This blog post is in response to a request in Vivienne Benson’s blog post Happy 70th birthday NHS, but you need a better gift than money, where we asked HSG members: “What’s your #MyHealthSystem story?”
By Gefra G. Fulane, Mozambican, PhD Candidate in Portugal
One of highlightable lessons from the fieldwork of my PhD thesis on barriers to cervical cancer screening is the functioning of Centro de Saúde de Marien Ngoabi, one of three health centres located in the city of Xai-Xai, southern Mozambique. Health centres (and health posts) are the entry points for care delivery and constitute the micro level of primary care in the country. Centro de Saúde de Marien Ngoabi has one physician, 13 nurses and several technical personnel, who respond to about 38,000 people living in the Administrative Post of Inhamissa. The great majority of this team are women ranging in age from 20 to 40 years. Some are natives, others come from other cities in Mozambique.
During my stay in this health centre, three aspects impressed me, namely:
- The organization and cleanliness of equipment and infrastructures, despite their poor quality;
- The energized and proactive environment within the staff, who, when arriving in the morning, greeted everyone in the corridors with a non-stop “bom dia, bom dia…” (good morning in Portuguese);
- The effort to ensure holistic care, with clinical practitioners working in coordination with psychosocial care colleagues.
In particular, one story really encapsulates this third aspect. In the health centre, there is a young counsellor who works with people who have recently tested positive for HIV – mostly women, born and raised in a patrilinear context that characterizes the southern region of Mozambique. It is hard for the women to accept their new status (as people living with HIV) and to disclose the results to their partners. The role of the counsellor is to help these women to break the wall and find ways of getting their partners tested. When I asked her how she was feeling about her job, she answered: “I cannot explain it with words [tears on her face]… I just feel delighted in a very meaningful way. It is very emotive. No one knows how women will react if tested positive for a disease that has no cure. It is all very sensitive. We enter into that room [psychosocial aid room] with a woman who thinks her life has ended, and our major achievement is to get her calm. You have no idea how pleased I am”.
Why did this all impress me? As a young Mozambican, born in the late 80s, I have experienced different stages of the Mozambican health system. When I was young, I don’t remember having seen so many young people leading changes in a health institution; I don’t remember having seen the staff approaching my mother so emphatically, unless they were relatives or friends of hers. I don’t remember my mother having had psychosocial aid the several times she was told my condition was severe and she should not expect anything. Mozambique has a weak health system, with shortage of – and poor incentives for – health professionals. However, this reality does not impede some practitioners from performing their tasks with dignity.
At this health centre, the national slogan “O nosso maior valor é a vida” (our major value is life) of the Ministry of Health seems personified in each professional, in their smiling faces and hopeful looks. This is the kind of lesson I want to share with the world. Together we can make a difference. Together we can achieve great value for patients. With humanity, dignity and true commitment to people’s needs, health professionals as actors are the right vehicles to deliver affordable care and attain value in health care.