Tag Archives: Development

Buscas Activas: A Day in the Field as a Health Volunteer

We lied. Of course we lied. Fortunately for us, he didn’t doubt us. Instead, he continued to write the names down into a professor’s schedule book under the January 4 header. It definitely wasn’t January 4. I don’t think he cared. The page was already packed with other information written in various colored pens. For our names, he chose red. Seemed fitting.

The secretary of the neighborhood, as is custom here, had brought out his best chairs and placed them underneath a large tree that shaded much of his front yard for the visiting guests. After formal introductions from my supervisor, a stocky man who practices psychology in our hospital, as well as the secretary, we explained to him that we were searching. He didn’t seem surprised.

It’s common practice throughout Mozambique to do active searches (buscas activas in Portuguese) throughout the vast neighborhoods of any given community. Usually the searches are done by health volunteers sent by the hospital with a handful of printed pages with countless names of patients who have either missed too many consultations or abandoned treatment altogether. The searches are for HIV patients who have gone missing.

A group of children had formed around our shaded tree as my supervisor began to list off names of patients who had identified the secretary’s neighborhood as their own.

“Is this for HIV?” the secretary asked with turned up brows as he looked up from his book. “Because a lot of these names are people who have HIV.”

“No, no, no,” my supervisor shakes his head and waves his hand. “We just need to do consultations with these patients.”

“For what?” the secretary said, still curious.

After a short pause, my supervisor tells the secretary we’re searching for malaria patients. The secretary continues to write the names in his book and repeat the names out loud several times, apparently attempting to remember the location of their house or hut.

A group of children has formed a group just outside the shade of the tree and underneath the bright, late morning sunshine. On the walk to the secretary’s house, I had spent the time learning more of the local language of Makua with our guide for the morning, Immanuel. As a native of the area, he spoke Portuguese and Makua fluently. We’d pass an animal, and he would tell me the word in Makua. Duck is “andrata.” Cat is “quato.” Children is “animwane.”

“Animwane!” I say to the group of children gathered around our tree. They burst into laughter, some running out of the yard and hiding behind the caniço fence, peering through its many slats and around its edges. Slowly they return, say something in Makua, wait for my response, and repeat their retreat for the safety of the fence.

The secretary’s children play nearer to the house. His house is made of clay, but I see an electric outlet and wires fitted to the outside of his house above the door. It’s rare for a house out in the neighborhoods to have access to electricity, but leaders in the community usually have increased resources and funds. Seems fair enough.

His children have something small and brown in their hands. One boy rolls the substance between his hands, pinches the top, the sides, and the bottom until the form of a person starts to take shape from the rolled up clay. I notice other little clay figures lined up along the houses foundation. The boy has the new clay man take a leap of faith from the foundation to the ground below, crashing to the ground and smashing everywhere. Boys all play the same.

The secretary’s wife is sitting by the door, busy cleaning and preparing food for the family’s lunch. She does not speak much and simply stares down at her current task. I catch eyes with her several times throughout the meeting with the secretary, and I can’t read the emotion.

“You do know that this neighborhood is very long, right?” the secretary asks us. He looks over at our guide, who is already laughing. “We have 11 secretaries in this neighborhood.”

“We understand,” my supervisor responds. “We’ll see how many we can find.”

The list is immense. While it contains all of the patients from all of the neighborhoods in Namapa, the list for the neighborhood in which we are searching contains 10 names. Earlier in the morning, 10 names sounded easy enough. By noon, it sounded daunting.

Searches are flawed simply because of the weak infrastructure within the towns and villages. Houses aren’t numbered. Streets aren’t named. GPS hasn’t quite hit here yet. When you ask patients to write their address, they describe where it is in relation to a common community landmark: next to the church, close to the secretary’s house, etc. The entire system requires a lot of effort to find one individual. People are dying by the thousands.

“Let’s go!” the secretary said, eager to help in the search. When we arrived at his house to both get his approval for the search as well as his assistance in locating the houses, he was out in his field working in his farm. His feet are covered in a thin layer of dirt, and his toenails are almost non-existent, transparent squares atop cracked nubs of toes.

The four of us continue our search as the secretary points out houses of other secretaries and possibly homes of our patients. We ask if secretaries are home. They’re out. Along the way, we pick up two more secretaries. The first is a large man with a bigger smile stretching across his face. He doesn’t say much, but he’s enthusiastic to help. The second is a round woman with a capulana (traditional cloth) wrapped around her waist and another around her head to block the sun. Our search group is now six strong.

Early afternoon hits, and we’ve yet to track down a single patient. The walk through the neighborhood is packed with more lessons of Makua, talking to small children who have yet to see me walking around the main street of the village, and older women asking the secretaries why they’re walking with a white person (kunha in Makua, a word I know well). It’s not offensive as much as they’re just stating a literal fact. I laugh each time. They laugh.

It’s the end of the day, and we end up in the front yard of one of our potential patients. Expecting him not to be home, I pull out my local cell phone to text back another volunteer.

“Hello,” a small voice comes from the yard. “I am who you are looking for.”

The man is reserved and quiet. My supervisor and I pull him aside from the larger group and ask him to come to the hospital the next morning for a consultation. Instead of explaining the entire situation in the moment, we’ve decided to reserve it for a quieter, private setting. Anonymity and privacy are followed well in a culture built on respect.

We end our search, thank the secretaries for their help, and part ways to end the day. On the way home back to my house, it’s hard not to feel both dissatisfied with the day’s search and relieved that we found one person.

I practice my new Makua words with neighbors on the way home. They all laugh with my new understanding.

I think back to the secretary’s house with all the children. As I was leaving the yard, I looked back and saw a completely naked baby walking through the yard in adult flip flops, five times the size of his little feet. He took small steps, one after another, as he walked toward his mother. The image makes me laugh out loud. Then I realize that it’s not hard to relate to him.

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Xenophobia & A Tale of Two Countries

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The neighborhood of Bo-Kaap in Cape Town, South Africa (Photo: Alek Shybut)

An hour before my bus departs, I’m sitting in a small restaurant in Maputo, the capital of Mozambique, with a Coke and my phone open to sites about Cape Town. The television on the wall turns to the evening news, and the opening story is about the ongoing violence due to xenophobia near the area of Durban in South Africa.

I switch sites and do a quick Google search of xenophobia in South Africa. The definition is the first thing to pop up: “…the unreasoned fear of that which is perceived to be foreign or strange. Xenophobia can manifest in many ways involving the relations and perceptions of an ingroup towards an outgroup, including a fear of losing identity, suspicion of its activities, aggression, and desire to eliminate its presence to secure a presumed purity” (Wikipedia).

Under the news tab, articles are listed describing the political response to the xenophobic violence occurring throughout the country. Some deny its existence while others swear to battle to end the ongoing turbulence. Mozambicans are listed among the groups being attacked and sent back to their host country. Immediately I feel slighted. Members of the Frelimo party, the national party of Mozambique, are on the television decrying the violence.

Being a foreigner in a still new land, I find myself wondering in which group I am living: the ingroup or the outgroup. While I am not Mozambican, I often tell members of my community that I am in order to earn their trust. Often they laugh, but I know they understand my intentions. I am most certainly not South African, so that leaves American. However, with all the horrific events occurring within our country since leaving for Africa, it’s hard to relate to the political climate. I sit in silence in the restaurant, tangled in thought.

