Samora Machel 1971

Our Health Service’s Role in the Revolution

Written:1 971;
First Published: 1971;
Source: Samora Machel, Mozambique Sowing the Seeds of Revolution, Mozambique, pp. 46-55;
Transcription: Liz Blasczak;

Speech at the beginning of a course for health cadres, in November 1971.


Today we are starting a new course for training nurses. In 1968 we were forced to suspend such courses and they were stopped for three years. For three years our struggle and our people were deprived of new health cadres. In the past three years fighters have died for lack of medical care, members of the population have died, children have died, because we were not in a position to provide even a minimum of medical aid. In many of the liberated areas, and for many of the people, these past three years were not years of struggle against disease. Our people were forgotten, as in the colonial period, during those three years.

Three years ago we engaged in the battle to train health cadres. We lost the battle at that time. There is no war in which there are only victories for us and defeat for the enemy.

We lost the battle because the political awareness of our nursing students was not such as to permit a true grasp of the meaning and importance of the battle that was being fought, and they thus allowed the enemy to come in their midst.

In 1968, our armed struggle made big advances. We were shelling enemy bases and taking them by assault. We were taking Portuguese prisoners of war and capturing tons of arms. We reopened the fighting front in Tete.

The essential struggle for the clarity of our political line and for the development of our ideology made the popular objectives of the revolutionary forces quite clear to all of us.

This struggle involved the health workers. It was also a struggle between two lines in the field of health. It was a struggle in the defense of the people’s interests in that field.

What is a FRELIMO hospital and what are its tasks?

It might at first seem absurd to talk about a political line, a struggle between two lines in the field of health. It might at first be thought that FRELIMO wishes to politicize something as apparently neutral as health. In the final analysis, those who believe in apolitical health would say, penicillin and chloroquine have the same effect whether administered by a revolutionary or not, whether given in a FRELIMO hospital or in a colonial hospital.

Yet all our actions, our whole life, are utterly and radically different from the actions and life in the enemy areas.

In the enemy zone, in the colonialist zone, in the capitalist zone, everything is intended to maintain domination over the people, to maintain the exploitation of the people and to provide profits for the capitalists.

In the capitalist zone, in the colonialist zone, the roads serve the rapid transportation of the army and police who seize you and take you off to forced labor. Roads are fast routes for coming to collect your taxes. Roads are used to transport the cotton which you produced but which belongs to the company. They are used by the trader who comes to sell back to you at fantastic prices, goods which you and your class brothers produced, and for which the colonialists pay starvation prices.

In the enemy zone, schools are for the children of the rich, even though it is your taxes that finance them. If, by some miracle, a poor man’s son sometimes goes to school, it is not in order to learn how to serve his people. He will be brainwashed by the school until he is ashamed of his origins, and turned into an instrument of the rich for the further exploitation of the workers.

Everything has a content determined by the zone in which it is, by the kind of power that prevails in that zone. In the capitalist and colonialist zone, schools, fields, roads, courts, shops, technology, laws and education – everything serves to oppress and exploit us.

In our zone, because we have power, because it is the peasants, the workers, the working masses who plan and lead, everything is directed towards liberating man, serving the people. This is what happens with the hospitals, the health services.

In the capitalist and colonialist zone, hospitals are among the centers of exploitation. Because what is at stake is a person’s life, the lives of one’s nearest and dearest, this is where the greed of the capitalist world shows itself most clearly and shamelessly.

One can’t enter and be treated in a capitalist hospital in accordance with one’s needs. If one is poor and without power of influence, it is difficult to get a hospital bed, even if cancer is devouring your flesh, tuberculosis eating away your lungs, or fever burning your body. The rich man, the gentleman, the boss, has not the slightest difficulty in getting a room, in finding place for himself and those who accompany him.

Eminent doctors and university professors are brought in to treat the capitalist’s cold, to cure the judge’s constipation, while nearby children are dying, people are dying, because they did not have the money to call a doctor.

