The Final Countdown...

Another week – our final full week – has come and gone. In many ways the pinnacle of our time here, this week has certainly been bitter-sweet. Goodbyes are looming and, for the majority of us, this quaint African farm has come to be so much a home that we are dreading the oh-so-near-future when it will be time to leave.
Bright and early Monday morning, the Geckos taught their final first aid class on “Wound Care, Burns, and Broken Bones”. Bulking tradition, they were able to complete the lesson in just over two hours. As per usual, the students were fascinated by the content, asking many practical questions as they sought to apply their newly gained knowledge to real-life realities. One fascinating aspect of teaching cross-culturally is learning of and either encouraging or dispelling traditional healing practices. For example, local tradition teaches that one home remedy for treating burns is to cover the wound with the fat of a python. Medically, the use of fat to cover a burn would serve only to trap in the heat – potentially causing greater pain and damage. Thus, this was a myth that the Gecko were able to dispel. Another remedy voiced was to cover the wound with a cool egg white and yolk to soothe the pain. While the Geckos reinforced that cool water was the “gold standard” of basic care, they did not completely discourage this practice. After all, egg yolk/whites are both cool and ‘clean’, thus a far better option than many other substances that may be applied to open wounds.

On Tuesday, the Geckos spent the day teaching at the school. In the morning, they tackled sexual health – a much anticipated topic - with the grade five class. A week prior they had introduced the topic to the class to ascertain what information the students were most confused and/or curious about. AIDS, locally known a SIDA, was flagged as the topic of most concern. With that in mind, the Geckos prepared an informative yet interactive class that briefly touched on “What is Sex?”; “What are Sexually Transmitted Infections (STIs), and HOW exactly are they transmitted?”; and “What are the major signs and symptoms of STIs?” … before delving into a comparatively lengthy discussion about AIDS, prevention of STIs, and overall sexual health. Shortly before this particular class, the Geckos spoke directly with the teachers to understand how knowledgeable the students were about sex, sexually transmitted infections, and AIDS; if they were sexually active; and how to best broach this “uncomfortable” topic. Their answers and suggestions proved invaluable. Needless to say, the students were attentive, engaged, asking thoughtful questions, and sharing their understanding of STIs/AIDS. It was incredibly fulfilling to see the students make connections with the content and with their teachers (the Geckos)… for in that hour it seemed as though cultural barriers crumbled and that classroom became a safe, non-judgemental arena to educate about sexual health. The afternoon was also special in that the team organized an outdoor “story time” where LeeAnne read to the grade one and two class about how to help someone who has a fever. ….

Wednesday the Geckos had the opportunity to aid two nurses from the Vanduzi hospital during a community immunization blitz in nearby Selva. After arriving in style just after 10am in ASAMs big ol’ grain truck, the team set up the clinic under a beautiful, shady tree and waited. Within the hour a substantial number of women and children had arrived with “Cartaos” (immunization records) in hand. Each team member took a turn processing the cartaos and determining which immunizations were indicated for either mom or baby, drawing up the vaccinations, and administering the vaccinations. Working alongside the local nurses was mutually benefical, with each team sharing their knowledge and expertise. Before long, the local nurses left the Geckos to “run” the clinic with only Celestino (our translator) to bridge the language gap. Not only did the team competently and confidently organize and deliver the appropriate vaccinations to these women and their babies, but they also all gained insight into how much they’ve progressed, from a cultural perspective, in only a few short weeks. At the beginning of this practicum, no one would have felt adequately prepared to independently (i.e. without Lynn or Joanne) attend to, let alone lead, the delivery of nursing care. Yet as time has passed in this context, each team member has grown tremendously in their ability to relate to and partner with the people… to comfortably work with and through translators… and to be ever cognizant of non-verbal communication to demonstrate their care and concern…

The Bush Babies had another busy week, spending several afternoons at the clinic with Ernesto and Celestino. They continued to share experiences (and many laughs) with the soccaristas while caring for the health needs of the community. It was encouraging to see the soccaristas implement some of the information they have been learning in their first aid course and from teachable moments with us. Tuesday the Bush Babies were part of the Selva school immunization blitz. Along with Ernesto and two nurses from Vanduzi, they provided tetanus vaccinations to well over a hundred school children. The younger students were vaccinated followed by the girls over fourteen, who are at greater risk because of unsterile tools used during childbirth. Wednesday afternoon, they were able to go on a home visit with Lynn to see Fred, a former employee of the farm. Part of Fred’s “retirement package” from the farm includes frequent home visits to ensure he has his medications and is in good health. Thursday morning the team went to Nhamondimo to provide health teaching to a newly formed women’s group. The women really challenged the team to tailor the information to their learning needs and also to dispel many myths surrounding traditional yet potentially dangerous treatments.

