Here are the salient points of the following report from Mozambique:
- The Ministry of Health wants our surgical facility to open soon.
- COVID-19 arrived in Mozambique 22 March and everything has changed.
- Our hospital was offered to and eagerly accepted by the Ministry of Health to serve as the COVID-19 treatment center for Nampula, population 1,200,000 persons.
- Arrangements are underway to meet the expected COVID outbreak in a prepared state, but much prayer and work is needed for this to happen.
- Supplemental oxygen is exorbitantly expensive in Nampula. It could cost $60,000 per day during the outbreak, or more than one million dollars every 2.5 weeks.
- Spiritual ministry carries on well despite restrictive COVID prevention measures.
In February, Julie and I traveled to Mozambique’s capital where I had meetings with the Health Ministry to finalise the memorandum of understanding that will govern relations between the hospital and the health authorities. Much intercession to God was made for these meetings because my proposal involved something I thought the government would frown upon; namely methods of obtaining as much funding as possible from the local population while not turning anyone away for inability to pay. Though it is a charity hospital, we want it to be self-sustaining, and my experience at our first hospital confirmed that this can be achieved even in Nampula as most surgical care required here is inexpensive to provide. Back in the ’90’s, hernia repairs cost the mission less than $3.00 each, and complicated abdominal operations cost less than $9.00 in terms of supplies consumed. Don’t expect that to be true in developed countries! Manufacturers of medical supplies generously provide basic surgical materials and medication to charity hospitals in developing nations at greatly reduced rates, and we are grateful!
Though I expected considerable resistance to my proposals, to my thankful surprise the authorities I dealt with were in complete agreement with my philosophy. They too believe that health care in Mozambique must become as independent as possible from outside means of support, provided the poor are not slighted in the process. So there was much interest in my experience years ago at one of their own hospitals obtaining the funds necessary to cover health care, and also in my proposals for our current facility. They seemed eager to see how well our plans will work when put into practice today and did not revoke the benefits we qualify for as a charitable enterprise.
So, to my great relief, the Memorandum of Understanding was approved at the ministry level, pending consultation with the local Provincial Health Director, and the ministry wants the hospital to open as soon as possible! Such an answer to prayer!
Julie and I then headed to South Africa for a three-week break at the vacation home of kind friends. It is an apartment on a bluff overlooking the Indian Ocean which lies just fifty meters below and away. Julie and I are not fans of sand, salt, sun, or too much skin, but we love the sound of the waves and the sight of the beach. During the days, seated in front of large picture windows, Julie read and I spent uninterrupted hours making progress on a major study from Scripture I have been attempting to complete for many years. In Nampula there is no opportunity for extensive Bible study apart from the late-night bursts of preparation required for sermons or Sunday school classes. So this was a treat for me and an important opportunity to prepare material I look forward to teaching in the future.
Another reason for the trip to South Africa was to pick up the truckload of supplies for the mission and hospital that had been left there since November when the mission truck broke down en route to Johannesburg. Our motorist/mechanics repaired it after a week’s delay in the bush, which was a virtual miracle on God’s part and theirs, then I flew down and drove the truck on to Johannesburg. But when I took it to the shop to have the repair checked out, major problems were found. After three months, the specialist was still struggling with the job. The main difficulty was finding satisfactory spares, given that the truck is forty years old. These off-road military trucks are tough as nails and refuse to die—but the result is they long outlive the factories that build parts for them!
COVID-19 arrived in Mozambique 22 March and since then everything has changed
Before finally bringing the load home to Nampula, Julie and I made a quick 20-day trip to the States for me to have my first encounter with our granddaughter Melody, already over a year old, and for a hospital board meeting called to prepare for opening our facility.
That trip suddenly terminated a week early, before the planned board meeting, when the United States became such a hotbed of SARS-CoV-2 virus that other countries started closing their borders to us. While we were in the States, the virus reached South Africa and began to spread quickly, prompting South Africa to announce the pending closure of their borders to anyone coming from leprous nations such as ours. We dropped everything and rushed to get back to Nampula before the door slammed shut. Nevertheless, before we could board a flight, the South African borders closed. We departed anyway because we did not plan to pass through immigration, needing only to stay in the international section of the airport until boarding a flight to Nampula the next day. But while flying over the Atlantic Ocean we were informed by the flight attendants that due to the evolving situation we would not be allowed to disembark at the airport without special permission.
