Oral Health Group
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A Dentist in the Mozambican Revolution – Noma, Civil War and More

June 8, 2022
by Joel Rosenbloom, DDS


My journey to Mozambique began at an early age with a fascination for Africa. I read what I could about the region and memorized all the African capital cities. I always had this dream to work there as a dentist. During my challenging years in dental school, I was motivated to succeed mostly by my desire to practice in the developing world. After a short stint working as a dentist in The Sudan in 1984, I decided that I wanted to commit to working in Africa for a longer period of time.

I arrived in The Sudan during the drought of 1984. Millions of people in Ethiopia were experiencing famine and during this time there were an estimated one million deaths from food shortages and hunger. The Eastern border of Sudan had refugee camps and reception centres for the hundreds of thousands of refugees leaving Ethiopia. This was during the Bob Geldof ‘Do They Know it’s Christmas’ times. I worked at a Refugee Reception Centre called Wad el-Heliew, near the Ethiopian border.

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The one experience that marked me deepest was watching a child die from preventable causes – dehydration secondary to intestinal parasites. The child was 2 years old and was brought into the clinic severely dehydrated and with bad diarrhea. He hardly had the energy to cry and was gasping for breath. He had the sunken face of an old man and he needed to be rehydrated quickly. Intravenous lines were tried in veins along his arm and head unsuccessfully – his veins had collapsed. Eventually I managed to place a line into a vein on the top of his head. Unfortunately, it was not soon enough and the child died shortly afterwards.

We wrapped the child in a white cloth and took him back to the family’s tukul so they could prepare him for burial. There were many deaths during my time in Sudan, but this child affected me the most, probably because it was the first time that I witnessed death and that it was such a young child. I knew this would stay with me for life – the Ethiopian famine eyeball to eyeball, one on one.

My next challenge took me to Mozambique in 1986. Why Mozambique? I had an interest in the Mozambican Revolution of 1975, and the dreams and aspirations of the newly independent country. After suffering 500 years of Portuguese Colonialism, Mozambique along with the 4 other Lusophone African countries, won their independence from Portugal.

The result of the 13-year liberation struggle in Mozambique was the Frelimo Party (Frente de Libertação de Moçambique) taking over as an independent government under Samora Machel, the first President of Mozambique. Frelimo began a social development experiment that embraced Marxism and sought to redress many years of inequality. Land was first nationalized, followed by the health care and education systems.

The results took the world by surprise: infant mortality fell, education rose and vaccination coverage grew dramatically. Mozambique was lauded on the world stage as an example of successful Black majority rule. This began to attract many foreigners who wanted to participate in the Mozambican Revolution: Doctors, Dentists, Left wing academics and intellectuals, Cubans and political refugees from South Africa, Chile and East Timor. The famous French New Wave film maker Jean-Luc Godard spent one year in Maputo developing the National Film Institute. It was a very engaged place to be – to watch history unfold as Apartheid was crumbling south of the border.

I wanted to be a part of this and joined the Mozambican revolution. In 1986, I went to work for Frelimo as a Government Dental Officer, based in the city of Beira. Aside from clinical duties in the hospital and the outpatient clinic, I trained dental workers and prepared for the re-opening of the National Oral Health Training Centre. Our meetings all started and ended with a rousing fist pumping chant: A Luta Continua … Continua, Continua … A Luta Continua. Viva, Viva a Frelimo!

Fig. 1

Sketch I made the night that the child died. Wad el-Heliew, Sudan, 1984 ©Joel Rosenbloom.

Sketch I made the night that the child died. Wad el-Heliew, Sudan, 1984 ©Joel Rosenbloom.

Fig. 2

Map of Africa and Mozambique ©Wikipedia.

Map of Africa and Mozambique ©Wikipedia.

In preparation for working in Mozambique I lived in Lisbon and was enrolled in a Portuguese language course at The Centro de Informação e Documentação de Amilcar Cabral (CIDAC). One day when we arrived for class we were informed that President Samora Machel was killed when his plane crashed in South Africa. It was suspected that South Africa had orchestrated the crash. Machel was a charismatic leader, widely adored, and I knew this would have a profound influence on the events in Mozambique. The socialist experiment I’d yearned to join was at risk.

