SCRIPT
REPORTER - Do you know when she'll go?
MELLO DE CARVALHO - No.
REPORTER - Does she need to go in order to survive?
MELLO DE CARVALHO - Yes.
FRANCISCO ALELUIA
The system used to evaluate candidates eligible for external treatment isn't always transparent.
YOANNES MOOIJ
I can't leave a 12 year-old boy in this state. Suffering like this. I don't want people crying in my hospital.
RITA MATOS CRUZ
Nobody can change the world, but we can make a difference. All we have to do is roll up our sleeves.
02:18 REPORTER V/O
The morning brings the first steps on a difficult journey.
It is said that here health is at death's door. And upon arriving at the Simão Mendes Hospital it is obvious that something is not right.
The vultures are permanent observers of what happens here. This is the National Hospital, which means just that, the hospital where almost every specialised doctor in the country works.
Even so with little training and virtually no diagnostic material... There is a shortage of everything here.
03:07 REPORTER V/O
Two dentists in the country for a million and a half inhabitants - such statistics lead one to fear the worst.
03:13 DENTIST
Let's take a look at the supplies, shall we Dr. Luisa?
These are gloves.
These are gauze bandages.
I'm going to put all the gloves to one side. I don't know if you need this, I don't think so, they're sterilisation packs.
I don't think so. Are there any syringes?
There are syringes, there are indeed. I'll give them to you in a second.
REPORTER - You don't have syringes either?
DENTIST - No.
REPORTER - What do you do then? Do you use the same syringe on everyone?
DENTIST - No.
REPORTER - On several people?
DENTIST - Yes.
REPORTER - Each patient brings his own supplies, is that it?
REPORTER - Is this where you store supplies?
DENTIST - Yes.
REPORTER - Are these all the supplies you have?
DENTIST - Yes.
04:08 REPORTER V/O
A donation from a team of volunteer Portuguese dentists is received like a miracle. The hospital is a true reflection of the difficulties the country faces. Steeped in debt, the Government has no provision in the budget for health spending, except to cover salaries.
The hospital survives on a cost recovery policy. In other words, as a rule, there is nothing. Each patient has to buy what he needs on the spot from the pharmacy in order to be able to be treated.
04:42 REPORTER V/O
This woman has an abscess. An infection that could be treated easily if detected in time, but here it takes on another dimension, in a hospital where there is little more than good will.
NENÉ SANKA
The only motivation bringing us here is our vocation. Even if there's no money, we do everything we can to come on duty and save other people's lives.
05:11 REPORTER V/O
The hospital team and the Portuguese man teaching how to run Simão Mendes, who works for the Abel Salazar Institute in Porto, show us the premises.
The hospital is divided into units. The maternity unit is the only one in Bissau equipped to perform cesareans including all its 8 regions and islands.
05:36 LUIS CAMALA
Since I came back in 95 from my training in Germany I've been working as the only national professional.
The death rate must be over 80 percent.
The problem is that there is a shortage of incubators in the regions.
REPORTER - Is there a shortage here too?
LUÍS CAMALA - Yes, there is. Right now we have the twins and the triplets, but we sometimes have 4 children to an incubator. We can't leave one outside just because we don't have room.
06:12 REPORTER V/O
Malaria is the primary cause of death in children up to 5 years of age. Next come acute respiratory infections, diarrhea and malnutrition.
Our visit takes us from the maternity ward to the pediatric ward.
06:30 REPORTER V/O
There are a lot of children who live here for months. So many of them stay here for years. The biggest problem is those with illnesses that can't be treated in Guinea. The so-called medical board, 5 doctors with different specialisations gather around a patient, a child in this case, to figure out whether the illness he has can be cured in the country. According to the cooperative agreement between Portugal and Guinea which was formalized in 1978, 300 patients a year who fit this profile can be treated. Really it's a sort of lottery try to win a trip to Portugal to be saved.
(respira)
07:11 FRANCISCO ALELUIA
We can confirm that not all those who go to Portugal under this agreement with Guinea Bissau are actually sick.