Thankfully, since we could show we were on our way home to Mozambique, the South Africans allowed us to stay in their airport long enough to catch the next flight to Nampula. Of course, there was no choice but to leave our truck and its load of supplies behind in Pretoria where it remains until today. But we did not worry about that: We were just relieved to make it home. The next day, South Africa ceased allowing passengers from the US to even set foot in their airports! How we thank God we were not trapped in the US for the duration of the COVID outbreak—yet when we flew to the States two weeks earlier we had no inkling any of this was about to happen!
While we were in Virginia with Kent, Anna, and granddaughter Melody, Paul Washer with HeartCry Missionary Society did the above interview to help us recruit likeminded medical associates.
It was as if the virus were chasing after us, however, because two days after we got home, the virus also showed up in Mozambique, though in the capital 900 miles away. I always thought that, if the virus reached the mud hut neighbourhoods of Mozambique’s cities, where good hygiene is impossible and social distancing and lockdowns are incompatible with life, it would spread quickly and widely, infecting nearly everyone and in a short time. People do not have refrigerators or pantries to store up food, nor is there indoor plumbing. People have to congregate every day in the markets and at the public water fountains in order to get what they need to survive for the next few hours. For many Africans, if they do not barter and trade every day, there is no money in the evening to purchase food for the family.
These presentiments were shared by the epidemiologists at the Imperial College in London, who released a study four days after the virus hit Mozambique predicting that the virus would sweep through Africa infecting 94% of the people if restrictive measures were not somehow put into effect, and soon. The African governments listened, and four days after the paper was published, with a grand total of only seven confirmed cases in our country, Mozambique declared a state of national emergency. Borders were closed, schools were shut down, all public gatherings of more than ten people were prohibited, and the use of face masks, social distancing, and compulsive hand washing at those stores and businesses allowed to function were all mandated. I suppose there is no breathing human on the planet who does not already know the routine.
Our hospital offered as the COVID-19 treatment center for Nampula
Because of the pessimistic view of what lay in store for Mozambique, I felt compelled to offer our sparkling, almost ready-to-open hospital to the Ministry of Health to help with the crisis. According to myself and the epidemiologists in London, Nampula would in a couple of months be engulfed in a viral tidal wave where 1.1 million people just in the city would be infected. Accepting those figures and assuming that one in five infected persons would seek medical consultation and twenty percent of those would require treatment, during the peak of the outbreak, 4,600 people would be presenting to the Central Hospital with symptoms of the disease every day, and 950 of them would need admission for supplemental oxygen to prolong their lives. With an average hospital course of ten days, Nampula would need to find 9,500 extra hospital beds somewhere! In the face of such predictions, it was inconceivable that Grace Missions should not make its new hospital available, nor my services as a physician, despite the fact that I have not treated hospitalised patients for twenty years now.
This was not a decision made lightly. I can only imagine what our beautiful facility will look like when it is passed back over to us. I am also concerned about the reputation it will gain through treatment rendered by people who do not necessarily share our priorities. I also wonder if adequate preparations will be made to be truly ready when the first patients arrive. Africa has a legacy of being caught unprepared for the crises that overtake it, though I am glad to say that in recent years Mozambique has made great improvements in that regard.
Partly to offset these potential deficiencies, I felt I needed to be part of the management team and one of the attending physicians. Actually, I requested to be made the hospital director, but ministry requirements stipulate that the director must be an employee in the ministry’s chain of command. However, the authorities did place me on the management team and made me an attending physician with full access to all the patients.
Though the concerns above were compelling reasons for the hospital and myself to be offered on behalf of the COVID patients, the vital reason towering above all of them is the importance of bringing the gospel to these patients at a critical time in their lives. No one is allowed in a COVID hospital except patients and staff, and it is essential to me that every one of the patients have the opportunity to hear the gospel. If the hospital has nothing to offer medically, at least Grace Missions can tell everyone willing to listen how they can receive a far greater cure, one they desperately need at this point in their lives, namely the remedy for the penalty and the power of sin which is much more destructive than the coronavirus.
