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.
It caused extensive power outages as well as destruction of housing and infrastructure. The loss of lives was devastating, from both the storm’s impact and that of the health system. There were many fewer casualties due to the investment made by governments in resilience. However, there’s still more work to do.
“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 equipment, infrastructure and logistics is not the only thing that will take time to heal.
The fact that I was required to keep track of my documents and move around my possessions caused me psychological distress. Salgado recalls that there were other colleagues who had to transport children under difficult circumstances.
Climate Change and the Foreboding future
The Cyclone Freddy ripped through South-Eastern Africa. It landed in Mozambique on February 23-24, and again on March 11th. Heavy rains in the region are not uncommon, but Cyclone Freddy’s path was unusual. It landed twice, first on February 23 and 24, then again on March 11. The World Meteorological Organization claims that Cyclone Freddy, after being named tropical cyclone and crossing the South Indian Ocean for over 34 days and covering 8,000 km, is possibly the longest tropical cyclone recorded.
Researchers have found that climate change will likely increase unpredictable weather events such as Cyclone Freddy. Climate change has been defined as the “long-term shifts” in weather patterns and temperatures, including increased and unpredictable rain, cyclones (with varying effects depending on geography), flooding, droughts and heatwaves. Recently, studies found a link between climate change (and the severity) of cyclones Ana 2022, Batsirai 2020 and Idai 2019. It has been a catalyst for investing in resilience to health systems, as communities around the world prepare themselves for more Freddy-like cyclones.
“You know that with climate change, Chókwe, Mozambique will always be affected. Salgado, EGPAF’s director of operations and planning, says: “We have to think about how we will organize ourselves to deal with future scenarios.” This is very important.
These investments have paid off for some EGPAF locations. This is a positive sign of what proactive actions can accomplish. While facilities in Malawi that still used paper filing systems lost their entire medical data, those who had digitized records stored on a “Data Lake” were protected from the destruction of the cyclone.
Charles Fodya is the Project Director for Health Information Systems, EGPAF-Malawi. He says that the Data Lake “has proven to be the backbone of the entire Health Information System.” The lost data due to paper and servers being washed off the floor has been recovered. “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, the wind speed reached over 120km/h, and heavy rains threatened basic infrastructure such as roads and power, making it impossible to access essential healthcare.
Edmundo Galiza Matos Jr. is the district administrator. “We’ve had trees and the roofing of the Rural Hospital in Vilankulos collapse,” he says. The Quewene Health Center, and also the Pambarra nursing technician’s residence, are also affected.
In the province, according to an emergency report by the Provincial Directorate of Health’s Emergency Survey, 20 health care facilities have suffered damage. Orlando Noreno is the regional coordinator for EGAPF and he said that the electricity is frequently interrupted in the entire region. He also stated that the main road leading to Mabote Health Center was impassable. Meanwhile, others were forced to seek shelter at the Mussengue Health Center after their homes flooded.
The Morrumbene Health Center is now facing a new obstacle to care, as treatment shortages are in place. This comes on top of the roof leaks that have been occurring in the Youth and Adolescent Friendly Health Services. Isaias Mculuve is the EGPAF focal point for care and treatment at the facility. He said that although the medication had been received the previous week, the ABC+3TC (600/300) formulation, an essential HIV first-line treatment drug, was not available. Re-stocking is expected to be delayed due to the damages caused by the storms. The impact on children who are HIV-positive can be severe, since gaps in the treatment regime can lead to HIV becoming drug-resistant and allowing it to return. This could force the child into a less effective second-line treatment.
The Nhachengue Health Center has enough antiretrovirals and other drugs to treat the patients. It is only missing the DTG 50mg and 600/300 ABC+3tc regimen (as a first-line HIV therapy for adults). We have zero stock,” said Massinga Regional Coordinator, Irene Menete.
Gaza and Mozambique: Health workers begin the road to recovery
What happened to Suabira Paulo of the Maternal and Child Health and Prevention of Mother-to-Child HIV Transmission Mobile Focal Point was unreal. She saw that her possessions were damaged during the flooding when she moved them to safer areas or vice versa. When she saw the river overflowing, she was terrified because it had never happened before. The nights were dark because of the lack of electricity. As the old saying says, “the opportunity is what makes the thief.” She panicked when opportunists used the flooding as an excuse to enter victims’ homes and steal their possessions.
“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 farm fields submerged under water. The fact that there was nothing recovered made it clear. The next few months are going to be very difficult. She added that food will become scarce and prices will increase.
EGPAF not only provided administrative and emotional assistance, but also logistical support for the teams as they moved them into safe zones. Nobody was left behind. The coordination was affected by the departure of officers from district offices and other members. EGPAF received a request from the Provincial Directorate of Health for it to continue providing support to certain health facilities as well as a resettlement centre. EGPAF responded by creating two teams of technical advisors to support the resettlement center.
Suabira believes that even though the team returned to their work after the 7th of March, there may still be some difficulties, because the waters haven’t yet receded in certain areas. This could affect the efficiency of service provision, since patients will want to rebuild and recover what they lost.
We have returned and are in recovery. I’m already recovered, but traumatized,” said coordinator Salgado.
Malawi: Investments in Digital Health Pay off
Malawi’s healthcare facilities suffered heavy losses.
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Flooding caused us to lose some of our medical equipment. We lost all of our equipment in other hospitals where flooding was extreme. Other times, we were able save movable devices (like J2 Terminals, Laptops Servers Tablets Batteries etc.). Fodya says that they lost the power cables and network wiring due to floods. Some of our servers suffered damage due to leakages in the roof caused by the heavy rainfall, and we also lost some inverters because lightning came along with the cyclone.
The recent digitalization of medical records in many healthcare institutions is a glimmer of hope.
Fodya says that the Central Data Repository, or Data Lake (Data Lake), has played a crucial role in restoring medical records to health facilities which have lost all. It also allowed HIV patients access to healthcare. The data lake is being used to print Emastercards and share them with all the healthcare facilities. We will use the printouts while mobilizing resources to replace lost hardware.
The cyclone showed that a digital record system has many benefits. The facilities that were already digital could simply print out new health records to continue service. The facilities that have not transitioned yet must start over, a huge 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 made worse by the flooding caused by Cyclone Freddy.
Fodya, while proud of the work his team has done, sees more room for improvement: “The next step is to migrate from a distributed to a central data repository. It will reduce data loss between the data stored on the server local and the data held on the server central. “We need to increase the frequency with which data dumps are collected in health care facilities”.