In Chókwe, in the Mozambique province of Gaza, the rains from Cyclone Freddy culminated in floods that forced the Elizabeth Glaser Pediatric AIDS Foundation (EGPAF) to stop activities for a week while moving the staff, the seriously ill, and the equipment to safer places.
The storm caused widespread power outages, destruction of infrastructure and housing, and devastating loss of life, both from the storm itself and from the impact of incapacitated health systems. Innumerable casualties were averted due to investment in resilience on the part of national governments and international partners, but there is more to do.
“This process has negatively affected us to the extent that we have reached the point of ceasing care at the main health facilities and transferring all services to the resettlement center in Chiaquelane,” says EGPAF’s Chókwe District coordinator, Aleixo Salgado. “This will have an impact in the future because the patients were left without care and they had no way of picking up medication, as not all of them managed to reach the resettlement center,” he adds.
In addition to the problems caused to infrastructure, equipment, and logistics, there are marks that perhaps only time can heal.
“I was psychologically affected because I had to move my belongings around and keep my files in order. There were colleagues who transported children in difficult situations, and there is no way to forget that,” recalls Salgado.
Climate Change’s Foreboding Future
Cyclone Freddy tore through South-Eastern Africa, landing in Mozambique and Malawi between February 23 and 24, and then a second time on March 11. While heavy rains are common in this region, Cyclone Freddy took a highly unusual path, was incredibly severe, and after having been named a tropical cyclone for 34 days, crossing the entire South Indian Ocean, and traveling over 8,000 kilometers, the World Meteorological Organization says Cyclone Freddy is potentially the “longest lasting tropical cyclone ever recorded.”
Research indicates that unpredictable weather events, such as Cyclone Freddy, are likely to increase due to climate change, which is defined by the United Nations as “the long-term shifts in temperature and weather patterns,” such as increased and unpredictable rainfall, cyclones, flooding, drought, and heat waves (with effects differing depending on a region’s geography). Recent studies have established links between climate change and the severity of cyclones Ana (2022), Batsirai (2022), and Idai (2019). The Cyclone has fueled a rallying cry to invest in the resilience of health systems as local and global communities brace for a future with more cyclones like Freddy.
“You know that with climate change, Chókwe, Mozambique will always be affected. As EGPAF, we have to see how we are going to organize ourselves for future situations,” says Salgado. “This is important.”
Some EGPAF sites had begun modernizing health systems, and these investments paid off; an encouraging sign for what proactive action can achieve. In Malawi, while facilities still on paper-based filing systems often lost everything, those with digitized medical records and storage in a digital “Data Lake” protected critical medical information from the cyclone’s destruction.
“The Data Lake has proved to be the resilience backbone for the whole Health Information System,” says Charles Fodya, Project Director of Health Information Systems at EGPAF-Malawi. “All lost records due to washed away servers, papers, etc. have been recovered through printing them from the Server.”
Threats to Basic Health Services, Including HIV treatment – Inhambane, Mozambique
In Vilankulos and Inhassoro, Mozambique, wind speeds reached more than 120 km/hour, with heavy rains threatening basic infrastructure, such as power and roads, cutting off access to essential health care.
“We had trees and the roof of the Rural Hospital of Vilankulos fall,” says Edmundo Galiza Matos Jr, the District administrator. “In addition, the Quewene Health Center is flooded, as well as the residence of the nursing technicians of Pambarra.”
According to the emergency survey by the Provincial Directorate of Health, around 20 health facilities suffered damage in the province. EGAPF’s regional care and treatment coordinator, Orlando Noreno, added that there is frequent interruption of the electric current throughout the region, and that “the main road that gives access to the Mabote Health Center is impassable. Meanwhile, some of the colleagues sheltered at the Mussengue Health Center due to the floods in their homes.”