Thursday afternoon was a highlight for both the Geckos and the Bush Babies as they combined the first aid students for the final class and graduation ceremony. They piled the students from the group at the farm into ASAM’s “school buses” (aka, a grain truck and the van) and headed up to the school to meet with the Interior group. At the school, they set up the final class and gave each of the twenty-one students their own first aid kit. Before departure to Mozambique, Lark’s mom made twenty-two first aid bags (complete with Canadian flag zipper ties!) to hold the assortment of supplies (THANK YOU!!). The team reviewed the contents of the bags with the students, explaining and demonstrating the use of: gauze, bandage pads, antiseptic liquid, chlorine for water purification, paracetamol (Tylenol), soap, a rehydration mix, tetracycline ointment, and bandage scissors. Many of the contents in the bags were purchased locally, thus contributing to the local economy and providing a first aid kit that the students would have an easier time re-stocking.

Following the first aid kit unveiling, they began an innocent game of first aid “Jeopardy” to test the students on the teaching they had received over the last three weeks. The game incorporated some questions that required the demonstration of the skills they had been taught along the way (ie. handwashing, splinting). Shortly into the game, as the intensity grew, there were team huddles, women and men jumping to their feet to shout out answers and naturally, some trademark celebratory dance moves. The class was split into two teams, the Geckos and the Bush Babies (okay, so maybe the team was also a little competitive) and they were neck and neck the entire game. Everyone had a blast, watching our students recall an incredible amount of information and provide some stellar first aid to our mock injuries.

The afternoon ended by handing out a Certificate of Completion to each individual student, taking pictures and sharing some snacks and juice. Both the students and ‘teachers’ took time to say thank you, and share how they had been impacted and blessed by the other. The class taught the team so much this past month, such that every member truly looked forward to each first aid class, their questions, sense of humor, and eagerness to learn. To round out a wonderful afternoon, everyone piled back into the van for the long ride home. Not speaking the same language did not prevent the two groups from communicating through song and laughter as the sun set behind the mountains.
Friday afternoon, the team got together with Lynn to debrief the week’s events and to discuss “disengagement” from this experience. This was a useful time to share concerns, express the challenges that each team member may face upon “re-entry” to Canada, and discuss how we will implement what we have learned and gained from this experience into personal and professional life at home.

Another One Bites the Dust…

Week 3 is coming to an end as we battle the Mozambican weather…and by battle, we mean complain that the temperature doesn’t rise above 20 degrees Celsius on rainy days. Ha ha ha.

This week has brought many changes to our lives here in Mozambique. The first being the departure of our fearless leader, Joanne (aka “Mother Bird”) and her husband David (aka “Handyman”). The loss of Joanne has forced the group to become more self-directed in our learning activities, which has been challenging. Lynn’s guidance and input has been an invaluable resource to us in planning and getting through our week.

The second big change around camp has been switching team roles. The Geckos have gone from focusing on the Health Post and home visits with Lynn, to teaching in the school. The Bush Babies have switched locations and instead of being at the school, they are now focusing on the nearby Health Post, along with taking over teaching the women’s health class.

The Geckos had to change their focus and teaching strategies to be more appropriate for a school-based setting. It was a definite challenge to determine how much content to deliver, and how to tailor that content to individual grades. Input from the Bush Babies on their experiences teaching at the school proved to be valuable, and all in all, the Geckos thoroughly enjoyed their week at the school. Using last week’s lesson of “Safety” as a spring board, the Geckos created a story and skit to demonstrate basic first aid – what to do when they get hurt. The kids really enjoyed themselves, and from their answers to our questions based on the skit, we could tell they pulled out most of the main points we wanted to get across. The Geckos are now considered to be “true Mozambican women” as they enjoyed a traditional lunch with the male teachers of the school (sadsa with some very salty fish sauce), while sitting on the ground. This proved to be an eye-opening experience showing the Geckos the male-dominance in this culture, as the men sat on the only available chairs. This has sparked much discussion amongst the group regarding male-female relationships in this cultural context.