REPORTER - Not all of those who go are sick. How does that happen?
FRANCISCO ALELUIA - The system used to evaluate candidates eligible for external treatment isn't always transparent.
ALFREDO ALVES
Around 20 percent of those who need to, actually go. How many of those who stay behind end up dying?
MELLO DE CARVALHO
That could also be around 20 percent. The same number as those who go. Say 10 are sent for treatment in Portugal, another 10 are left behind to wait for treatment and end up dying.
08:06 REPORTER V/O
Heart problems, congenital malformations and nephrotic illnesses, are the most frequent cases.
The children add up, spending 2, 3, 4 years in a hospital bed waiting for their case to travel from the Ministry of Health in Guinea to the Embassy in Lisbon, then to the Directorate-General of Health to set up an appointment at Portuguese public hospitals. The bills all have to be paid by the patients - enrollment with the medical board, the birth certificate for the child who often hasn't even been registered, the identity card and passport required to apply for a visa at the Portuguese Embassy, the health insurance, all cost about 150 euros. In other words, more than even the hospital's most valued doctor can afford.
REPORTER - Of the children here? Which are the most urgent cases?
MELLO DE CARVALHO - The most urgent cases?
This child here, that one. In another room we have a case where the person who will accompany the child has a visa but the child doesn't yet.
REPORTER - Which is the oldest case you have here?
MELLO DE CARVALHO- This one here, and the one in the other room.
REPORTER - Do you have any idea when she'll be going to Portugal?
MELLO DE CARVALHO - I have no idea when she'll go.
REPORTER - But she needs to go?
MELLO DE CARVALHO - Yes, she does.
REPORTER - Does she need to go in order to survive?
MELLO DE CARVALHO - Yes she does.
09:33 REPORTER V/O
Contrary to what is stipulated in the agreement, the trip to Portugal also has to be paid for by the patient and not by the Guinean Government. Only in the case of government employees does the Government pay a small part. Patients must also have a relative or friend living in Portugal. In other words, the hospital admittance scholarship is anything but a scholarship, and the hardest thing to accept is that there are children in dire circumstances, forgotten in the middle of all the beaurocracy.
10:00 YOANNES MOOIJ (SUBTITLED)
There's a child here who fell from a tree, who has bedsores, at the end of his femur, I can put my hand almost right inside. He is waiting, waiting for an appointment. You can't set up an appointment for Someone who is anemic and has been lying in bed for a year and a half waiting for an appointment.
Domingos!
If the boy doesn't die from his wounds he'll die from the anemia.
Things like this revolt us, they upset us. Sometimes someone dies because he wasn't seen in time.
10:49 YOANNES MOOIJ (SUBTITLED)
Spinal problems. He has a fractured spine, he can't move, so he's getting bedsores.
Open his bandages.
REPORTER - No, don't open them. It's OK.
MOOIJ - Sometimes he wets the bed at night, and and since he can't get up, that isn't good for him either.
REPORTER - He's been lying in this bed for a year and a half?
MOOIJ - Yes.
REPORTER - Has he been approved by the board?
MOOIJ - Yes, he has. I say it's ridiculous that he needs a doctor's appointment when the case is this bad.
I have been promised by the Ministry of Solidarity that the tickets will be bought, I've talked to his mother's relatives and they're going to sell a cow or a goat. So the plane ticket isn't a problem, the problem is - and this is what annoys me - we don't have a doctor's appointment.
REPORTER - A doctor's appointment where, here?
MOOIJ- No, in Portugal.
REPORTER - You need to make an appointment in Portugal?
MOOIJ - Yes. But there are two things. There are doctor's appointments and there are emergencies. This isn't something that requires a doctor's appointment, that's what outrages me, this is an emergency, that's what it is. I can't leave a 12 year old boy in this state. Suffering like this. I don't want people crying in my hospital. I'm sorry to raise my voice, but as he can tell you, as my nurses can tell you, we have all cried together so many times because we aren't going to get it done and the child is going to die in our arms.
MARIANA DJATA - I don't want that.