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The bus is larger than I had thought with seats that completely recline in order to sleep during the first leg of my overnight trip from Maputo to Johannesburg. I find myself sitting on the second level of the bus in the very front with a large windshield in front of me, displaying the city lights of Maputo. My own personal observation deck.

“Excuse me,” a soft voice comes from behind, “but is anyone sitting next to you?”

A Mozambican man stands near to me, and I gesture toward the seat, welcoming him. We introduce ourselves, and I learn he is originally from Mozambican but has been living in Johannesburg for the majority of the past 10 years. He talks fondly about Mozambique and how it has changed over the course of its young 40-year history as an independent country.

We exchange notes on the different parts of the country, our favorite areas to visit, and the areas that still need the most help. We agree that Maputo has become somewhat of an urban sprawl, complete with western chains and South African product. He mentions the tea fields of Gurue. I mention the Portuguese architecture and untouched nature of Ilha de Moçambique. We laugh in our shared knowledge of quirks, mainly in the form of the national transportation. We stretch our legs toward the viewing window, laughing as we describe how it’s the complete opposite of traveling by chapa (small mini-buses).

Deep into the overnight trip following a few failed attempts at sleeping, he asks me if I’m Christian. I explain to him my experiences with faith, and he opens up to me about his own personal walk with his faith. He opens his phone and shares a book written by his favorite pastor. He promises to send me an e-mail with more information on the man, who he says is one of the wisest men he’s ever known. I’m grateful for his kindness.

The bus stops at a series of bright lights and small buildings blocking the highway. “Come on,” my friend says to me. “Let’s go.” The bus starts to empty, and I realize we’ve made it to the border of South Africa, and we are required to exit the bus, walk through the immigration process, and proceed to the other side by foot. It’s 3:00 a.m. and pitch black.

Passport in hand, I follow side by side with my friend and the other passengers of the sleeper bus. Immigration involves queuing for a while, speaking with a border patrol agent about our visit to the country, and a quick stamping of the passport, but the complex is extensive, confusing. I quickly become separated from my friend and am swallowed into the group.

When I come out on the other side, I’m unsure of where to go. I scan the room and find a familiar face, my friend, waving me toward an exit near the back of the first building. He had waited for me to finish to continue to the next building. We pass armed guards without any hassle, and we eventually find our way back to the bus to finish our journey.

Upon arriving at the bus station in Johannesburg, I explain to my friend that I’ll be staying at the bus station until my next bus leaves 8 hours later. He offers his house as a place to sleep for a while before heading back to the station to catch my bus. I thank him for his kindness but decide to stay at the station until my next bus leaves. We shake hands, and he walks toward his car to return home to his family.

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With my backpack and small bag thrown over my shoulder, I walk around Cape Town taking in the scenery: Table Mountain is seen in the distance with its flat top and a small cable car station dotted at the far end. Small restaurants and shop fill the streets, and families walk in groups with ice cream or bags of food in their hands. A small art market is tucked in a small central square area with vendors of locally crafted goods.

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The neighborhood of Bo-Kaap in Cape Town, South Africa (Photo: Alek Shybut)

A couple days before when I first arrived in Cape Town after my second bus trip, I explored the city with a friend from the states. We visited the colorful district of Bo-Kaap before sitting on a small step of a park and people watching our way through the rest of the day. That night we met locals at a busy bar on Long Street, even taking a photo with a man who resembles almost exactly my former roommate in Atlanta. When the photo was posted on Facebook, both of my former roommates were shocked at the likeness.

Today, I am alone in my exploration of the city. The tour bus I take drops me at the base of Table Mountain. I ride the cable car to the top with camera-ready tourists, and together we take in breathtaking glimpses of the city below and ocean beyond. At the top of the mountain, my phone dies. My sorrow is soon replaced with access to a free recharging station available for all visitors to the mountain. I smile at the coincidence.

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View from the top of Table Mountain in Cape Town, South Africa (Photo: Alek Shybut)

Later we visit a few local vineyards, and while the winter season has turned most of the plants brown, the wine is still in abundance, and I find myself sitting with the vineyards in the distance enjoying a white wine. A little buzzy from the three glasses of chardonnay, I find my way back to the bus and we continue to explore, visiting the beaches of Camps Bay, the ferris wheel at V&A Waterfront, and finally ending up back in the city by evening.

The art market all shut down, the square is now quiet with streetlights guiding the way to my hotel. I walk along the brick street breathing in the day’s air and thinking back to my site in Mozambique. I wonder how my colleagues are doing. I think ahead to helping with the new health volunteers’ training. I try to live in the moment, but the moment is instead living in me, re-motivating me, re-energizing me to return home.

I enter the small, street-side door of the Tudor Hotel on Longmarket street. Described as the oldest hotel in Cape Town, visitors are greeted by a tall staircase, a bar area to the left, and a vintage restaurant with wooden tables. Just beyond the restaurant is reception, and a robust woman greets me as I enter. She finds my reservation, explains the details of the stay, and gives me the key to my room. She helps me to find the room.

As she drops me off at the room, she asks me what I think of Cape Town. I tell her it’s gorgeous and that I’ve already decided I want to spend the rest of my life within its borders. We both laugh. She finishes by asking where I’m coming from.

As I open the door, drop my bags inside, I look back and tell her, “I’m from Mozambique.”

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The Hour of the Thief: On Corruption, Transparency, and Silver Linings

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A portrait of former Mozambique President Armando Guebuza hanging in the community radio station in Namapa, Mozambique (Photo: Alek Shybut)

I’m holding the katana in my hand, and I can’t quite remember how I got to this point. I remember why I bought the giant knife in the first place, but the movements leading up to it were not entirely my own. It’s easy enough to blame the culture, even easier to blame the one who tried to enter my house, but my reaction is entirely my own, and it is within my reaction that I find myself lost, detached from the original motivations for arriving here.

I walk around my community with a new sense of foreignness. With each set of eyes that I find myself locked, I consider the possibility that this is the person who attempted to intrude into my private life, quickly gather my things to sell on the road, maybe try to subdue me through violence (although I’m not entirely sure the person knew I was home). The faces that were starting to become familiar are drastically distorted into potential threats. I feel nervous, uncomfortable, unable to breath. I can’t remember how I got here.

My work in the community is affected, as I start to fear the outside. Instead of wanting to spend my days walking through the community, exchanging gestures with my new family, I find myself locked indoors, cradled under my mosquito net, attempting to catch up on sleep after a week of lost sleep due to the incident. I wonder if this is something I’ll be able to come back from. I wonder if this will happen again. I fear both, and I find no answers.

When I do eventually sleep, I wake often. The night that it happened, I woke around 3:30 a.m. to the sound of metal on metal, screwdriver on lock, knife on grate, my imagination races. The veranda of my house shares a window with my bedroom, and my bed is tucked closely to said window, allowing me to peer outside toward my front door and beyond. The sound causes me to rise in bed and slowly assess the environment. My contacts, sleeping soundly in their case, and glasses, tucked somewhere in my backpack, are not with me, and the entire room is blurred, making it difficult to see. I realize that the sound is coming from my front door’s grate, and I instinctively yell Leave! in Portuguese. A blurred figure slowly walks away from my front door, and I’m left breathless in the silence, heart pounding.