I arrived in Maputo, Mozambique from Portugal in November 1986. It was directly out of the Costa-Gavras film Missing, which was set during the military coup in Chile. A few days after I landed in the capital city, there was a large rally in the Praça de Independençia in central Maputo. An enormous portrait of Machel was hanging from the Conselho Executivo and the Mozambican flag was flying at half-mast. It was nighttime and the praça was filled with thousands of people. Set up as a memorial for Samora Machel, it was a steamy tropical night – hot, humid and alive with a buzz of uncertainty. On the roofs of the buildings that surrounded the square, soldiers were perched with AK47s trained on the crowd.

In the few years preceding my arrival, the situation began to deteriorate. In the interest of destabilizing the region and supporting the racist Apartheid system in South Africa, the Apartheid government funded a rebel force in Mozambique, called Renamo or known as Os Bandidos Armados or simply the Bandits. Renamo was initially created by Rhodesia in the late 1970s, but when Zimbabwe became independent in 1980, Renamo became a surrogate force of South Africa. Their intent was to wage a brutal bush war and make the majority of rural Mozambique ungovernable. They were successful and this plunged the Revolution into free fall, development and war rarely co-exist. The writer Alexandra Fuller says that in the 1980s Mozambique became widely acknowledged as the “most miserable nation on earth”. When I arrived, the war intensified even more and the situation was dangerous. Travel outside of Beira was very difficult.

Beira was the second largest city in Mozambique at the time and is almost half way up the country on the coast. It is a small city and beautiful in a run-down tropical way – lovely, curving Portuguese architecture with faded blue walls and cement columns. Flowering trees and papayas grew wild throughout the city. As I walked or cycled to work the air was thick with the soft, rich floral scent of frangipani and the intense, sweet smell of jasmine. There were few cars on the streets and even fewer goods in the stores. Life was difficult, it was wartime.
Although there was no threat of danger in the city, the war affected every aspect of life, from power lines being sabotaged to lack of food and other necessary items. Water for drinking and for domestic life was scarce when the power was cut. During these periods without electricity, I would carry water from a local well, 2 blocks from my apartment and the outpatient dental clinic would close due an inability to sterilize instruments.

Yet, in Beira the ocean provided a tropical paradise to read, think and swim plus an endless supply of seafood. The beaches were usually empty save for local fisherman. We would buy fish that they’d drag back in their vast rope nets after a day fishing out at sea.

A notable landmark in Beira was the GRANDE Hotel, a few short blocks from my apartment. This was built as a five-star hotel during Portuguese colonial times for the big game hunters from Rhodesia and Mozambique to relax and enjoy cold beers and appetizers by the pool after a day of hunting and fishing. During the war it became home to 5,000 war refugees who were desperate, and in the interest of survival burned the parquet flooring as fuel and hung their laundry on the once coveted ocean view balconies. Over time the letters slowly dropped off the rooftop sign one by one and the GRANDE Hotel soon became the RAND Hotel, then eventually the A Hotel.

Fig. 3

The Grande Hotel, Beira Mozambique. ©Joel Rosenbloom

The Grande Hotel, Beira Mozambique. ©Joel Rosenbloom

The Grande Hotel, Beira Mozambique. ©Joel Rosenbloom

The Grande Hotel, Beira Mozambique. ©Joel Rosenbloom

During my first night in Beira I was in my dark apartment unpacking and I heard a small tap on the door, almost inaudible. I finally went to the door, and there was a Mozambican hospital worker in a characteristic blue hospital uniform. He said “Doutor, doutor, tem que ir para o hospital”. I went with him through the dark, quiet streets of Beira to the hospital emergency ward. There had been a Renamo attack outside of Beira recently and the emergency room was packed with soldiers, both alive and dead.

The hospital staff led me to my patient. He was a soldier, who had spent 2 days in the bush and was now in hospital. He had an enormous bandage around his face, which when removed revealed a gaping wound to the entire side of his face caused by a bullet. His tongue was severed and had swelled many times its normal size. It was incredible that he was still alive.

I examined him I gave him various prescriptions for a blood transfusion, fluids, 2 types of antibiotics.

I went home to sleep, only to return the next day after a fitful night. I could not find this soldier anywhere in the hospital. One orderly recommended I check the morgue. My heart skipped a beat when I thought about the previous night. As I walked toward the low grey one story building in the far corner of the hospital grounds the same orderly called to me to say he had found the soldier in the military wing of the hospital. I went to see him, he was in remarkably good spirits – the resilience of Mozambicans was a constant source of wonder. The soldier lived, and was transferred to the capital city, Maputo, a few days later by military plane for surgery.

