March 29, 2005
Heart of Darkness
One thing I keep noticing here is how often the arguments about how abstinence education won't work or the difficulties of changing behavior rest on the notion that these people, Mozambicans, are savages. It happened twice just yesterday. First a freelance do-gooder from the United States told me that people here just haven't learned to control their bodies the way we have. "If they want to go to the bathroom, they just find a piece of grass and they go." [This is true for some people.] "If they want to have sex, they just have sex." Later some Zimbabweans -- black Zimbabweans, mind -- told me much the same story. "They are very uncivilized, Mozambicans," one said. I get this line from non-governmental groups, from aid workers and even from Mozambican health officials.
So why does AIDS spread like wildfire here, unlike in developed lands? It's easier to explain as a cultural difference: People have different views toward relationships and sex, for one thing. For another, lack of basic nutrition, sanitation and health care makes the disease far more communicable, and far more deadly. Josh Benton explains. (Scroll down to Jan. 18.)
Update: The latest to join this chorus is the opposition party, Renamo. "The allegedly voracious sexual habits of the Mozambican public" is a well-turned phrase. Check it out.
Posted by Adam Graham-Silverman at 5:13 PM | Comments (0)
March 26, 2005
Choose Leisurewear and Matching Luggage
Last week I met with the head of a local group called Care for Life, which runs education programs in schools and provides teacher training and services to orphans and widows. They have 62 employees, who have built 20 houses for widows and given orphans money for school and school supplies. They even have a farm on which they raise animals and vegetables.
Their HIV education programs are in more than 300 schools in Sofala province. They train teachers in the Choose Life program, which has been taught to more than 50,000 students aged eight to 12. What's the message of Choose Life? "To be happy with their family, they need to do a good choice now." Uh, so what does that mean? "If you're involved in the sex very early, you will die." Is there anything about how HIV is transmitted, how to protect yourself, any junior high-style health information? "No."
The director tells me the group has no religious affiliation, but in fact it's U.S.-based and run by Mormons. According to the director, they get money from the government of Mozambique and their five-year plans will expand Choose Life into all of its provinces. Choose life. Now why would I want to do a thing like that?
Posted by Adam Graham-Silverman at 7:12 PM | Comments (3)
March 22, 2005
I am Fine. I am So Fine.
My friend Dercio translates his greetings directly from the Portuguese. Thus he asks me, "Are you fine?"
"Yes, Dercio," I say. "I am fine."
"I am fine too," he says. Sometimes he kicks off an e-mail by writing, "I am so fine, so anyway..."
But the point of this message is to say that I am so fine. I am writing from the port city of Beira in central Mozambique. I have just spent an hour listening to the provincial health director bitch at me about the lack of support from the central government. Beira is a run-down city of about 400,000 without much to recommend it. The HIV prevalence rate here is about 40 percent; Beira is the endpoint of a transportation corridor from central Mozambique, Zimbabwe and Malawi.
Tomorrow I head into the bush to visit several very rural clinics. My guide for this trip is Dr. Aurelio Gomes, perhaps the most cynical person I´ve met about the AIDS situation here and the government´s ability to manage it.
The Internet access here is slow, and I´m sure it´s non-existent where I´m going. I have much more I want to post, but I don´t know when I´ll find the time.
Update: My luggage also is so fine. Thanks to everyone for asking. It arrived in Maputo three days after me. To get it, I just walked into the international arrival baggage claim, picked it up, and walked out. It was very efficient.
Posted by Adam Graham-Silverman at 4:24 PM | Comments (2)
March 14, 2005
Progress Continues
The World Bank is often at odds with local interests even as it promotes itself as being in their favor. The latest whiffs of this seem to be over tourism. According to sources here - and I'll admit I haven't talked to the bank - tourism is a new priority. That includes developing parts of the coastline and national parks. The ports of Xai Xai and Nacala are also keen to have deeper harbors and bigger roads to them. What would be the environmental cost of this work? It's not clear there’s a mechanism in place to examine it. Eventually, when vistas are polluted or crowded with high-rises, development and tourism will be at odds.
Meanwhile, LAM, the Mozambican national airline, is facing competition for the first time in its history. Air Corridor has for the past six months been flying the same routes within the country and, reportedly, LAM’s prices have more than halved because of it. A flight to the far north that once cost close to $800 and now is around $300.
Posted by Adam Graham-Silverman at 5:40 PM | Comments (2)
Scenes Behind the Scenes
A doctor holds a flow chart in front of me. It's nothing medical; it's the structure of Mozambique's Ministry of Health. It's a head and shoulders of little boxes with lines between them. Here's how it works.