A few minutes later, I rise to my feet, carefully enter my kitchen area, open the door to the veranda, and check the front grate. The lock that had been firmly in place before I lay down to rest is now several feet away in the dirt, popped open, broken. I scan the front yard and find nobody remaining behind. The silence of the middle of the night, with the exception of the occasional cat meowing or insect calling, is both comforting and terrifying. I throw on a different lock, slam the door, take additional precautions in closing it, and return to bed.

The next day, the katana is resting in my hands. With its wooden handle and long, metal blade, it seems sturdy enough but probably only good for a couple uses. Along one face of the blade are three, printed lines for writing information. I examine the blade and don’t understand what one would write on the printed lines: This weapon belongs to Alek Shybut. Please don’t steal it. The word weapon bounces around inside my head, unfamiliar and foreign among my normal thoughts of volunteerism, health, peace.

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My first home in Mozambique consisted of three small rooms: one for the kitchen, one for my host family to sleep in, and the other for a volunteer (newly built, as I was their first volunteer). The town of Namaacha always felt safe to me, whether it was because I am a male or I was naïve to the dangers of maintaining American habits in a country rebounding from war, loss, corruption. My family helped me feel safe. They were warm, loving, enough to distract me from the risks of being a foreigner in a foreign place.

Each night when we would go to sleep, my host mother would pile large, yellow water containers in front of the main door. When asked about it, she simply replied that “there are thieves everywhere.” I wasn’t completely oblivious to the fact that thieves existed in Mozambique, my ideas were just temporarily blurred by observing the warm spirit of the neighborhood in which I lived: families offering assistance to a growing child, waving and yelling of my name as I enter the community. This is the Mozambique for which I signed up. This is the Mozambique that is presented to us. Although, the signs of thievery were in front of me the whole time. There’s no one to blame but the one who refuses to see.

Late in our training during the first two months of service, a female trainee in my group was returning home in the dark of the night by herself. She was using a cell phone and a stranger passed her in the darkness. He said good evening before turning around, striking her in the face, and swiping the phone from her possession before disappearing in the shadows. The following day, we comforted our friend and heard from our supervisors about the incident. The thieves who were hidden before had unveiled their true nature.

However, sometimes the thieves do not need the darkness; they simply need the law.

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Speak with any volunteer who has served in Mozambique about public transportation in the country, and you’ll surely hear about the damaged infrastructure of the roads, poor condition of bridges, and dangerous state of the vans and busses that carry passengers to their destination. It’s common knowledge that transportation in Mozambique is treacherous. Volunteers in the past have lost their lives trusting those who work in it.

However, the second thing you’re likely to hear about is the way in which the drivers of these vans and busses are treated by those who have sworn to protect the laws of the country: police officers. Drivers have learned to carry large currency in case they are stopped by one of many control officers that are placed on the national highway running north and south in Mozambique. Upon stopping, the officers explain to the driver that they are hungry, thirsty, or in need of a fee for a random infraction. The driver pays, because what else can the driver do, the police officer dismisses the driver, and life continues.

One day I was traveling by bus to visit a friend in the northern province of Cabo Delgado. Stopped at one of these control areas, a member of the police entered the bus, started asking Mozambicans and foreigners for documentation (luckily we’re told to carry our passports or certified copies with us at all times), and searched for those who did not have any. A man sitting close to me across the aisle was the unfortunate one of the day to not have proper documentation. He was told to stand from his seat and follow the officer off the bus, but the man refused. He sat in place, asked the police officer repeatedly for the reason, and attempted to evade the situation. Eventually the police officer grabbed the man by the arm, pulled him from his seat kicking and arguing, and was hauled off the bus.

During this altercation, I looked around the bus to see reactions of those with whom I was traveling. Eyes were firmly locked in an unknown space outside the window. Even the man sitting next to the frustrated passenger refused to acknowledge the happening. Much as malaria or other common illnesses have become everyday life for the people of Mozambique, putting up with and simply surviving the wrath of corruption has as well. The law is strong, and while the people are stronger, the will to push against it has yet to build.

While corruption flourishes on the ground, it’s high above with those who make the laws that corruption really finds its home.

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Transparency International, a non-profit, non-governmental organization against corruption, works “to stop corruption and promote transparency, accountability and integrity at all levels and across all sectors of society” (Mission statement). With the vision of a “world in which government, political, business, civil society and the daily lives of people are free of corruption,” the organization provides statistical data about a country’s corruption and offers the information free of charge in order to hold accountable those who aren’t.

Using their Corruption Perceptions Index, TI measures levels of perceived corruption around the world. The CPI, a composite index, ranks countries based on how corrupt a country’s public sector is perceived to be. Scores range from 0 (highly corrupt) to 100 (very clean) with additional data provided about a country’s control of corruption (perceptions of the extent to which public power is exercised for private gain), open budget index (availability in each country of eight key budget documents), and judicial independence (perceived extent in which the judiciary of a country is independent from the influences of members of government, citizens, or firms).

Let’s start by looking at the least corrupt country in the world (according to TI): Denmark (population: 5.5 million, GDP: $309.87 billion, life expectancy: 78.6 years)

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Corruption Percentage Index Score (2014): 92/100 (Rank: 1/175 countries)

Scores range from 0 (very corrupt) to 100 (very clean)

 

Control of Corruption Score (2010): 2.373760444 (Percentile rank: 100%)

Point estimates range from about -2.5 to 2.5. Higher values correspond to better governance outcomes.

 

Judicial Independence Score (2011-2012): 6.6/7 (Rank: 2/142 countries)

Scores range from 1 (heavily influenced) to 7 (entirely independent).

 

Additionally, using information from the United Nations, TI includes statistics on the Human Development Index rank and score for each country. Denmark is ranked very high and ranks sixteenth in the world out of 187 countries on the index.

Let’s continue by taking a look at one of the most corrupt countries in the world (according to TI): North Korea (population: 24.3 million, life expectancy: 68.43 years)

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Corruption Perceptions Index Score (2014): 8/100 (Rank: 174/175 countries)

Scores range from 0 (very corrupt) to 100 (very clean)

 

Control of Corruption Score (2010): -1.340157209 (Percentile rank: 3%)

Point estimates range from about -2.5 to 2.5. Higher values correspond to better governance outcomes.

 

Using the statistics above to put into context the amount of corruption that may or may not be existent in Mozambique (population: 23.4 million, GDP: $9.59 billion, life expectancy: 49.28 years), let’s take a look at the findings according to TI.

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Corruption Perceptions Index Score (2014): 31/100 (Rank: 119/175 countries)

Scores range from 0 (very corrupt) to 100 (very clean)

 

Control of Corruption Score (2010): -0.395968044 (Percentile rank: 43%)

Point estimates range from about -2.5 to 2.5. Higher values correspond to better governance outcomes.

 

Judicial Independence Score (2011-2012): 2.7/7 (Rank: 114/142 countries)

Scores range from 1 (heavily influenced) to 7 (entirely independent).

