From the Archive | Health’s role in the revolution

Samora Machel describes a revolutionary hospital where anyone can get proper care and everyone – from the doctors to the cleaning staff – is treated the same way.

Samora Machel, a Marxist revolutionary, was the first president of Mozambique from the country’s independence in 1975. This is an excerpt from a speech he gave at the beginning of a course for health cadres in November 1971 and found in Mozambique: Sowing the Seeds of Revolution (Committee for Freedom in Mozambique, 1975) on


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.

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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 politicise 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 labour. 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.

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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 centres 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 a 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.

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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 Lourenço Marques there are more hospital beds, more doctors, more nurses and more laboratories than in all the rest of Mozambique. Does this mean that Lourenço 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 Delgado, 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 centres for dispensing medicines and cures. A Frelimo hospital is a centre where our political line – that of serving the masses – is put into practice. It is a centre 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 centres of the revolution, they exist because of the revolution and are closely associated with the revolution.

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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 centre of national unity, a centre of class unity, a centre of clarification of ideas, a centre of revolutionary and organisational 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 centre of revolutionary and organisational 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.

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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 centre of production, it is also a centre 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 endeavour 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 organise 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.

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