Having this opportunity to concentrate all the COVID patients of Nampula on our compound so the gospel can be preached to every one of them is worth what it may cost the mission in other ways.
But the medical situation before us is not bright. Besides overwhelming numbers of ill persons, the health authorities will have to cope with underwhelming resources. There are only 34 ventilators in the entire country, with none to my knowledge in our city. Of the medicines that have been shown in any study to be helpful in treating COVID patients, not one can be had in Mozambique. Even chloroquine is unavailable, though thirty years ago it was sold in Nampula like candy because of the ubiquitous presence of malaria. Long ago, health officials banned the drug as they did not want people with life-threatening malaria using a treatment which today is often ineffective due to resistant strains of the parasite. Ironically, with Europe and the US now buying up all the chloroquine the world’s pharmaceutical companies can manufacture, it is impossible for Africans to get the drug that is once more considered important for them.
Our facility can accommodate only 55 patients without over-crowding, not nearly enough if in Nampula the virus lives up to its reputation elsewhere. So to increase our capacity to 195 beds, we plan to erect our conference tents and use our conference cots to make three field-hospital infirmaries as needed. Three more marquee tents are available in South Africa for $10,000, which would get our capacity up to three hundred patients if we could find the extra beds.
While the London experts predicted a possible infection rate of 94% if no restrictive measures were taken, I also calculated what would happen if somehow the attack rate were reduced to only 7.5%, three times what was thought to be happening in the US. At that “low” rate, our hospital could finally accommodate all the patients in Nampula needing admission if the epidemic could be slowed to a five-month duration.
The exorbitant cost of supplemental oxygen
But what can we do for COVID patients with no medications and no ventilators? One thing is critical and exceedingly helpful: oxygen. Providing oxygen is the most important supportive measure that can be used anywhere to buy time for patients with COVID pneumonia to develop antibodies to the virus, destroy it, then heal before succumbing to respiratory failure.
But while we in the West take medical oxygen completely for granted, it is not so in Nampula! Here, oxygen is produced only in South Africa, then shipped by sea in tanks to storage depots in Mozambique’s ports. The port serving Nampula is 120 miles away. There the oxygen is transferred to large, heavy cylinders and taken by truck to Nampula. A cylinder weighing 100 pounds can hold 8kg (18lbs) of compressed oxygen, or 5,600 litres (1400 gallons) at normal pressure. This much oxygen costs $75 and will last only 3–6 hours for typical COVID patients. At those rates, a 270-bed COVID hospital would require 186,000 liters of oxygen per hour which would have to be shipped all the way from South Africa and would cost $60,000 per day, or over one million dollars every 2.5 weeks during the five month outbreak! Obviously, Grace Missions does not have that kind of money, nor does the Ministry of Health.
Because the turn-around time for filling the tanks is 48 hours, just to buy the 2,350 tanks necessary for transporting so much oxygen back and forth without running out would cost $425,000, if that many tanks can be found in northern Mozambique. Purchasing the regulators to control the flow rates of oxygen for each patient will cost another $77,000. That brings the total investment just for oxygen in a five-month outbreak resulting in 2,520 hospitalised patients to $4.6 million!
Beyond high cost, the suppliers in South Africa have told me it would not be possible to ship that much oxygen to Nampula even if we could pay for it. But if oxygen therapy is deemed too expensive or too impractical to use in Mozambique, then there is no need to admit any COVID patient to a hospital, since patients admitted will experience the same conditions and the same fate in the hospital as they would in their own huts. Such are the difficulties before us!
Our offer eagerly received by the local authorities
Given the desperate situation I have described, it is not surprising that the government authorities were much encouraged when they checked out the hospital that was being freely offered to them for the duration of the epidemic. Only a few people from the health department had previously visited our facility, but some of them said that when it opened, it would be the most sought-after hospital in the province just because of the attractiveness of the center, thanks to our volunteer builder from South Africa, Mike Stolk, and his expatriate associates. Another feature that makes our hospital unusual in Mozambique is the in-wall plumbing for oxygen and suction. All of our regular beds have ports for both purposes, a most helpful asset in treating COVID pneumonia patients.
