Thinking outside boxed workers

Firms constructing the 179-kilometre Nacala-Moatze railway line must rethink their inward-looking public health approach because reaching out to surrounding communities saves their workforce too. JAMES CHAVULA writes.

From a motorcycle carrier, glimpses of Mkwinda in Mwanza and Emvulo in Chikhwawa, the camps for workers building the Nacala Corridor Project, flash past: Busy dusty roads splitting remote villages dominated by grass-thatched huts, temporary buildings housing nearly 3 000 workers in the highly guarded fences crowned by barbed wires.

The majority of the occupants, the workers laying the railway line, are dressed in blue work suits, white masks and yellow crash helmets.

The camps are dangerous. Not only because they need to be guarded by armed police officers all day long, but undercurrents of sexual encounters are steadily spiraling, threatening lives in surrounding communities and the workforce drawn from Malawi, Mozambique, South Africa, Portugal and Thailand.

The settlements that surround the camps have swollen since the project, funded by Brazil’s mining and logistics giant, Vale, began in December 2012. There is an influx of workers from all parts of the country and temporary houses are mushrooming daily, raising the cost of housing and other basic goods and services.

Since November 2012, Mota-Engil carpenter Boniface Taipalero has been living in a glass-thatched house measuring three metres long, two metres wide and almost his height. Located in the centre of the village, the K2 000-per-month house—an equivalent of his fortnightly pay—stands like a metaphor of how the borderlines between the visiting workers and locals are being erased. There are many like him as the camps can hardly accommodate the ever-increasing labour force for the ambitious project.

“There are lots of people here and it’s no secret that the construction workers, especially our incoming colleagues who have left their stable homes elsewhere, are engaging in risky sexual relationships among themselves and with locals, even under-age girls,” said Taipalero, who said he had to bring his wife along to avoid falling into the trap of risky sexual encounters.

The sex webs, which involve school-going girls either too poor or ill-informed to negotiate for condom use, have catalysed a leap in sexually transmitted infections (STIs). This was not only confirmed by health workers at Chithumba Health Centre near Emvulo Camp and Zalewa Partners in Health near Mkwinda. The study by Mwanza District Council showed that STIs reported in health centres—Kunenekude, Tulonkhondo and Thambani and Mwanza District Hospital—increased by 47 percent since December 2012.

For Mkwinda resident Chuma Kanyemba, a 32-year-old from Kawale in Lilongwe who has been working with Mota-Engil since 2011, it is alarming how STIs and sexual activity is bustling in the camps and beyond. He describes the situation as “shocking” and “a recipe for a catastrophe which will be costly for government to avert.”

Likening construction and dangerous sexual affairs to groundnuts of the same pods, he said: “After the contract, the workers from abroad and other parts of the country will vanish, but the STIs and HIV infections will remain in the communities where we work.”

Nothing new

This presents a silent setback to the country’s strides towards getting to zero new infections and Aids-related deaths, but the construction workers count themselves lucky because they have unrestrained access to clinics within their camps where they get pep talks on HIV prevention, antiretroviral drugs, STIs treatment and condoms.

“If it was not for the clinics, most workers would not cope with STIs,” said a health worker at one of the camps, adding that they see up to 25 patients with STIs daily.

He feared the situation could be worse in the communities where most workers live, work and spend their leisure time. But what has changed to help the affected populations cope with the new challenge?

“We have got nothing new out of the project. The only difference is that more people are contracting STIs and the virus which causes Aids. The country will pay huge costs to avert the looming crisis if this continues to go unchecked,” said Mwanza district health officer Raphael Piringu.

Top secret

According to the National Environmental Management Act of 2004 and the Environmental Management Act of 2006, projects the size of the $1 billion railway construction can only take off after a comprehensive environmental impact assessment. In its environmental and social impact management plan, Vale had foreseen the temporary jobs increasing infectious diseases along the Nacala Corridor Project and budgeted K168 million (US$400 954) for health awareness raising “to thoroughly spread information about the spread of HIV-related problems”.

The promise was reaffirmed during Mwanza district’s World Aids Day commemorations which the company co-sponsored this year.

In an interview, Mwanza West MP Paul Chibingu, who chairs the Parliamentary Committee on Health, partly blamed government for failing to sensitise affected communities in time so that they can embrace risk-reducing behaviours in the face of increasing circulation of money from the railway project.

Sadly, Chibingu said his committee is powerless to move government to jolt Vale to implement its social responsibility because investors enter into agreements with the central government and information is hardly accessible.