REPORTER - She's slept here for a year and a half?
MALAM MANÉ - Yes.
REPORTER - Why?
MALAM MANÉ - Because they need someone to help look after the boy. He soils the bed, wets the bed, she's his mother, so she stays to look after him.
She buys everything he needs for his treatments.
MARIAMA DJATA- It takes a lot of goodwill to be able to take the child out of here.
REPORTER- Is there anyone here who would like to take the child to Portugal to help him?
REPORTER - His name is Domingos, I don't know if you know about his case.
FRANCISCO ALELUIA - Let me see.
REPORTER - He's been here for a year and a half.
FRANCISCO ALELUIA - This child needed to be evacuated. This case was presented to the embassy. This is the urgent request for a visa and that's my signature and the date when I made the evaluation.
This document, the proposal regarding this clinical case is at the embassy.
14:03 REPORTER V/O
Since the Portuguese ambassador was unavailable to comment on the files, the vice-consul assured us that the name Domingos Djata does not appear on any files at the embassy. He also assured us that no visa has been requested in the child's name.
Martinho Cá, the employee in charge of the evacuation cases for the Ministry of Health reacted a week later. Domingos' file had finally been found.
ON SCREEN - On the phone from Bissau
REPORTER - If this was an urgent case, why wasn't it dealt with before?
MARTINHO CÁ - The Embassy said they were awaiting a doctor's appointment. That's why we're waiting for them to make a doctor's appointment.
REPORTER - In an urgent case, you can't wait around for a doctor's appointment, right Mr. Martinho?
MARTINHO CÁ - That's what the Embassy told us.
DR. AUGUSTO PAULO - I don't consider that normal, I think it's abnormal. This is abnormal. But you say it happened?
REPORTER - Yes, it did.
DR. AUGUSTO PAULO - That's absolutely inadmissible.
15:00 REPORTER V/O
No-one attributes blame for this forgetfulness, sloppiness, disorganization or lack of transparency, but the truth is that the medical board, the evacuation system and the relationship between the various entities just don't work. Like they say here, what is needed is the means to treat patients within the country, trained doctors, medicines. But until life changes, the resentment is widespread.
15:25 FRANCISCO ALELUIA
There is no safe alternative to evacuating them to Portugal. People die here. It pains me to say this, believe me. It is a shocking thing. But there is no alternative.
15:42 YOANNES MOOIJ
I'm an Evangelical priest and I don't usually drink beer. I don't take tranquilizers, but sometimes in the evening I drink 3 beers to take the pressure off, or I wouldn't be able to sleep because of the frustration I feel.
15:57 REPORTER V/O
There are another 16 children like Domingos staying at this hospital alone, all with approval from the medical board and awaiting evacuation to Portugal. Domingos finally got a visa and was admitted to hospital in Portugal a month after we left Guinea Bissau.
16:26 REPORTER V/O
The hospital is left behind, but in a country with serious health shortages, children are always the ones who suffer the most, even in a project loved by many, such as Casa Emanuel, run by missionaries from Costa Rica.
16:54 REPORTER V/O
Casa Emanuel is an orphanage with 95 children, many of whom lost their mothers at birth and were abandoned by their fathers.
REPORTER - Do these women work here?
SISTER CASTRO - These women help us, they are the children's aunts.
17:22 REPORTER V/O
There is a shortage of helping hands. They live with obvious difficulties. They are in need of everything - milk, nappies, books. Under a sweltering heat, protected by the netting are close to 50 children who cannot yet walk, and who have therefore not yet gained freedom. They don't get much lap time because there aren't enough laps to take them out of their cribs.
18:03 SISTER CASTRO
There are some traditions ... they are scared to look after orphans because they believe that they bring a curse. But really the opposite is true, isn't it? If someone takes in an orphan, it's a blessing.
REPORTER - These handicapped children were abandoned in the bush?
SISTER CASTRO - Yes.
REPORTER - You find them and bring them back here.
SISTER CASTRO - Yes, when somebody finds them, we take them in. We know that no-one is going to come claim these children. They think it's better not to have the children in their homes, they might be possessed by demons.
