by Nanette Braun

12 June 1998

Bonn, Germany: "The UNVs were the first to roll up their sleeves and work day and night when cholera broke out. They really demonstrated what volunteerism is about." It is with deep respect that Luciano Lisboa, Director of the Institute of Health Services in Beira recalls the dedication of the UNV tutor nurses Aisha Mtwana from Tanzania, and her Cuban colleagues Julia Isabel Vazquez Prieto and Mayda Rosa Font during the two months when the epidemic hit Mozambique’s second largest city.

Normally, the three UN Volunteers train future nurses in mother-and-child-health (MCH) and in midwifery. Qualified health personnel are badly needed: When Aisha Mtwana, the longest serving UNV in Mozambique, took up her assignment six years ago, the number of basic MCH nurses was estimated at less than 850, with not even half as many elementary midwives - for the country’s 19 million inhabitants. Since then, 86 nurses at basic and middle level have finished their exams under the guidance of the experienced nurse tutor. "Wherever I go now in Mozambique, it might happen that I run into one of my students", she says.

Yet many more are needed. A mother-and-child-clinic in a suburb of Beira where dozens of women and children are patiently waiting in the small courtyard gives a vivid impression of the constraints and the enormous workload of medical personnel in Mozambique. Two nurses work here in pre- and post-natal care, treating some 800 patients per month. Four more colleagues tend to the 300 women who deliver in the same period of time. These women belong to a lucky minority: Seventy percent of all babies are born without any medical assistance at all.

The three UNVs have adapted to these working conditions - yet, nothing had prepared them for the suffering they were to witness when one Sunday afternoon in January, Director Lisboa called in on them after the first cases of cholera had been diagnosed. Within hours, the hospital almost burst with patients. "People would lie everywhere, in the corridors, on the floors; we had to put up to five children in one bed." The students’ classrooms were turned into wards and tents pitched in the courtyard to accommodate the alarmingly growing stream of patients who arrived at the hospital gates. Everybody - doctors, nurses, students - worked twelve-hour shifts seven days a week. Yet it was still impossible to render help to everybody who was in need of it: "People would break down, pleading to us for help; we would treat somebody who was gravely ill while somebody else died right in front of our eyes." 15 children died during one night when Mayda was on duty, a workshift she will never forget: "It was a nightmare."

It was a battle for life and death, "leaving us with an indelible imprint and a strong bind to these people", said Julia Isabel. Some 300 patients did not survive - despite the enormous, physically and mentally exhausting efforts during the two months before the epidemic curve began to decrease. Sometimes whole families would pass away; countless children would be left behind as orphans. How many more died at home without any medical care cannot be estimated.

"The one common factor was poverty and improper hygienic conditions", recalls Julia Isabel. Having resumed teaching, she and her colleagues aim at providing the qualified personnel needed to prevent such catastrophes in the future.