For the first two weeks after our offer of the hospital was made, successive delegations of increasing importance came to check us out, providing unexpected notoriety for Grace Missions. The investigation finally culminated in a visit from the secretary of state for our province. The night before I had been advised that yet another team of visitors was slated to arrive the next morning and would include somebody’s secretary, but we only discovered one hour before the visit that this “secretary of state” was not the assistant of some bureaucrat, but the new title for the governor! Actually, as of this year, each province has two governors, one appointed by the federal government and one elected—and both were coming to check us out! So with only one hour left to prepare, we quickly cleaned the hospital and threw sheets and pillows on all the beds. By the grace of God, the grass had been cut three days before and everything looked perfect when the grand entourage arrived including both governors, the Provincial Health Director, the Surgeon General of the province, the clinical director for the regional referral hospital, and an army of TV and newspaper reporters! They too were impressed at this medical facility none had known about before, and quite apart from the COVID situation, the governors were eager to see it open as a surgical clinic during their term of office!
Mozambique has only three pulmonary specialists, and the one heading up the COVID program arrived from Maputo as our last inspector. Visiting our facility, he pronounced it “spectacular.”
So it felt like yet another compliment when a few days later we received word that the authorities had appointed us the COVID treatment center for Nampula.
All this grateful attention was not even imagined by me when the decision was made to offer our services to the government during the epidemic, but I hope it is the beginning of something that will in time bring glory to the Savior we serve and who has made this resource possible.
Another unexpected benefit arose the next day, when representatives from UNICEF paid a visit wanting to know what still needed to be done for the hospital to open. I mentioned that we needed to pressurise our water system and install two 10,000-litre reserve tanks. We also needed an incinerator to destroy biological wastes, and in order to function as a COVID treatment centre we needed to build a special ablution block where staff could remove their personal protective equipment, then shower and dress in a non-infected chamber before returning home. I thought I was only mentioning what Grace Missions needed to accomplish, so was completely surprised when they said they would take care of it, saving us at least $20,000! With new optimism, I visited the electric company who for more than a year has insisted we pay them $3,000 to install our transformer (which we had to purchase and import ourselves!) so that our expensive electronic equipment could function with clean energy. Praise the Lord, now that we are gearing up for COVID, they promised to do the installation immediately at no charge!
Preparing for the challenges
For weeks now, my assistant Hannah and I have been hard at work researching everything the hospital is likely to need to meet this task effectively. Oxygen is obviously the most important factor needing to be addressed. Because of the prohibitive cost of imported oxygen, the only viable solution we know is to purchase, import, and install our own oxygen generating plant right on the property and pipe the oxygen directly to each patient’s bedside, even in the tent infirmaries. We have located a manufacturer in Europe who can send six skid-mounted units to us, each roughly the size of a twenty-foot shipping container, which would meet all our oxygen needs for $390,000, less than the cost of purchasing just the 2,350 tanks required to transport oxygen constantly from the port to Nampula. When the epidemic has passed, the six units could be given by their donors to the six largest hospitals in Mozambique to provide all the oxygen they will need for years to come at no charge. But we have to find donors first.
We are now approaching UNICEF, embassies, and other potential contributors with a full list of equipment needed to treat COVID patients here in Nampula. We know that the heart of the king is in the hand of the Lord as channels of water to be directed according to his will—so please pray that God may give us favour in the sight of these institutions and that they will provide what we need in order to render proper medical care to our patients!
Below is a one-minuted introductory video for potential donors.
Other important needs are pulse oximeters. These are non-invasive devices that provide a continuous read-out on the lungs’ ability to supply oxygen to the blood. They are essential in determining the amount of supplemental oxygen needed by COVID patients. Though they cost only $10.00, pulse oximeters do not exist in Nampula, and we have been unable to obtain any from the States. Manufacturers cannot help us. In the panic back home, they are swamped with orders from healthy Americans wanting their own personal pulse oximeters so they can be re-assured moment by moment that all is well with their lungs!
