When she became involved in community activism, Amélia Uamba – affectionately treated by Mama Amélia – did not think that she could desperately watch the death of people in her hands. She never imagined that she could deal directly with individuals with tuberculosis, just as she did not imagine that she could play a crucial role in the lives of those living with HIV and tuberculosis.
In 2008 – when she joined activism for the health of the chronically ill – Amélia was only 40 years old. After 13 years, her will to save lives is still strong. She does not allow herself to be discouraged by the complex circumstances that characterise community activism.
“Our biggest challenge lies in the fact that we are dealing with extremely sick people, bedridden individuals and without the strength to get up. We have already been in situations where a patient, on the way to the health unit, loses his life”, says Amélia, making a serious facial expression.
Since her mouth and nose are hidden behind a mask against Covid-19, Mamma Amélia’s voice is heard with certain limitations, but the content of the words is very clear.
“After a while, we managed to get some stretchers that made it easier for us to work. HIV and tuberculosis patients were no longer dying in our hands. We started taking them directly to the hospital, we no longer carried them on our laps”, adds the activist.
According to Mamã Amélia, another disturbing challenge for the activist lies in the lack of food items to offer to the chronically ill who mostly suffer from hunger.
“You get to visit a patient who does not have food, but even so, you have to advise the patient to medicate, but in order to medicate, it is necessary to eat something. It is easy to give up treatment when you have no food. Most of the time, we have nothing to offer patients, so it’s difficult to save lives”, says the activist.
Amélia Uamba – who throughout her activism has dealt with more than 800 tuberculosis patients and countless HIV carriers – assumes that it makes no sense to advise a hungry person to take medication.
“Trying to help hungry people is sad. That is why, when we become aware of the patient’s condition, we are obliged to offer them the only transportation money that we have left and, consequently, we start to travel long distances on foot “, says the activist.
In order to minimise the condition of the chronically ill, Amélia Uamba defends the urgency of the government – through its institutions and ministries – to improve the chronically ill eating conditions.
“Even if they do the treatment properly, without food they will not improve. On the contrary, they will die because the medication is heavy”.
Mamã Amélia is a member of the Hixikamwe Association (an expression in Changana which means We’re Together in Portuguese). The association is located on the outskirts of Maputo City, while Mamã Amélia is a resident of the municipal area of Matola, in the Liberdade neighbourhood. Every day, she wakes up at 4 am to ensure she’s present at the offices of her association in Malhazine. Sometimes she goes to work without knowing what time she’ll return home.
“Sometimes, I work long hours because we work with all kinds of people. There are days when traditional doctors come to us with their patients. Other chronic patients (mainly those with HIV and tuberculosis) tend to hide their illnesses from family members and neighbours, so they go to our offices at night, they don’t want to be seen. They self-censor; the bigwigs want to speak to us secretly, without many people”, reveals Mamã Amélia.
Patients Torture Themselves Silently
“The bathrooms are kept closed and the patients are forced to urinate or defecate in inappropriate places …”
In health facilities, according to the source, health professionals sometimes create barriers so that activists do not freely to carry out their activities.
“Very recently, we received negative information about the functioning of the health units: professionals work haphazardly, they do not respect patients and do not prioritise those who arrive early, “says Amélia, adding that professionals” work well when policed by someone who has the ability to report mistreatment to the management.”
“I have witnessed several atrocities in the health units: the professionals open and close the units at any time they want, they leave the post before the scheduled time… the bathrooms are kept closed and the patients are forced to urinate and defecate in inappropriate places. Patients are threatened by health professionals, so they censor themselves… professionals say they own the hospitals; the patients do not complain because they fear reprisals and rejections… the patients torture themselves silently, thinking this: it is better not to complain to be cared for/or if they speak, they will treat me badly ”, denounces the activist.
The activist defends the need for the establishment of a professional class responsible for the supervision of the services provided in the health units. If the class in question existed, the source stresses, corruption and disorder in public service would be mitigated.
“All public hospitals should be supervised. Supervisors would be undercover individuals who, in detail and secretly, would monitor the activities of the professionals. Then, the same supervisors would survey the problems of each health unit and, subsequently, present them to the management in the health sector, so that they can find strong answers to the problem that arises”, she argues.
From Mamã Amélia’s point of view, the hospital – in terms of inspection – should not differ from the police station.
“Similarly, the police attend the drill in the early hours of the day, the health professional should also attend the hospital drill … with the inspections, the professionals would remember that they are in the health unit to serve people. The inspection, or supervision, would end the privatisation of the public thing”, says the source.
The continued absence of drugs in health facilities would also be minimised if there was hospital supervision, argues the activist, lamenting the fact that “there are many patients who give up treatment, because they never find the drugs they are looking for in the health centre. Patients always use private chemists. There is a system of corruption that steals medicines from the public sector.”
“We have to solve this dilemma. Someone with authority should intervene”, says interviewee
With her hand on her chin, in search of events that settle in her memory, Mama Amelia tells us about a tremendous episode that happened to her more than five years ago. She was returning home when, at 11 pm, she came across a group of criminals, armed with blunt instruments. Everything was dark, but the machetes that the men were holding were visible.
“Nobody escapes from bandits. I ran into those machete men. Fortunately, they passed by me mysteriously, they didn’t demand anything from me. I was very lucky. A better luck than the fear I felt. As we end our activities late, we are, from time to time, exposed to complex moments similar to this one ”, says the activist.
Covid-19 Surprises Young People and Adolescents with HIV
“They realised that being in the health unit is not safe…”
When the Covi-19 pandemic broke out, Mamã Amélia was working with a group of HIV-positive teenagers and young people. She sensitised them not to give up taking the medication, due to the restrictions imposed by Covid-19.
“The outbreak of Covid-19 worried me a lot, I thought my boys could give up treatment… they are people of sensitive age, they need a lot of care ”, says the activist, adding that“ I did a lot to make my boys motivated to continue the treatment, even though there are restrictions imposed by Covid-19”.
During the months of hard quarantine, in order to keep in touch with her patients, Mamã Amélia used radio, telephone calls and social networks (Whatsapp).
“I was always alerting the kids on the days when medicines were picked up. The message was always clear: we should not stop medicating because of Covid-19. In the early days, it was not easy, but we gradually overcame the barriers imposed by the pandemic … none of my patients had Covid-19 and none of them lost their lives.
The health units, the activist stresses, also contributed positively by providing antiretrovirals in stock, so that patients, in the wake of social distancing, would not always visit the health centre.
“When Covid-19 broke up, they realised that being in the health unit is not good, they preferred to supply the medicine bottles every three months ”, says the activist.
The source is pleased that she got the vaccine against Covid-19 and, ultimately, defends the need to carry out, throughout the National Health System, a thorough inspection so that there is an equitable distribution of the vaccine against Covid-19 and other drugs.
“Now, in the context of the pandemic, I feel safer to exercise activism”, says the lady who is the mother of two children and the grandmother of four grandchildren, concluding that“ the main points that should be highlighted in the National Health System are: fast and efficient delivery of medicines; supervision of activities and work mechanisms of health professionals and, finally, the prioritisation of people over money”.