Africa: Rising Waters – Cyclone Freddy a Call for Resilience in Health Systems
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 resulted in widespread power outages, destruction to infrastructure and housing as well as a devastating loss of lives, caused by both the storm and its impact on the health system. The investment of national governments as well as international partners in resilience has prevented many deaths and injuries. However, there is still more work 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 affect the future, because patients are left without medical care and have no access to medication as they did not reach the resettlement centre,” says Aleixo Salgado.
The damage to infrastructure, equipment, logistics and other areas may not be able to be repaired until time passes.
“I felt a psychological impact because I had my things moved around and my files organized. Salgado recalls that there were colleagues who transported kids in difficult circumstances.
Climate Change: A Foreboding Future
Cyclone Freddy tore across South-Eastern Africa. Landing in Mozambique, Malawi and a second time March 11, it was a cyclone that ravaged the region. Heavy rains in this area are not uncommon, but Cyclone Freddy’s path was unusual. It landed twice, first on February 23 and 24, and then again on March 11. The World Meteorological Organization claims that Cyclone Freddy, after being named a tropical storm for 34 days and crossing the South Indian Ocean and traveling more than 8,000 km, is possibly the “longest-lasting tropical cyclone recorded.”
Climate change is likely to cause unpredictable weather events like Cyclone Freddy. According to the United Nations, climate change refers to “the long-term changes in temperatures and weather patterns” such as increased rainfall and unpredictable cyclones. Recent studies show a correlation between climate changes and the severity of Cyclones Ana (2022), Batsirai (2022) and Idai (1999). The Cyclone sparked a call for investment in health systems to prepare local and global communities for more cyclones.
“You know that with climate change, Chókwe, Mozambique will always be affected. Salgado says that as EGPAF we need to plan for the future. “This is crucial.”
These investments have paid off for some EGPAF sites. This is a positive sign of what proactive action can accomplish. While facilities in Malawi that still used paper-based filing lost everything, those who had digitized their medical records and stored them in a “Data Lake” were able to protect critical medical data from the cyclone.
Charles Fodya (Project Director, Health Information Systems EGPAF-Malawi) says: “The Data Lake has been proven to be a resilience backbone for all the Health Information System.” “All records lost due to paper, servers and other items being washed off have been recovered.” The Server has been used to print them.
Inhambane (Mozambique): Threats to basic health services, including HIV treatment
In Vilankulos & Inhassoro Mozambique wind speeds have reached over 120 km/hr. Heavy rains are threatening the basic infrastructure of roads and electricity, which is preventing essential health care.
Edmundo Galiza Matos Jr., District administrator, says that the Rural Hospital in Vilankulos had its roof and trees fall. “The Quewene Health Center, as well the Pambarra nursing technician’s residence, is also flooded.”
According to an emergency survey conducted by the Provincial Directorate of Health in the province, 20 health facilities have suffered damage. Orlando Noreno is the regional coordinator for EGAPF and he said that the electric current is frequently interrupted throughout the region. He also added that the main road leading to the Mabote Health Center was impassable. Some colleagues were sheltered in the Mussengue Health Center because of flooding at their homes.
The Morrumbene Health Center is now facing a new obstacle to providing continuous care. This comes on top of the roof leaks in the Youth and Adolescent Friendly Health Services section. Isaias Mculuve, EGPAF’s focal point for care and treatment at the facility, said that although some medication had been received in the previous week, the ABC+3TC formula (600/300) was not available. This is an essential first line HIV treatment medication used by children and adolescents. Re-stocking is expected to be delayed due to the storm damage. It can be devastating to children with HIV. Gaps in treatment can lead to HIV becoming drug-resistant and resurgent, forcing the child to switch to a less effective treatment regimen.
The Nhachengue Health Center has enough antiretrovirals and other drugs to treat the patients. The only thing missing is the regimen 600/300 ABC+3tc and 50mg DTG, which are first-line HIV treatments for adults. We have zero stock,” said Massinga Regional Coordinator, Irene Menete.
Gaza and Mozambique: Health Workers Start the Road to Recovery
Suabira Paulo is the Mobile Focal Point for Maternal and Child Health and Prevention of Mother-to-Child HIV Transmission. The events that occurred were surreal. She was shocked to see her possessions being damaged by the floods. She was afraid when she came upon the overflowing rivers because she had not seen them before. She spent her nights in darkness, as there was no power. As the saying goes, “opportunity makes the thief.” She was panicked because opportunists took advantage of flooding to steal from victims and break into their homes.
“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 difficult to see so many houses destroyed, and the agricultural fields submerged under water. There was no sign of anything being recovered. We will all have to start over and the next few weeks will be difficult. She added that food will be scarce and costs will increase.
EGPAF also provided logistical support to the teams that moved them to safer areas. Everyone was included. The coordination was affected by the departures of district officers and members. EGPAF received a request from the Provincial Directorate of Health for it to continue support of some health facilities, as well as a resettlement center. EGPAF responded by creating two technical support teams, led by advisors, for the resettlement center.
Suabira believes that the service delivery will be affected by the fact that some areas are still flooded. Patients are also concerned about rebuilding what they have lost.
“We’re back and recovering. I’m already recovered, but traumatized,” said coordinator Salgado.
Malawi: Digital Health Investments Pay Off
Malawi’s health facilities have also suffered severe losses.
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“We lost some our equipment to floods. In some health facilities, where the flooding was extreme, we lost all of our equipment. In some cases, we were able to save the mobile gadgets (such J2 terminals and Laptops. Servers, Tablets etc.). Fodya says that they lost the power and network cables, which were soaked in floods. “Some of the servers were damaged by roof leaks from the heavy rainfall, and we lost the inverters that came with cyclone due to the lightning.”
Recent digitization of records in healthcare facilities is one glimmering hope.
Fodya says, “In health centers that have lost everything, the Central Data Repository has been critical in recovering medical records and continuing healthcare access for HIV patients.” We are printing Emastercards from the data lakes for each patient and sharing them with the health centers. We will use the printouts while we mobilize our resources to replace lost hardware.
The cyclone showed that a digital record system has many benefits. Facilities that had already made the transition were able simply to re-print records and continue providing service. Facilities that have not yet made the transition will have to start over, a huge drain on resources.
Fodya’s team is proud of their work, but he sees room for improvement. “The next thing that we need to do to is migrate from a data architecture decentralized system to a data repository centralized system. This will prevent data from being lost between the local server data and the central server data. We need to collect data dumps more frequently in the healthcare facilities.