In a capitalist hospital they do not examine patients, they examine wealth. Medicine is sold for its weight in gold. Only those who can pay are treated. Food, special diet, fruit, milk, salad, meat and fine fish restore the convalescent’s strength. But they are given only to those who can pay, not to those who need them. Even the ambulance sent off in an emergency to fetch someone who is dying often comes back empty because the dying man’s family can’t guarantee to pay the bill.

In the enemy zone, the rich man’s dog gets more in the way of vaccinations, medicine and medical care than do the workers upon whom the rich man’s wealth is built.

It is not surprising, therefore, that in the enemy zone to be a doctor means to be rich, and to be a nurse means very high salary. To be a doctor is to enjoy a position of social prominence as an exploiter, to be a nurse means to enjoy many privileges.

In the Mozambique of the colonialists and capitalists there are hospitals only where there are settlers. There are only doctors and nurses where people who can pay live. In Lourenšo Marques there are more hospital beds, more doctors, more nurses and more laboratories than in all the rest of Mozambique. Does this mean that Lourenšo Marques is the only place where people get sick?

In the mines where we work, on the company plantations that we cultivate, on the roads that we build, in the factories, in the fields, in the villages, there are millions of Mozambicans who have never seen a doctor, who have never seen a nurse, who have never had any medical care when they are ill.

Our hospital is different. It is not surgical instruments, or medicines that make a hospital. These are of course important, but the main thing, the decisive fact, is the human factor. That is why today, for the first time, the people in Cabo Delegado, Niassa and Tete are receiving medical care and vaccinations, and hygiene is being taught in the villages. Yet we have still very little medicine, very few surgical instruments, and our buildings are so modest that from outside one can barely distinguish them from ordinary grass huts.

Our hospitals belong to the people. They are a fruit of the revolution. Our hospitals are far more than centers for dispensing medicines and cures. A FRELIMO hospital is a center where our political line – that of serving the masses – is put into practice. It is a center where our principle that the revolution frees the people becomes a reality.

Our hospitals are intended to free the people from disease, to make our fighters, militants and workers physically fit so that they can fulfill the revolutionary tasks in which they are engaged. We cure people through the confidence we inspire, through the high morale we instill in them. Health workers, patients and medicines all combine to free the people from disease.

Our hospitals are centers of the revolution, they exist because of the revolution, and are closely associated with the revolution.

Whereas the capitalist hospitals have links with the exploiters, the settlers, because that is whom they serve, our hospitals have links with the people, because they are there to serve them. Thus our hospital is a center of national unity, a center of class unity, a center of clarification of ideas, a center of revolutionary and organizational propaganda, a combat unit, Medical staff, students, orderlies, patients and society as a whole are all closely united.

In a FRELIMO hospital there are no tribes, no regions, no races, no religious beliefs – there is nothing to divide us. The hospital is accomplishing a revolutionary task. Medical staff, students and hospital orderlies are carrying out the essential tasks entrusted to them by the people. The whole people, from the Rovuma to the Maputo, through their sacrifices and bloodshed, built this hospital to serve them, to free them from disease. No one is sent to work in a hospital by any tribe or region.

As the patients feel the unity of those working in the hospital, from doctors to orderlies, they will unite with the medical and non-medical staff, and they will all combine their efforts to wipe out disease. If there is disunity, there will be distrust; the patient will refuse medicines for fear that the treatment he is being given will make his condition worse.

We are all united in the fulfillment of our tasks. There are no menial or unimportant tasks for us, just because I might be an orderly and someone else a nurse or a doctor. All of our tasks are essential, even though our responsibilities may be different. Feeling any inferiority complex in the carrying out of our tasks and worrying about whether we are being given big or small jobs means a lack of class consciousness. We all come from the working people and we are serving the working people. Our task is therefore a great one. Any other attitude merely reflects elitism, privilege-seeking, the loss of class consciousness and the adoption of bourgeois ideas.