At the Morrumbene Health Center, in addition to leaking roofs in the Youth and Adolescent Friendly Health Services area, treatment shortages now proved an added barrier to continuous care. According to Isaias Maculuve, EGPAF’s care and treatment focal point at the health facility, although some medication was received the week before, there was no ABC+3TC formulation (600/300), an essential first-line HIV treatment medication for pediatric and adolescent populations. With the damage of the storms, delays in re-stocking are expected. This can be devastating for children living with HIV, as gaps in treatment can cause HIV to become drug-resistant, allowing the virus to resurge, potentially requiring the child to transition to a second-line (less effective) treatment regimen.
“As for the Nhachengue Health Center, three tents have collapsed, but the health facility has sufficient stocks of antiretrovirals, as well as other general drugs. The health facility just lacks the 600/300 ABC+3tc regimen and 50mg DTG (a first-line HIV treatment for adults). We have zero stock,” said Massinga Regional Coordinator, Irene Menete.
Health Workers Begin the Road to Recovery – Gaza, Mozambique
For the Maternal and Child Health and Prevention of Mother -To-Child Transmission of HIV Mobile Focal Point, Suabira Paulo, what happened was surreal. During the days of the floods, she saw her belongings damaged when she transported them from her house to safe areas and vice versa. She was scared when she came across the overflowing river because she had never seen it like that before. She lived nights in darkness because there was no electricity and as the saying goes “the opportunity makes the thief.” She was in panic because of the opportunists who took advantage of the floods to break into victims’ houses and steal items.
“First, I was affected because I had to leave my residence and leave my place of work as I am not from Guijá,” said Suabira. “It was hard to see many houses destroyed and agricultural fields submerged in the water. It was clear that nothing had been recovered. People will start from scratch and, consequently, the next few months will be difficult for all of us. Food will be scarce, and the cost of living will rise,” she added.
In addition to the administrative and emotional support, EGPAF provided logistical assistance to the teams moving them to safe areas. No one was left behind. With the departure of district officers and other members, there were coordination gaps. The Provincial Directorate of Health asked EGPAF to continue supporting some health facilities and the resettlement center. In response, EGPAF created two technical support teams for the resettlement centers, headed by advisors.
After the end of the emergency, on March 7th, the teams went back to work, but Suabira fears that there will still be difficulties because there are areas where the water has not yet subsided and this could harm the effectiveness of service delivery, as patients are concerned with rebuilding and recovering what they lost.
“We are back, and we are recovering. I’m already recovered, but traumatized,” said coordinator Salgado.
Investments in Digital Health Pay Off – Malawi
Malawi health facilities also took severe losses.
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“We lost some of our equipment to flooding. In other health facilities where the flooding was severe, we lost everything. In others, we managed to save the movable gadgets (such as J2 terminals, Laptops, Servers, Tablets, batteries, etc.) but lost power and network cabling that got soaked by floods,” says Fodya. “Some of our servers were damaged due to roof leakages from the heavy rains, and we lost inverters due to lightning that came with the cyclone.”
One glimmering piece of hope is the recent digitization of medical records across many of the healthcare facilities.
“In health facilities that lost everything, the Central Data Repository (Data Lake) has been crucial in recovery of medical records and continuation of healthcare access to HIV patients,” says Fodya. “We are currently printing the Emastercards for every patient from the data lake and sharing with the health facilities. The printouts will be used while we mobilize resources to replace the hardware lost.”
Although the project of transitioning to digital records was at first seen as a cumbersome and unnecessary transition, the cyclone highlighted the diverse benefits of such a system. Facilities that had transitioned were able to simply re-print health records and continue with service delivery. Facilities that had not yet transitioned now have to start from scratch, an immense draw on human resources that are deeply needed to address existing and intensified health threats, including re-starting clients on treatment who may have lost theirs in the storm, and addressing the ongoing cholera outbreak which was exacerbated by the heavy flooding brought by cyclone Freddy.
Fodya is proud of his team’s work but sees even greater opportunity to improve: “The next thing we need to do is migrate our data architecture from a decentralized to a centralized data repository system. This will minimize loss of data between data on the local server and data on the central server. In the meantime, we need to intensify the frequency of collection of data dumps in the health facilities.”