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International Health Program
Dr. Elizabeth Walker - Mozambique
Partnership for Rural Health Education in Central Mozambique
Catholic University of Mozambique Faculty of Medicine, Beira, MZ and West Virginia University School of Medicine, Morgantown, WV
- Dr. Elizabeth Walker, Department of Neurobiology and Anatomy
- Dr. John Pearson and Dr. Priscah Mujuru, Community Medicine Department
Abstract
The rural health system in central Mozambique was destroyed during a long period of war. A colonial war (1964-1975) was followed by civil war (1975-1992). The health system is now in an early stage of redevelopment. Infrastructure must be rebuilt, health care personnel trained, public health information gathered and acted upon, education about nutrition, maternal child health, and HIV / AIDS made available to the rural population. A strong partnership has been established between the newly established Faculty of Medicine at the Catholic University of Mozambique (UCM) and the School of Medicine of West Virginia University (WVU). Our partnership goal is to draw upon the experience of the WV Rural Health Education Partnerships (www.wvrhep.org) which has integrated rural health into the medical curriculum and established community support and infrastructure for rural doctors to stay and work in West Virginia. The assessments of similarities and differences of rural health care in West Virginia and Mozambique are underway so that rural health education can be designed to support and care for the people of Mozambique.
 
Support for this Partnership is provided by the Association Liaison Office for University Cooperation in Development (www.aascu.org/alo) and the US Agency for International Development (USAID) (www.usaid.gov).
UCM – WVU Partnership
The UCM Faculty of Medicine collaborates with the WVU School of Medicine through a Partnership for Rural Health Education in Mozambique awarded by ALO / USAID. It addresses the USAID Strategic Objectives for Mozambique to:
- Strengthen the central Mozambique rural public health system with an emphasis on maternal and child health and HIV / AIDS research, education, prevention;
- Build capacity for community based health care in central Mozambique using West Virginia Rural Health Education Partnerships (WVRHEP) as a model.
 West Virginia Rural Health Education Partnerships (WVRHEP)
Community - based health care in a rural setting;
Thirteen consortia link 300 training sites for students, including hospitals, health centers, social services, doctors’ and dentist’ offices, and pharmacies in rural communities;
Rural health and public health education integrated into the health sciences programs with expanded rural clinical rotations for all health sciences students;
All WV health sciences students complete three-month rotations in rural communities. This includes clinical psychology, dentistry, dental hygiene, medical technology, medicine, nursing, pharmacy, physician assistant, and physical therapy.
Learning resource centers with computer stations and educational materials at 18 locations, 11 of which are connected to statewide educational programs through MDTV (interactive telemedicine); and
Scholarships and stipends that provide incentives for rural practice.
Catholic University
 The Catholic University of Mozambique is a private educational institution established at the time of the Peace Accords of 1992, to serve central and northern Mozambique. The establishment of a private university (not under government control) in the central region of the country was a huge concession from a government located far to the south in the capital city of Maputo. This was one of the concessions made to the rebel forces, RENAMO, still in control of central and northern parts of the country at the end of the war.
The Faculty of Medicine focuses on educating professionals to provide health care to the primarily rural central and northern regions of Mozambique. This means that the infrastructure of a rural health system must be established in the next five years before the first class of medical students begin to practice medicine.
Mozambique
Mozambique is a cross roads between southern Africa and eastern Africa with a 1,500 mile coast line on the Indian Ocean. The Faculty of Medicine of the Catholic University of Mozambique is located in the city of Beira. The Beira Corridor is a major port of entry for oil and goods coming to the neighboring land locked countries. Other cities in central and northern Mozambique (indicated with red squares) are the locations of UCM Faculties of Agriculture, Economics and Management, Education, Law, and Tourism and Informatics.
 Quality of Life
Mozambique is one of the poorest countries in the world with a per capita gross domestic product (GDP) estimated at US$ 220. Consequently the health status of the population, especially among vulnerable groups, is poor. Average life expectancy is 44 years, illiteracy is estimated at 40 %. The 1997 Demographic and Health Survey (DHS) estimated the infant mortality rate at 135 per 1,000 live births, and the under five mortality rate at 80 per 1,000 live births - rates that have not significantly improved in the last twenty years. Estimates of maternal mortality rate vary, but are generally calculated to be in the neighborhood of 15 per 1,000 live births.
There are only six hundred medical doctors in Mozambique. Half of these work in the capital city of Maputo serving a population of one million. The other sixteen million people of Mozambique are served by the remaining three hundred medical doctors who work at level 3 and level 4 hospitals in the cities of Mozambique.
In rural areas, the government health infrastructure was destroyed in the long period of war. There are approximately one thousand remaining government health posts and health centres in the country. This works out to one health centre for every 75,000 people. Forty percent of these health facilities have no trained staff.
Because the Catholic University of Mozambique has social responsibilities to the communities and the people of the central and northern regions of Mozambique, the Faculty of Medicine intends to apply the full force of its resources to combat these problems.
 Mission Health Care
In Mozambique the best health clinics are associated with Catholic Church missions.
One clinic along the Beira Corridor is pictured here near the church at Altera de Manga or “high place with mango trees”.
Maternity Ward
Ten to twenty babies are delivered by midwives every day at this mission health clinic although more than 50% of babies are born at home in Mozambique. This is the most successful work of the clinic as the patients go away happy and satisfied with the outcome.
Outpatient Clinic
Hundreds of patients wait to see the doctor who visits this clinic once a week for half a day. The patients often have serious problems – STDs , possible HIV / AIDS, and TB. There is little that the doctor can do for them in this setting.
It is within this social and economic context that sexually transmitted infections (STI) / TB / AIDS patients live or will live, and it is in this context that the fight against HIV /AIDS will be fought.
HIV / AIDS
Sentinel data show that the prevalence rates of HIV / AIDS are not homogeneous all over the country. The rates are much higher in the central provinces as well as the districts bordering the neighboring countries. South Africa, Zimbabwe, Zambia, Malawi and Tanzania have prevalence rates greater than twenty percent.
Regional patterns of HIV seroprevalence has been derived from HIV / AIDS projections. Yellow color indicates a high prevalence (more than 20%), blue color indicates the lowest prevalence (less than 10%) and the green color indicates an intermediate level.
In addition to this grim picture of HIV infection, recent data suggest that the central zone is clearly in epidemiological transition, from HIV infection to AIDS cases.
 Centre for HIV / AIDS Study
The UCM Faculty of Medicine is establishing a HIV / AIDS program of research and intervention that takes advantages of all available resources in the region. The goal is to establish research leadership in HIV / AIDS care and prevention at the Faculty of Medicine in Beira. The research will be linked to the primary health care system, beginning with the establishment of research stations with professional staff at sixteen Catholic mission health clinics located along the Beira Corridor, now known as “the road of AIDS”. Community health workers from the religious communities will provide a network of volunteers who will deliver home based care to HIV / AIDS patients. Community - based treatment for opportunistic infections and TB will rely on the assistance of these volunteers and treatment supervisors. Personal attention helps ensure that the long medication regimen is completed.
In conclusion, the UCM – WVU Partnership provides valuable opportunities for rebuilding the community - based health care in Mozambique.
Rotary Report
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