ONE Staff Africa Trip
I woke up at 3:30am this morning, left my son Harrison in the hotel room, and headed for our 4:30am departure to Nampula, Mozambique. We flew in a Cessna Caravan of AIM AIR with Capt. Dan Spooner. Capt. Spooner had taken me in AIM AIR with Samaritan’s Purse about a year and a half ago to Darfur from Nairobi, Kenya and then into northern Uganda into the area of the Lord’s Resistance Army.
On the plane flying the length of Mozambique, we were able to capture the beautiful morning light with sun rising on a sharp horizon, red-orange turning bright orange and then a brilliant yellow. After about six hours of travel and one stop in Beira to refuel, we landed in Nampula city and were met by Mayor Castro Serafim who spent the day with us. He is articulate and is now running for reelection. He has been mayor of Nampula city for five years. We also had lunch with the Governor of the Nampula province, Felismino Ernesto Tocale. Interestingly enough, he was a former organic chemistry professor before entering politics.
We spent the afternoon with the Millennium Challenge Corporation (MCC). Accompanying me were Cassia Carvalho-Pacheco, Resident Country Director of the MCC in Mozambique, and Paulo Fumane, Executive Director MCA-Mozambique, who will be responsible for implementation of the Compact.
We visited four different sites which ran the spectrum of the clean water, sanitation, and land tenure aspects of the MCC Compact. Since the MCC compact has been signed but not yet implemented, we went to the areas where MCC will have an impact before the program had begun, where the planning stages had started. Implementation does not start until mid-September.
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I woke up to a crystal blue sky in Maputo. I began the day performing a major lung operation for tuberculosis (pneumonectomy), and I ended the day discussing with the President of Mozambique the American people’s commitment to fighting extreme poverty in his country.
Maputo Central Hospital: Surgery
At 7:30am, we departed for Maputo Central Hospital, housed in a 100 year old building, but nonetheless a functional, governmental hospital with 1200 beds. All the doctors are governmental employees, and they make about $700USD per month. That being said, they are very prestigious figures in the community. In Mozambique, there are only 500 doctors for 20 million people, and there are very few specialists. In terms of equipment, there is one CT Scan, in Maputo, for 4 million people. By way of comparison, there are probably 32 in Nashville for about 1 million people.
Dr. Atilo Morais, a superb, thoracic surgeon training in cardiac surgery, gave us a tour through the hospital. He introduced us to his patients. Elias Novela, a 59 year old man, had a history of tuberculosis (TB). His symptoms included a shortness of breath, bloody coughing, and fevers. We reviewed his x-rays which presented a huge right lung mass, thought to be an empyema secondary to his TB. This man would die without surgery of his “bronchopleural fistula” that had developed because of the TB. About 2 million people die of TB every year in Mozambique (about 2.5 million die of HIV/AIDS, and 1 million die of Malaria).
I operated with Dr. Morais having been given full surgical privileges granted for the length of our stay. He spoke little English, and I speak no Portuguese – but luckily, cutting and sewing don’t require any talking!
I explored the patient through the bed of the 6th right rib. We removed the empyema cavity, careful not to spill the purulent material within the TB abscess. This is a big operation, but one common in Maputo because of the high incidence of tuberculosis infection. We removed the entire lung, suturing closed the bronchus, the pulmonary artery and vein. The patient as of right now is recovering well. He will remain on anti-TB therapy and should have a good long-term course. This is something very very rare in the US because out TB gets treated early. (more…)
Sen. Bill Frist, MD, is traveling through Mozambique and Rwanda on a 10-day trip to visit and observe the great work of U.S. led initiatives. Throughout the trip he’s blogging on the Healing Hands blog and here on the ONE Blog.
In Maputo, Mozambique, today, I met with senior officials to discuss the progress of the Millennium Challenge Corporation Compact (MCC) that Mozambique signed with the United States last summer.
This five-year, $507 million agreement focuses on the neglected northern part of the country where I will visit later this week. The Compact will bring clean water to tens of thousands of people for the first time—making them less vulnerable to disease and more economically productive. MCC’s grant will also allow Mozambique to build new roads that link poor communities with markets. A land tenure component will help ensure that property rights are respected. Finally, the Compact seeks to eradicate a coconut disease that threatens one of northern Mozambique’s most valuable crops.
