BEIRA, Mozambique — The immediate priority was to save lives.
In the hours after Cyclone Idai made landfall in the city at Category 2 strength, the staff at Mascarenhas Hospital rushed to their posts in an attempt to care for as many of their wounded and sick neighbors as possible.
“We didn’t stop treating patients,” said Dr. Shilpa Jamnadas, 27, the medical director of the hospital, which was devastated by the powerful March 2019 storm. Since the roof was destroyed, and the inside gutted, Jamnadas’ team moved into tents outside. “When the cyclone hit, it was a complete disaster, there was not even a room here to see patients,” she said.
But staff made sure services continued. “We treated all patients with malaria, tuberculosis, even pregnant women,” Fino Massalambane, Beira’s director of health, told Direct Relief through a translator.
Beyond the hospital walls, Beira was in tatters, with some estimating 90 percent of the area’s buildings had been destroyed. The storm resulted in more than 1,300 deaths and led to over $2 billion in damage across Mozambique, Zimbabwe, Malawi, and Madagascar, making it one of the most destructive on record in the Southern Hemisphere.
Beira is home to more than half a million people, and was in such bad condition that it elicited a visceral reaction from those who saw it, even weeks later.
“It was, wow, after two weeks the situation was very, very bad. It was completely destroyed, the city, the urban area, the rural area. I was very emotional about what I found in Beira when I arrived,” said Dr. Isaias Ramiro, head of Health Alliance International in Mozambique, an NGO working in-country since 1987. Ramiro was previously head of the provincial ministry of heath in Beira’s Sofala province.
Though there was still no power or water, Ramiro and his team set out with the same mission as Jamnadas and her staff at the hospital: to save lives, by transporting people to safe places and and then helping them find shelter.
While doing that, they also ran fact-finding missions for local health officials, who were still trying to understand the scale of damage to their area, and what they would need — in terms of transportation, fuel and people — to get the health system back to full capacity.
After an initial assessment, Ramiro found that all of the city’s hospitals were damaged. He decided to pick one, Mascarenhas, and dedicated his full attention to fixing it.
“We started rebuilding the hospital immediately, the very first day. The impact of that facility in Beira is huge,” he said, noting that it is one of just five major health facilities serving the city.
By focusing on one site, he thought he could fully repair it, instead of only fixing the roofs or exteriors of several hospitals.
“My plan was to do a big intervention, on the roof, and in many areas throughout the facility that were in need,” he said. “We had to address these problems.”
Though the storm had created apparent problems — such as a destroyed roof — Ramiro and his team realized that less obvious, but no less severe, problems were lurking. A substandard electrical system had led to at least one fire and a decrepit sewage system threatened to render the buildings unusable.
“We found that health facility had problems was very old and was not caused by the cyclone, so by only repairing the damage caused by the cyclone and those problems, the impact would be nothing, zero” he said.
With a grant from Direct Relief, Health Alliance International was able to get started on critical repairs, which would take six months, and included replacing the roof as well as damaged cables, fans, lamps, sockets, and switches. For the sewage system, septic tanks were cleaned or replaced, and new covers were outfitted as well. HAI would also go on to repair a hospital in the adjacent, and heavily flooded, community of Buzi as well.
“Direct Relief, through HAI, was able to support the government to rehabilitate these facilities. It was not only to replace the roof, but it was general rehabilitation. Today, we are happy for the fact that we have health facilities to provide services and attend to patients,” Massalambane said.
Critical medicines also began to flow in from Direct Relief within weeks, increasing the capacity of the hospital’s providers to continue treating the community of 26,000 people in their area of responsibility. Incredibly, the facility operates with only two doctors, Jamnadas and Dr. Neide Santos, 27, as well as an on-site dentist, pharmacists and nurses.
Beira’s health care system would face another challenge in the weeks after Idai, when a deadly cholera outbreak occurred. An influx of about 900,000 doses of cholera vaccine helped curb that crisis, which health care providers throughout the region, including at Mascarenhas administered, even as they were treating thousands of patients.
Now eight months after Cyclone Idai, the facility’s structures are fully repaired, though many pre-storm challenges remain. The most pressing issues facing the hospital include a lack of staffing for the 500 daily patient visits they experience and 200 prescriptions they fill per day, a water supply that is vulnerable to contamination, no dental x-ray machines, and a non-functioning dentist chair.
The hospital is comprised of two buildings, once built during the colonial era and one built about a decade ago. Both are single story buildings, with yellow-painted rooms featuring iron-fenced windows and wall-mounted air conditioning units.
The surrounding neighborhood was still very much in recovery mode, with many houses unrepaired and strewn with debris. Still, life continued as small stores were open in the midday heat, and local sellers lined the unpaved road leading to the hospital.
Standing under the shade of a tree in the yard, Jamnadas and Santos, both dressed in white, explained that the usual, pre-storm array of patient conditions had resumed.
“We see every type of patient, I see everything,” Jamnadas said, with more common diagnoses including malaria, diarrhea, and HIV. The facility operates with a triage system, where nurses decide whether to diagnose and treat patients, send them home, or call in one of the doctors. For more complicated cases, the doctors will refer patients to the city’s main hospital.
“We are just two doctors for an entire hospital, so it’s difficult to manage,” Jamnadas said.
Like her colleagues, Dr. Maria Eugênia Jossefa, a dentist, does the most for the 15 patients she sees daily. Being without access to an x-ray machine, she diagnoses her patients based only on what she can see and what they tell her. Sometimes the limitations prove to be too much.
“I couldn’t do anything for him,” Jossefa said, referring to a 9-year-old boy who came in earlier in the day with a dental abscess. She referred him to another facility in town. She also discussed how she is able to overcome the broken patient chair and lack of electrical tools in bringing dental care to hundreds, evincing a kind of dueling frustration and pride that was common amongst health care providers and other staff at the hospital.
In the facility’s pharmacy, new wooden shelves were being installed, preferred over metal because wood will not rust. Staff were arranging knee-high stacks of drug boxes on the stockroom floor, reaching head-high on surrounding tables before transferring them to their new locations. Technicians at the in-house lab assessed cultures and blood work.
As the midday lull came to an end, Jamnadas and Santos shared a laugh as they prepared to return to the facility’s toughest cases.
“If the nurses have a doubt, or can’t resolve a condition, they send it to us,” Jamnadas said.