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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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