From Charles Woodrow:

The following is a report prepared yesterday for workers in the U.S. involved with the mission. It describes remarkable things that have happened in only the preceding days. I have adapted it for a general newsletter which should interest those who have time to read it. Please note at the end the low cost of treating COVID patients according to our regimens. Your contribution could make an important difference for someone suffering from COVID here in Nampula.

You can read this newsletter online here.
Read the two-minute version in red below.
COVID in Mozambique
Mozambique now has 472 confirmed COVID cases, of which 145 are here in Nampula. There are only six patients in the nation hospitalized with COVID, of which all are in our hospital. None of them are very sick, and until now none have needed supplemental oxygen, let alone ventilators which do not exist here. But we are just getting started. In the next few months we expect 240,000 people to contract the virus in our city.
Six COVID-19 patients are already in our hospital.
This is the 18th day since the virus appeared in Nampula. In the first 15 days it was multiplying with a doubling time of less than 3 days, but now it is between 3 and 4 days. We are the only place in the country with a rate of progression that carries the advanced designation of “community transmission,” and that right out of the starting gate. On the first day, the virus appeared in three disparate parts of the city, all of them mud hut neighbor-hoods. Then it took off, as I had originally expected it to do in Africa. 

Because of what is happening in our city, Mozambique has the 17th highest rate of attack among the nations presently affected by the virus, and Nampula has the highest rate of attack in Mozambique. I believe we are the only place in the country where the virus has escaped control of the Ministry’s valiant efforts during the past 2.5 months to track, test, and quarantine all exposed/infected persons.
Aerial view of Nampula
The virus is spreading fast in our city.
Progress on the Medical Front
In the midst of this situation, with God's grace and the favor He has given us from people all around, we are making much progress at the hospital which is now open and functioning:
The hospital project is rapidly moving forward.
1. Thanks to our status as the COVID treatment center for Nampula, our new 200 kVA transformer dedicated exclusively to our property was finally installed by the electric company and for two days has provided perfect, clean electricity, something previously unknown to us during 30 years of living in Africa, but vital for expensive hospital equipment.
Our new transformer is now operational.
Transformer
Transformer
2. As of Monday, Jon Beutler, an independent "civil engineer" missionary support person has been working daily with us on all our projects. His family was in Nampula for a brief project when the borders closed, leaving them trapped here for months - much to our present benefit! We thank God for this unexpected help!
Jon Beutler
Jon Beutler in the makeshift bath house to be used by the staff before leaving the property
Missionary-engineer Jon Beutler is working with us.
3. The incinerator for biomedical waste is being built now by UNICEF.
UNICEF is building our incinerator ...
4. The system for pressurization and storage of water in three large tanks is underway, also thanks to UNICEF.
Utility workspace
Putting in the foundations for the generator and water systems
... and upgrading our water system.
5. The 13-unit ablution block built by the mission for the tent-infirmaries is finished except for hanging the wash basins and painting the walls.
Ablution blocks are nearly complete.
Ablution block
Ablution block
6. We are finishing the outdoor laundry and are well along with the bathing and dressing facility for the staff which they must use after removing their PPE before leaving the property.
Building bath house
Laundry and staff bathing facilities too.
7. The 33-bed tent infirmary is up, and Jon is installing the steel framework for the oxygen lines.
Jon Beutler working with our workers
The tent-infirmary is being erected.
8. The generator foundation is laid and we were going to take possession of the generator today, but Jon knew of a better machine and this afternoon worked out a special deal with the store owner who discounted it drastically as his contribution to the cause. For the same price we were going to pay for a 44 kVA generator ($23,000) we now have a 164 kVA generator, almost four times the capacity. This one turns itself on and off automatically when there are electrical outages. It is powered by a Perkins diesel engine. Before we knew this information, Jon had told me that the best diesel generator engines were built by Perkins. God was gracious to lead us at the last minute to this alternative, and I am grateful He sent our way someone knowledgeable like Jon to supervise these projects! And Jon will hook up the generator when it is delivered without our having to hire an electrician!
Generator
Our new generator is the height of a man.
God has provided an excellent generator for the same price we were about to pay for one-fourth the power.