Just as we disinfect ourselves on entering an operating theatre, so must we cleanse ourselves of incorrect ideas and complexes which could contaminate our hospital. Just as we put on masks and smocks, so we must always be armed with our unity and class consciousness, so as to serve the people in a revolutionary way. In this way, our hospital will really be a center of revolutionary and organizational propaganda, a concrete example of the correctness of our political line – a true FRELIMO area. Thus, a hospital performs our tasks fighting disease, molding people and producing.

Production can’t be separated from our health work. A hospital needs food. Often the local population and FRELIMO are unable to supply the hospital because we are at war, because the enemy is attacking us, because our production is one of the enemy’s targets. A hospital must therefore try to rely on its own resources, to be as self-sufficient in food as possible.

On the other hand, we must not forget the importance of an adequate diet in the proper treatment of disease. Patients need to eat properly in order to get well again. Fruit, salads, green vegetables, meat, eggs, fish and milk are the foods containing the vitamins, salts, minerals and proteins that strengthen the body in the fight against disease.

Since a hospital is a center of production, it is also a center for the education of patients. We must not neglect any opportunity of heightening our people’s political consciousness and knowledge. In our hospitals there should be no inactivity, no laziness. Moreover, experience has shown that involving patients and especially convalescents in activities, boosts their morale and is an important contribution to their recovery.

This said, we should like to suggest that our hospitals should constantly endeavor to widen their range of activities in cooperation with the Political Commissariat and the Department of Education and Culture. We must teach patients and convalescents to read and write, teach them Portuguese, and make sure that they know, understand and regard as their own the cultural wealth of our entire country.

We must organize short courses on hygiene for patients, so that they acquire good hygienic habits, which prevent many diseases.

We want all those who come to our hospitals for treatment to become active disseminators of methods of hygiene when they leave. We must also remember that in many regions of our country people have very bad eating habits. It is important that the people acquire new eating habits; therefore we should hold short courses for patients in the hospitals, especially for mothers, explaining to them the nutritional value of various foods and even how to prepare them.

We can never neglect political work, since this task always has first priority. A patient’s stay in hospital should serve to heighten his awareness of national unity, his determination to fight and his hatred of the exploiting enemy.

It will now be seen why we define a FRELIMO hospital as one of our fighting detachments, a front line.

Our nurses, our medical staff, besides having their specific tasks, are also instructors, teachers, political commissars. The activity of our revolutionary medical staff not only cures the body but also frees and forms the mind. The enemy understands this very well – so much so that they have made our hospitals one of the main targets of their bombing raids and of their criminal troops.

The Hospital – A Front Line

In starting this course we are opening up a new fighting front. In starting this course we are creating conditions to open new hospitals, more centers in which FRELIMO’s political line is put into practice. New hospitals are new front lines.

When we open a new front, we can say that the struggle has grown; but we have also enlarged the target, we have given the enemy another target. In 1968, as we said, we were forced to retreat, we were forced to suspend the course. We lost a battle. Today we are re-launching the battle, backed by the experience gained through our successes and failures.

When we launch a battle, if we are to succeed it is essential we know the enemy, define our methods and know where our strength lies. In our struggle, we face three enemies:

The Portuguese colonialists are our direct enemy. They attack us openly, physically. They come in their planes and bomb our hospitals, they attack us from their helicopters, they send in their troops to murder our patients, to destroy our equipment and to prevent medicines from reaching their destination. Colonialism is the most easily identifiable enemy, because it is open and attacks with weapons of war.

More dangerous, because they are more easily believed than the colonialists, are our indirect enemies, Portugal’s allies, those who fight us under cover, behind the Portuguese troops. They fight us with newspaper articles, rumors, slander. Today they will say that we are selling medicine, and tomorrow they will say one or another region is looked down upon in our hospitals. One day they will write that we are incompetent, and the next that the people don’t trust our hospitals. And the campaign will continue, to divide us, undermine our confidence and subtly force us to surrender. Every error, every mistake we make will be used by them as irrefutable proof that everything they say is true.

