In Chókwe, in the Mozambique province of Gaza, the rains from Cyclone Freddy culminated in floods that forced the Elizabeth Glaser Pediatric AIDS Foundation (EGPAF) to stop activities for a week while moving the staff, the seriously ill, and the equipment to safer places.
Storms caused widespread power outages and destruction of housing and infrastructure. Deaths were also tragically high, due to the storm and the incapacitated healthcare systems. Innumerable deaths were prevented by the investment of national governments and partners in resilience, but much more can be done.
“This process has negatively affected us to the extent that we have reached the point of ceasing care at the main health facilities and transferring all services to the resettlement center in Chiaquelane,” says EGPAF’s Chókwe District coordinator, Aleixo Salgado. The future will be affected by this because many patients did not receive care, and could not pick up their medication since they were unable to get to the resettlement centers.
The damage to infrastructure, equipment, logistics and other areas may not be able to be repaired until time passes.
“I felt a psychological impact because I had my things moved around and my files organized. Salgado says that it is impossible to forget the colleagues who took children into difficult situations.
Climate Change and the Foreboding future
Cyclone Freddy was a cyclone that ravaged South-Eastern Africa. Landing in Mozambique, Malawi and a second time March 11, it landed on the continent between February 23-24. Although heavy rains can be expected in the region, Cyclone Freddy was extremely severe and took an unusual path. After crossing the South Indian Ocean for over 8,000km and being named as a tropical system for 34 consecutive days, the World Meteorological Organization has said that Cyclone Freddy could have been the longest tropical cyclone to ever be recorded.
Researchers have found that climate change will likely increase unpredictable weather events such as Cyclone Freddy. Climate change, as defined by the United Nations is “the long term shifts in weather patterns and temperatures,” which include increased and unpredictable rainfalls, cyclones flooding, droughts, and heatwaves (with different effects depending on geography). Recent studies show a correlation between climate changes and the severity cyclones Ana, Batsirai and Idai. The Cyclone is a catalyst for investing in health systems to be resilient as communities prepare for an upcoming future of more cyclones.
“You know that with climate change, Chókwe, Mozambique will always be affected. Salgado, EGPAF’s director of operations, says: “We have to think about how we will organize ourselves to deal with future situations.” “This is crucial.”
These investments were a sign that proactive action is possible. While facilities in Malawi that still used paper-based filing lost everything, those who had digitized their medical records and stored them in a “Data Lake” were able to protect critical medical data from the cyclone.
Charles Fodya (Project Director, Health Information Systems EGPAF-Malawi) says: “The Data Lake has been proven to be the resilience core for the entire Health Information System.” “All lost records due washed-away servers, papers, and so on, have been recovered by printing them from the Server.” “All lost records due to washed away servers, papers, etc.
Inhambane, Mozambique: Threats to basic health services, including HIV treatment
In Vilankulos, Mozambique and Inhassoro in Zimbabwe, wind speeds exceeded 120 km/h, and heavy rains threatened basic infrastructure such as roads and power, cutting off the access to vital health care.
Edmundo Galiza Matos Jr. is the district administrator. “We saw trees and roofs of the Rural Hospital Vilankulos collapse,” he says. “The Quewene Health Center, as well the Pambarra nursing technician’s residence, is also flooded.”
According to an emergency survey conducted by the Provincial Directorate of Health in the province, 20 health facilities have suffered damage. Orlando Noreno is the regional coordinator for EGAPF and he said that the electric current is frequently interrupted throughout the region. He also added that the main road leading to the Mabote Health Center was impassable. Some colleagues were sheltered in the Mussengue Health Center because of flooding at their homes.
The Morrumbene Health Center is now facing a new obstacle to providing continuous care. This comes on top of the roof leaks in the Youth and Adolescent Friendly Health Services section. Isaias Mculuve, EGPAF’s focal point for care and treatment at the facility, said that although some medication had been received in the previous week, the ABC+3TC formula (600/300) was not available. This is an essential first line HIV treatment medication used by children and adolescents. The storm damage will cause delays in stocking. It is a serious problem for children who are HIV positive, because gaps in treatment may cause HIV to become resistant to drugs, causing the virus to resurge. This could require the child’s transition to second-line treatment (less effective).
Three tents collapsed at the Nhachengue Health Center. However, the facility still has enough stock of antiretrovirals as well as general drugs. The only thing missing is the regimen 600/300 ABC+3tc and 50mg DTG, which are first-line HIV treatments for adults. We have zero stock,” said Massinga Regional Coordinator, Irene Menete.
Gaza, Mozambique – Health Workers begin the road to recovery
Suabira Paulo is the Mobile Focal Point for Maternal and Child Health and Prevention of Mother-To-Child HIV Transmission. The events that occurred were surreal. She saw that her belongings were damaged during the floods when she moved them from her home to safer areas or vice versa. She was afraid when she came upon the overflowing rivers because she had not seen them before. She spent her nights in darkness, as there was no power. As the saying goes, “opportunity makes the thief.” She was panicked because opportunists took advantage of flooding to steal from victims and break into their homes.
“First, I was affected because I had to leave my residence and leave my place of work as I am not from Guijá,” said Suabira. It was difficult to witness many homes destroyed and fields of agricultural land submerged by the water. The fact that there was nothing recovered was evident. The next few months are going to be very difficult for everyone. She added that food will be scarce and costs will increase.
EGPAF also provided logistical support to the teams that moved them to safer areas. Everyone was included. The coordination was affected by the departures of district officers and members. EGPAF received a request from the Provincial Directorate of Health for it to continue support of some health facilities, as well as a resettlement center. EGPAF responded by creating two technical support teams, led by advisors, for the resettlement center.
The teams returned to work on 7th March after the emergency ended. However, Suabira is concerned that there may still be problems because some areas have not yet been drained. This could affect the efficiency of the service delivery as patients are focused on rebuilding their homes and recovering from the losses they suffered.
“We’re back, and recovering,” said coordinator Salgado. I’m already recovered, but traumatized,” said coordinator Salgado.
Malawi: Investments in Digital Health Pay off
Malawi’s healthcare facilities also suffered serious losses.
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We had to replace some of our equipment because of flooding. In some health facilities, where flooding was extreme, we lost all of our equipment. In some cases, we were able to save the mobile gadgets (such J2 terminals and Laptops. Servers, Tablets etc.). Fodya explains that the company lost network and power cabling due to floods. “Some of the servers were damaged by roof leakages due to the heavy rainfall, and we lost the inverters as a result of the lightning that accompanied the cyclone.”
The recent digitization in many healthcare facilities of medical records is a glimmer of hope.
Fodya says, “The Central Data Repository has proven to be crucial in recovering medical records from health facilities which have lost everything. It also allows HIV patients to continue receiving healthcare.” We are printing Emastercards from the data lakes for each patient and sharing them with the health centers. Printouts are being used to replace hardware while we mobilise resources.
The project to transition to digital records at first seemed like a burdensome and unnecessary change, but the Cyclone highlighted the many benefits of a similar system. The facilities that were already digital could simply reprint their health records to continue service delivery. Facilities that were not yet in transition now need to start all over again, which is a major drain on the human resources needed to deal with the intensified and existing health threats. This includes re-starting treatment for clients who lost theirs during the storm and dealing with the ongoing cholera epidemic that was exacerbated due to the heavy flooding caused by cyclone Freddy.
Fodya’s team is proud of their work, but he sees room for improvement. “The next thing that we need to do to is migrate from a data repository decentralized system to a data repository centralized system.” This will prevent data from being lost between the local server data and data stored on the central servers. “We need to increase the frequency with which data dumps are collected in health facilities.”