 

Human Development Index Score (2011): 0.322 (Low) (Rank: 184/187 countries)

The index is classified into four quartiles: very high, high, medium, and low.

While Mozambique lands somewhere in the middle, the information is alarming. Falling closer to the more corrupt line, it’s clear that government and personal interest influence not only the judicial systems within the country but also lead to lower life expectancy and a lower HDI score for its people. However, there is some good news.

Using their Global Corruption Barometer, Transparency International collected surveys from everyday people who have confronted corruption around the world. Out of the 1,000 people who completed the survey (2013), 32% said that corruption has increased a lot in the past two years, 27% said it’s increased a little, 24% said it’s stayed the same, and 15% said it has decreased a little.

When asked to what extent the participants thought corruption was a problem in the public sector in Mozambique, 45% said it is a serious problem, 29% said it’s a problem, 17% said it’s a slight problem, and only 4% said it’s not a problem at all.

When asked to what extent is the government run by a few big entities acting in their own best interests, 29% of participants said entirely, 31% said to a large extent, 29% said somewhat, and 10% said limited extent.

When asked how effective the people though their government’s actions were in the fight against corruption, 18% said very ineffective, 30% said their ineffective, 31% said they are neither effective nor ineffective, 19% said they are effective, and 2% said they are very effective.

The following are percentages of respondents who felt that the institutions listed below were corrupt/extremely corrupt in Mozambique:

Political parties: 58%

 

Parliament/Legislature: 49%

 

Business: 45%

 

Education systems: 79%

 

Judiciary: 69%

 

Medical and health services: 70%

 

Police: 84%

 

Public officials and civil servants: 74%

 

While the argument is clear that the people believe that many systems and areas of Mozambique are severely corrupt, there is a bright spot to be found in this data, and it’s one that has many implications for Peace Corps volunteers as well as those who are looking to change the system from within.

The respondents were asked to what extent they agree that ordinary people can make a difference in the fight against corruption: 16% said they strongly agree, 48% said they agree, 25% disagreed, and 12% strongly disagreed. There is hope for fueling change from those who believe corruption can be changed through strong programs, whistleblowing activities, and organizations working to strengthen those systems seen as corrupt.

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Just for fun, let’s take a look at the United States of America (population: 309.1 million, GDP: $14.59 trillion, life expectancy: 78.09 years) and see where we land as far as corruption and transparency (according to TI).

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Corruption Perceptions Index Score (2014): 74/100 (Rank: 17/175 countries)

Scores range from 0 (very corrupt) to 100 (very clean)

 

Control of Corruption Score (2010): 1.232890271 (Percentile rank: 86%)

Point estimates range from about -2.5 to 2.5. Higher values correspond to better governance outcomes.

 

Judicial Independence Score (2011-2012): 4.9/7 (Rank: 36/142 countries)

Scores range from 1 (heavily influenced) to 7 (entirely independent).

 

Human Development Index Score (2011): 0.910 (Very High) (Rank: 4/187 countries)

The index is classified into four quartiles: very high, high, medium, and low.

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A few weeks later, and I have a guard who watches over my house at night thanks to my landlord who kindly hired him for me. I’m sleeping well, and the incident has since been forgotten from my instinctual memory. No longer do I look at those around me in fear, but I am finding once again the reasons for choosing to be here (because at the end of the day, we have to remember that we chose to be here.) Our lives directed us here for a reason, and I refuse to give up on the possibility of witnessing great (or minor) change in Mozambique.

The katana is tucked safely away in a storage area in my house, only to be used to cut tall grass, open coconuts, or attack the real dangers of the community: giant spiders. While I don’t think I would ever fully be able to attack another human being with a weapon, being in that place of mind was one I hope I do not have to experience again.

It’s easy to lose sight of who is to blame when it comes to thieves and their need to steal. It’s easy to blame them for their decisions in life, but we must have the strength and knowledge to look beyond our own anger and recognize the fractures and breaks within an already fragile infrastructure. The people of Mozambique clearly recognize the issues, and together we can help them to strengthen their own systems, strengthen their lives.

The day after the incident happened, I was talking to a friend who works at the small store across from my house. When he heard that the thief showed up to my house around 3:30 a.m., he raised his head and said, “Awww, the hour of the thief.” This stuck in my head and continues to bounce around when I start to feel myself slipping into the safety of isolation. Just as thieves are affected by the umbrella of a broken system, so, too, are we affected by the umbrella of negative thoughts that steal our days and disregard our hopes.

Not today, thief. Not today.

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On God and Finding Faith in the Shadow of Uncertainty

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The woman points toward an unimpressive house adjacent to the recently constructed gas station parking lot. The cement extends toward the house before breaking up, exposing thick grass that rests upon a lanky, wooden fence that obscures the view of the yard.

“A woman used to live in that house,” she says staring in the direction of the house and barely blinking. “She died last week.”

“That’s so sad,” I say in response, now also staring toward the house. “What happened?”

“She died from some disease,” now she’s looking in her lap and fiddling with her cell in her hands. “Not sure what disease.”

I tell her that I work in a hospital up the road about 100 kilometers and see a lot of patients who abandon their treatment early for various reasons and end up dying from the complications.

Seemingly unsurprised by this information, she raises her eyebrows and rises from her chair to go and help a customer who is putting gas in his car’s tank. “If it’s God’s will,” she says as she continues toward the man, “it’s God’s will.”

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I’m taken aback by the sight of it. A familiar symbol (above) is painted above the entryway to the church: the thick, black cross with the red cloth resting upon the arms. The words Igreja Metodista are painted above the symbol.

Until this moment, I had not seen a Methodist Church in Mozambique. Sure, I’d seen places of worship for other beliefs – Muslim, Catholic, Evangelical – but this was different. This was personal.

It’s a few days before Christmas Day, and I’m visiting close friends in the southern province of Inhambane in Mozambique. I take a moment to let the sight of the church sink into place before continuing on to my friend’s house located next door.

A few days later, I excuse myself from my group of friends and head toward the church. I expect to encounter life and jubilance and, instead, am surprised to find the church completely empty. The front door is propped open, and the wooden shudders that act as windows are spread wide, flooding the interior of the church with the remaining light of the day.

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I slowly move through the small church, taking in the familiar and appreciating the unfamiliar. Long, wooden pews stretch in rows through the room. Tucked in the back of the pews are hymn books. I brush my fingers along the smooth wood as I pass toward the front of the room. Each window I pass reveals something new: a child running past, thick trees producing fruit, the sun setting in the distance.

I find myself at the front of the room looking down at a table adorned with flowers, books, and pieces of cloth. In front of the table is a podium. I let the image of a packed church fill my senses.

My phone buzzes in my pocket, and I turn it on to find messages from home wishing me a Merry Christmas. It didn’t feel like Christmas before, but today it does.

I sit down in one of the empty pews, lift a hymn book from the back of the pew in front of me, and I open it to a random page. I tuck my nose into the crease of the book and inhale deeply, pulling from the book a familiar scent and welcomed calm.

