1. Lucas Molfino, MSF Mozambique
MSF emergency intervention Limpopo River floods in Mozambique January-March 2013
“ There was water up to your knees and people started coming to look for their ART”
Health care worker at Chokwe Carmelo Hospital
ART registers and patient files from a flooded clinic drying in the sun
Lucas Molfino, MSF Mozambique

2. Context
Heavy rains caused floods in 24 districts in different areas of Mozambique.
More than affected people by Limpopo floods.
The hardest-hit District were Chokwe and Guija in Gaza Province:
HIV prevalence of 25,1% in age group years in Gaza Province – Insida 2009
people temporally allocated in 15 displacement sites.
Widespread disruption of Health & support services
Health facilities severely damaged
Lost of equipment, drugs stock and patients files
The National Disaster Management Institute (INGC)
Led the coordination & Provided initial emergency response.
The Humanitarian Country Team Working Group (HCTWG)
Tightened coordination with government sectors
Deployed more staff and essential relief to support the local structures.

5. MSF Responses
In partnership with MoH and Carmelo Hospital authorities, MSF launch an intervention based in Chokwe city and temporary shelters around the city
To re-establish health care services
Ensuring continuum of HIV care and treatment.
Main activities:
Emergency Care & OPD- including HIV package in Carmelo Hospital, main HIV
Treatment center with the largest patient cohort in the area.
Mobile clinics
System of reference for severe patients
Set up a epidemiological surveillance system
Monitor the environmental health (Water & sanitation)
Support the re-opening of Chokwe Rural Hospital
Duration of intervention: 8 weeks

6. Total consultations: 23.401 (8217 HIV consultations & pick up ART)
Results (1)
Total consultations: (8217 HIV consultations & pick up ART)
(965 TB consultations & pick up TB drugs)
Morbidity: Wounds & skin conditions -first stage-
Malaria, diarrhea and RTI. -second stage
Referrals: 353 referrals to Main hospitals in a early stage of intervention
Malaria, Malnutrition, complicate deliveries
Hospital care: 223 admissions after re-opening of Chokwe Rural
Hospital. - HIV/AIDS – 30% mortality-

7. ART treatment interruption
Results (2)
ART treatment interruption
Estimations based on the number of PLWHA enrolled in care pre-floods and numbers receiving drugs in all facilities during and post-floods, more than 50% of the PLWHA experienced treatment interruption during the floods only in Chokwe district.

8. Challenges for HIV care during Limpopo floods
Uncertainty about where to access to ART refills
Fear to leave houses and belongings unattended
Patients not fully aware of Type ART regimen that they were taking.
ART provision was not seen as a priority by emergency teams
Stock-outs of ART 2nd Line, ART pediatrics, PMTCT and OI drugs.
Sexual and gender-based violence & lack of access to PEP kit in the displacement sites.
Medical management of complex cases (malnourished HIV patients)
Use of ARV drugs affected by the floods?

9. Conclusion & lessons learned (1)
Despite considerable challenges, the local health authorities, with the support of partners, were able to keep medical services and provision of ART treatment functioning in Chokwe city after the floods
Develop of a contingency plan for emergencies that includes the basic elements of the HIV program to ensure continuity of ART care in determinate areas. This should include discussions with MoH agencies and other partners
Develop a communication structure with close ties with the community
Use of a “patient card" outlining current and previous ART regimens, side effects and any recent laboratory results, so care can be obtained at alternative sites.

10. Conclusion & lessons learned (2)
Develop patient empowerment through treatment literacy & prepare then for eventual treatment interruptions.
In determinate period of time or high risk setting, consider extending the ART supply for patients (3 months refill) or the buffer stock of ART & OI medications in the health centers.
Develop a safe storage from floods for the medical files & pharmacy.
Develop a robust paper based emergency data management system that contend essential information for on-going care
Ongoing work between partners and MSF is assessing attrition rates and the longer-term impact of this natural catastrophe.

11. Acknowledgments
Provincial & Districts Health authorities of Gaza province.
Patients & Staff of Carmelo Hospital
MSF emergency team