If your child gets sick out here you have very few options; wait and do nothing hoping they will get better, walk to the nearest health post carrying them in your arms (the distance depends on which village you live in but it might be anything from 3 to 20 miles), or if you are very lucky find someone with a motorbike - or extremely rare - car, to take you there. There is one truck which will come from the largest big town, Macomia, but the trip takes up to 3 or 4 hours at the moment and the road is shocking. If you need an emergency caesarean your chances are not great.
The most common causes of infant mortality are dysentery and malaria but as you might expect there are also many problems during labour and birth. In the past few days we have been visiting the doctors, nurses and hospital. We are trying to work out where it would be best to help.
Despite being here for a few days and knowing how basic the facilities are, I'm still shocked when we visit the first health post. Two small buildings, one for general sickness, the other a maternity ward. No basic amenities, no order, no frills. Yet, despite my concerns, my fellow visitors are impressed; this is an example of how things can be done well. I need to shed my Western expectations and get back to basics. I'm so ashamed that I complained about the services offered by the NHS when I had my babies, the nurses did not come when you called. At the time I moaned to my husband that the bathroom was not cleaned regularly and I had to scrub the tub before having a bath. The most common causes of infant mortality here are diarrhoea and malaria. Here there is no bathroom; in fact there is no running water, no electricity, and no waiting room other than the shade of a large tree where people gather patiently for hours at a time, waiting their turn to see the overworked nurse.
My travelling companion, Elisabeth, who has been fundraising for charities in Mozambique much longer than I and from whom I am learning the ropes, tells me this is a great little clinic. She is impressed! I try to see the world through her eyes. Lisa, our new charity manager, who has spent the last 18 months working in Angola for the Halo Foundation removing land mines, tells me there is almost no foreign aid there. In context the villagers of Naunde are lucky to have this clinic.
Seeking some endorsement for what I've written above, I've just asked Amisse, who lives in the village and is a waiter at the lodge, what he does if he is sick. He is one of the lucky few with a full time job which means he can afford a bicycle. He tells me the local health post in Nuande is near enough and when he got really sick with malaria last year he cycled himself to hospital; "It's only 5 miles", he tells me "and they gave me Paracetamol, then I cycled home." I ask him what happens to the mothers who have sick babies and no bicycles? He shrugs his shoulders and smiles. (He smiles a lot.)
Since we have been in this area we have only seen two vans and one of them is the charity's vehicle. I know I need to see this African rural land in perspective, but I just can't stop thinking how worried I am about the tiny twins we saw yesterday. They were 8 weeks old and appeared to be less than 5 lbs in weight. Their mother looked thin - no baby weight to show. I got so fat when I was pregnant that it took four years to get back to my normal size. Here there is no understanding of weight issues. 'Fat' is not in the dictionary. The village we were in was not the lucky one with the health post. Surely Nema should try to find a way to put a nurse or midwife at the very least in every community? With the majority of women having their first child in their teens and family sizes ranging upwards from 5 children, maternal and post-partum health has to be a high priority.
Tomorrow we head for Mucojo, where the Chef de Posto for the four localities is based. We need to hear his opinions in order to make any sensible decisions.
The sun has gone down and my battery is dying. Time to stop writing and find something to do in the dark until the generator is switched on tomorrow morning and I can charge it. Tricky to know what to do in the dark (here, with no partner). No wonder there are so many children...