My role as the Dental Officer enabled me to visit other provinces, health posts and village dental clinics. I often traveled to the town of Buzi, which is located on the Buzi River, a three-hour trip on a small river boat from Beira. It is a narrow ribbon of water with thickly forested banks and an abundance of tropical vegetation. The journey starts with a sometimes-treacherous crossing of the confluence of the Buzi and Pungwe Rivers from the port of Beira. The journey down the river was where the real excitement was. I spent the three hours watching birds, looking for crocodiles and wondering what it would be like to live there.

I remembered reading Heart of Darkness by Joseph Conrad, based on Conrad’s own river travels in Africa in the 1890s. Buzi was my heart of darkness trip.

The town of Buzi was built around the sugar company, called the Companhia do Buzi. Arriving in Buzi, the first vista that you notice is the loading apparatus of the sugar company suspended over the water on the south side of the river – it reminded me of a tableau from a Graham Greene novel. The village is on the north side, where the health post is located. To cross the river from village to factory, we went in an old rickety row boat that was barely seaworthy. The sugar company dates back to colonial times and runs 3 months of the year–it is the only legal alcohol producer in Mozambique.

I stayed in the village in the house of the Mozambican doctor, Dr. Cassim, and had the entire second floor to myself which included a wraparound balcony overlooking the jungle. At night the sound of crickets was overwhelming, a veritable insect orchestra.

One drawback was the mosquitos that were plentiful in the lush riverside breeding grounds. Malaria was common and I did not have a bed net. Thoughts of my near-death experience with malaria in Sudan one year before haunted me.

Fig. 4

. A Gunshot wound victim ©B.E. Edentanlen, Birch D O Saheeb, Research Gate .

A Gunshot wound victim ©B.E. Edentanlen, Birch D O Saheeb, Research Gate .

Fig. 5

Hospital Central da Beira, Sofala Province, Mozambique.

Hospital Central da Beira, Sofala Province, Mozambique.

One experience from Buzi that will always stay with me was yet another tragic outcome of the war. It began with an attempted visit to a smaller village called Bandua, 27 kms from Buzi, to investigate the potential for a small jungle dental clinic. There was a dental chair in the health post at Bandua. Our car broke down 8 kms outside of Buzi and we had to walk back through the palm and bamboo forest. The bamboo grew in clumps rising up to over thirty feet in height. It was lush and beautiful, but it was wartime and the threat of a bandit attack was very possible. Snakes were also a concern, I had heard from the healthcare workers in the village health post that they treated many snake bites, and I was not wearing proper footwear.

While walking we encountered a military vehicle filled with Frelimo soldiers going in the direction of Bandua. They were heavily armed and were headed off to destroy a ‘bandit base’ near the village of Estaquinho. They were led by the District Commandante.

We eventually returned to Buzi and I spent another night with the kind Mozambican doctor and his wife. They fed me well and entertained me with stories about living in Buzi – its dangers and its joys. One such joy was the availability of tropical fruit – this was the first time I ate a fruit called coração de vaca (cow’s heart). It was delicious – green and spiky outside with an almost pineapple-like syrupy pulp filled with ovoid dark brown seeds. It was very fragrant, almost like cheap perfume.

The following morning, we waited 2½ hours on the dock for the river boat to take us back to Beira. My childhood fascination with reptiles had me scanning the grass for snakes and the beaches for crocodiles. All of sudden everybody who was gathered around the dock stood up. I did as well and looked up the road leading to the dock. I saw a group of soldiers slowly marching down the road in formation carrying a home-made coffin on their shoulders. Everybody bowed their heads and there was absolute silence. They placed the coffin on the dock to wait for the boat. The coffin and corpse were coming back to Beira with us.

On the return boat trip, I found out that this was the same group of soldiers we encountered on our way back from Bandua. One soldier was killed in their attempt to destroy the base. Yet another chilling reminder that wherever you are in Mozambique the war always catches up to you.

These work-related trips were my adrenalin pumping reality check on what was going on in rural Mozambique, the heart of the war. During one week I managed to tag along with a Médicins Sans Frontiéres (MSF) doctor who was visiting health centres in isolated areas by small plane. During these flights over vast areas of Mozambique I saw some very unusual sights.