If you're a woman who comes into a maternal health center in Mozambique, you can get tested for HIV. (Unlike for example a syphilis test, because of the stigma around AIDS, testing remains voluntary, not compulsory.) How many then make it to the next step of getting their levels checked so they can see whether they're sick enough to take antiretroviral drugs? "Not many," says the doctor with the chart. "How many sick people in regular hospital get an HIV test?" he asks. "They'd have to be physically taken to day hospitals."
The day hospital seems to be a term, if not a concept, unique to Mozambique. It's a facility designed to handle all facets of AIDS treatment - doctor visits, dispensing of drugs and so on. (Prevention is a separate story.) Day hospitals and the massive drug program that Mozambique is rolling out belong to an office called the Department of Medical Assistance, one arm of the ministry. The government's AIDS program, however, is in the Department of Epidemiology - a completely separate arm. You start to get the idea about how the ministry coordination that everyone praises in Maputo can break down in the field.
It's Epidemiology that handles tuberculosis, for example. That seems to make sense. But AIDS and TB often go hand in hand - many AIDS patients actually die of TB. Since the day hospitals are separate, a patient admitted to the hospital for TB may not get tested for HIV. Epidemiology doesn't have a monopoly on infectious diseases. The Community Health Department oversees maternal care and, by extension, programs designed to prevent mothers from passing HIV to their children.
External funding reinforces the divide. Money from the Global Fund goes to Epidemiology, while some World Bank and U.S. money goes to yet another department, Farmacia, where it is used to buy drugs. In fact, outside funding is one of the causes of the problem. If a donor or non-governmental organization comes in with a particular goal to solve a particular problem - eliminating cholera in an area, for example - it makes sense to tunnel in with that money and achieve the goal. "All evaluations suggest vertical programs get specific things done better," a public health worker told me. So the ministry adds limbs as it tries to deal with many problems, and help from many donors.
The ministry in is the process of implementing a five-year plan whose goal is to raise all of its boats on the tide of money to fight AIDS. Ministers, doctors and donors worked together on the plan, but at least two big obstacles await. First, last December's elections put a new health minister in office. His attitude toward the plan is positive, but his actions, including the firing of three key regional officials, have been tepid.
The other obstacle is the United States. With a promise to bring in about $48 million this year to fight AIDS, it's the 800-pound gorilla. While the U.S. consults with the government and other donors, most of its money goes directly to non-governmental groups. How do you make that part of a national health system? Particularly when U.S. policy on discussing condoms with youth, for example, is at odds with the government's? There is a fear that the U.S. is building itself another massive limb on the ministry. "I'll be leaving if it is," my doctor says.
Posted by Adam Graham-Silverman at 5:30 PM | Comments (2)
Crossing to Safety
When you walk in front of Armando Guebuza's place here in Maputo, you have to cross to the other side of the street. Mozambique's new president occupies what locals call an "office" but is really a walled compound. You can't see much inside, particularly from the opposite sidewalk, but the wall goes on for several blocks. When you get to the end, you're standing in front of Nelson Mandela's. He, too, has an impenetrable wall around his property. (Mandela is married to Graca Machel, the widow of Mozambique's first president, Samora Machel.)
Guebuza won a peaceful election last December, taking over for the twice-elected Joaquim Chissano. Chissano pulled a rarity in sub-Saharan Africa when he announced he would voluntarily step down and hand over power in the 2005 election. Guebuza and Chissano both come from the majority Frelimo party, whose origins lie in the armed conflict for independence from Portugal.
Guebuza is already shaking things up. He's appointed new ministers to nearly every cabinet post. Many of them seem to be reform-minded. The minister of health, for example, is showing up randomly at hospitals in disguise and berating the workers who are drunk or disorderly. The minister also has an autocratic streak. He's made some discombobulating noises at the ministry's five-year plan to fight AIDS, over which it slaved with donors and NGOs. The plan gets high praise all around, but the new minister, years out of medicine, could undermine its approach. "If it's perceived as a vertical program, the minister will withdraw support," said one official.
Guebuza could be ready to exhume another political skeleton with the trial of an alleged assassin. Anibalzinho, as he is known, purportedly helped gun down investigative journalist Carlos Cardoso as Cardoso was homing in on a high-level embezzlement case. Chissano's son was questioned as part of the investigation, but never charged. Despite their war days together, Chissano and Guebuza apparently never got along. Trying Anibalzinho is a chance to poke a finger at Chissano and send a message to the world that the country is not soft on corruption. (Folks say Mozambique is plagued by low-level corruption, but nothing along the lines of some of its neighbors.)
