Home-Based Care: Extreme Edition

The Bike Brigade

This morning I had planned to meet up with 3 activistas to shadow them on home-visits and get to know one of the communities outside of Mandimba.  Of course, no one showed up until a half hour after our planned meeting time at 7am, and then it was only one of them. It turned out that one had backed out of our trip to the campo in favor of attending the inauguration of the new district finance office, and the other had misunderstood our meeting place – not unusual when plans are getting made in 4 different languages.

The "before" picture - there is no after, but it would have been me looking seriously worse for the wear, and the other two looking exactly the same.

Our destination was a community about 7km outside of Mandimba.  Both of the activistas I went with, Laurinda and Fatima, have current and recovered patients living there, so the plan was to go introduce me to the chefe informal  (informal boss) of the community, and then check in on some patients.  Almost immediately I realized my bike had a couple flaws: the seat was far too short, and it wasn’t screwed on well, so it tipped backwards until I was leaning out over the back wheel.  After not having ridden a bike much more than a couple blocks in the past few years, I thought these might be problems I just needed to deal with.  However, after a couple kilometers and an already aching crotch, I had enough.  Laurinda was incredible and switched bikes with me until we got to a roadside handyman who was able to screw down the seat – unfortunately it was still tipped back a bit, but it was much better than before.

Road-side savior tightening up the bike seat.

After finally arriving at around 9am, already sore and with thigh muscles the resembling jello, we started to make the rounds.  The first stop at the casa de chefe informal was interesting.  As we sat down and shook hands, the smell of liquor wafted off of him.  It then became clear that not only were we there for the purpose of introducing me, but also because he and his wife were in and out of the home-based care program.  The reason that they hadn’t recovered as well as other patients?  For a reason that Laurinda did not know, they wouldn’t each get their own ARVs – so they shared with each other, and were periodically getting severe malaria and needing care. 

We next visited a woman who had just given birth at home, and had some sort of skin condition that was started on her scalp and reached her left eye, which was quite swollen.  Laurinda and Fatima decided that they would tell someone at the hospital the next day so that they could see her and the baby, but there was no decision on how transport would happen.  The rest of the visits were to women who were almost recovered or had already been officially discharged from the program.  They all told stories of having been so sick they couldn’t get out of bed, then having been tested for HIV and starting ARVs.  They are now are doing well, taking care of their children, and are even healthy enough to capinar (a vague verb relating to agricultural activities: weeding, hoeing, cutting down straw, etc.) 

Our last visit was to some woman who didn’t end up being home, but en route to her house, I “met” the malouca (crazy lady) who has been hanging out in that community recently.  I didn’t really meet her.  She chased after me, grabbed my backpack as I furiously peddled away, and didn’t let go until I stopped.  At that time, she demanded money, and when I refused, she took off her clothes and kicked over one of the activisita’s bikes.  She eventually wandered off, and when we passed her on the way out, some man was holding her back – she had apparently just tried to poop in the middle of the community’s mosque.  They were not happy.

Getting ready to head back to Mandimba. One of the recovered patients and her daughter insisted on walking my bike partway down the road for me.

We started our trek back just after 10am – and then I found out why they usually try to leave at 6am instead of 7am: the sun is brutal.  In preparation, I quickly drank some water and reapplied sunscreen, but it was to no avail.  When we arrived back in town after another 7 kilometers of brutal bumpy dirt roads with the added peril of sand and dust patches, I was sunburnt, terribly dehydrated, and could barely walk.   Fatima and Laurinda were completely unphased – they chatted with the folks at ESTAMOS, and then declared that they were off to go home and cook lunch and perhaps rest a little.  I, on the other hand, could think of nothing but drinking water, bathing my grimy, sweaty, self, and taking a nap.  The two people who serve as ESTAMOS groundskeepers, Malicio and Violeta, fed me delicious papaya while I recuperated, and offered me hot tea, which I declined.

To say the least, between 7am and noon today was the most mentally tasking 5 hours I’ve had in many years.  The few moments when I was able to take my mind off the pain I was in while bike riding, I would look up to see beautiful mountains in the distance, tropical fruit trees everywhere and picturesque mud houses with straw roofs strung along the road.  The recovered patients I met were an excellent way for me to understand what the smaller organization I work with – Irmãos Unidos – is all about.  Chatting with the activistas along the way gave me insight into their lives and work, and that excruciating bike ride itself that they make several times a week reminded me that I know nothing.  

So, like every day, there were ups and downs – today was just a little extreme.