One time we were flying quite low and I saw a ring of fire approximately 100 feet in diameter -a perfect circle. To me, it was completely mysterious. The pilot knew it was a weapon drop for Renamo; South Africa illegally supplied weapons dropped from airplanes. Another image I became accustomed to seeing was small cemeteries with many tiny graves for infants and children.

One place we visited was Catandica in northern Manica Province near the border with Zimbabwe in the Nyanga mountain range. My goal was to visit the dental clinic in Catandica and in a nearby smaller town called Inhazonia to try to rehabilitate it. Catandica is a district capital, but like most of rural Mozambique accessible only by air and cut off from other major centres due to dangerous road travel.

Fig. 6

Catandica, Mozambique ©Joel Rosenbloom.

Catandica, Mozambique ©Joel Rosenbloom.

Fig. 7

Killey’s Fractures of the Mandible ©Joel Rosenbloom

Killey’s Fractures of the Mandible ©Joel Rosenbloom

About 5 minutes after our arrival a lorry pulled into the district health centre with 5 people on the back who were attacked by Renamo north of Catandica on the main road. One person was a 12-year-old child who was dead and immediately taken to the morgue. Another man had part of his lower leg blown off and yet another had a bullet in his hand. Three were immediately placed on the plane we came on to go to the provincial capital, Chimoio, for surgery.

Shortly after the wounded were attended to we hopped into a land rover to visit the health post where the dental clinic was located. It was north along the road in the village of Inhazonia. As we were travelling up the road, I asked my Mozambican colleagues where the attack took place, and the response was “up the road a bit”. This was puzzling to me given how calm they were and that we just saw a lorry full of injured people and one dead child. I braced for the worse.

To get to Inhazonia, we had to turn off the main road 12 km north of Catandica and travel through the bush for 2-3 km. We finally arrived and the setting was breathtaking, the Nyanga mountain range in the distance, picturesque, peaceful, yet full of bandit bases.

We located the sala de estomatologia or dental clinic, which was beautiful and had a dental chair that was barely used and sets of forceps and other instruments. The story I was told was that missionaries set this up before independence and it has never been used since the revolution. I thought it would be useful to station a Mozambican agente de estomatologia there and start a village dental clinic.

During our entire visit to the health post I never saw one Frelimo soldier – clearly concerning given the recent attack. We arrived back in Catandica and spent the night in a guest house since the plane did not return.

The following day we travelled again north on the road, this time to Mungare to do oral health surveys, conduct traditional oral health education using tree branch tooth brushes and visit the health facilities. While we were there we heard that 2 nights before we arrived Renamo tried to enter and take Mungare, and FPLM (Frelimo soldiers) launched a counter grenade attack and repelled the bandits. The centre of the town was subsequently surrounded by mine fields. I could have spent weeks in Catandica, it was magical and beautiful set in the lush mountains of the Nyanga range.

My clinical duties included dental treatment in the outpatient clinic in Beira and at O Hospital Central da Beira; extractions, fractures, osteomyelitis and some trauma.

In preparation for being able to wire fractures I spent some time in Toronto with an oral surgeon. He gave me a book called, Killey’s Fractures of the Mandible, a classic in dental literature. The first fracture I had to wire alone in the operating room was a bilateral mandibular fracture. I remember reviewing the relevant chapter outside the OR as I scrubbed in. No matter how well I may have prepared myself didactically, nothing really readied me for doing this.

Fig. 8

Outpatient clinic in Sofala with Mozambican Agente de Estomatologia, 1987. ©Joel Rosenbloom.

Outpatient clinic in Sofala with Mozambican Agente de Estomatologia, 1987. ©Joel Rosenbloom.

Fig. 9

Dona Ana Bridge, Sena after it was damaged by Renamo attack in 1985. ©Kok Nam.

Dona Ana Bridge, Sena after it was damaged by Renamo attack in 1985. ©Kok Nam.

I had no idea how sharp the cut fracture wires would be and I repeatedly poked myself through my gloves. One time it was such a deep jab that the finger of my surgical glove filled up with blood like a mini water balloon. It took approximately 4 hours to fully immobilize the fracture and when I walked out of the hospital that day, I felt as if I was walking on air, thrilled with success.