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I’m standing next to my father in a packed worship hall with the rest of the congregation. We are all singing a hymn while the pastor and co-pastor walk up the aisle and out of the room following the service. I notice that nobody is really singing, and I strain my voice to match the volume and pitch of those around me. I know I can sing better, but I don’t try.

I’ve been going to church with my father and siblings for as long as I can remember. The church is a beautifully constructed building tucked in my small town in my small state. The triangular, main worship hall is home to a towering plate-glass window that stretches from the floor to the highest point in the ceiling.

In front of the window is a sizeable, wooden cross that hangs high above the heads of the congregation, held in place by chains. The pastor stands below this cross in sermon, and during each service, it’s hard not to worry that one day the cross will fall. It doesn’t.

I grew up in the walls of this church, attending summer programs, joining my family for Sunday and holiday services, and volunteering to help younger kids. Some of my closest friends grew up in the walls of this church. Some of the cutest girls in our town attended this church. Each Sunday, I would scan the room looking for a current crush.

We follow the congregation out of the church and head for our car. We won’t return to the church until the following Sunday, but that doesn’t mean that I leave everything inside its walls.

Each night as a teenager I find myself praying in a similar routine before I sleep. Using the same script but splicing in names of people or concerns of the week, I fold my hands together, close my eyes, and whisper my message into the world. I don’t know who’s listening, but I have hope, optimism, faith that someone is.

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The document is opened on my computer at my desk, but I’m staring out the window. On the opposite side is a row of bushes and a patch of grass that stretches to the cement parking lot. A grasshopper has landed on the window. I rise from my seat and get closer to the window to look at the colorful details of the insect, but it jumps away as I approach.

The next day I decide to quit my job at the bank. It’s a great job working with friendly, passionate people, but I didn’t share the same passion for the work. Something inside me had been leading me to this day, shaking at me and alerting me to a life unlived. I pack up all my belongings and make the drive from Nebraska to Washington State.

During my two years in Seattle, I spend my Sundays at a middle school located close to my house that hosts Mars Hill, a popular Christian congregation in the northwest and west. The group isn’t without controversy with some members calling the group a cult and denouncing the church’s leader, Mark Driscoll, for his sometimes radical practices.

For me, the group is a place to find the familiar calm felt growing up. While that calm had since been replaced with stress, sadness, insecurity, and uncertainty, deep within my soul was a faith that everything will turn out fine.

I continue to spend my days living with this notion in my heart, although my faith has always been a private one.

Looking back, the decision to leave Nebraska saved my life, but whose decision was it? For the longest time (and still today), I knew it was my decision, but I also know that it was driven by faith, a belief strengthened through the church.

So I ask again, whose decision was it?

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I’m sitting with a book in a restaurant in my small town in Mozambique. A doctor friend who is visiting from the provincial capital to work with cataracts patients in my area approaches my table. Behind her is a short man with a large smile on his face.

“Alek, I want to introduce you to someone,” my friend says as she gestures toward the man. “This is Jose, he is the pastor at the Catholic church here in Namapa.”

“Nice to meet you, father,” I say and extend my hand.

He grabs my hand and, with a smile on his face, says “It’s very nice to meet you too. I’m very happy that we are able to meet.”

He continues to tell me that he’s been living in Mozambique for about a year, is originally from Mexico, and wants to learn English because he has family in Scotland. I tell him that I’m happy to help, and he leaves the restaurant thanking me numerous times.

A few weeks later, the father contacts me and says he wants to have lunch with me at his house. Joined by another volunteer from a nearby town, we head to the church and meet him by the main road. He leads us through a set of large, metal doors that lead to his house and main yard.

He tells us that 14 young boys work with him at the church, and that with time they’ll be able to preach as well. My friend and I meet a couple of the boys, and we continue into the pastor’s main living area that has a table set for our lunch.

On the walls are pictures of religious leaders, including Pope Francis. The pastor has bookshelves stacked with literature on religious practice, language books, and other materials. Set on the table alongside the plates is a small speaker. The pastor turns on the speaker, raises the volume, and The Beatles’ Let It Be fills the room.

“I love this music,” he tells us. “The Beatles!”

We tell him that we also love the Beatles, and the smile seen at the restaurant grows across his face as he gestures toward the food to help ourselves. The meal consists of corn on the cob, potatoes, salad, and rabbit, which the pastor raises at his house.

We finish the meal, and the pastor tells us how happy he is that he met us. “Thanks be to God,” he says as he raises both his hands toward the ceiling.

“Thanks be to God,” my friend and I say in unison as another Beatles song plays from the speaker.

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Her comment catches me off guard. How could the death of a woman from a preventable disease be the will of God?

It isn’t the first time I’ve heard this in Mozambique. When someone passes of old age or disease or accident, it is common for the people to find their comfort in knowing it’s God’s will.

While it’s easy to be cynical of this view (and many volunteers are), who are we to try and tell anyone how to find comfort, how to find faith?

How are we supposed to be strong volunteers without faith in something? Having faith in the better, the stronger, the more righteous can guide our hands, our actions.

Will we be able to work in cooperation with the many churches here to deliver beneficial health information? Information on prevention? Long-term behavior change?

Perhaps the answer is simply: If it’s God’s will, it’s God’s will.

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Questions? Comments? Contact me!

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On Volunteerism & Development: A World Just Within Our Reach



A Peace Corps staff member assesses the projects planned and presented at the Community Health Project Design & Management conference in Nampula City, Mozambique.

Half the room is made up of American (and one Puerto Rican) volunteers, and the other half is made up of our Mozambican counterparts. We enter the conference room for the start of a three-day training that promises to introduce all of us to project implementation in our communities, a topic that all of us need to understand as projects start to get off the ground.

The all-Portuguese training begins, and I realize the importance of the situation. Roughly 25 years ago, this country was tangled in a civil war that crippled the country, destroyed infrastructures, and left emotional scars that still remain today. While not many people here openly speak about the war, it’s clear to see the effects on the developing country.

However, one product of the end of this war was pure, and understandable hope for a brighter future for the country and its people.

My counterpart is sitting next to me as we spend the day learning about the role of Peace Corps volunteers in Mozambique, developing goals and objectives for our plans, and starting to list out the activities which we are going to complete once we return to our sites.

The American volunteers are familiar with this environment as we scoff at the pile of papers and handouts we receive throughout the day. However, to our Mozambican counterparts, the information is (mostly) new and (mostly) exciting, sparking an energy in the room that is hard to resist.

A fellow PCVs counterpart is a community health worker. He lives a very simple life, but today he is attending a conference in an urban hotel surrounded by accommodations, intelligent discussions, and a bountiful supply of water and food. 

To say that he was elated would be understating it. He was completely and totally beyond himself. Literally, a world had been opened up to him. Not one of excess, but one of deserved recognition for the work that he and the other Mozambican counterparts do on a daily basis.

While employment is hanging over every conversation with volunteers as the country faces high unemployment, especially in rural areas, he sits in his seat for the remainder of the training with a smile across his face and a shirt nicely ironed and buttoned all the way to the top.

We spend three days exchanging ideas, mapping out our activities, and providing advice to one another. While us Americans see this as a normal, everyday brainstorming session, Mozambicans embrace this dialogue as the new foundation to their newly developed home. These conversations provide them a glimpse into a world that is not fully their own but, at the same time, just within their reach. A world of community health and progress. A developed world.