Last year, President Bush appointed me to the Board of Directors of the MCC, which was created by Congress in 2003 when I was Majority Leader of the United States Senate to reduce global poverty through economic growth. The MCC represents a fundamentally different way of giving American development aid to the world’s most deserving nations.
In the past, most of our aid money was, frankly, wasted. That’s because we didn’t pay attention to the quality of the government or how well it treated its people. That caused many Americans to grow skeptical about foreign aid. The late Senator Jesse Helms used to refer to foreign aid as a “rat-hole” because of all the waste and corruption!
We learned something from those failures. MCC only awards aid to countries that are accountable, both to their own people, and to the American taxpayers who ultimately provide the grants. There is no point at all in wasting your taxpayer dollars in countries with bad governments. But in well-governed countries, American generosity can produce transformational change in the daily lives of poor people. (more…)
With a vote of 80-16.
(All but one of the amendments we worried about failed. More on all in just a bit.)
Later this month, the ONE Campaign is set to reach out to senior advisors and key political voices from the Democratic and Republican parties as we continue to make the case that aid works, that American leadership can help a generation of people break the brutal cycle of extreme poverty. To drive that point home, we’re headed to Rwanda with an impressive roster of folks. We’re fortunate to have people who understand what’s at stake, both in terms of the lives which are on the line from poverty and preventable disease, and in terms of the benefit for America’s renewed leadership role in the world through expanded investment and assistance in these terribly poor countries.
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The trip will be led by former U.S. Senate Majority Leaders Tom Daschle and Bill Frist – the two men who, for the past year, have co-chaired our ONE Vote ’08 effort. They’ll be joined by people like John Podesta (who was Chief of Staff to President Clinton and heads the Center for American Progress), Mike Huckabee (former Governor of Arkansas who expressed support for the ONE platform when he was running for the GOP nomination), and John Kasich (former member of the House of Representatives who worked as House Budget Committee Chairman). Cindy McCain will join the bipartisan trip as well. Mrs. McCain has a solid history of work in the fight against extreme poverty and preventable global disease. She’s served on the Board of Directors to ONE-partner CARE International since 2005. She founded the American Voluntary Medical Team in 1988, organizing trips for medical personnel to provide emergency care to disaster-struck or war-torn regions. She also serves on the boards for the non-profits Operation Smile and the HALO Trust.
The American people have made an incredible difference in the lives of millions of people struggling to survive extreme, brutal poverty. Our next president has the opportunity to finish the job – to finally erase preventable diseases from the planet and eliminate the kind of suffocating poverty which claims thousands of lives a day. We know the way, but we need our next president to show the will. That’s why we’re bringing this group of people to Rwanda. Each of them is in a unique position to help shape the policies and priorities of the man who could be our next president, and we want the fight against extreme poverty and preventable diseases to be front and center.
In Rwanda, we’ll visit places where PEPFAR is providing funds to save lives at risk from HIV/AIDS. We’ll stop at a school to hear from the students about the importance of their education to break free from extreme poverty. We’ll hear from farmers about their efforts to grow more crops and address the food crisis by growing their way out of it. All told, it will be an eye-opening trip, and one that we hope pays off with stronger policy commitments to the issues we care so much about – ending poverty and disease — from the two leading presidential candidates.
We’ll send updates from the trip and let you know how things are going.
-David Lane
Yesterday morning, I traveled with fellow ONE staff to several health-focused development programs in Lusaka, Zambia. (The country is gorgeous and we’ve taken incredible photos, but because of some technical issues I’ll have to wait until next week to post a few here.)
A couple of today’s highlights were visiting with the Matero Refferal Clinic – a health center in Lusaka that is heavily supported by the Center for Infectious Disease Research – and a meeting with the Clinton HIV/AIDS Initiative and the Zambia Minister of Health. All of the healthcare workers at the Matero Refferal Clinic were wonderful as they showed us around their extremely busy and well-organized clinic. They showed us a new wing they’re building for HIV/AIDS and general health, but they did let us know that they need more medical supplies and staff. There were two doctors at the facility who, combined, see 200 patients each day.
