The Mobile Clinic

I love the efficiency of the Mobile Clinic, sponsored by Columbia University, PEPFAR, the CDC and the Mozambican government.  My colleagues normally insist that I sit up front to enjoy the air conditioning and the area views from on high.  But, I prefer to sit in the back of the vehicle.

Mobile Clinic - side door for vaccinations

The small chairs fold down and we strap ourselves in for the bumpy journey.   The drawers latch shut, keeping medicines and stethoscopes and log books in place.  Folding chairs supplied by a major USA camping outfit are stored neatly in between the cabinets.  The heavy metal ladders that allow us to exit and enter the side and rear of the van lock into the floor.

Enter here to begin with consults 

I look out the window and see only the tops of coconut trees and blue skies that are full of puffy white clouds, the kind of clouds that make you feel like an eight year old girl, the kind of girl that dreams of unicorns and fairies and purple ponies.  The litter-lined streets and the mud houses and the throngs of people moving along the side of the road don’t exist for the moment.  The chaos of Mozambique is far, far away when I sit inside this well-organized, expensive and sterile mobile medical unit.

The place we are travelling to, and where we will dispense medicines and provide consults for the day, has been built in a cleared area.  Trees have been felled to make room for hundreds of tents.   Severed trees and stumps sharply stick out of the land, fooling one to believe that the flood had violently torn them away.  But this area is above the flood zone.  The damage to the land was made by man, for man.  Cooking fires smoke in front of the heavy canvas and plastic tents as the residents sit languidly on tree limbs, their gaze lost to the smoke and embers.  The scene is straight out of a low budget apocalypse film.

Outdoor Cooking Station

Surveying local families

Our team of five visits a handful of tents to survey them about their conditions.  We ask if they received mosquito nets, and if so, we request to look inside to verify that they are in use and hung properly.  We quiz the residents on the use of the water purifier and ask if anyone in the household has had malaria in the past two weeks.  Half of the families are not using the nets.  They tell us their daughter has taken the net to the river for washing.  We explain that the nets do not have to be washed for the first three months.  They were distributed only a few weeks ago.  Likely the nets are being safe-guarded by the family, as a prized possession, or they have been sold.  Only a handful of those asked know how to use the water sanitizer.  Most of the bottles are yet unopened.

Raised bed with mosquito netting

Tent wtih no flooring, mosquito netting tied to tent posts

Mosquito netting over straw mat

Wordly Possessions

The tents have no flooring and no ventilation.  For those using the nets, they sleep on straw mats and tuck the sides of the netting underneath them.  One family built a raised bed, meant for four, with the net hanging from the ceiling rafter.  Plastic water jugs and plastic plates and cups sit to the side of the tent.  The blankets are used as doors.  Some families drag large pieces of trees indoors to try to keep them dry from the rain that continues, almost daily.  Three stones make up the outdoor fire-pit, most of them burning throughout the day.  Dishes are washed outside and dried on a table made from sticks.

Drying Rack

Firewood stored inside the tent

Crews have built latrines throughout the camp, each providing six individual stalls.  Three- sided shower areas, sheeted in the same heavy black plastic as the tents, dot the landscape.  World Vision and US AID use these temporary homes and shower stalls as billboards, their names printed larger than life on the material, as if this is the latest trend in humanitarian advertising.

Women's Latrine with hand-washing station, called Tippy Taps ( yellow buckets )

I think of all the camping trips I have enjoyed, and those I haven’t, usually due to rain.  My mind flips through the pages of the L.L. Bean catalog, imagining all of the fancy gadgets available to our American need to tame the outdoor experience with luxury.  And, I realize that these people aren’t in these tents as a choice, or for recreation.  They are there with families, some with small children, up to eight people living in one tent.  They will live in these tents for up to four months, at which time the government will be able to supply them with metal roofs and cement to build a proper home. 

But for now, as the rains continue to pour down, life in these camps will continue.  Roughly 90% of those who come to our clinic are sick with malaria, in addition to respiratory illness and stomach malaise.  We hand out malaria meds like candy and offer paracetamol and other benign pills to attempt to counter their discomfort.  It is surely not camping like I have known and I doubt that I will ever think of camping in much the same way.  But at least, for a few moments, we can offer these people a clean and somewhat hi-tech experience.