My experience trying to do research in Mozambique was first and foremost a lesson in patience. I think any time people from different cultures, experiences, or training levels are working together, patience and openness are the key to that relationship. Mozambique certainly presents a culture that is much slower pace and significantly more patient than I am accustomed to. For me, many of the meetings that were arranged did not happen at all. The ones that did happen typically started at least two to three hours after they were scheduled to occur. This is something that is hard for me to reconcile with my Western culture of immediacy. The challenge I faced with this slow pace is that each step is often slow, which can make it difficult to move forward and make progress.
While this has certainly been frustrating at times, it has also taught me about why certain cultures foster different approaches to the workplace. In the United States, there are certainly shortages. Any clinic or laboratory can tell you that there is never enough money. However, I’ve realized that there are many resources that I take for granted. While money is certainly a concern here, the limited physical and educational resources that accompany these financial struggles also have important implications. For example, there are many patients who come to the hospital with AKI or CKD, and diseases like malaria and AIDS can be horribly detrimental to the kidney. However, there is only one nephrologist in all of Mozambique and there are less than 10 hemodialysis machines. That means that even if a patient can pay for care, it may simply not be available. Similarly, cardiac surgeries are still only accessible to the wealthy, even in Maputo. The private cardiology clinic is beyond the reach of the general population. Though they will do some free surgeries for people below the age of 21, anyone beyond that age has few options. Even on a more basic level, certain lab tests, like chemistries or CD4 counts may not be done if that hospital does not have enough resources that day.
Research shares similar challenges. Since Mozambique is not necessarily a large research hub, supplies may take weeks, if not months, to arrive. More complicated experiments must be shipped out to nations with fancier equipment. Also, in the event of difficulties, there may be no one to ask for help. There are very few PhD programs in the country at this point in time, so biomedical researchers are usually veterinary students and physicians with other important responsibilities and often no formal research training. When setting up a study, if you don’t know how to troubleshoot the protocol, how to run the analysis, or how to navigate your study procedures, advisors and mentors are much harder to find.
Despite these challenges, successes eventually happen. People find ways to overcome the obstacles they face in order to nurse patients back to health and make progress in their research. And when they do, the results are remarkable.
In the hospital, it is certainly difficult, and sometimes impossible, to make a diagnosis or help a patient when there are limited tests and treatments available. However, it is amazing to see what can be accomplished with an excellent physical exam, empirical analysis, and effective utilization of the resources available. There is something incredible about the way in which the medical technician I worked with in the Manhica Hospital usually already knows the diagnosis, even before the positive test results appear. And no words can really describe the relief and joy on a mother’s face when she is told that her child can go home after spending weeks in the malnutrition ward.
Despite shortages in supplies or missing data, research also makes progress. When people finish a study here, it is a huge accomplishment, often accompanied by bolo (cake!). Furthermore, the results of these studies are almost always guaranteed to have life-changing implications. Knowing which pathogens are the worst culprits for pediatric diarrheal illness is saving thousands of lives. Understanding antimalarial drug efficacy will change future treatment strategies. These are the types of impacts that excite me about the projects that I am helping with.
So while sitting in the hospital waiting for a meeting, I take it all in. The pungent smell of antiseptic. The rumble of voices. The students and residents rushing in and out with paper charts. This is a place of great patience, resilience, and hopefully, great successes.