The next day I went to see the patient in the ward and he looked amazing; happy, healthy and the fracture was nicely fixated. As I was about to leave the patient’s bedside, he called me over and reached for his groin. He asked me to examine a sore on his penis as he pulled up his hospital gown. I let him know that another doctor would be better suited for this.

The realization quickly dawned on me that what’s in his blood is in my blood. What could I do now? I left the hospital and walked across the street to the ocean and swam in the cleansing salt water.

Another clinical first occurred one Saturday morning in the outpatient clinic in Beira. We were just getting ready to close for the weekend and we noticed a young woman sitting in the corner of the waiting room with a cloth covering her face. The waiting room was dark due missing light bulbs, so at first, we could not see her clearly. As she came forward from the shadow to ask to be seen, we noticed the right side of her face was swollen almost twice the normal size. My Mozambican colleague, Sr. Luis, and I took her into the operatory and examined her. She had a draining sore from her face in the mandible.

A portion of bone from the mandible was protruding from the opening. Immediately I recognized this to be osteomyelitis and the bone was a fragment of dead bone from the mandible, called a sequestrum. We placed anaesthetic and after cutting an incision I dissected deep into the infection and found the accumulated infection and drained a kidney bowl of pus from the wound. I also removed a piece of the sequestrum approximately 3 cm x 2 cm then stitched a drain in place. The patient was immediately sent to the hospital to be admitted for a course of intravenous antibiotics and surgical curettage of the remaining infection.

The next day when I went to the hospital to check on her she was not there. I was stunned to think that she never went to the hospital, but likely just went back to her village. I soon realized that she had to return home as her children depended on her for survival and in her absence, they could become ill, maybe even die. I could not imagine having to make such decisions – her life or her children’s.

I tried to visit as many health posts as possible in Sofala Province and the surrounding provinces. This included a health visit to the Vila de Sena, in northern Sofala Province. Sena is known for the Dona Ana bridge, the longest railway bridge in Africa, 3.6 km long and built in 1934. It crosses the Zambezi River connecting Sena to Mutarara in Tete Province. It was initially built as a link for transportation from Southern Malawi to the port of Beira. The bridge was blown up by Renamo at 2 points in 1985 and the only way to cross the river was by canoe, a dangerous crossing due to unpredictable currents, floating pods of hippos and carnivorous crocodiles.

I travelled to Sena on a food aid plane with a colleague and friend Dr. Eduardo, a Chilean political refugee doctor. The plane was a Russian Antonov – a large cargo plane often used to transport trucks – flown by a Russian pilot. The windowless cargo bay was loaded with 50 kg sacks of grain, which we sat on.

Fig. 10

Children under a baobab tree in Sena, 1987 ©Joel Rosenbloom.

Children under a baobab tree in Sena, 1987 ©Joel Rosenbloom.

Before agreeing to go to Sena, I knew it would be unlike anything that I had yet experienced in Mozambique. Sena was almost completely destroyed. Renamo entered and held it for 4 days in December, 1987. The remaining buildings were pockmarked with large grenade and bullet wounds. Many people were killed both in the taking and the liberating of the town.

We were there shortly after Frelimo liberated the town and people were only starting to come out of the forest in search of food and medicine. They had been surviving in the bush on roots and plants for years, often times succumbing to hunger and dying. I had never
witnessed a population so desperately clinging to life.

I had the feeling of imminent danger in Sena from the moment I stepped off the plane. The town was heavily guarded by FPLM soldiers and the commandante was always protected by 2 armed guards. The air pulsed with the threat of a possible attack and we were completely isolated from the outside world. If we suddenly disappeared, nobody would ever know.

Dr. Eduardo and I did health assessments and found that aside from dehydration and malnourishment, many people had skin problems, eye problems and diarrhea and malaria were widespread. We gathered approximately 300 people around a tree to hear about the concerns of the local population so we could advocate to Beira health officials for services in Sena.

As dusk came I battled two conflicting thoughts. I could not imagine spending the night in a recently liberated town knowing that there were large numbers of rebels in the bush on the outskirts. And that it would be a thrill to sleep in Sena, to feel the full body sensation that all could change in a split second. The Antonov returned before dark and we returned to Beira.