18:49 REPORTER V/O
There are around 20 babies under three months old. Almost all the children in the orphanage arrived here at a very young age.
19:00 SISTER CASTRO
Luckily for us, the premises you just saw were built with the help of Portuguese cooperation.
Before, the children slept in the refectory, with beds next to tables, everything. Now we have a nice place for them, it's beautiful, it's wonderful for us.
19:40 REPORTER V/O
Guinea Bissau is one of the poorest countries in the world. With over 20 ethnicities, it has a culture of deep-rooted traditions where animist religions rub shoulders with Islam. Guinea is also one of the countries most in need of international aid in order to be able to grow.
20:19 REPORTER V/O
"Mundo a Sorrir", traveling the world smiling... since last year this team of Portuguese dentists has spent the holidays educating the young people of this country and teaching them about prevention.
20:30 RITA MATOS CRUZ
As soon as I started being a volunteer I realized it was something I had to do, because I think it's a commitment of civic responsibility, of social responsibility.
20:46 REPORTER V/O
Destination - the Catholic mission in Comura, a project run by Franciscan priests and nuns who have taken on ministering to leprosy patients and many others.
20:55 MIGUEL PAVÃO
Place the toothbrush between the tooth and the gum (translator) without pressing too hard (translator).
You should always brush using circular movements.
It is also important to have one toothbrush per person and not one toothbrush for the entire family, nor to share with neighbours.
21:30 REPORTER V/O
In the makeshift Dentist's Office, right next door, stocked with medicine and a dentist's chair, procedures are carried out almost normally - applying fluoride and sealing cracks to prevent caries is about to begin.
DENTIST - What's your name? How old are you?
DENTIST - Legs up. Head back.
DENTIST - Don't be afraid, it's OK.
22:29 REPORTER V/O
For almost everyone here, this is the first time they have sat in a dentist's chair. Unfamiliar instruments, doctors they've never seen before - but the volunteers' insistence ends up getting the patients to overcome their fear.
22:51 MIGEUL PAVÃO
The "Mundo a Sorrir" Association is the first association of Portuguese dentists. For cultural reasons, obviously, we started our projects in countries where Portuguese is spoken.
23:01 RITA MATOS CRUZ
In a continent where the incidence of AIDS, HIV and other highly contagious disease is so widespread, it is obviously shocking to me that we should have to use the same needle on so many different people.
REPORTER - Do they usually brush their teeth, take care of them?
MARIANA FREITAS - I don't think so. They have good teeth, they have very white teeth, because they don't eat sweets, they don't drink juice. The consumption of sugar here is much less than in Europe.
23:43 REPORTER V/O
The children wait outside anxiously for their appointment. This is when Ruben showed up.
REPORTER - Have they fixed your teeth yet?
RUBEN - No.
REPORTER - No? What do you think they will do in there?
RUBEN - I don't know.
REPORTER - Are you scared?
RUBEN - No.
24:04 REPORTER V/O
Ruben was one of the lucky children. During his stay in the Simão Mendes Hospital in Bissau he was seen by a visiting team of Portuguese doctors. He was diagnosed with multiple Osteomyelitis. He was luckier still, he traveled to Portugal after approval from the medical board.
24:24 SISTER AMATO
The child must have had 28, 30 bone-cleaning operations in Portugal and when he got back he was still quite weak, he still needed treatment. The same team asked us to help out by letting the boy stay here.
24;48 REPORTER V/O
He has lived here for a year and three months. In a community of lepers, tuberculosis patients and AIDS patients. The house that took him in, also took in his 8-year old best friend, found with leprosy during a search of the territory, and two other friends of the same age. Ruben dreams of being a doctor one day, because the best friends he made in Portugal made such a lasting impression on his short life.
REPORTER - Do you miss them?
RUBEN - Yes.
REPORTER - Who are your friends in Portugal?
RUBEN - The doctors.
REPORTER - The Portuguese doctors?
RUBEN - Yes.