I share a table with my counterpart, and he is also elated. He speaks up often, shares his insights, thanks for me bringing him to this place where he is learning much. 



Ivan with the final project proposal.

As an unemployed member of our shared community, my 28-year-old counterpart, Ivan, thrives on giving back and offering his hands and heart. He describes to me in detail during a lunch break that his last name isn’t actually his last name, as his parents disappeared when he was very young, leaving him to grow up in an orphanage. When asked about his parents, he only knows that someone told him his parents were taken away with the trash.

Today, he’s advocating for youth and health in our community. He is engaging in difficult conversations to move the efforts closer to success. At the conference, he develops a plan to work with the HIV-support groups in our town to raise chickens for sale, gaining money for the groups and the promotion of support groups.

We can learn something from Ivan and Mozambicans: conversation with peers about moving forward should be our constant motivations in life. Why can’t we all see the bigger picture for the future of our own country? Instead of bowing our heads during brainstorming sessions, let us raise our fists and demand change.

The conference asked us to design a project. However, the conference also asked us to be better listeners, not only to our own peers, but those on the outside who still have the motivation and energy to love more, push harder, and seek results.

Ivan, as well as the other counterparts, receive certificates for their work during the conference. A piece of paper to us, the next step in changing their home for the better to them.



Ivan with Peace Corps staff receiving his certificate for completion of the training.

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Photo: Learning with a View

A classroom at the Secondary School in Namapa, Nampula in Mozambique.



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Ten Things You’ll See In Mozambique that You Won’t See in America (But Maybe We Should)

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Same-Sex Friends Holding Hands

A recent study (LiveScience) in the United States found that the majority of the population still feels uncomfortable when they see two people of the same sex holding hands. While our country has, thankfully, made much progress in terms of accepting and understanding the diverse communities that share our home, we are still far behind in creating a safe climate, especially when as individuals we are not questioning our own thoughts and beliefs.

A couple months into my site, and I found myself holding hands with a male friend of mine as we joked, laughed, and walked back to a mutual friend’s house. Walk around Mozambique and you’ll quickly notice that the gesture of holding a friend’s hand (regardless of sex) is common and just as beautiful as it sounds (header photo).

Teenage students walking out of a school, an older adult leading his friend through a busy market, two doctors having a conversation in the middle of the hospital, two friends walking and joking down a street. How simple life is if we can simply let go of our uncomfortable thoughts and hang on tight to the one thing that bonds us: humanity.

Respect for Different Religions

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While this may be slightly unfair to say about our current American climate, nowhere else have I seen people with drastically different religious beliefs living in such unified harmony than in Mozambique. On any given day, one can see the congregation of the Catholic church gathering in the main lawn while the daily prayers from the mosque’s loud speaker fill the air above.

In the United States, a person is often not only judged by what they do but also what they believe. In our current climate, an individual’s beliefs are firmly tied to the actions and beliefs of others who identify themselves under the same religious umbrella, and we are quick to label the individual as a bigot, an extremist, a terrorist.

However, what an individual believes in Mozambique is the sole property of the individual. Their beliefs are not questioned, denounced, analyzed. One face is equal to another, and in a country that thrives on development and moving forward, it’s refreshing to see that the people of Mozambique have already learned something that American’s haven’t: tolerance.

Fun FYI: While writing this portion of the post, I was introduced to a Pastor who works at the local Catholic church. He is from Mexico and wants to learn English. Serendipity or divine acknowledgement?

Watching (As In Watching) the News

In a packed bar in my town, people crash glasses together, laugh loudly at inside jokes, and join together in singing and dancing. The television is showing a movie with the audio projected from speakers. Nobody is paying any attention until the movie ends and the program switches to Jornal da Noite (Nightly News). Silence blankets the bar, and all eyes turn to watch the television or screen and listen in as the anchor delivers the news.

The country is large, but when it comes to the news, everyone in Mozambique wants to be informed of the happenings across their homeland. Whether they’re getting updates about the floods in Zambezia or watching as two burglary suspects are placed in front of the camera in a display of public shaming, Mozambicans love their news. While one could argue that it’s simply an issue of variety (Mozambicans usually watch either the news or telenovellas), the amount of interest in the news is hard to ignore.

Election Season Enthusiasm

Coupled with Mozambicans’ love for the news is their commitment to national elections and choosing the best leaders for their communities. During the 2014 Presidential Elections (which usually only occur after two, 5-year terms of the sitting president), the energy in the air around the election was thick and loud. From the rallies that filled the streets in a color-coordinated act of support or the political posters that blanketed the town, Mozambicans made it clear that they are pushing for progress.

One of the better sights of the election season last year was seeing a truck full of older women (mid-50’s) with large signs, megaphones, and matching shirts yelling as they drove through the community to promote their political party. Regardless of sex or age, Mozambicans will put work on hold for the possibility of improving their daily lives. Crazy, right?

Rainwater as a Resource

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When I first got to the country, other volunteers as well as Mozambicans described the impending rainy season. “It’s horrible,” my German neighbor told me. “The roads become rivers, and the rivers become seas.” It was hard to believe him at the time, but upon returning to my site following a trip south for the holidays, the rain was heavy, the power quickly went out, but one thing surprised me most: the use of rainwater.

Children were using falling water from the roofs to wash their bodies (photo above). Teenagers with large buckets were collecting the water and carrying it out into the neighborhoods. Women were using small, plastic bottles to refill their beverage with fresh rainwater from the hospital roof (photo above). At first, it was hard to join on the rain-wagon. “I’ll just carry my water from the mosque,” I said. “I don’t need to use the rainwater.”

When the power finally went out for the month, it was clear that rainwater was the best option. I bathed in the water with the kids from my neighborhood, it became routine to set out my buckets during a heavy rainstorm and even wash my dishes and clothes with the falling resource. While we don’t necessarily need to establish a similar routine in the states with our abundance of water (in most states), the notion of this reusable resource is intriguing.

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With the increase of products being imported into the country (looking at you Coke), the amount of litter that is filling beaches and roadsides is staggering. However, people of Mozambique have learned to reuse these some of the resources found throughout the community in the house, in the market, and in their gardens.

Acting as water bottles, small Coke bottles are used to refill water (photo above). Vendors in the market use the same bottles to fill with oil to sell on the side of the road. Plastic coverings from mattresses and plastic bags are used to cover bananas as they hang on the tree, preventing insects from destroying the plant. While the country is still in dire need of a recycling plan, the community is attempting to reduce the abundance of trash by recycling it themselves.

Gardens & Fresh Produce

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The rainy season not only brings the floods and abundance of drinkable, usable water, but it is prime time for Mozambicans to build their gardens (photo above). The community is transformed from dry and dirty to fertile and lush lands, producing not only fresh produce for consumption and sale, but also providing local community members more work in the building and maintaining of the large gardens.

Children, teenagers, adults, and older adults will all be in the garden throughout the rainy season, tending to the crops, harvesting, and selling them in the local market. For this reason, there is a constant supply of fresh produce for the community. However, the issue still remains the cost for those who can’t afford the produce and the need for education of the community to learn how to build and maintain their own gardens.

