“For people who live too far from the hospital to receive treatment, this programme saves their lives."

Marinho Malavi is an activista with AMODEFA, Mozambique

Marinho, 30, works as an activista for Amodefa’s Challenge TB programme, bringing treatment to remote villages in the Ribaué district of Nampula. Since August last year he has identified 84 cases of TB in the eight communities in which we works; “75 patients are in treatment at the moment, the rest are recovered,” he says.

Before Amodefa started work in Nampula, Marinho says, “people were dying because they couldn’t reach the hospital, but with this programme it is becoming easier because we bring the medication to the patients.” However, lack of transport means it is a challenge for him to keep on top of all his cases. “The distances are far and the few bikes we have are breaking,” Marinho says. Yesterday he travelled 40 km to visit his patients. Some of the communities he visits are up to 50 km away.

In the first quarter of this year 1,318 people were tested for TB in the eight districts where Amodefa operates; in the second quarter, 2,106 were tested; and in the third quarter, the number reached 3,154. More than half of these people were diagnosed to have TB.

The surge in the number of people going for tests is in a large part due to Amodefa’s ‘Day of the Cough’.  On the 27th of each month teams of activistas and volunteers go into communities, schools and jails to educate people about TB.   Before volunteers had to go from house to house to identify patients, “but now, with the lectures, it’s easy to find people who are TB positive because they are identifying themselves,” says Marinho.

Staff and volunteers remain dedicated and determined as the impact of the GGR takes effect