The Bush Babies were eager to have their first experience teaching a women’s health class as they heard great stories from the Geckos about traditional songs and dancing that welcomed them to each class. The Bush Babies were not disappointed, and they participated whole-heartedly in clapping and dancing along with the women. The Bush Babies’ experience was slightly different from that of the Geckos’, as their class was delivered underneath a tree, with the women and children sitting on grass mats. The Bush Babies gave gifts of nail files to each of the women in attendance at the class, allowing them a little luxury in their lives.

As we have become more comfortable teaching our First Aid group, we ventured into new territory in planning our lesson and included a hilarious skit to close it off. Our team was able to integrate feedback into the skit from during the lesson about the treatment of burns, as some members of the class use raw eggs, instead of cool water, to put on the burn. The Bush Babies were able to re-iterate that cool water is the best treatment, and made their class members howl with laughter at the same time. (If we can post the video, we will)

First Aid classes for both teams have continued on, and as we become more comfortable with class members it becomes easier to connect with them and shift our teaching strategies to maximize learning. For example, the Geckos’ First Aid class notoriously runs for 3 hours instead of 2 as we have been providing Portugese notes for the class to take down (a time-consuming process). Although Portugese is the official language in Mozambique, the Geckos’ and the Bush Babies have learned not to assume everyone in their First Aid class can read Portugese. The Geckos and Bush Babies have teamed up to create English notes for past and upcoming First Aid classes that will be translated both into Portugese and Shona (local dialect). We are hoping this will meet the learning needs of the classes and provide them with a resource to refer to.

Planning for next week’s First Aid graduation extravaganza has begun, with hopes of purchasing snacks and decorations on our trip into Chimoio on the weekend. We have created “official” Portugese certificates of completion (“Certificado”) to give to each class member, along with their First Aid Kit. The First Aid Kits have been planned based on what we have learned from teaching the classes. We have created the kits in hopes of them being appropriate to address common health challenges in the community (e.g. providing a home-made rehydration mix of salt and sugar to help fluid loss from diarrhea), as well as being sustainable, in terms of purchasing items for the kits locally.

Hospital Tours and an Immunization Blitz!

Yet another full week has come and gone. The Sede group, now known as “The Geckos”, started bright and early Monday morning with a first aid lesson for the local community leaders. The purpose of these classes is to mobilize the Mucombeze community by training the leaders in health promotion, prevention, and basic first aid. Nursing school has taught us that one of the most effective ways to have a lasting impact in a community is to partner with the people and empower them to be effectors of their own changes toward health and wellness. The team’s hope for these classes is to accomplish this aim, if only to a small degree.

LeeAnne, Lark and April

teaching First Aid class to

community leaders

Additionally, the Geckos spent time with Ernesto and Celestino, the local soccaristas (health care workers), at the health post assessing patients and providing health teaching. Soccaristas receive a two week basic health training course before being stationed.

Hence, there is a great deal of education they can benefit from, especially regarding prevention, but also a great deal that we can and have been learning from these two men.

April and LeeAnne in health clinic with Ernesto

Further, the Geckos had a unique opportunity to meet and teach both the women and their husbands in the small community of Pina. It was an unusual case where the men took time out of their work day to receive information on basic illness prevention and pregnancy issues. The intent was to emphasize that health depends on the whole families’ efforts. A great discussion with questions ensued.

This week the Zuze team, now known as “The Bush Babies”, taught the school children about safety in their homes, neighborhoods and on the highway.

The children were especially interested in learning about snakes and crocodiles, as this is a daily reality. Several poisonous snakes live here including the black and green mamba, spitting cobra, and puff adder… We’re definitely not in Kansas anymore!

A challenge that has been forefront for the team is making the lesson plans practical and applicable in light of the scarce resources available to the students – men, women, and children.

For example, part of the focus of their first aid class has been concerned with the “Common Signs of Sickness” - diarrhea, fever and cough. When teaching about treatment for diarrhea, the team shared an oral rehydration drink “recipe” by simply adding certain proportions of sugar and salt to the water. However, they quickly learned that salt, being a precious commodity, would be much more likely used for preparing sadsa (maize-flour and water, the local staple food), and that sugar was a near unheard-of luxury. As such, they had to tweak their “recipe” to include supplies locally available and affordable. For every teaching about prevention and treatment, they had to ensure that their “pupils” understood the rationale, so when substitutions were/are necessary, they know what to use. For example, interestingly enough, ashes can be used in lieu of soap. They are a clean exfoliant because all of the organic material has been burned off.

