Bill Frist. MD
I woke up to a crystal blue sky in Maputo. I began the day performing a major lung operation for tuberculosis (pneumonectomy), and I ended the day discussing with the President of Mozambique the American people's commitment to fighting extreme poverty in his country.
Maputo Central Hospital: Surgery
At 7:30am, we departed for Maputo Central Hospital, housed in a 100 year old building, but nonetheless a functional public hospital with 1,200 beds. All the doctors are government employees, and they make about $700 per month. They are very prestigious figures in the community. In Mozambique, there are only 500 doctors for 20 million people, and there are very few specialists. In terms of equipment, there is one CT Scan, in Maputo, for 4 million people. By way of comparison, there are probably 32 in Nashville for about 1 million people.
Dr. Atilo Morais, a superb thoracic surgeon training in cardiac surgery, gave us a tour through the hospital. His patient, Elias Novela, a 59 year old man, had a history of tuberculosis (TB). His symptoms included shortness of breath, bloody coughing, and fevers. We reviewed his x-rays which presented a huge right lung mass, thought to be an empyema secondary to his TB. This man would die without surgery of his “bronchopleural fistula” that had developed because of the TB.
I operated with Dr. Morais having been given full surgical privileges granted for the length of our stay. He spoke basic English, and I speak no Portuguese – but luckily cutting and sewing don’t require any talking!
I explored the patient through the bed of the 6th right rib. We removed the empyema cavity, careful not to spill the purulent material within the TB abscess. This is a big operation, but one common in Maputo because of the high incidence of tuberculosis infection. We removed the entire lung, suturing closed the bronchus, the pulmonary artery and vein. The patient as of right now is recovering well. He will remain on anti-TB therapy and should have a good long-term course. This is something very very rare in the US because TB gets treated early.
Save the Children: Mozambique
I'm also here visiting with Mary Beth Powers and John Grabowski of Save the Children. Mary Beth leads Save the Children's Survive to 5 Campaign, which I chair. More than 26,000 children die every day from easily treatable maladies. Almost half of these are newborns. About 6 million children could be saved every year through a concerted effort at vaccination, the use of cheap and readily available treatments for pneumonia, diarrhea, and malaria, ensuring mothers protect their children from malaria-bearing mosquitoes with bed nets, and improving nutrition.
Save the Children in Mozambique has focused our work on interior rural areas, where most Mozambicans live. This majority is extremely vulnerable to shocks such as floods, drought and crop diseases, as they are solely reliant on rain-fed agriculture. HIV/AIDS is dealing severe blows as well, fueled by the expansion of international trade corridors with neighboring countries. Save the Children’s work includes strengthening food security and combating child malnutrition, especially during the “hungry season,” as well as aggressively expanding HIV/AIDS programs to help stem what the government has termed a national emergency.
John Grabowski recently oversaw the merger of three Save the Children programs operating in Maputo: US, Ireland, and the UK. He explained the synergy that emerged from this commonsensical pooling of resources and strategy. Save the Children has moved strongly in the direction of outcomes measurement, moving in a results-driven direction.
African hospitals and clinics usually lack the equipment and laboratories necessary to save lives. That's why technological innovations that can reduce the costs of medical technology for developing countries are so important. I've been joined here in Maputo by Dr. Rebecca Richards-Kortum, professor of bioengineering at Rice University in Houston, Texas. Dr. Rebecca is a national leader in designing effective, simple health technologies that are appropriate for the conditions in African clinics. She's also a pioneer in looking for enterprise-based solutions for getting these technologies into the hands of the people who need them most. She demonstrated three fantastic devices that she and her students at Rice have been working on: a diagnostic lab-in-a-backpack, a low-cost imaging device to detect oral and cervical cancer, and a combined incubator and bilirubin phototherapy device for newborns (it costs less than $100 to build with locally-available materials, as opposed to about $2,000 for factory-made equipment).
You can learn more about Dr Rebecca's pioneering work right here: (http://beyondtraditionalborders.rice.edu/)
Iris Ministries Orphanage and Clinic: Samaritan’s Purse
In the afternoon, we drove about 35 minutes outside of Maputo, to Zimpeto to the Iris Ministries orphanage which houses over 425 children ranging from a few weeks old (they have 42 babies) to 20 years of age. Arco-Iris in Portuguese means “rainbow,” signifying God’s promises. This remarkable orphanage began simply by reaching out to the street children, providing them with clothes, food, shelter, and medicine. It has grown to where it now has a 700 person school, a pastor’s training center, and a large community clinic where I was able to see several patients over the course of the afternoon. We were greeted by a warm, prayerful crowd of about 200 people; many were students from the school. A young boy read a welcome message, and there were songs and dancing! Iris is supported by Samaritan’s Purse.
The first little boy was 24 months old. He had spontaneous tremors of his distal arms and legs; he is hyperreflexic. With normal facial features, the cranium seemed quite small. My diagnosis was severe brain injury probably suffered at birth. He really needs a CT, given the contours of his hea,d to evaluate his brain, and I will make the referral. But he probably will not receive it due to the lack of CT scans in the country.
The second patient was a 14 year old girl. She had a 6 month progressive history of difficulty swallowing and talking --a feeling of fullness in the throat. Chest x-ray shows a military pattern consistent with TB; barium swallow shows a mass high in the neck – the culprit. The remainder of exam was fine: intraoral, thyroid, neck nodes. I tested her for TB, and while waiting for results, she will be started on triple therapy to fight TB. Tentative diagnosis: TB mass of the neck (She should respond to the medicines I gave her).
There is no greater or more gratifying profession than being a doctor.
Meeting with President Armando Guebuza
Hurriedly, I switched from casual clothes to more formal attire to go see the President of Mozambique. He was friendly, quick to smile and respond. I introduced him to my son, Harrison, who is an investment banker in New York, which made him pay a little extra attention.
I told him we had had the opportunity to see Maputo, Chimoio, and Nampula, though they were quite a distance from one another (the coast line of Mozambique is twice as long as that of California). I told him that I loved exploring the inside of his country and the insides of his people! (That was supposed to be a joke since just hours before I had had my hands in a patient’s chest. His staff got the joke, but he kept a poker face.)
I congratulated the President on his outstanding leadership in signing an MCC Compact with the United States last July, focusing on clean water, agriculture, and land tenure. But, since then, Mozambique has fallen 6 months behind schedule. The American people are holding them accountable for the $507 million dollars. And Congress will watch how well they implement this funding like a hawk.
Save the Children Reception
The Save the Children’s reception was held at the home of John Grabowski. I met with a number of doctors, including a senior cardiologist, Dr. Albertino Damasceno, who asked if Vanderbilt would send a team of cardiac surgeons, cardiologists, an intensivist, and a perfusionist to help upgrade the cardiac surgery program in Maputo. Since Vandy is already doing so much in Mozambique on global health with the Institute of Global Health run by Sten Vermund, we should give it a shot. We noted that 2/3 of the 27,000 people who will die over the next 24 hours could be saved with inexpensive technologies, if we could just get them out in time.