Of note, we learned that patients receiving AIDS treatment at the clinic also receive “nutritional portions” from the World Food Programme. Food is vital to the fight against AIDS. For people infected with HIV, proper nutrition can slow the progression of the virus to full-blown AIDS and improve the effectiveness of antiretrovirals. Unfortunately, at the Matero Refferal Clinic, the size of food portions has decreased from 45 kilograms 5 years ago to just 12 kilograms today. On top of this, many people receiving these small, individually-sized portions will also share the food with their full families.
The meeting with officials from the Clinton HIV/AIDS Initiative (CHAI) and the Zambia Ministry of Health was extremely informative as well. A main take-away: the government’s decision to focus its attention on children with HIV – combined with the government’s collaboration with NGOs and funding from international programs like PEPFAR – has more than doubled the number of children receiving life-saving AIDS-treatment in the country.
Throughout the day, the need for more trained healthcare workers was repeated by doctors, nurses and officials. This is a need that is echoed across Africa: Africa bears 25% of the global disease burden and has 14% of the world’s population- but just 1.3% of the world’s health care workforce. This deficit in capacity means that countries like Zambia face enormous obstacles in improving basic health care for children and scaling-up access to vital health interventions, such as HIV/AIDS treatment.
-Virginia Simmons
Many African countries are facing a grave threat from rising food prices. That’s why we’ve been asking President Bush and other G8 leaders to take immediate action to soften the blow on the poor and reverse the underinvestment in long-term agricultural productivity.
Some of us have been in Mozambique this week; a country like Mozambique is particularly vulnerable to global food shocks. Not only is it very poor (75% of the country lives on less than $2 per day), it also imports roughly 75% of its food and is hit by a drought or flood every six months.
Despite these challenges, many parts of Mozambique have ideal climate conditions for agriculture production and there’s certainly no shortage of land – Mozambique runs 1,500 miles down Africa’s eastern coast and is twice the size of California.
Today we tried to learn why Mozambique is not able produce more food – both for local consumption and export. To find answers to our questions, we visited plant scientist Pedro Fato at the Instituto de Investigacao Agraria de Mozambique (IIAM) just south of Maputo. IIAM is an agricultural research institute jointly funded by the Government of Mozambique and private donors, including the Alliance for a Green Revolution in Africa (AGRA) and the Rockefeller Foundation. Pedro and his team are breeding more nutritious and insect resistant varieties of maize (corn), cassava, sorghum and sweet potatoes – all foods considered staples here in Mozambique. In the accompanying picture you can see Pedro holding orange maize which IIAM has bred to be rich in vitamin A and beta carotene.
Pedro outlined three major challenges to boosting agriculture growth and productivity in Mozambique
1. Water: nearly all agricultural production in Mozambique is rain-fed. With a typical rainy season lasting only three months, basic irrigation techniques and technology could significantly boost yields
2. Inputs (fertilizers and seeds): Fertilizer is expensive and not widely available in Mozambique. There is currently no domestic production; the limited quantities that are available are imported from South Africa. New seed varieties are also lacking. Approximately 70% of farmers are using unimproved local maize, which has lower yields and isn’t as resistant to pests and diseases. Like fertilizer, there is also no local seed production
3. Infrastructure: most of Mozambique’s agricultural activity occurs in the north of the country, where long distances and poor roads make it difficult to move crops beyond village markets. Improved access to markets could dramatically increase incomes for farmers and cooperative groups.
Pedro also told us more money is needed for agriculture research and extension workers so that new seed varieties and inputs can make it into the hands of farmers. He also said commercial farming is needed in Mozambique. Agriculture in here is mainly limited to smallholder farmers, limiting productivity, distribution and export potential. Pedro told us that 95% of maize in Mozambique is produced by small holder farmers.
Mozambique certainly isn’t alone. Many sub Saharan African countries are facing similar challenges. We’re hopeful that the global attention on food prices will translate into a sustained investment in long-term agriculture growth in places like Mozambique.
-Ben Hubbard and Tyler Denton, ONE.org
