In Changara, a district in the central Tete province, the lights of conventional light bulbs in health units are generally replaced by the dim light from lanterns, in hospitals where water and medicines are scarce, and as a result, users are the most affected.

At night, only the emergency services and the health units’s maternity wards have lighting, leaving other rooms, such as the corridors, among others, in the dark.

Celso Fernandes, an activist from the association Action for Social Development (ADS), has watched this scenario for roughly five years when he decided to embrace community activism to respond to a personal intention: “saving lives as a means to save myself.”

“We have health facilities that use weak power. They use solar energy. Most of the time, solar energy has not been enough during the execution of the works”, says the activist, adding that in the absence of solar energy, technicians use flashlights.

“In the same way that we fight for medicines, we have been doing everything to, at least, re-establish solar energy for a decent care to patients. In some hospitals, power from EDM (Electricity of Mozambique) is not supplied. Hospitals that are on the side of the road have an advantage, they have electricity. But even then, it is low quality power”.

On the other hand, the activist denounces the lack of water. “The problem with water in health units is extremely chronic. To have water in health units, health technicians walk over 50 metres to fetch water. They carry buckets and drums.”

The responsibility of walking 50 metres in search of water is also the responsibility of the activists. Sometimes, users themselves carry water from their homes to the hospital.

“Health technicians, activists and users themselves travel a 50 metres distance in search of water for the hospital. We have health units that use poor quality energy. They use solar energy”, says Celso Fernandes. 

Between the corridors and the hospital premises, characterized by the presence of sick people, Celso witnesses several episodes of illness. Several times, he saw desperate people going from the chemist to the consultation room to explain to the health technician that there is no medicine prescribed on the prescription.

“When this is the case, the health professional recommends another medicine, as the chemist does not have a certain medicine”, says the activist, as he walks back to his association ADS.

“The patient had cerebral malaria, but instead of going to the hospital he looked for traditional healers, prophets and other types of traditional doctors”

The first time Celso Fernandes witnessed a frightening case, caused by a chronic illness, he was 20 years old. He wasn’t a father yet and he didn’t even shack up.

“The chronic patient had lost his memory. The communities lacked information and, because of that, they associated the disease with obscurantism or witchcraft”, says Fernandes, adding that, “instead of going to the hospital, the person looked for healers, prophets and other types of traditional doctors”.

The patient was advised to go to the health unit, where he would undergo a diagnosis, in order to find out what he was suffering from. At first, the activist recalls, he showed slight resistance. However, after a while he ended up listening to the activists’ advice to undergo a medical examination and, finally, it was found that he had cerebral malaria.

“After a while, the person got better. Today, he is in good health”, stresses the young activist.
“The problem of medicines for the chronically ill is over”

Nowadays, Celso Fernandes is a supervisor in ADS. The organization – which works to raise awareness in communities about various diseases: HIV, malaria, tuberculosis, Covid-19, among others – is located in Changara district, in the central Tete province.   

“Thanks to ADS’ monitoring, the lack of medicines health centres tends to be minimised”, stresses the activist.

Fernandes is currently 25 years old and is entirely dedicated to activism. He is the father of a boy who goes to first grade and wants to develop more skills to deal with people in need.

“I want to work harder to help those in need. Now, for example, the problem of medicines, for the chronically ill, is over”, adds the activist, with the intention of highlighting the success of the persistent work that his organization has carried out.

Like other ADS supervisors, Fernandes, using a motorbike, usually travels 94 kilometres in search of essential material for his organisation to continue working for the most disadvantaged and sick.  

“Traveling 94 kilometres to the city center, in search of material to carry out our activities, has been a huge challenge”, says the activist, defending, however, that the ADC has had facilitators in the city.

“The activist must accept that his work is part of himself. Saving other lives is saving myself”, adds Fernandes.

Fernandes says that ADS has been working in several health units, within the Changara district, as well as in the Moatize district (Tete Province). In each health unit, there are two activists, who usually travel long distances on bicycles. Supervisors, in turn, cover the same (and other distances) using motorbikes.

“The activist must accept the challenges, even if there is no payment. He must always take to the streets, give lectures, raise awareness and be in the hospital with patients… the activist knows that by helping others, he helps himself”, says Fernandes.  

Stigma and Covid-19: “it is important to prevent diseases, following medical recommendations.”

Throughout his explanation, Celso Fernandes, discussing the current position of communities on chronic diseases, expresses his enthusiasm by watching the lucidity in people’s behaviour.      

“We currently have few cases of stigmatization of people living with HIV or tuberculosis. People in the community used to despise and abhor the chronically ill”, says the activist, with a certain tremor in his voice.

Fernandes believes that “thanks to our awareness, people have realised that there is no difference between an HIV-positive and an HIV-negative individual. Finally, they can see that we are all human beings”.

Continue discussing the way communities deal with certain diseases, Fernandes reveals that when Covid-19 broke out in that part of the country, people didn’t want to hear about activists. They fled. Children in schools thought that health workers were mean people. But, finally, the fears were overcome, after arduous awareness campaigns in markets and schools.

“Working in the context of Covid-19 has been a challenge, but so far it’s all under control. In the beginning, people didn’t accept to wear masks… we had to reinforce the work so that people started to accept the prevention methods. Now, activists and people in general are ready to vaccinate”, he argues.

Throughout the interview, Fernandes did not let his criticism of the institutions responsible for providing distance communication mechanisms escape. The criticism is associated with the lack of electrical current in some areas – in this case, there are barriers for health sector agents to be informed about essential day-to-day issues.           

“Some ADS activists have not yet vaccinated for lack of information. Communication in this area does not reach us well because there are problems with the network and electrical current”, he says.

Despite the criticism, the interviewee is happy with the fact that the Project Sou Cidadão is managing to minimise some basic problems in the sector.

“The community is learning about its rights and duties at the health unit. Community dialogues have been developed… patients already know their rights, they already know that they should not be forced to take a drug that is harmful to them.”    

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