Bicycles, and Motorcycles, and Walking, Oh My!

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While this just may be a circumstance of both income and increasing development, there are far more bicycles and motorcycles on the roads of Mozambique than large cars. The main highway that runs north and south through the country is packed with larger vehicles used by those who can afford them, but as you travel inward and away from the main highway, the local villages and towns are thriving on smaller, more cost-effective and environmentally friendly (whether they know this or not) means of transportation.

If walking through a small town in Mozambique, you’ll notice people yelling “taxi mota” in your direction. You’ll recognize the word taxi right away and realize that they are providing a service for those who don’t want to walk and need a ride. Usually this is cheap, helps the driver pay for gas, and builds a sense of a growing and thriving community.

Fun FYI: Peace Corps does not allow volunteers to own or use a motorcycle due to the dangers. If a volunteer is caught owning or using a motorcycle, it’s terms for immediate removal from the country. Bicycles, however, are warmly welcomed and recommended.

Hitchhiking (Boleias)

In the United States, hitchhiking brings to mind plenty of movies and stories about the dangerous men and women who walk the interstates and highways in search of trusting drivers. For this reason, hitchhiking is both illegal in the states and generally looked down upon as a collective culture. We’d rather drive to our destination with the doors locked and eyes forward.

In Mozambique, it’s not uncommon to see people receiving boleias (Portuguese for lifts) from friends and strangers both inside the community (on the back of motorcycles) and along the national highway. This is an ongoing topic being discussed by both Peace Corps staff and volunteers, because it could potentially be dangerous; however, the consensus is that it’s a safer option to the country’s national transportation, which is dangerous and often leads to more accidents than hitchhiking.

Business Owners, Community Members, Thriving

With the discovery of gas in the northern province of Cabo Delgado and other natural resources that are underneath the country, more and more international companies and organizations are moving in to harvest and export the resources. While this is creating additional jobs and increased money into the country (although many doubt that the money will be put back into the communities because of unchecked corruption), it’s also creating a dependency on international companies instead of looking inward.

Walk around a smaller community, and you’ll see small businesses and shops owned by members (even families) of the community. With enough motivation and resources, a person in Mozambique can build and maintain a rather successful small operation in a small town. The country has yet to build large factories or companies, so in the meantime, the age of the local business owner is still strong and vibrant, including agriculture.

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Questions? Comments? Contact me!

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Productive Chaos in the Face of Unemployment

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The scene is familiar to what we see in the states: A member of the group gives a PowerPoint presentation in front of the larger groups. The presentation is filled with statistics and findings from their area health center. Each slide paints a more detailed portrait of life and work for the presenting group. However, a harsh criticism hits the air.

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“These numbers are horrible,” he interrupts the speaker. “Where is the rest of your data?”

“Doctor, we collected all the information, and these are the results,” the presenter responds.

“Well it’s not good enough,” the doctor says. “We have to do better.” He turns to the group. “We are not playing here, we are working.” The group shifts in their seats. I catch eyes with one of the ICAP Mozambique team members. She gives me a soft smile and opens her eyes wide before returning attention to the doctor who is in charge of the group.

“What he is saying is that the information is all accounted for, it’s just lower than we want,” another member of the group says in support of the presenter. “But it’s all there.”

The group erupts in conversation, and the presenter patiently stands at the front waiting for the time to continue. The leader is now looking at his cell phone and smiling. Members of the nearly 20-person group are having loud, fractioned conversations about the data and presentation throughout the room.

There’s a name for this kind of environment: productive chaos.

In the United States (in most cases, or at least the ones I am most familiar), we are all about productive order. We sit, listen (or pretend to listen), smile, read along with the information, and wait for the appropriate time to ask our focused and polite questions to the presenter, the expert.

There is a somewhat artificiality to our system of presentations. The presenter knows what is expected of her or him, and the audience knows what is expected of them. With the exception of jokes and stories thrown in for effect, it is a polite ritual that goes back throughout our history.

As the only two Americans in the room, I lock eyes with another Peace Corps Volunteer (PCV) who is sitting across the room. She and I shrug our shoulders but sit in silence waiting for the chaos to settle. We expect the harsh comments to draw criticism or spite from the members of the group.

Yet, the conversation never turns toward the negative. Instead, the environment feels productive, energetic, fruitful. While it does cause the meeting to go two hours over time, we leave feeling like we just witnessed something truly refreshing: a meeting filled with criticism that doesn’t leave the group feeling like a failure. A level of honesty from a culture that cuts through the bullshit and gets right to the point.

The Issue of Employment
In the world of international non-governmental organization (INGO) work, the pressure to provide results is sometimes overwhelming. The groups on the ground need to show that they are worth the paycheck they are receiving, or else the worst is possible: being replaced.

As a developing country, opportunities are rare and hard to acquire. The availability of open positions is limited (although with the export of gas and other natural resources, the demand for more labor is increasing). Even for those who have higher educations, it’s a battle to fill positions in hospitals or government offices. This is why many Mozambicans live far away from their families for months or years at a time.

My supervisor just had a new, baby girl with his wife who lives in Maputo on the other side of the country. He opens his phone and shows me a photo of her in a pink hat. It’s easy to tell from his talking of her that he loves and misses her dearly.

Another colleague is a newlywed. He took advantage of the holidays in November and December to travel to Maputo to marry his now wife. His wallpaper on his phone is an image of her standing along the beach, the wind blowing her hair.

For them, being in Namapa and working for an INGO is simple: a good job with good pay to support the families who they love, who they will be able to see again once their contract is complete. They understand the rarity of a quality job and will do their hardest to succeed.

While unemployment in the United States is always a societal concern, we often make the decision on where to work based on the location of our families, loved ones. We need their constant presence to keep us motivated, grounded. Mozambicans need this as well, but until the day comes that more opportunities are established, the work they often do separates them from their support networks.

Action and Accolades
The meetings with ICAP groups from around northern Mozambique comes to an end. Additional chairs are brought in, and the drivers of our groups join the larger group for one last item on the agenda: awards.

The productive chaos is replaced with a slow clapping as the names are announced of the community groups that produced the best numbers for the past three months of reporting. My team (header photo) is awarded three times, and each time they stand to receive a rousing applause. They shake hands, hug and kiss, and sit down to examine their reward: an expensive pen still in it’s box. Photos are taken by a professional photographer.

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The accolades come not only with a gift and feeling of success, but a sense of security regarding employment. While similar to the states in the sense that we perform to keep our jobs, employment and purpose for Mozambicans goes beyond earning money. It falls firmly in the strong national pride that all Mozambicans hold dearly.

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Questions? Comments? Contact me!

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Community Needs Assessment in Mozambique: Personal Insights, Tailored Focus

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This is the second (first) in a series of posts about implementing health projects in a developing country. It is meant to introduce a reader to the inner workings of public health training and action, especially the collection of baseline information, and share with the world data, stories, and personal thoughts about the ongoing challenges of global health in Mozambique.

Public health is all about knowing who matters most.

We want to believe that all information that we need to be successful in any area or field is advice, input, and research from those who we deem as “experts.” While these voices are crucial in public health to develop a robust assessment, there are lesser-heard voices that act to compliment the information gained from national health statistics and evidence-based research and provide a more personal insight and tailored focus of the CNA.