But above all, in order to defeat us, in order to deprive our people of medical care again, the enemy, whether direct or indirect, relies on the work of its forces in our midst. The decisive force that can defeat us is the hidden enemy in our midst, he who holds high the banner of FRELIMO with us in order to destroy FRELIMO more easily.

This has been our experience, this was our main reason for defeat in 1968, the reason for the suspension of the courses. Having infiltrated its spies among us, the enemy fostered tribalism, racism, selfishness, ambition, elitism, ignorance, superstition, religious fanaticism and corruption. Each of these is an enemy detachment in our midst.

Tribalism divided the students, made them counter-revolutionary and caused them to fight against the FRELIMO leadership, against FRELIMO and against the people. Each saw himself as representing the interests of this or that region, meticulously seeking to assess whether another linguistic group had more students on the course than his, spreading mistrust and disunity amongst us.

Racism led to the disunity between students and teachers. Claiming to be very revolutionary, students who had yet to show proof of true revolutionary commitment fought against teachers who had already given ample proof of their dedication to the people’s cause, solely because the teachers were white.

Combing selfishness and ambition, the students rejected a program of studies planned to meet the immediate and urgent needs of the struggle and demanded programs that would give them diplomas and privileges so that they could exploit the people in the future. They wanted to become an elite of parasites, acquiring wealth and social prominence at the expense of the people’s suffering.

Ignorance, superstition and religious fanaticism also caused the students to believe in non-existen supernatural forces, in amulets and stones, scorning science and rejecting the lessons of the teachers, which were founded on the laws of nature, on objective reality. It was in this climate that indiscipline, anarchy, corruption and chaos were fostered.

The battle had been lost. The indirect enemy published articles in their newspapers on the “revolt of the revolutionary students against the leadership of FRELIMO.” The colonialists were delighted and intensified the campaign to reinforce the enemy in our midst: old ideas and the habits of the old society.

Our people were for a long time crushed under the dead weight of obsolete and reactionary traditions and colonialist and capitalist ideas. Many students, cadres, medical workers and leading cadres have still not shaken off the burden of a corrupt past.

There are those who envisage a Mozambique reduced to the tiny scale of one linguistic group or region. No matter how important it may be, no organ can live outside the body. An arm or a leg rots if it is no longer supplied with the body’s blood, if it is separated from its unity with the body.

Through the unity we create among ourselves, by the revolutionary way in which hospitals serve the people, we give the masses a concrete demonstration of the need to make the nation live and to ensure the death of tribalism. Just as we kill germs and harmful bacteria to protect the patient, a hospital must be a living example of the extermination of the contagious microbe which is tribalism, so that the nation may live.

Others seek the answers to concrete problems in the supernatural, which is born of ignorance. They can’t yet see that the answer to all problems depends absolutely on the combination of intelligence and energy with the objective laws that govern natural and social phenomena.

They seek answers in the heavens when answers can be found on earth. Because the people see science at work, because the people see the results of science, because we continually explain to the patients and people the origins of disease and ways of fighting it, our hospitals can become bases of struggle against obscurantism.

The more we believe in mankind, the more superstition among the people will be destroyed. The more our work demonstrates the value of science, the more supernatural obscurantism will be made to retreat.

Some regard themselves as irreplaceable, as being all things in themselves. Full or arrogance, they refuse to learn from others or to share their knowledge, rejoicing at the failures of their comrades. By acting in this manner, they are trying to create conditions which will allow them to establish themselves as a privileged class, to exploit the masses and have their own wretched whims prevail. To consolidate their position, they both accept and spread rumors and intrigues, selfishly confining themselves to their own petty interests.

Individualism, selfishness, ambition and arrogance are germs carrying division, incubators of the old ideas of the exploiting society.