Posted by Adam Graham-Silverman at 5:24 PM | Comments (0)
March 13, 2005
'We Can Never Cover Up This Point'
Something tells me a young man who speaks six languages knows how to communicate. He and I shared Cokes at Mundo's one afternoon and he told me about an idea he had whipped up. "The way I talk about AIDS here in Maputo I would never use to talk about AIDS in the countryside," he said. "It’s very difficult to go to a small place and tell someone: 'You will die of AIDS.' You know what he will say? 'My father never told me about that.'" Without understanding the cultural context, my new friend said trying to talk about AIDS is nearly useless. Most traditions and languages in Mozambique don't have a word for AIDS, he said. In places where polygamy is customary, it makes no sense to lecture about multiple partners and the spread of disease.
My friend's mission: "Trying to convert the occidental model of communication into the African model of communication." He wants to survey the countryside to understand the culture in different communities. From that information, he thinks he can provide a plan that will enable educators, even Westerners, to communicate effectively. It comes through working with traditional leaders, such as witch doctors. "We consider more with traditional authority that with government authority," he said. "Before we invest we need to start with communication. Nobody is doing this job."
There's no stigma attached to AIDS in some places because people don’t even know what it is. This article in Slate illustrates one of several approaches in the pipeline that may help stop the spread of AIDS, but my friend suggests it will take a lot more. "This is a very big point, this culture. We can never jump, we can never cover up this point." Why is this easygoing guy from the countryside, who corrects my Portuguese without condescending and keeps dropping by to hang out, spending his free time on this plan? "It's very simple. I love my country. My country is one of the 10 most infected in the world. Five hundred people die a day. I can do something in my time."
Posted by Adam Graham-Silverman at 12:43 AM | Comments (1)
March 12, 2005
Stop the Presses
A journalism student I met with at Mundo's, a popular ex-pat hang out on Avenida Julius Nyerere, told me about a photo he snapped while covering last fall's election campaign. It was the best shot he took, ready to go into the student newspaper he helped found, but there was one problem: It was of Renamo followers, and Renamo is the opposition party. My friend was advised, and wisely agreed, to run the picture small, and inside the paper. It would not be a good idea to appear to support Renamo, even with a photograph.
The dean of the journalism school learned the lesson a bit harder. He came out in support of Renamo during the campaign. Shortly after it ended, he lost his job. Given the political environment toward the press here, it's unlikely he was surprised. The Mozambican press has come a long way since the country earned independence in 1975. At first the new government assumed the press would be a party organ, since the agitation for revolution here came from journalists and rebels alike. But over several decades, an independent and robust press evolved, and in 1991 the government endorsed a set of rights for journalists.
The law came in large part thanks to Carlos Cardoso, an investigative journalist, politician and critic who almost single-handedly established an activist press. Cardoso was gunned down in 2000 while investigating an embezzlement scandal that implicated the president's son. Recently one of the alleged killers turned up in Canada and was extradited to Mozambique. He could be tried soon.
Clarifications: Anibalzinho, the alleged assassin, has already been convicted and sentenced for his role in the killing. Because he escaped from prison and was tried in absentia, the Mozambican supreme court recently ruled he should face another trial. Since he's been sentenced, some say the only reason to haul him back into court is to uncover more of the plot. The new trial, from what I understand, will begin in May.
Also, I've learned more about the dean who lost his job. It turns out he was working as a spokesperson for Renamo, and after the election was elected to parliament to represent the party. While there are some who think his firing came as a result of his support for the opposition, it's also pretty much unheard of to have a full-time job in addition to a parliament seat.
Posted by Adam Graham-Silverman at 11:21 PM | Comments (1)
March 10, 2005
Lightning Storm!
Posted by Adam Graham-Silverman at 9:11 PM | Comments (5)
March 9, 2005
In Other News...
In case you are wondering what some of the other fellows on this program are up to, the right-hand column of this site now contains links to their blogs. Fellows, please e-mail me if you've started one without my knowledge and I'll add you.
Yes, I'm doing some reporting here.
Posted by Adam Graham-Silverman at 11:13 PM | Comments (3)
From the Rooftops
Some views from the balcony, looking into Maputo, out into the bay, or just the balcony itself. Mostly just testing the ability to post photos.