REPORTER - What would you like to say to your friends in Portugal?
RUBEN - I want to tell them I'm OK.
25:33 REPORTER V/O
Right next door, in the middle of the bush, the Village was built.
A group of 8 houses where those rejected by society have been placed.
25:45 SISTER AMATO
Good afternoon.
This is the village for former leprosy patients. Almost all of them are severely mutilated, they need assistance, help to feed themselves.
REPORTER - Do you have a lot of children here?
SISTER AMATO
Yes, a lot of children. Until they come to us, the patients have nobody. But once they get here, with the support we give them, their families start to come around.
Each room has a patient, this is the common room, and outside there is a bathroom with running water, a shower and a stove that they cook on.
REPORTER - How long has Isabel been here?
SISTER AMATO - How long have you been here, Isabel?
REPORTER - Can she remember?
SISTER AMATO - Maybe twenty years. You're not wearing any shoes. You need to get dressed later.
REPORTER - Is she one of the people who has been here the longest?
SISTER AMATO - Many, many years. She is quite mutilated.
27:13 REPORTER V/O
There are about 60 new cases of leprosy detected each year in Guinea. It's a chronic infectious disease, but you need to have a congenital susceptibility and lack of immunity in order to catch the disease from close and prolonged contact.
Leprosy was at one time thought to be a punishment from God, but it is man who doesn't know how to deal with these patients.
27:36
SISTER AMATO - Good afternoon.
DOMINGOS - Good afternoon.
SISTER AMATO - How are you? These are people from Portugal, come to visit you.
REPORTER - Do you like living here?
DOMINGOS - I do. I don't feel abandoned, even though I have no family.
REPORTER - And you have food here.
DOMINGOS - Everything. The sisters do everything for us.
REPORTER - You have a good life here.
DOMINGOS - I have a good life.
28:05 REPORTER V/O
On the same land, at the same mission, they take in 1500 AIDS patients on an outpatient basis and it is one of the few places available to take in terminally ill patients. AIDS already affects about ten percent of the population.
28:23 REPORTER V/O
The Portuguese Cooperation celebrated a partnership with this mission to feed the younger patients at risk. This is the case for over 500 children and these twins who lost their father, who died of AIDS.
They come here every week with their mother to get the most essential provisions.
28:40
REPORTER - How old are they?
ELISABETE - A year old.
REPORTER - Do you have food?
ELISABETE - No.
REPORTER - How long since they last ate?
ELISABETE - 8 hours, sometimes 10.
REPORTER - They eat every 10 hours?
ELISABETE - More or less.
29:04 REPORTER V/O
This is a small oasis, an example like many others - International Missions, scattered throughout Guinea. These are projects that breathe more life into such a poor country.
DIALOGUE BETWEEN REPORTER AND WOMAN
- Where do you live?
- In Bissau.
- Why did you come here to have your baby? Why not in the hospital in Bissau?
- There's too much noise there. A lot of reasons. I didn't like it.
- Did you go there to see?
- I went there many times.
- So you didn't want to have your baby there?
- No.
SISTER BENEDITA
Bissau receives people from all over and sometimes when the mother comes in their fetus is already dead, other times the mothers are in a very weak state and the newborn ends up dying.
29:52 REPORTER V/O
She has been delivering babies for over 40 years, in Brazil and here, but it was Guinea that stole Sister Benedita's heart. She lives in this community supported by the Franciscan priests and nuns from Venice.
SISTER BENEDITA - They need lots of love and attention.
REPORTER - Are some ethnicities stronger than others?
SISTER BENEDITA - Yes, the Balantes, like this woman here. The Balantes during childbirth are like no other. It's very quick.
Come on Balante, push, push
he's a small one....there we go.
31:06 REPORTER V/O
Nô Pincha is creole for "Let's push". NÔ PINCHA is also the name of one of the local newspapers. NO PINCHA is like the MUNDO A SORRIR - hundreds of volunteers, missionaries and doctors, all helping these people every day. They assure us that all it takes is a push. A sign of hope that can make a difference. So that this road can have a different exit