Because we have come a long way, because everyone is joining the struggle, we sometimes find in our midst people who used to be accustomed to banditry. These people often introduce their vices into the new society.

Some of them may steal medicines, sheets or food. Others betraying the confidence of patients, may use delicate secrets they know to satisfy their taste for intrigue and their ambition.

There may also be those who use their position to try to corrupt the youth, contaminating the new generation with their low instincts. This kind of behavior has to be fought. A nurse who destroyed bottles of plasma in a hospital would be regarded as a criminal. A nurse who poisoned patients would be regarded as a criminal. Our revolutionary mortality, our principles, are our plasma, and the new society we are building is our life. Our fight is against our enemy, against those who want to destroy our plasma, our blood, those who want to take our life.

Our methods of struggle

On the health front it is our medical personnel who are our operational forces. They are vanguard forces in our movement, in our revolution.

The medical staff represent our political line of serving the masses in the hospital.

A strong bond of trust and hope is established between the patient and the nurse or doctor who is treating him. The patient associates the alleviation of pain and the curing of disease with the work of the nurse or doctor.

This confidence of the patient and of his family and friends is an extraordinary political asset which we must use to advance the revolution. On the basis of the confidence that is established, we must help the patient to take the road of national unity, to increase his class consciousness and to learn more about hygiene, science and culture. In short, treatment of the body should be accompanied by corresponding treatment of the mind, in order that the new mentality may triumph.

One needs a vocation, a natural enthusiasm for this type of work. This vocation is closely related to and guided by consciousness and the requirements of the struggle.

Whereas in the capitalist zone, a vocation combined with the desire for profits and privilege is corrupted and stranded, in our zone, since one’s vocation is combined with sound political consciousness, it becomes a powerful incentive in our work.

Precisely because we regard man as the decisive factor, in training our medical personnel, priority must be given to political education, to political consciousness. The experience of seven years of struggle has amply proved that despite their low technical level and lack of medicines our medical personnel have been able to do very much more for the people than the colonialist health services with all their technology and means. With two doctors we did more work than the colonialist health services which have dozens and even hundreds of doctors. These results are evidence of the vital importance of the political line pursued by us.

Political education means above all cultivating political consciousness in the students and medical and hospital staff, developing the anti-colonialist and anti-imperialist spirit, increasing understanding of oppression and making class consciousness and feeling more deep-rooted.

Members of the hospital staff are in constant contact with the human suffering caused by exploitation and ignorance. This involvement with suffering should serve to sharpen political consciousness, increase the knowledge of the medical staff, and strengthen their determination to fight the enemy, to fight disease and to fight ignorance.

The medical staff’s professional consciousness must be based on heightened political consciousness. A nurse does not have working hours and rest hours. His work usually starts at a certain time – and he must be punctual – but he has no set time at which to finish.

Disease, suffering and war can’t be subject to bureaucratic decisions. A hospital functions 24 hours a day and seven days a week. Wherever there are patients, wherever there is suffering, there the doctor must be, regardless of the time. This is the only way to serve the people. A war is not fought with rest hours, and neither can disease be fought with rest hours for the medical staff. If nursing students are to get used to this exacting pace, their program of studies must include at least ten hours of activity a day.

In the course of duty, medical workers are forced to come into close contact with all kinds of human weakness and misery.

Even if they want to, patients can’t conceal their ailments and their causes. Scientific analysis is revealing. It is therefore essential that the medical staff understand the concept of professional secrecy. Their knowledge of weaknesses and miseries must not be the subject of general conversation or worse still, an instrument of ambition or revenge.

The patient is sacred to the hospital. A nurse, hospital worker or doctor is not involved with revenge in the course of duty. For the medical staff there are no races, colors, creeds or even nationalities. To them there are only patients. A wounded or sick Portuguese soldier is treated like one of us in our hospital. We do this because we have a revolutionary morality, a higher morality, radically opposed to the baseness of fascism and colonialism.