A few days after I returned to Beira, I was told that Renamo had attacked and successfully taken Sena again. I thought of all the people who I had met there, hungry, sick and now scattered into the bush for safety for however long the occupation lasted.

Together with a few cooperantes – foreigners who supported Frelimo’s socialist development of Mozambique – I traveled to Zimbabwe to buy supplies and to escape the war for a few days. The journey to Zimbabwe was a 5-hour road trip along the Beira Corredore from Beira to the border town of Mutare. The Beira Corredore was a strategic link from Zimbabwe to the coast for shipping and it was also the route for an oil pipeline and railway. Due to its strategic importance it was a target for Renamo attacks and was often dangerous to travel.

The day before we were to set off we heard that there had been an attack and 8 people were killed, including three top Mozambican musicians. This did not deter us … not sure why? Perhaps we were flirting with danger or just craved the foolish excitement of driving through the war.

We left at dawn to travel in the daytime, the safest time. About an hour after setting out we came upon the smoldering remains of a lorry. At first there appeared to be nobody around, but as we passed by, one soldier came up from the ditch on the side of the road. He was startled by our vehicle and raised his AK47 and pointed it at our jeep. I threw myself to the floor, but he did not fire. We soon realized that this was the remains from yesterday’s attack.

We arrived with no further incident and spent a few relaxing days in Harare eating hamburgers and drinking coca colas, 2 luxuries not available in Beira. Zimbabwe was the land of milk and honey in those days, the shops were laden with goods. I couldn’t relax knowing that we had to make the journey back along the corredore. I had a sense of dread in the pit of my stomach, even fear.

Fig. 11

WHO©

WHO©

We set out early to return to Beira and all was going well until we encountered car troubles about a third of the way along the corredore. We stopped in Gondola to arrange a pick-up truck and a driver for the remaining journey. Once this was done we had to decide – do we push on with the distinct possibility of driving at night, which was outright dangerous, or do we overnight in Gondola?

For reasons I no longer remember, we decided to continue on to Beira. The Mozambican driver made clear his objection, but we convinced him to go. The last few hours of the drive were at night. I was sitting in the open pick-up truck with my friend Julian, a political refugee from South Africa. We stared into the ominous dark fringes off the side of the road knowing Renamo rebels were out there. We were the only car on this deserted stretch of the corredore at night.

My nerves were buzzing and it did not help matters when Julian began to tell me of the precision and accuracy of bazookas from the woods beyond the highway. We drove most of the way with our headlights off. Hard to judge what was more dangerous – hitting an elephant or being hit by a bazooka? We arrived and our friend who rode with the driver in the cab told us of the terrified look on the driver’s face the entire way and how his knuckles wrapped around the steering wheel were white.

My closest friend in Beira was a South African named Julian. He was from a prominent anti-Apartheid ANC family. His father was a doctor and his mother was a nurse and they both provided services in the townships. His brother was the highest-ranking white member of COSATU, the largest trade union in South Africa.

He left South Africa in the nighttime when his draft papers arrived to serve in the South African Defense Force (SADF). He went to England to bide his time and prepare his return to Southern Africa to continue the fight against Apartheid.

We met in Lisbon at CIDAC the political language school named after the revered revolutionary leader Amilcar Cabral from Guinea-Bissau.

We both studied Portuguese and the history of the armed struggles in Lusophone Africa.

In Beira, we spent many hours talking about the events in Southern Africa. I learned a great deal from him about the region, for example – details of the Matabeleland massacres shortly after independence in 1980. This understanding would bring me clarity and insight many years later to explain the eventual brutality and collapse of Zimbabwe under President Robert Mugabe.

Julian was a source of knowledge for me and a wonderful person to discuss and make sense of what we witnessed and had to negotiate on a daily basis. We talked for hours about the Front-Line States, as the countries bordering South Africa were known, and the successes and failures of their liberation struggles. We were both drawn to Mozambique as supporters of Frelimo, and its Marxist political path.

The war raged on and there was no hope in sight, but we carried on as members of a Revolution that was running out of steam. Renamo became increasingly brutal resorting to wide scale massacres and continuing to kill and maim – cutting off noses, lips and tongues being their trademark.

One morning at the hospital, I saw a patient who had his lips cut off by the bandits. It was unlike anything I had ever seen before. The man had a permanent wide mouth grin on his face with bared teeth and an exaggerated smile, producing an effect similar to the ‘sardonic grin’ seen in tetanus patients. I thought about how difficult it must be to eat without lips.