One of the group highlights of the week was a tour of the local hospitals. Senhor Paz, the health director for Vanduzi, graciously took us on an informative tour of the health clinic. Of particular note, the extensive organization and programming surrounding the HIV/AIDS program was impressive. Beyond the “arms” of the program which spanned from prevention, diagnosis, counseling, and long-term treatment, the emphasis on reducing the stigma surrounding the disease paralleled Canada’s own attempts to decrease the misconceptions about mental health issues. It has been in operation since 2006 and continues to grow as word spreads. Not only was this a learning experience about how the health clinic operates but now the team has a clearer picture of where patients are sent for referrals from the local health post. The group then continued on to Manica to tour the district hospital. Because it is a bigger centre, they have greater access to medications. However, the center is quite burdened in that there is a much greater volume of patients, and like Vanduzi, a vast shortage of medical and nursing staff to meet the overwhelming demands.

Another highlight of the week was an immunization blitz , a ‘brigada movel’ or mobile brigade, for the women, infants and children in the Mucombeze Interior. After Joanne inquired about the possiblity of our nursing team participating in a brigada movel in Mucombeze Interior (an area with no previous access to immunizations), the director and two community health nurses from Vanduzi Health Centre graciously organized and oversaw the event, after SAMM agreed to provide them transportation to the site.

It was well attended, with hundreds of vaccinations of Tetanus, DPT, Polio, Vitamin A and BCG (for tuberculosis) administered. The students, under Joanne’s leadership and expertise, helped weigh and assess babies, determine what immunizations were indicated for each person, and inoculate (often malnourished) infants, and children. This was an eye-opening time for everyone.

The team was greatly encouraged by the tangible impact this will have on a community that would not have otherwise had

this opportunity. Part of the funds that the team has raised will provide transportation for local nurses to follow through with the immunization program in Mucombeze Interior, which will require two more "brigadas moveis" over the next two months to complete the primary series for many infants and children.

Week One Over and Time is Flying!

The first week has been an exhausting blur of eye-opening experiences and activities. The Sede group, facilitated by Lynn, had a focus on community and orphan home visits, health teaching in women’s and adult literacy groups, and some experience in the health post nearest the farm. One highlight occurred during a women’s health class for ladies of the Pina community. As rhythm and music is such an integral part of African culture, these women joyfully sang and danced for the team before the lesson began. Needless the say, the team was nearly brought to tears by the beauty of the moment, and especially the joy on the women’s faces. It’s quite unbelievable to see what can come about with a group of Mozambicans and one small drum. After this, the team had a “class” discussion on health promotion and illness prevention, as well as a special section on health during pregnancy. The women were animated and engaged in the discussion…and a real sense of connection developed, despite culture differences and language barriers. After all, we were all women… The Zuze group, facilitated by Joanne, went to the Mucombeze Interior each day (45 minute drive one way) to work in health-related activities based out of the elementary school and area. They were involved in health education and helping with the lunch program in the elementary school, some observation in the health post near the school, and implementation of a First Aid Course for community leaders at the school (teachers, health care worker, women’s leaders and pastors). Of particular note, they (along with Joanne and Lynn) were given the opportunity to meet with the Director of the Vanduzi Hospital and organize a mobile immunization clinic to be run on Thursday, March 13th at the school. This will be an all-day “blitz” that the team is greatly anticipating.

Another exciting update is that the team has hired an English/Shona (local dialect) speaking woman named Vimbai to assist with laundry and cleaning, as well as translation for team members who are visiting people and homes in the nearby community. She is a Zimbabwean refuge who was an elementary school teacher in Zimbabwe and is proving to be an invaluable asset to our team…having quickly become the “seventh member”.