We have already said that the hospital embodies our political line, that the medical workers must actively embody our ideology. For this, our words and deeds must correspond rigorously to our line. This is the main thing. If despite our technical and material shortcomings we have already achieved better results in the field of health than the colonialists, this is due solely to the correctness and superiority of our line.

Waging an internal struggle to make our words and actions comply with our line is to create the conditions for the success of our work. Our hospitals must be the daily source of a thousand good examples to the masses of our principles.

Technical knowledge takes second place. It is important nevertheless. Only the knowledge of the laws of nature and their use for our purposes will enable us to eradicate disease. There can be no limits to study. No on knows everything, or even enough. So long as there are diseases, so long as people are dying, we must study, we must learn.

If we are to be of greater service, we must study a great deal. We must study everything. Naturally we must first study medical science, acquiring the theoretical knowledge that synthesizes and rationalizes practical teaching. But we must also study and learn from practice – we must study and learn from the people.

We must study society. We must know the traditions, history, culture and specific features of each region, and constantly relate them to the national context.

We must study people, get to know them. Illness does not exist in the abstract, but in actual people, each with his own psychological make-up and specific abilities. Knowing a man is the best way of helping him to summon his energy against the illness attacking him, and also the best way of guiding our actions to bring about the revolutionary transformation of his mind. Through knowledge we achieve understanding, and only after understanding can we act.

But the most important thing is to constantly study the policy of our movement, because only this can give us an overall view and provide the clear perspective ensuring the proper orientation of our work. For us the aim of study is not to gain the means of exploiting people better or to acquire privileged positions as in the capitalist zone.

We are not interested in one person getting good grades, in imparting a lot of knowledge to one individual. However knowledgeable he might be, one person would not be able to run all the hospitals we need or attend to all the patients.

We study collectively and our progress goes in waves, everyone advancing together. This requires a spirit of mutual aid among the students and medical staff, the falling behind of one being regarded as a step backward for the movement, a step backward in serving the people.

This collective spirit should govern our entire lives. Without national unity, we will be defeated by the colonialists. Without unity, our worker and peasant class will be dominated by the exploiters. Without unity, our health work will fail.

The collective spirit makes us face each problem, each situation, each shortcoming as if it were our own. There is no problem to which we are indifferent. Power belongs to us and therefore we can’t sit with folded arms when faced with a situation, however small, which hampers our progress. A minor cut may open the way for tetanus, which destroys the whole organism. In the case of the body, a cut on our little toe can kill if it is not treated. We must not disregard a problem just because it does not affect us personally: this problem is part of the body to which we too belong.

Our hospitals exist because sacrifices have been made. Our hospitals represent all the blood that has been shed.

The surgical instruments, drugs and equipment are a result of the sacrifices made by the people, the sacrifices made by our friends.

Because blood is flowing in Mozambique, a powerful tide of solidarity has built up in many countries to help us. People voluntarily deprive themselves to help us.

Having a well developed sense of how to fight waste, indicates that we respect the sacrifices made by our friends – it shows the collective spirit.

Comrades often die in our hospitals for lack of medicines. Very often there is not even peroxide to treat a patient. Saving medicines and equipment is to save the lives of the people that these medicines and equipment can cure.

This course is being started at the Americo Boavida hospital. This is a symbolic coincidence.

Comrade Boavida, an Angolan doctor, sacrificed his life for the people. He could have been doing medical research, but he died serving the people, fighting against sickness and exploitation.

A further example and encouragement to us should be the internationalist spirit of the foreign comrades who, out of revolutionary solidarity, have left their own countries and the comfort created through their labor to come and work with us.

Our responsibility is great. Our struggle is not only to liberate our people but also to support brother peoples, the working class of the whole world.

In our work united under the leadership of FRELIMO and guided by our ideology, let us apply the watchword: serve the people. We will thus perform our national and international duty.