Disposable personal protective gear is not available either. The whole world’s supply is going to Europe and the United States. I have no problem with improvising our own reusable equipment (except for the special mask-respirators) and disinfecting it every day, as even American hospitals did that forty years ago. But there are so many workers needing this equipment that making enough will be a challenge, and that too costs money.
The course of COVID in Mozambique to date
As previously mentioned, the African nations took quick action after the London epidemiologists released their gloomy forecast for COVID in Africa. And the restrictive measures have worked well in Mozambique, thanks to the diligence of the Ministry of Health in hunting down and isolating the virus for 49 days. Normally there should be over 65,000 confirmed cases by now, but Mozambique has recorded only 107!
Before the borders closed, seven infected persons came into the country, but they were quickly identified and quarantined in the capital at the southern tip of Mozambique. Their contacts and contacts of contacts were successively tested and quarantined, such that after 49 days, the virus succeeded in infecting only 24 persons in the capital. However, one of those persons travelled to a remote work camp at the far northern tip of Mozambique and took the virus with him before he was finally tracked down by the Health Ministry. The disease broke out in the isolated camp of 886 workers, but has struggled to move anywhere due to the camp’s remoteness and a complete lockdown confining workers to their personal living units. Only 74 of these persons have been infected.
Thus the virus has been restricted to two small loci a thousand miles apart. Most importantly, the Ministry of Health has kept it from invading the tightly packed mud hut neighborhoods containing upwards of 50,000 persons each where it would surely escape control and possibly multiply at the rates predicted by the London epidemiologists. We are thankful for the 49-day reprieve we have experienced, which seems miraculous. But we are wondering what will happen when the virus escapes control.
We may learn soon. During the writing of this report, persons have tested positive in two new and disparate parts of the country. It is evident that the virus has slipped its bonds, and now the Health Ministry will have four loci in which to concentrate their efforts, then eight, then sixteen, etc. Meanwhile, the question of how long Mozambique can keep its borders closed and ban public gatherings hangs in the air. Constitutionally, this can be done for only ninety days, and we are nearly halfway through that period, but constitutions can be changed. Economic laws are less flexible.
For Mozambique, the effort of the Health Ministry buys time for a vaccine to become available. For Grace Missions, it buys desperately needed time to prepare for whatever lies ahead medically. It is encouraging that of 104 infected persons so far, only one has required hospitalization and none have died. My initial calculations were based on the unproven suspicion that one in 25 COVID-infected persons would require hospitalisation, but in Mozambique so far the rate is only one in a hundred. If that holds true for the duration, we can still handle all the cases in Nampula even if 21% of the population contracts the virus.
- Pray that God will continue to shed his mercy on the struggling people of Africa as they brace for their turn with this epidemic.
- Pray that He will use our efforts to rescue many people spiritually and medically.
- Praise that the virus has been held in check so long after its debut in Mozambique, and pray that the Health Ministry can successfully restrain it for weeks to come – we need the time!
- Praise that through these unusual circumstances, God is bringing the hospital project to fruition in a way we never anticipated.
- Pray that we can arrange oxygen for our patients!
- Pray that embassies and other donors now reviewing our request for help will respond positively.
- Pray for our truck and equipment still pinned down in South Africa.
- Pray for protection of our workers and the hospital staff.
One of our very poor occasional labourers asked if there would be jobs opening up through the Mission’s involvement with the COVID crisis. I said he could probably be hired on as a cleaner. According to WHO requirements, the floors and walls and all surfaces for the entire hospital and field infirmaries must be washed down every hour with dilute bleach. To accomplish that, we must purchase 36 55-gallon drums of bleach at a cost of $7,200 and hire 109 workers to clean 24 hours a day. “But,” I said, “you need to realise you will be working in an atmosphere seething with coronavirus.”
Though he is not a religious man, he said, “That’s not a problem. It is better to die for something than to live for nothing!”
I thought: “How true. But only Christians can begin to appreciate how important that Something is, and how truly empty is the nothing that so many in this world are living and dying for!”
May the Lord use this opportunity to draw others to the light he has given to us, that they may share in the privilege of knowing and serving him!