As the teams have become more involved in working with the people in Mucombeze, we’ve developed a greater awareness that, while there are certainly vast differences between rural Mozambique and rural/northern Saskatchewan, there are more similarities than we first might have imagined. Such parallels include:
· The further away one is from big centers (Maputo, Mozambique; Saskatoon/Regina, SK) the less likely he or she will be able to access adequate resources (including health care). This is due to the challenge of making scarce resources available to a scattered, impoverished population.
· Poverty, the struggle to meet basic needs, is the norm. This disheartening knowledge has affected our health teaching (including lesson planning) in that, while the people can grasp and understand concepts around hygiene and food/water safety as means of preventing illness, they rarely have the means to implement these lessons. Soap, for example, is far lesser on a priority list when the few meticals that are earned do not even cover food costs to feed one’s family. This mirrors northern Saskatchewan in terms of the relative expenses for food and sundry items.
· Traditional healing practices and the focus on spirituality which permeates every day life.

Daily we have been inspired by the generosity demonstrated by community members, despite their bleak circumstances. One example of this occurred when an elderly, disabled woman with little means to earn money for her family, yet is taking care of her own children as well as an orphan, offered to give us her only chicken in return for the supply of maize, salted fish, rice and beans that the mission gave her. As well, we have been moved by the perseverance and resolve of the children, such that they will walk up to 40 kilometers a day to receive an education and a meal, prepared by a dedicated cook “Fernando”. This has challenged the team, both professionally and personally, to be better stewards of the resources that we have been given and to maintain an attitude of thankfulness.

Meet the Ministry

SAMM is a faith-based organization with a focus on development initiatives. The farm was purchased and is being developed to provide sustainable initiatives to improve the quality of life for individuals and families in Mucombeze. Some examples of the major programs include elementary school, lunch program for school children, health clinics, sustainable agriculture, animal husbandry, economic development for women (through learning of new skills – sewing, crafts, small business initiatives), community health education, orphan home development. The school and health initiatives are planned and implemented in partnership with local and regional government. For example, the SAMM elementary school is a satellite classroom of the Mucombeze School, serving children who live up to 20 kilometers away from Mucombeze School, their closest school. The health posts are developed and staffed by Mozambican trained health workers, following the guidelines of all Mozambican health posts, with monthly statistics and reporting going to the health department in Manica. The two health posts are situated in remote areas, and are providing accessible health care to a population who would otherwise need to walk up to 50 kilometers to the nearest health post.

The mission directors, Dwight and Lynn Lagore, are actively involved in these programs, training the Mozambican teachers, health care workers, and orphan home leaders (as well as all SAMM workers in the wide range of initiatives) in best practice, holistic methods. Lynn is a Canadian trained nurse, registered in Alberta, with years of experience in tropical medicine and community health. Both are excellent teachers, and are open and eager to work with us on a daily basis. With each interaction we have with this highly qualified pair, we are learning about cultural and health practices, economic and political realities, community development strategies, and the resulting impact on the ability to build capacity in health. Though we’ve only been with them for a week, we know that we will miss them tremendously when it is time to leave the farm.

Settling In...

After a couple of exhausting days of travel, and five flights in planes of various sizes, we arrived in Chimoio, Mozambique. The first few days were spent settling into our new "home" - a campsite on Dwight and Lynn Lagore's farm property - and orientating to our roles as health workers in this rural community.

A few highlights of this experience include: meeting the community (of Mucombeze) chief, accompanying Lynn on three orphan home visits, touring the farm where we are staying, and visiting one of the primary bush schools. It has been incredible and inspiring to see the holistic approach that the SAMM team has taken to address the needs of the people of Manica Province. Needless to say, it's been an overwhelming, eye-opening time...but we are finally beginning to shape a clearer vision of how we will be able to assist the health-work that is already in place.

Tomorrow our group is splitting into two separate teams. The Sede Team will be working closely with Lynn and Ernisto (a local healthcare worker) at one of the health posts, providing care for young and old alike. Coupled with this, they will be conducting home visits for orphans and those that are too ill to come to the clinic. In preparation for this, they've packed a "tickle trunk" of medical supplies. The Zuze Team will be working in the primary school that we visited - providing health teaching and english lessons to children from grades 1-5. Beyond this, they will be caring for the children in the pre-school program, and helping Fernando (school cook) with lunch preparation. Both teams also have the privilege to teach adult literacy courses using health concepts, a women's general health lesson (for a different group of women each week), and a 4-part first aid series for community members. As we've been preparing lesson plans, speaking with SAMM staff, meeting the local people who are so excited to have us here, and seeing the immense needs, we realize that our time here is so very short...and that we must make the most of every and all opportunities.