“The health committee has not met to discuss the public health challenges in Mwanza and surrounding districts. But as an MP for one of the affected areas, I have engaged Mwanza district commissioner to give me a copy of the promise Vale made to the community so that I can take it up with them to appreciate their side of the story,” he said.

On the other hand, chairperson of the Parliamentary HIV and Aids Committee, Mzimba South MP Rabie Chihaula Shawa, said Parliament is aware of the “worrisome lack of interventions which threaten the country’s remarkable strides in reducing the burden of HIV and Aids” but the committee is yet to meet on the matter because of lack of funding.

“The stories from the railway project under construction are deplorable. This is why the Parliamentary Committee on HIV and Aids wants those in such projects to set aside funds for mitigating the spread of HIV and Aids, but many don’t.

“Unless we have information and copies of the agreements, it is hard for the committee to follow up what particular investors agreed with government and how they are breaking the promise. Sadly, details of the agreements are not readily available,” said Shawa.

Excerpts of the document Weekend Nation has obtained from the National Aids Commission (NAC) compellingly oblige Vale and its agents to begin implementing the preventive and sensitisation measures to lessen the spread of the HIV virus and lower poor Malawians’ vulnerability.

High risk corridor

Along the emerging railway, residents, local government officials and watchdogs are petitioning hard for renewed action to save endangered lives outside the camp. They want an immediate end to the perilous spiral of silence.

In March, just three months after the take-off of the project, Malawi Network of People Living with HIV and Aids (Manet+) executive director Safari Mbewe christened Mwanza and Neno “a high-risk corridor.”

“Government must ensure national responses to HIV and Aids do not leave any gaps, cracks and loopholes for any stakeholders, including the railway makers,” said Mbewe.

The National Aids Policy categorises mobile populations involved in construction works, cross-border trade, sex work, long-distance trucking—all a common sight in the two border districts—as requiring special interventions because they are at high risk to contract and spread the virus. Besides, the National HIV and Aids Framework recommends intensified behavioural change communication to promote safe sex practices among the high-risk groups and settings such as the railway construction sites.

The inertia on HIV and Aids matters is ironic considering that Vale and its contractors have embarked on accelerated works—involving massive mobilisation of  more equipment, employment of expatriates and introducing night shifts—to achieve its “ambitious milestones” of completing the railway by December next year.

As the deadline draws closer, Mota-Engil has only put in place clinics in its campsites which are only accessible to its personnel, a situation that worries Alfred Mhango, HIV and Aids workplace coordinator in the Ministry of Labour.

 “Guidelines require companies to focus not only on their workers but also the people surrounding their work stations. Of course, most firms feel sensitising communities is not their core job, but any intervention is nothing without community outreach,” said Mhango.

The country is a signatory of Article 200—an International Labour Organisation (ILO) code of practice on HIV and Aids in the world of work—which encourages employers to put in place community outreach as part of key areas of action for prevention of HIV infections and promoting decent work.

By providing health services and pep talks in their camps, Vale and its contractors might have recognised HIV and Aids as a workplace issue because it affects their workforce.  However, they need to reach out to the external public because their railway project is part of the local community and has a role to play in the wider struggle to limit the spread and effects of the Aids epidemic.

ILO, a United Nations labour agency, recommends the information and education programmes on prevention and management of the pandemic within local communities because they accord people an opportunity to express themselves, cut back on risky behaviours and avoid ostracising those affected and infected.

Mota-Engil spokesperson Jose Dinis has refused repeated attempts by Weekend Nation to seek the company’s comment on the issue of sidelining local communities in its public health approach.

Call for renewed action

But the increase in STIs calls for urgent remedies—for the study by Mwanza District Council shows strong correlation with such variables as tripling number of sex workers, high circulation of money and illicit sexual encounters.

The council’s director of planning and development Edgar Chihana, while confirming the secrecy on Vale’s agreements with government, said the research indicates strong links between the railway project and the infections caused by unprotected sex and erroneous use of condoms. It also exposed misconceptions and periodic scarcity of condoms.

“It’s ironic that Vale and its subcontractors have yet to start reaching out to the communities with sensitisation behavioural change campaigns when the environmental and social management plan for the railway project provides for the strategies to reduce the spread of infectious diseases such as HIV through awareness,” said Chihana.

Strangely, Vale’s blueprint spells out neither contractors to undertake the sensitization campaign nor the roles of NAC and district councils, a spectacular recipe for endless blame shifting.