It is nine o’clock on a Monday morning at the Alto Mae Reference Center (CRAM) in Maputo, and counsellor Luis Ginote and nurse Margarida Bazar are carefully packing their medical kit into the back of a car. The CRAM, in collaboration with the Ministry of Health of Mozambique, was set up in 2010 for patients suffering from severe health problems related to HIV. Complicated cases, patients with Kaposi sarcoma in need of chemotherapy, and patients on second and third line antiretroviral treatment are all given care at the CRAM.

Home visits

Luis and Margarida, through home visits, attend to those who are unable to reach the referral centre for their consultations. Leaving the city of Maputo, the nurse and counsellor drive to the address at the top of their list. In this neighbourhood, the houses are modest and surrounded by clumps of trees. Passing vehicles raise clouds of dust which linger in the air.

Drawing up outside a house, they are greeted by Maria, who leads them indoors to where her husband, Joao, is resting.*

'My whole body is painful'

Joao has tuberculosis (TB) and has been unable to travel to the clinic for the past three weeks. “My whole body is painful, I have a fever and I cannot sit,” says Joao. “Sometimes I feel bad when I take my pills.”

“He has improved a little,” says his wife Maria. “But he is still coughing a lot, he has many cuts in his mouth, and he needs help bathing and eating. He also has skin allergies.”

Infection control

Luis and Margarida provide Joao with the medical care he needs, and give advice to Maria on infection control. "Whenever possible, keep the windows open for better air circulation and to reduce the risk of infection,” says Margarida. “We will be back next week, but if your husband’s health deteriorates in the meantime, please let us know.”

Then Luis and Margarida pack up their kit, return to the car and head for the next address on their list. Twice a week, they leave Alto-Mae Referral Centre, in Maputo, to pay home visits to patients suffering from chronic diseases such as HIV/AIDS, Kaposi’s sarcoma or TB.

'Medical and moral support'

“When we arrive at a patient’s home, we provide medical and moral support to the patient, and we also help the family,” says Margarida. “We check the drug refills. We encourage the patient to stick to their treatment, and we encourage the family to give their support and avoid discrimination. Patients are happy to see us visit, because they feel comfortable telling us about their difficulties in following a specific treatment. This is something they don’t find in the hospital.”

In the course of a day, Luis and Margarida visit two to four patients. They are careful to ensure that their visits do not arouse suspicion amongst patients’ neighbours. "Sometimes we leave the MSF car far away and walk to the patient’s home, so that the village doesn’t see the car and associate medical staff with AIDS,” says Margarida. “There is still a lot of discrimination.”

Difficult to hear sad news

During their final home visit that day, Luis and Margarida hear the sad news that their patient – who was very sick with multidrug-resistant TB – died earlier that week.

"It is hard for us to hear the news that our patient has died,” says Luis, “because everything we do is to keep the person alive and improve their health. But when the opposite happens, and our patients get better, we rejoice with their families.”

* Names have been changed.