Tuesday, July 10, 2012

The Train

It is rumored by some fellow PCVs that Mozambique runs one of the only passenger trains left in this part of Africa. I have been reading my Mozambique guidebooks and have not found anything to confirm this, but I do know that the train I took last week is AWESOME.

Mozambique is a large country, with most of its area stretching from north to south, with most of the development in the south, stemming from bustling Maputo, the capital, which lies practically on the country’s southern border with South Africa. Most of the traffic and roads that are passable and frequented take people in this longitude-direction. In the far north, there are not many paved roads and a promising throughway east to west is only traversable with a private car, and even then, not at all times of year. Because of all this, the train, which takes you from Nampula (Mozambique’s third largest city and about 150-200km from a large industrial port on the Indian Ocean) west to Cuamba (an extremely dusty, wild-west-esque town that lies at the south of a province that is mostly pure bush and wild reserves, but which also borders Malawi and Lake Malawi). Therefore, this form of transport is highly utilized by people wanting to travel east to west, and it brings a lot of produce and other goodies to this more humble, northern part of the country. One of the PCVs that live in Cuamba is a walking billboard for the train, so a few friends and I decided to take it, and then visit the famously beautiful lake.

We got to the train station at 4am with our second-class tickets in hand. Second-class is the highest class offered, and sometimes it is not even an option. Third-class is much cheaper, but you are packed in on hard wooden benches, well over-capacity, and with ever-accumulating sacks of onions, beans, corn, and more. So we broke the bank and spent the extra $8 to travel in the “lap of luxury:” second-class. We were three people, and got our own little room with a futon-like padded bed/seat. We spent the 11-hour ride lounging with our feet up, playing cards, drinking beer, and eating the food that could be bought through the window at every stop. Or we could often be found standing in the hallway, with our heads out the window, taking in the breathtaking, mountainous scenery. The train traveled at a grand-spanking 30-40mph and had some technical problems, but we didn’t care. Honestly, it was the most comfortable travel experience I have ever had (there is even a cantina that sells beer and half-chicken with fried potatoes! Imagine that, Mozambique). Yes, on a 10-hour international flight, you now get your own personal TV and movie selection, and free drinks, but you are still sitting immobile in a 2ft by 2ft box when in economy class. This was like having our own living room as we rumbled, grumbled, and bumped along, with the whole 2 cars we witnessed on the adjacent road all day, easily passing us (it is the dry season, however, and thus the roads are a little easier to maneuver). Some of the train stops are probably only denoted by an interesting looking-tree, but others have cement 1-room stations. At every stop, there are women and children selling food through the windows: large, discounted quantities of tomatoes, carrots, and onions; huge sacks of who knows what; and snacks, which we eagerly bought up: boiled eggs, roasted peanuts, tangerines, oranges, bananas, bread, Mozambican falafel, etc. I. LOVE. THE. TRAIN. Really though, the train should be featured on a travel show, and should be a hit with the truly fledgling tourist-industry here.

I have also been continuing to volunteer at the hospital, and every time, I notice new things. The women bring these forms to their pre-natal visits, of which they usually get 1 or 2 during their pregnancies, and children have cards to keep track of weight, vaccinations, de-worming meds, vitamin A doses, etc. And it makes sense, there are no computers to store the information, but on the other hand, the majority of the people frequenting a health posts out in the bush are illiterate. They don’t know their age, which is why women with 7 children will say they are 20 years old, they rarely speak Portuguese, and they cannot read or understand the date that is listed for them to return for their next consult. But what are Irma and I to do? Neither of us is from northern Zamb├ęzia (Irma is from a neighboring province) and therefore we don’t speak the local language. So we try our best. As opposed to the education system, I believe that even a half-assed health system is better than nothing. Even if all we accomplished in five hours was giving 30 babies vaccines against polio and giving out 30 packets of birth control (to women who think they don’t have to take it on days they don’t have sex or if their husband if not there, because they don’t understand the instructions we give them…), that is still something important. Even if the infant or maternal mortality rate is lowered only by 1% because of this health post, its existence and the work the small staff does are justified. But I have recently had an internal debate. Apparently, the measles vaccine, once the bottle is opened, must be administered that same day. So if they only administer 2 doses out of a 10-dose bottle, they have wasted 8 whole vaccines and run out before their new Ministry of Health/UniCef shipment. So they implemented a new system: they only offer the measles vaccine on Fridays. At first glance, this seems to make sense. But everyday, women come in from 3 hours away to get the vaccine and Irma tells them to come back on Friday. Now, even if they understood the words Irma said, because they attended at least some school, they inevitably don’t have anything that tells them the date at home. So I assume many do not come back on the right day and many babies are without the measles vaccine even though the health post has it in stock. So which is better: giving out the vaccine everyday and running out before the end of each month because of the wasted doses, or only giving it out to the people who happen to be there on Fridays? Which system inoculates more babies? I am truly searching for an answer. Yet it seems to be a veritable conundrum that can only be solved with a statistical study that I have no desire to instigate.

I asked Irma why women come from so far to the Invinha health post when they have them in other towns nearby. Her answer: 1. They like to have a nun around and 2. Because our health post employees steal less of the medications than they give out. Apparently, other health workers throughout the country (and I assume the continent) steal the meds and sell them to people who need them at a higher price than the almost miniscule fee they are supposed to give them out for at the health post. The supply runs out quickly and only those with money are getting meds. Invinha is famous for actually giving out vaccines and medications, and only stealing a little. I’m glad that is the bar upon which a trustworthy, health center is judged at.

In the US, I feel like doctors, nurses, and family members are very supportive and encouraging of a woman in labor. Here, they are not. They leave them be and really the only interaction between nurse or traditional midwife and patient is to check how many centimeters she is. So here I come, white, with no nursing experience, and I am holding women’s hands and telling them things I think might motivate them about how great they are doing. And every single time, Irma, the other female nurse, and the 2 traditional midwives laugh and make fun of me. And I only slightly care because I just can’t sit back and watch women in pain, screaming in Elomwe about who knows what, without trying to give them some support. Here, the family members that come with the women to the health post to give birth (friend, sister, mother, aunt, or other random female relative) must stay outside, shooting the shit with the other relatives-in-waiting, cooking over fires, and only entering the birthing room to give sips of water and capulana to the screeching women. But they form a small community out there, as I assume men in the 50s in the US did, though instead of cigars and scotch, they have corn mush and sugar cane.

 I would like to dedicate this post to my grandma Ruth, a true matriarch, and an absolutely incredible grandmother, mother, wife, and so much more. I love you and miss you and am doing my best to approximate a version of the world´s best stuffing.

1 comment:

  1. Maybe give them out on 2 or 3 days a week rather than just fridays. It seems like it would increase the chances that some woman+baby would arrive on that day, but not be as wasteful as giving it out everyday. Or maybe only give it out on fridays unless there is at least 3 women+babies around to vaccinate or something. I dunno its a very hard decision.

    Also, there is this huge colorful mural outside my house (I'm working in Chile for the summer by the way) of people on a train and it says 'Happy Train' and now makes me think of you. I'll have to send you a picture.