Upstream Executive Director, Dr. Ryan Meili, is in Mozambique this summer as part of a program that gives medical students an opportunity to work with underserved populations and get a better understanding of the social determinants of health! Back in 2010, when Ryan was on a similar trip coordinating the program, he took some time to blog about his experience.
We’re going to share a few of those experiences with you here, some four years later.
Wishing all the best to Ryan, Mahli, Abraham, and the students!
"Income is perhaps the most important social determinant of health. Level of income shapes overall living conditions, affects psychological functioning, and influences health-related behaviours such as quality of diet, extent of physical activity, tobacco use, and excessive alcohol use."
- Social Determinants of Health- The Canadian Facts, Raphael and Mikkonen, 2010
[they] may not have read the latest research on social determinants of health, but they see everyday the way in which the amount of money people have access to shapes their well-being and longevity
The most important determinant of health, much more than access to health care, genetics or culture, is income. The members of the Tevele health núcleo* may not have read the latest research on social determinants of health, but they see everyday the way in which the amount of money people have access to shapes their well-being and longevity. Everyone of them has lost many friends and family members to preventable and treatable illnesses like malaria, HIV and malnutrition. They see that it is the poorest families that suffer the most, see how for the want of a few meticais a child dies at home rather than reaching the hospital for treatment.
One of the younger núcleo members, Senhor Roberto, has not been feeling well lately. He has been losing weight and having frequent minor illnesses. His wife had left for South Africa a few years ago and last year she returned. She died a few months later. Many people from the area leave to go to South Africa for work in the mines and other industries there. Coming home sick from South Africa has become synonymous with AIDS. Roberto has worked with the núcleo educating local communities about HIV/AIDS and other Sexually Transmitted Illnesses. He knows very well he should be tested and start treatment if positive, but he hasn't gone yet. This is not procrastination; he simply can't afford the 50 meticais (about $2.00 CDN) to make the trip in one of the battered Toyota pickups that go regularly to Massinga. If he had some form of income beyond what he can grow on his machamba (small farm cultivated by hand) he would be able to access the care he needs. If there were more local income opportunities perhaps his wife wouldn't have had to leave for South Africa to make money.
Recognizing how important local sources of income are for their families and their community, the núcleo members have embarked on a program of economic development. With the help of Canadian partners and a group of young people called Zambo ni Zambo (Xitswa for step by step) they have begun a machamba and a carpentry work shop and have recently started to raise chickens. With help from CIDA (the Canadian International Development Agency), they have built a new "centre of competencies" for meetings related to the economic projects and storage of related materials. Proceeds from the project go to a common account to continue development, with a portion going to individuals involved depending on the work they do. Zambo ni Zambo also works with another of the Centre's partner communities, Basso, on a sewing project and a bakery.
The underlying idea is to increase the capacity of the community to sustain itself economically. This allows local people to have more access to gainful employment and income for necessities like travel for hospital care and medications, simple household goods like blankets, and more varied food than what they can grow themselves.
The underlying idea is to increase the capacity of the community to sustain itself economically. This allows local people to have more access to gainful employment and income for necessities like travel for hospital care and medications, simple household goods like blankets, and more varied food than what they can grow themselves. It allows them to find this income closer to home, decreasing the disruption to family life and community health brought by from migrant work. This goes step by step with the health promotion and disease prevention activities of the núcleo, as rather than waiting for help from outside the people of Tevele start to take charge of their own development. In the long run these efforts may prove to be what makes a real difference, helping people like Senhor Ronaldo and his family to do better economically and live healthier, longer lives as a result.
*The núcleo are a group of leaders selected by various surrounding communities who work with the Centre for Continuing Education in Health to address the health needs of the people of Tevele