washing down the drain with the hot suds. 

I volunteered at the Hospital Rural de Vilanculos for two months in early 2015 and it was during this time that my understanding of the true nature of Mozambique’s poverty deepened tremendously. Because, as one woman told me, “As pessoas chegam aqui para morrer”- people come to the hospital to die. It's safe to say Mozambican's don't expect much from their healthcare system - one of the main reasons cuninderos - witchdoctors - remain so influential.

As I’ve written before in other posts, the problems plaguing the Mozambican health care system are numerous and complex. From the theft and selling of state-sponsored medicines on the black-market, to doctors having to bridge the gap between science and popular beliefs in witch-doctors and magic, to a lack of consistent patient education crucial for patient treatment adherence -  each of these topics could easily boast their own million dollar research grants.  This post is not to dissect those problems. It is instead to document my observations and people I met there there. 

My day would start with a brisk walk to work along the palm-treed sandy roads of the bairos, curling my toes through deep patches trying to keep the sand out of my not-so-white shoes. Dressed in my bata, I would get nods from other commuters, nods sent as expressions of respect to the white coat and all that it symbolized - education, authority, knowledge, power. "Doctora!" they would shout, waving. "Nao sou uma doctora... I'm not a doctor," I would reply abashedly. But they'd already be gone, dodging behind the next corrigated metal loja for a shortcut.

Walking through the gates of the hospital and through the open-aired waiting room, my eyes would be met with the sight of hundreds of people already waiting for  consultations. These consultations are served on a first-come, first-serve basis, so unless you are literally dying, you have to wait your turn like everybody else. But of course, you don't really just "wait your turn." The minute anyone with any sort of VIP status, whether its the friend of the second-cousin twice removed of one of surgeons, or the son of the mayor,  receiving prompt medical care is largely who you know. And if you don't happen to have any connections, then resign yourself to finding a bench or what little standing room is left.

I was able to drift through the hospital unquestioned - my presence tolerated because of my estrangeira privilege, and because frankly the nurses could use as much help as they could get. Even a white girl with a soft heart and soft hands.

And so, I did as I was told - to fetch this and grab that. Traga this, traga that. Consequentially, I was given an unparalleled opportunity to observe and witness the stories of the men, women, and children from across the northern province seeking care.

My mentors were Nera and Hortencio - bright and pragmatic nurses who ran the front-lines on the TB, HIV and infectious diseases ward. I was their shadow - glued to their hip, like a child clinging to a mother's skirt. Sights, sounds, and smells I often found overwhelming and upsetting caused them to hardly bat an eye. I wouldn't say that they suffered from compassion fatigue (but maybe). Rather, there was simply no time to grieve for each new life-changing diagnosis. They delivered HIV diagnoses to patients like one gives their spouse a routine honey-do-list. Mana, you are not pregnant. But, oh by the way, the test indicated that you are positive for HIV. But don't worry, we can treat it. Let's start with this... And you need to stop by the farmacia...

No time for grief. Just triage.

Next person. Next day. Next fight. Next life.

Heal them. Lose them. Either way another bed will become empty and be filled again tomorrow.

What struck me more than anything, was the degree of such meaningless loss. From loss of limb to loss of life. That as amazing and heroic as the hospital staff were, they could never give their patients the best possible care because the system in which they were operating gave them insurmountable odds. I remember how typical it was for the electricity to go out in the middle of someone's surgery. Nera would say a little prayer under her breath when it happened. If you were lucky, the generator would be started up. But that would only happen if someone had filled it up with gas. Gas costs money and the little money the hospital had may or may not have gone toward filling the generator.  I saw a grandmother in her 70s get her leg amputated with only minimal morphine. The doctor didn't want to "waste" any more on her than necessary because she was old, and he'd rather it go to someone young with many more years left to live. Her pain and agony is something I will never forget.

Add to that the death of my dear friend Hermenigilda in childbirth a year into my time in Moz.

And the near death of my friend Joana from sepsis that was poorly diagnosed and treated.

There are too many other stories to count. Loss adds up, especially when it's personal.

It's these encounters with preventable death, preventable loss that make me angry. Angry that this injustice is a reality for so many. Angry because even a few minor changes would have a huge impact in saving lives and improving quality of life.

Living with anger ultimately however makes you humble because you know what it means to feel powerless. Ultimately, it makes you realize that there are only a few things in this crazy world that you have any actual control over. Suddenly those few things give you hope. Hope that if you act to the best of your ability in the things that you have control over, you can stare down these everyday cruelties. Stare them down and fight them back into the abyss.

Hospital rural de Vilanculos taught me all these things, and affirmed my desire to pursue nursing school. One day, I hope I can give back all that it gave me and more.