Fig. 12

Sufyanu, a 3 year old boy, Sokoto Nigeria, Image ©Inediz, Claire Jeantet and Fabrice Caterini.

Sufyanu, a 3 year old boy, Sokoto Nigeria, Image ©Inediz, Claire Jeantet and
Fabrice Caterini.

The opposing forces of Frelimo’s success with Marxism and Renamo’s campaign of destabilization left me with the deep sense that this war would never end. South Africa could not tolerate successful Black majority rule in a neighbouring country while trying to maintain the Apartheid system, and Renamo offered no political alternative to Frelimo.

During another shift at the hospital a Mozambican nurse presented a three-year old child to me. He had an enormous bandage around his face, akin to wrapping a towel around it. The Nurse slowly unwound the gauze to expose and irrigate the wound. The child could not hide the terror in his eyes.

When the nurse removed the bandage, I saw a wound that amounted to the middle third of the child’s face destroyed to expose a window into his oral cavity: displaced teeth, gangrenous tissue and massive damage to his face. It was as if a bulldozer of germs plowed its way from the inside of his mouth through his cheek to reach its goal, the outside world.

This was my first encounter with the disease called noma. Noma is a severe oral infection causing orofacial gangrene that carries a 90% mortality rate, with 140,000 new cases each year, according to the WHO. Its victims are mostly children under 5 years of age, primarily in Sub-Saharan Africa. Noma stems from the Greek word nomein, which means to devour. The risk factors are from poverty (malnutrition, malaria, measles and oral disease) and it is 100% preventable. I remember this day vividly, the look in the child’s eyes, the anger I felt and the deep feeling of injustice changed me fundamentally as a human being. I have seen noma since this time in Mozambique and Ethiopia.

Nearing the end of my time in Beira, a very unusual story occurred. I had met a group of missionaries who ran a small health clinic about 2 hours from Beira along the corredore near the town of Nhamatanda. They lived in a manor house that had belonged to a Baroness during Portuguese colonial times. It was one of the most tranquil and bizarre places I had yet seen – beautifully set on a hill overlooking a valley filled with wild colourful flowers. The outside of the house was lined with two dozen mounted water buffalo skulls, while the inside sitting room was decorated with tusks of wild boar and other grotesque trophies culled from the African savannah.

This was a dangerous place to live. They heard gunshots from the road and Renamo frequently paid them midnight visits to ransack their house for food while they had to run and hide in the bush. How they continued to live there was baffling. We were accustomed to visiting them on our trips down the corredore.

Sometime after we visited them we heard that they had been taken by the bandits. No news was reported about them after that. One day about three months after they were abducted, we saw them on the beach in Beira and they told us about their ordeal.

Renamo walked them to Malawi from Nhamatanda. Before going they were allowed to outfit themselves with one extra set of clothes and a medical kit, that included medication to treat malaria. First, they were taken to Gorongosa, Renamo headquarters, to meet the rebel leaders. Gorongosa is a National Game Reserve once known for easily spotting the ‘Big Five’ African animals. Renamo had slaughtered and eaten most of the wildlife in the park.

They mostly walked at night and stayed in makeshift camps which were put up and taken down rapidly. They saw many bandit bases with groups of 70-200 armed men. The bandits were well armed with AK47s and rockets and they witnessed several ambushes of Frelimo soldiers on the road. The bandits were able to travel freely about large portions of the bush.

Fig. 13

13. Posters for Canadian Premiere of Restoring Dignity. ©NAG/Noma Action Group.

Posters for Canadian Premiere of Restoring Dignity. ©NAG/Noma Action Group.

13. Posters for Canadian Premiere of Restoring Dignity. ©NAG/Noma Action Group.

Posters for Canadian Premiere of Restoring Dignity. ©NAG/Noma Action Group.

They were marched to Malawi through the jungle of lower Zambezia, through dense bush, mangrove swamps and intervals of dry open savannah. They crossed rivers on pieces of bark, encountering pods of hippopotamus, the world’s deadliest mammal.

Their belief in G-d is what enabled them to endure their time with Renamo. They deeply believed in G-d’s presence throughout the march and related one anecdote that stuck with me. One of the missionaries had three days of malaria followed by six days of dysentery. She didn’t think she would make it. She prayed hard and she felt the presence of G-d, “he touched my belly and the next day the dysentery healed.”