The lesser-heard voices belong to those in the community who are living with and seeing the daily effects of any given disease or health issue: the mother of two who is HIV-positive along with her children, the community leaders who have daily discussions with their neighborhoods about issues, the volunteers in the health system that work to seek out the patients who have abandoned their treatment. They all have voices and deserve to be heard. The simplicity of public health: Listen to these people and, often, solutions will reveal themselves.

Public health is all about understanding those who matter most.

Before we can collect personal information from those in the community, we need to first better understand the community itself. Sure, we have national statistics, photographs of key places in the town, a history of the community, and an overall opinion about the health issues that matter most to people, but we need to round out our understanding with a current snapshot of the community and its resources to better understand the people.

Community Map

Everyone shook their heads in confusion when I first asked about a map of my community. From the local health leaders to those who work in the local government, nobody was able to provide a detailed map of the neighborhoods and main streets. Having an overall view of the layout of the community is crucial in understanding proximity, abundance, and availability of local resources for those living in the neighborhoods. Good place to start.

Instead of walking the entirety of the community and sketching out a rough map, I thought about who would already have this information through experience and knowledge of the community. The answer was simple. Located in each hospital in Mozambique are activistas, or volunteers from the community who search out patients who have either abandoned treatment or are in need of crucial medication. Each day, these volunteers are given stacks of cards with patient information. Their task sounds simple: search the neighborhoods, find the patients, give them treatment or bring them back to the hospital. The reality is much more difficult, but we will discuss that more later.

Working with the activistas, we created a detailed community map (below) with the district hospital as the central point, names and borders of neighborhoods, and the locations of key resources, including the markets, the police station, and churches.

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Seasonal Calendar

Now that we have a better understanding of the locations of key points in the community, we also need to better understand specifics about some of these points, mainly the abundance of food in the markets. Since nutrition and availability of food is firmly linked to the overall health of the community, we need to know which foods are available during which parts of the year, thus knowing which foods we are able to use in future interventions and health programs.

Working with the chefe (boss) of the market located to the east of the hospital as well as vendors who work daily in the market, we together created a seasonal calendar complete with the name of the product, the months along the top of the calendar, the time in which the crop is planted (plantar), harvested (colher), and sold/eaten (consumir). The yellow bars are the crops that are available all year. It is clear that Namapa has a high abundance of available food items. While the issue is usually cost, we now know that food is available.

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Additional Resources

In addition to an abundance of food from the markets, other resources in the community include: a community radio station that airs health messages in both Portuguese and the local language; water pumps around the community that provide a constant (with energy) supply of water for the neighborhoods; access to the national highway for travel and import of crucial supplies; cellular networks for both phone calls and internet access; and Namapa is home to the district government offices.

Public health is all about listening to those who matter most.

Now that we have a detailed profile of our community, a general opinion from the public and patients regarding health problems, a precise community map, and more information regarding the availability of food items, we are able to start collecting qualitative information from the community to best identify our direction for future health programs.

Activistas

Who better to understand both the inner-workings of the hospital system as well as the health issues in the community than those who are volunteering their time to locate lost patients and reduce the burden of diseases in the community? The activistas not only have detailed information on the best direction to take future activities, but since they are volunteer workers they also have an unbiased view to provide honest answers and a personal motivation that will help us to better understand Mozambican’s values.

At the time of this assessment, my hospital had six activistas (now seven). Using a sign-up sheet, I scheduled interview times with each activista. During each interview, I first collected demographic information (below) regarding the activistas, including age, where they are from, time as an activista, the reason for becoming an activista, daily hours in the hospital, daily hours out in the field, with how many patients they speak in the hospital, and with how many patients they speak out in the field.

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Following the collection of demographics, I asked each activista a series of questions about logistics, strengths, and challenges of improving health in Namapa. Below I will share a couple insights from each category, but all are located in my assessment that will be available once it has been reviewed and corrected for grammar by Peace Corps staff.

Logistics

Besides some of the demographic questions asked above, I asked the activistas, “What do the members of the community think about activistas?” All of the activistas agreed that the people of Namapa, especially those patients who abandon treatment early, believe that the activistas are improving the health of the community. People know that the activistas are linked to the hospital and, therefore, are able to provide information regarding health, illnesses, and prevention.

All of the activistas discussed the importance of the palestras (health talks) that they both create and complete out in the neighborhoods. Community health workers and Peace Corps Volunteers (PCVs) complete palestras in the community because of the lack of information regarding prevention and limited resources. The activistas discussed the fact that since they are seen daily in the community with important health information, they are trusted. It is more difficult for a PCV to enter the community with information since they are new.

Strengths & Motivations

I asked the activistas, “What motivates you to work as an activista?” Since the activistas don’t earn any money for their work (besides the occasional money given by one of our team members), they all agreed that helping to diminish the burden of disease in the community was their main motivation. The demographics show that five out of six of the volunteers are from Namapa, so they have a strong connection to the community.

One of the female activistas described how her son is living with HIV. Looking down as she describes the disease, it’s clear that the issue is close to her heart and family. Also, another volunteer said that he himself is living with a disease, and by working in the community, he knows he is helping others and decreasing the likelihood that they’ll acquire the disease.

Challenges

I asked the activistas, “What are the challenges of the job?” While they are all motivated by improving the health of the community, they all agreed that one challenge is actually diminishing the burden. They are out in the community each day searching for patients or giving health talks, yet the diseases continue to tear through the neighborhoods. They discussed how it is difficult for six people to reach so many people. With a population of more than 60,000 people, Namapa is too large of a town for such a small group.

Another challenge that is seen throughout the health system in Mozambique is the organization of the patient cards in the hospital. All patients are registered when entering the hospital, but because the system is not (yet) electronic, the paper forms are put into filing cases that are disorganized, dirty, and confusing to understand. The activistas spend crucial time in the morning simply searching for the patient’s information before heading out into the community. A faster system could help them reach more patients.

Finally, a problem that is also seen nationwide is transportation for the activistas. Since they are volunteers and there is limited funding for the hospitals, the activistas have to search the community by foot. With so many neighborhoods and limited time, not as many patients are reached. In the past, the volunteers had bicycles, but because of thieves, poor quality of the bikes, and poor maintenance, the bikes don’t last very long. Additionally, a motorcycle or car is out of the question because of cost.

Final Thoughts

I asked the activistas, “If you could change one thing about your position, what would it be?” While all of the volunteers said they were content with the job, they mentioned the need for a little bit of money for their families, transportation to get around the community, and the need for more material. The activistas enter the community without any physical pamphlets or information. Their palestras are just through speaking. However, there is the issue of literacy in the community as well as those who only speak the local language.

Public health is all about continuing the conversation.

The conversations with the activistas were crucial in developing a focused assessment. However, the conversation needs to continue into the implementation of the interventions or health programs. Additionally, we need to continue to speak with as many members of the community as possible to make sure all voices are heard and all voices are included.

Next, we need to better understand our organization’s reach in the community, speak with those directly affected by our organization, and identify any areas of improvement.

Questions? Concerns? Contact me!

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