So Maputo. This place is undeniably a colonial city which grew up largely before the civil war. The war started in the 1970s and lasted until 1992 – fueled in large part by the apartheid movement in South Africa. The war resulted in a terrible division of the country north to south, the country north of the Zambezi River controlled by one party and the country south, including Maputo, controlled by another. One of the major tactics during the war, like in Angola, was to use land mines, and apparently there were millions planted throughout the country. Hundreds of thousands persist, but at least today you can travel outside of Maputo on main roads without the risk of encountering a landmine. Even six years ago that was not the case. Interestingly one of the tools that has been developed to find and remove landmines is rats that can sniff them out. Can you believe it, rats!
The city is still recovering from the war, physically and economically in particular. There is not much industry here in Mocambique and less than 10% of arable land is used for agriculture. Great potential, but large strides left to be made... and of course the toll – now and in the future – of AIDS/HIV is serious and devastating. Like in most African countries struck hard by the pandemic, the patients in our project are young, the median age being around 30 years old. Moreover, the death rate among seropositive children is very high, the majority of whom die before their second birthdays. But of course there is great hope that the progress of this disease can be halted, or at least slowed dramatically. So as one can imagine, the presence of NGOs, multilateral agencies and big donors here is enormous, and in turn so is the pressure felt by the government to act, rapidly and with broad powerful strokes. And not a day goes by that there is not one or more articles in the local newspaper about HIV/AIDS. Yet, something which is not surprising, the topic is not one of everyday casual conversation. While understandable that people are not motivated to talk constantly about things that are quite dark in many respects, nonetheless, HIV/AIDS is certainly something that touches everyone's life.
Still in my work I feel somewhat removed and without a deep sense of the reality of the epidemic here, since the majority of my time is spent at a computer looking at numbers. Sigh. Hence I really enjoy the days in the clinic, seeing patients with the doctors and other project staff, and getting a better sense of the situation and the work that goes on. It is incredible really how many patients are treated - thousands at one clinic, one small clinic. The manpower and resources necessary to deliver what is quite complicated care that will last a person's lifetime are extraordinary and immense.
There are an estimated 1.5M in Mocambique with HIV, and 1/3rd of those people likely are in need of treatment with antiretrovirals (500,000). Currently there are a bit less than 40,000 people on treatment in the country, and the efforts to manage just that are huge. To fill the gap is nearly unimaginable, at least to me in this moment, and I don't think that I am alone in that feeling. And the reality of that gap and the ever-growing and continuous need creates a political, cultural and economic sense that HIV and AIDS is big business, here and abroad. A reality that does not sit well with the public health hippy in me. Bom, as we say in Portuguese, such is life. The road ahead is uncertain, but the level of commitment of many (for better and for worse) is really quite something.