Reflecting on their story with my friend Julian we both had this weird twisted sort of envy and said almost simultaneously that we wished it was us who had been kidnapped. Another example of the confused thinking that I struggled with living in wartime Mozambique.

There are startling images that I carry from Mozambique that sneak up on me, vivid and surreal. I watched a man on a motorcycle – a health worker in Niassa – skid on sand, and then do a 3/4 somersault in the air and land, strangely quiet, on his back. It seemed to happen in slow motion, perhaps a prompt for me to record the details?

“A man suspended in the air, his position almost acrobatic, then ‘gently’ drops to the ground never to awaken.”

We carried him into the health center where he had worked and I watched him die over the next night and day. I found myself repeatedly going over the details trying to grapple with the split-second change from him riding a motorcycle to him lying in a coma. It all seemed
so senseless.

There are other unexpected reminders, less grave, that seize me, and remind me of my time in Mozambique. The smell of cooking braziers as I shop in Kensington market in Toronto instantly transports me back to the delicious street food that I was so fond of in Beira.

After my two-year contract was finished, I chose to stay on in Beira for several months to prepare for the Oral Health Training Centre. Subsequently, I was asked to work for the Mozambican Ministry of Health in a central planning capacity at a National level and live in Maputo.

After careful consideration I decided to return to Canada, mostly to be near my parents who were unwell. I continued my involvement in Mozambique with yearly visits to develop the curricula and plan for the next stage of dental training in Mozambique.

The violence of living in a civil war and witnessing tragedy and horror on a regular basis had many effects on me. While living there it engendered an indescribable yet vaguely trance like effect on me to want to experience the war. At times I was not able to make safe and rational decisions. I wanted to know how it felt to be in danger and come close to the edge of life and death. I found myself often at either end of the violence cycle – before or after it occurred, but I wanted to be in it. It was a great unknown and I wanted to know more. On some level this explains why I was driven to visit towns such as Sena and Buzi and my cavalier, yet terrified, attitude when we drove down the road in Catandica or along the corredore at night.

It also explains why I so badly wanted to have lived through the 3-month trek that the missionaries were forced to endure.

After returning to live in Toronto, I knew that this period in Mozambique would shape my future career as a dentist. I was determined not to lose my focus on social justice. I looked for and found ways to use my skills to reach people living in poverty. I would never go back to private dental practice.

I knew that I could only fulfil my ambitions if I worked in poverty-based settings – I worked in community health centres, public health and a psychiatric hospital dental clinic.

My experience with noma and the terror and intensity of the look in that child’s eyes stayed with me long after leaving Mozambique. I felt this child was holding me accountable. In a way this was testing my commitment to what I started when I first went to Mozambique.

Noma is the ultimate disease of poverty, often called the ‘face of poverty’. After many years of developing my skills as a health activist, noma became my focus. I was determined to ensure that this disease was not overshadowed by so many other diseases or overlooked from a comfortable perch in Canada.

The nature of the disease – its ugly stigmatizing effect on the ‘lucky’ 10% who survive, and the annual death toll of over 100,000 children would not let go of me. I had an opportunity to use my voice as a dentist and professor to spread awareness about noma. My outrage has taken hold and there is a student group called NAG/Noma Action Group at our dental school dedicated to the eradication of noma. The disease is slowly becoming better known in the dental community in Canada.

To say I was a different person when I returned from Mozambique would be inaccurate. I was the same person who boarded that flight to Maputo from Lisbon in 1986, but I have found my voice, my strength and my ability to hold people accountable, just as that 3-year-old child has long held me accountable for his avoidable condition.

Oral Health welcomes this original article.


About the Author

Joel Rosenbloom has a long history of providing dental services to patients in Community Health Centres, Public Health, The Centre for Addiction and Mental Health (CAMH) and in parts of Africa. He has dedicated his career to both teaching and to poverty dentistry. He has lived and travelled in Africa for over 4 years and worked as a dentist in Mozambique, The Sudan, and Ethiopia. He is currently an Assistant Professor Teaching Stream, Faculty of Dentistry, Univ Toronto and a Staff Dentist CAMH. ©Centre for Addiction and Mental Health (CAMH).


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