Healthy Skepticism Library item: 20527

Warning: This library includes all items relevant to health product marketing that we are aware of regardless of quality. Often we do not agree with all or part of the contents.

Publication type: Journal Article

The People's Health
The Lancet 1984 Jun 16; (i):1172-73

Abstract:

“I was amazed by the nurses’ skill at putting large bore intramuscular injection needles into the tiny collapsed scalp veins of grossly dehydrated infants. They had none of the special ‘butterfly’ needles I was accustomed to seeing in Britian, and none of the special intravenous fluids really needed for these babies suffering from diarrhoea and vomiting, malnutrition, malaria, umbilical tetanus and pneumonia. I was distressed to see them tie the babies’ arms and legs to the side of cots with bandage to keep them still for the duration of the drip feed, but there were no sedative drugs or nurses to sit and comfort them, and undoubtedly hundreds of babies were saved in this way even during my short stay”. Christine Webb, lecturer in nursing at the University of Manchester, went to Mozambique in November, 1975 (four months after independence), and worked in the country for three years training nurses at the Institute of Health Sciences in the province of Zambesia. Her account forms a part of a collection of narratives by nine professionals who witnessed and assisted in the reconstruction of Mozambique’s health service after the war of independence and subsequent mass exodus of Portuguese colonial settlers.

Another contributor to the book,1 Carol Barker, who helped plan the country’s pharmaceutical policy with the Ministry Health, described last year2 how Mozambique was left on Independence Day with only 30 doctors. By 1983, however, there were nearly 400 doctors in the country and 3250 new health workers. FRELIMO’s health policy strives to ensure that no-one is denied care because they cannot afford it. A small charge is made for outpatient visits, but it is waived if the patient cannot afford it. All inpatient care is free. Primary contact with the health services is at a health post, which may be run by a nurse, midwife, or untrained servente. The trained village health worker is supported by his or her community and drugs supplied by the health service.

The authors of the book are committed socialists who write not only of the difficulties in extending health care to impoverished and scattered rural communities but also of the legacy of colonialism and the ideology of a people’s health service. Christine Webb found, for instance, that nurses had acquired middle-class attitudes from the Portuguese, and aspired to the latters’ lifestyle since, “in preindependence Mozambique, nursing was a path to assimilado status, a status superior to other Africans though never acceptable as fully Portuguese”. Student nurses found it hard to accept that nuts and beans were as nutritious as meat, that ‘Coca Cola’ had no food value, and that brown flour and rice were preferable to white. Training courses had to be restructed when it was understood that priority must be given to paediatrics and preventive health care. Likewise, the new social climate affected the old professional/patient relationship, so that students learned to relate to patients as equals, and everyone, including patients, began to take part in evaluating achievements so that standards could be constantly improved.