  • Talking about the impact of the Global Gag Rule, Executive Director of Amodefa, the Mozambican Association for Family Development, Santos Simione says, “We estimate half million people across our HIV, tuberculosis, malaria and family planning projects will be affected."
    Talking about the impact of the Global Gag Rule, Executive Director of Amodefa, the Mozambican Association for Family Development, Santos Simione says, “We estimate half million people across our HIV, tuberculosis, malaria and family planning projects will be affected."
  • A client being tested for HIV.
    A client being tested for HIV.
  •  21-year old Jenny Marcelino* and her three-year old son wait for free counselling, tests and treatment at the Amodefa clinic in Maputo.
    21-year old Jenny Marcelino* and her three-year old son wait for free counselling, tests and treatment at the Amodefa clinic in Maputo.
  • Palmira Enoque Tembe, 54, is HIV positive. She lives on the outskirts of Maputo with her two sons (also HIV positive) and four grandchildren. Amodefa volunteers visit three times a week and a nurse once a week who provide medication, food and therapy to the family.
    Palmira Enoque Tembe, 54, is HIV positive. She lives on the outskirts of Maputo with her two sons (also HIV positive) and four grandchildren. Amodefa volunteers visit three times a week and a nurse once a week who provide medication, food and therapy to the family.
  • Albertina Machaieie has been working with HIV patients for Amodefa for 38 years and is their longest serving nurse. Albertina now heads up Amodefa’s home care programme which provides medical, nutritional and emotional support to HIV positive patients living in the poorest suburbs of Maputo. longest serving nurse. “I’m going to work forever,” she says. “I like helping people, that’s why I do this job.”
    Albertina Machaieie has been working with HIV patients for Amodefa for 38 years and is their longest serving nurse. Albertina now heads up Amodefa’s home care programme which provides medical, nutritional and emotional support to HIV positive patients living in the poorest suburbs of Maputo. longest serving nurse. “I’m going to work forever,” she says. “I like helping people, that’s why I do this job.”
  • Palmira Enoque Tembe with Albertina Machaieie. “Amodefa counsels me through the difficulties in life,” Palmira says. “They help counsel me though my problems, my thoughts and worries. Sometimes I don’t know what to do when things get out of control, but Amodefa helps me through.”
    Palmira Enoque Tembe with Albertina Machaieie. “Amodefa counsels me through the difficulties in life,” Palmira says. “They help counsel me though my problems, my thoughts and worries. Sometimes I don’t know what to do when things get out of control, but Amodefa helps me through.”
  • 12 year old orphan Antonio Junior Xirindza* who is HIV positive, was almost given up as as lost cause. He has gained a new lease on life following Amodefa’s intervention. His health has improved rapidly and he is gaining weight. He is well enough now to attend school regularly and is already thinking about the future; when he grows up he wants to be a fireman. “I am happy about life here,” he says, shyly.
    12 year old orphan Antonio Junior Xirindza* who is HIV positive, was almost given up as as lost cause. He has gained a new lease on life following Amodefa’s intervention. His health has improved rapidly and he is gaining weight. He is well enough now to attend school regularly and is already thinking about the future; when he grows up he wants to be a fireman. “I am happy about life here,” he says, shyly.
  • 18 year old Yuran Nhaquila* gets a HIV test at the Amodefa clinic in Maputo.
    18 year old Yuran Nhaquila* gets a HIV test at the Amodefa clinic in Maputo.
  • Nurse Julia Suzette Mulambo* administers hormonal contraceptive injection to Eleria Horacio Mabucule.
    Nurse Julia Suzette Mulambo* administers hormonal contraceptive injection to Eleria Horacio Mabucule.
  • Aida Carlos Cossa, 17, is a student at the Armando Emilio Guebuza secondary school in Maputo. She has come to Amodefa’s clinic for free counselling at the “Tua Cena” at Armando Emilio Guebuza School in Maputo. “This is better than a hospital – it’s close, it’s private, I feel comfortable,” says Aida Carlos Cossa.
    Aida Carlos Cossa, 17, is a student at the Armando Emilio Guebuza secondary school in Maputo. She has come to Amodefa’s clinic for free counselling at the “Tua Cena” at Armando Emilio Guebuza School in Maputo. “This is better than a hospital – it’s close, it’s private, I feel comfortable,” says Aida Carlos Cossa.
  • A fresh delivery of bikes for staff and volunteers to use to reach local communities sit piled in a store room. The programmes that use these to deliver services will cease to operate as the funding stops.
    A fresh delivery of bikes for staff and volunteers to use to reach local communities sit piled in a store room. The programmes that use these to deliver services will cease to operate as the funding stops.
  • Nurse Julia Suzette Mulambo* gives family planning counselling and treatment to 16-year old student Eleria Horacio Mabucule, at the Amodefa clinic in Boane, in southern Mozambique.
    Nurse Julia Suzette Mulambo* gives family planning counselling and treatment to 16-year old student Eleria Horacio Mabucule, at the Amodefa clinic in Boane, in southern Mozambique.
  • At the Armando Emilio Guebuza secondary school in Maputo Amodefa has set up a sexual and reproductive health clinic to provide access to services including contraception. Known locally as the 'Tua Cena' project, the clinic aims to increase access to quality services and information on safe abortion, STIs and HIV, relationships.
    At the Armando Emilio Guebuza secondary school in Maputo Amodefa has set up a sexual and reproductive health clinic to provide access to services including contraception. Known locally as the 'Tua Cena' project, the clinic aims to increase access to quality services and information on safe abortion, STIs and HIV, relationships.
  • Cacilda Antonio Nimaco, is responsible for transporting HIV and TB tests from the local communities to the lab. Amodefa's TB programme is under threat; the programme, which has been running just over a year, identifies and treats patients with tuberculosis, some living more than 80 km from the nearest health centres. “I like the programme because it helps a lot of families,” she says. “There are lots of families who are sick, but can’t reach healthcare – people who can’t leave their homes.”
    Cacilda Antonio Nimaco, is responsible for transporting HIV and TB tests from the local communities to the lab. Amodefa's TB programme is under threat; the programme, which has been running just over a year, identifies and treats patients with tuberculosis, some living more than 80 km from the nearest health centres. “I like the programme because it helps a lot of families,” she says. “There are lots of families who are sick, but can’t reach healthcare – people who can’t leave their homes.”
  • Cacilda Antonio Nimaco picks up a TB sample in rural Ribaue District, Nampula Province, Mozambique.
    Cacilda Antonio Nimaco picks up a TB sample in rural Ribaue District, Nampula Province, Mozambique.
  • A free HIV test is administered in a village that has just registered eight new cases of TB. TB is prevalent in Mozambique with an estimated 12.5% infection rate. Communities will be abandoned just as the success of the treatments, and the effects of educating communities about HIV and TB, is breaking fear and stigma around the diseases.
    A free HIV test is administered in a village that has just registered eight new cases of TB. TB is prevalent in Mozambique with an estimated 12.5% infection rate. Communities will be abandoned just as the success of the treatments, and the effects of educating communities about HIV and TB, is breaking fear and stigma around the diseases.
  • Amodefa staff work late into the evening in Nampula’s local communities. Maria Teresa de Fátima and her team have been testing for HIV and TB. “If the US cuts this off, it’s going to implode. This is finished, you can’t imagine what will happen. If we could bring Trump here to come and see this, if he could see the work we are doing, maybe he would change his mind.”
    Amodefa staff work late into the evening in Nampula’s local communities. Maria Teresa de Fátima and her team have been testing for HIV and TB. “If the US cuts this off, it’s going to implode. This is finished, you can’t imagine what will happen. If we could bring Trump here to come and see this, if he could see the work we are doing, maybe he would change his mind.”

Children are particularly receptive to Amodefa’s message, Marinho says. He remembers one woman who had been sick for a long time and her daughter, knowing he was an activist, sought him out. The patient’s initial test for TB came back negative, so she was given alternative medication.  “She took the tablets but she was still sick - she was unable to walk or to eat,” Marinho says.  “We brought her here to the clinic, examined her and she immediately started TB treatment. Now she has started her recovery and is able to sit.”

Lessons taught during the ‘Day of the Cough’ means communities are also now taking greater precautions against the disease, he says. Steps such as opening windows, cleaning the house, not eating from one communal bowl, and practising ‘coughing etiquette’ have all helped limit the spread of TB.  “People understand now and are taking serious measures to prevent it,” Marinho says.

However, the US decision to withdraw funding from Amodefa following the introduction of the Global Gag Rule , could halt the Challenge TB programme just as it is gaining momentum.

“If the programme stops the people will suffer,” says Marinho. “For people who live too far from the hospital to receive treatment, this programme saves their lives. Knowing Amodefa has come to eliminate TB, it can’t stop. If they stop now the TB will get resistant, so we’ve got to keep going, we’ve got to get stronger.”