Posted by Adam Graham-Silverman at 7:01 PM | Comments (5)
March 8, 2005
To the Rooftops
For those of you familiar with my apartment in Washington, let me say that the place I looked at yesterday put it to shame. Like the place in DC, it's on the 10th story and has a large balcony. This balcony has a 360 degree view of Maputo and Delagoa Bay and a mini-cabana. It's got a big kitchen, washing machine and high-speed Internet. And the rent is cheaper too. It looks like I'll be moving in there sometime this week.
I went to visit the apartment as the sun went down on an exhausting day. After struggling with the airport authorities over my bags, I was slumping over my computer when the phone in my room rang. It was Sophie Beal, a good family friend of the McTurners. She is in Mozambique on a Fulbright and happened to be walking by the hotel. I met her in the lobby with her brother Justin and his girlfriend, Malena. I was anxious to get out of the hotel and glad to see friendly faces, so I went on a walk with them to a fabric shop nearby, where they pored over thin waxy cotton cloths. Malena, a clothing designer, bought more than a dozen bizarre plaids, Mozambican logos and prints of Pope John Paul II. We also visited an art exhibit at the Brazilian embassy and an old colonial fort filled with nameless statues.
Sophie seemed to know just about everyone I'd heard of before coming to Mozambique. She also arranged to hook me up with a cell phone, which I hope to pick up today. Her main competition for acquaintances -- and friendliness -- is Suzanne, the putative landlady of the penthouse apartment. After learning (perhaps through olfactory means) that I'd been wearing the same clothes since Saturday, she offered me some cast-off items she'd been planning to donate.
The rest of the day I spent making phone calls, trying to line up appointments to meet with contacts I'd made before leaving. My record here was mixed. While I talked to several people, others were absent, or their numbers out of order. I hope to offer more background information on my reporting project soon.
Some of you noted that the comments function on the blog was not working. Thanks to Josh Benton for fixing it up. Thanks also to Josh for setting up this blog and providing technical support.
More about this place (and less about me) soon, I hope. Since the site is called "reporters abroad," I hope to describe some of the difficulties and rewards of being a first-time international correspondent. I'm still taking suggestions for a better name for the blog, too. Thanks to all.
Posted by Adam Graham-Silverman at 9:24 AM | Comments (8)
Hot and Sweaty, With More Hot and Sweaty in the Afternoon
To imagine the weather here, take the most humid day of the Washington DC summer and add a layer of grit and exhaust. That gets you close. The humidity and bright sunshine is a nice change from the brown winter of Washington.
Yesterday was my first full day in Mozambique. My luggage, however, has yet to spend a single minute here. I waited at the baggage carousel after getting off the plane, and waited and waited. No luck. An officer at the Lost and Found desk directed a group of us -- probably 10 percent of the flight -- halfway across the Maputo airport to another desk, from which emanated a long line. After about 20 minutes in this line with little sign of movement, the power went out. The light over the desk and its computer screen went dark. After a few minutes the line transplanted itself to a better-lit location, where after another wait I filled out a form and described my bags.
Since then I've had a series of phone calls to and from the airport, asking about my luggage. Call back in 10 minutes, I'm told. Or, we'll call you back in 10 minutes. Today I think I'll go out there and see for myself.
After reporting the luggage missing I discovered my hotel shuttle had either left without me or never arrived. Two boys helped me find a phone service in which one racks up phone time on a meter and then pays at a desk. I called the hotel and asked about the shuttle. Since I had no meticais, the boys paid and then asked for a little compensation. "15 dollars, 20, whatever," one said. I offered each a dollar. "We just paid 10,000 meticais," the other said. "That's already a dollar." I knew that it's more like 20,000 meticais to a dollar, but I laughingly handed over one more dollar. "One for each," the second boy said. So I forked over one more. This seemed like a good scam.
After I checked into the hotel, I wandered up to one of the main drags. Maputo seems to share an adolescent boy's obsession with pizza: there were several places in the first couple of blocks, including one called Domino's. I settled in at Mimmo's for a vegetarian pizza.
Posted by Adam Graham-Silverman at 9:08 AM | Comments (0)
March 4, 2005
This is Not a Test
Welcome to the blog tracking my exploits in Mozambique for the next five weeks. I leave tomorrow morning at 6 a.m., flying to the capital, Maputo, through Atlanta and then Johannesburg. You can learn more about the journalism fellowship through which I'm going here. Please check back often as I hope to post my stories and observations on a regular basis. You can also leave comments here that I'll be able to see. For example: Anyone got a catchier title for this site? Thanks very much, and I'll see you in Mozambique.
Posted by Adam Graham-Silverman at 8:28 PM | Comments (4)