By Solange Guambe
Arrive at five in the morning. No, better at four. In fact, if you want to be seen this month, it is recommended that you set up a tent the night before and celebrate your birthday in the triage corridor. The queue at health centers in Mozambique is not just a queue; it is a cultural institution, a rite of passage, a spiritual experience in which the patient learns patience, humility, and the delicate art of sleeping standing up.
After hours of heroic waiting, during which you will have time to make new friends, tell your life story, and develop a second illness from prolonged sun exposure, you will finally reach the long-awaited pharmacy window. The employee, with the serenity of someone who has heard this dialogue ten thousand times, will consult the system with a solemn air, frown professionally, and chant the national refrain:
— We don’t have that medicine. You can try at a private pharmacy.
Naturally. The private pharmacy, located a forty-minute walk away and charging the equivalent of a six-person family’s monthly salary, will be fully stocked. The market, after all, functions very well. It is the public service that seems to have adopted the motto:
“Serving the people, when we are able.”
Mozambique, this country blessed by the sun, the land, and an unparalleled creativity in the art of solving problems without resources, has demonstrated to the world that it is perfectly possible to manage a health system without that small detail called medication. Why treat a disease when you can simply pray, wait, and hope? The result, it is guaranteed, is equally uncertain.
The Mozambican people, endowed with a resilience that simultaneously inspires and shames those who should do something about it, have developed, over the years, a remarkable set of therapeutic alternatives. The most popular of these is, without a doubt, lemon balm tea—a plant of seemingly infinite virtues according to local folk medicine, indicated for fever, headache, malaria, hypertension, diabetes, existential depression, and lack of hope in the health system. It has the advantage of growing in almost every backyard and not requiring a prescription, special prescription, or a visit to the hospital.
Secondly comes intercessory medical prayer, a method with a success rate that experts classify as statistically equivalent to the absence of treatment, but with the added advantage of being free, not requiring a queue, and providing psychological comfort that, in certain circumstances, is the only type of comfort available. Thirdly, and with growing popularity in peripheral neighborhoods, comes borrowing medication from a neighbor, a practice in which the patient asks for leftover pills from a different illness, with a different dosage, for a different organism. The result is unpredictable, but at least it demonstrates that community solidarity in Mozambique is in excellent shape—much better shape than the health system.
Over the years, health authorities have produced a truly remarkable collection of public statements. There is one that has circulated virtually unchanged since time immemorial:
“The situation is being monitored and the necessary measures will be taken.”
Another favorite is:
“We are working with our international partners to ensure supply” — invariably uttered whenever the international partners are in the room.
But the crown jewel belongs to the one that states, with a serious face and a tone of urgency, that “the disruption is punctual and temporary” — a statement issued for at least fifteen consecutive years regarding the same situation.
It must be acknowledged that these statements have an admirable consistency. In decades of public communication, the messages have remained remarkably stable, as has, regrettably, the problem they purport to solve.
There is also a phenomenon that economists classify as market distortion and that ordinary Mozambicans classify as a huge shame: the same medicines that are lacking in public pharmacies appear, almost magically, in adjacent private pharmacies, often at prices that are only accessible to those who are healthy enough not to need them. This phenomenon has been the subject of investigation by the authorities, who have promised to determine responsibility. Investigations have been ongoing for several years and are expected to yield results as soon as researchers gain access to pens and paper, which, judging by the general pattern, may also be in short supply.
The astute citizen has long learned to read public shelves like an inverted treasure map: where there is emptiness, there is business. Where there is business, there is someone who has made the stock disappear creatively enough to leave no evidence, and regularly enough that everyone knows, but no one can prove it.
Let us, for a moment, lower the tone of the irony, not because it is not deserved, but because there is a reality that irony, however sharp, cannot properly cut through.
There is a mother who walked six kilometers on foot with her child on her back to reach the health center. When she arrived, after a two-hour wait, she heard that the antibiotic prescribed for her child’s infection was not available. There was no money for the private pharmacy. The mother returned home with the same child she brought, plus the certainty that the system was not made for her.
There is a pregnant woman who religiously attended prenatal care, followed all the guidelines, and arrived at the delivery room in a health unit without gloves, without oxytocin, without blood for transfusion. What happened next is one of the many stories that do not make it into the annual reports with colorful graphs and progress indicators.
There is an elderly man with chronic hypertension who has been unable to obtain his usual medications for three months. He has learned to control his blood pressure with less salt, more rest, and—supreme irony—less worry. The worry, they tell her, raises the tension. Not worrying about a healthcare system that has failed you is, it seems, the only prescription available for free.
Mozambique has competent pharmacy technicians, dedicated doctors, and nurses who work in conditions that would make any European manager resign immediately. What is lacking is not talent, not training, not the will of healthcare professionals. These professionals graduate from medical institutes and colleges with real knowledge, trained hands, and a genuine willingness to serve. What is lacking is, literally, the material. And the political will to ensure that it reaches those who need it, without diversions, without escapes, without the miraculous disappearances that everyone knows about, but no one can solve.
A healthcare professional without the material to work with is like a musician on a stage without instruments: they can make gestures, they can read sheet music, they can have all the technique in the world, but the concert doesn’t happen. And the patient who was in the audience goes home without having heard anything, without having received anything, except the kind suggestion to try somewhere else.
Satire exists because reality is sometimes too painful to face head-on, especially when there are no painkillers available. Laughter, the wise say, is the best medicine. In Mozambique, it has the added advantage of being the only medicine that is not exhausted.
But behind every joke about empty shelves, there is a real patient who went home without treatment. There is a healthcare professional who felt ashamed of a system they don’t control. There is a child whose recovery was delayed, a pregnancy that went wrong, a life that could have been different with a twenty-meticais pill that the State failed to provide.
Until then, the lemon balm continues to grow. And we continue to laugh, because the alternative is to cry, and tears, as far as we know, also have no proven therapeutic value. At least not on the shelves of any pharmacy.