9. Though the borders of both Mozambique and South Africa are closed, the governor is writing letters to enable us to fly in a technician from South Africa to install the oxygen lines for our tent infirmary and to flush and test the existing lines in the hospital which so far have never been used. Perhaps getting this arranged is easy for the governor, but I "worry" that we must pray earnestly that something so contrary to normal regulations may actually come to pass. MAF is providing at no cost to us their large 15-seater plane to make the ten-hour round trip necessary to get the technician and the equipment he needs to Nampula. The round trip to get him home again will be at our expense.
MAF airplane
The governor and MAF are arranging to bring us an oxygen technician and supplies across closed borders.
10. The governor also promised to purchase the massive $65,000 oxygen producing plant we requested. The plant must be shipped on a special 40-foot flat rack container. It has been two weeks under construction already, but I have not had confirmation from the manufacturer that the first payment has been made by the province, so that is another matter for prayer. 
Oxygen plant
Our oxygen producing plant is a little larger than a 20 foot shipping container and weighs 11,000 lbs.
The governor also agreed to purchase our $65,000 oxygen-producing plant.
11. This morning I received a kind letter from the Ministry of Health thanking the mission for its patience and perseverance these past weeks, promising to assist us as we try to help our city. They invited me to submit my formal request for authorization to import the medications and medical articles that we will need. Until today, the central authorities had been balky on this point for nearly three weeks, but the Minister visited the hospital last week and was impressed with everything he saw and the fact that it was all freely donated to their cause. Back at provincial headquarters he asked the local health authorities why the hospital was not already authorized and wanted to know where the obstruction was. So I think he has begun fixing the problem we have had with the reluctance of ministry bureaucrats to accept my many overtures related to COVID and their slowness in processing the documents for opening the hospital which they have had since January.  In actual fact, the Ministry workers have been enthusiastic and helpful about opening the hospital – but it requires a lot of work from them too, and without constant pressure the project keeps getting set aside.
Mozambique's Minister of Health visits our hospital
The recent visit from the Minister of Health
After a visit from the Health Minister, t he Ministry has welcomed our assistance.
12. Yesterday the provincial person in charge of the COVID response together with two representatives from the World Health Organization spent two hours with me at the hospital, providing useful information that had been withheld until now. So did the central authorities today. One important revelation was that only a fraction of the funding expected from donor nations had been supplied, and that had to be spent on PPE for protecting the workers who must treat the patients. Then they invited me to submit my request for authorization to import everything needed for the hospital to function well, and I think now we will see results. This evening I sent the letters to both the provincial and central authorities responsible for granting that approval.
Health leaders are providing useful information and opening doors for us to receive support for our center.
13. Also yesterday the Provincial health department finally let me see the official protocol for COVID treatment that none of the doctors here have seen according to my questioning (the provincial chief medical officer evaded my questions on the matter and the practicing physicians lamented that they still did not have instructions from above about how to treat the patients). I have been sending and re-sending the Ministry my own protocol for weeks now, asking permission to buy and import the lab reagents and medications necessary to carry it out. They kept responding by referring me back and forth but without granting permission. But when I was handed the Ministry's protocol yesterday everything began to make sense.
I finally received their official COVID treatment protocol.
Looking at the protocol, I had two reactions:
I thought:
First, I was very pleased – it was virtually identical to what I had been sending them – the same medications, the same lab tests, the same use of oxygen, the same parameters for admission, etc. I thought they must have copied my protocol, but then noticed theirs was dated 13 April and mine was only sent in 22 May.
It's basically identical to my protocol.
Tent infirmary
Second, I felt sorry for the health leaders and the position they find themselves in, as it was apparent why the front-line doctors had not seen the protocol. The leaders have a great plan, but little with which to execute it. Neither the important lab tests nor the important medications on the protocol are readily available here. A physician looking at this protocol on the one hand, and at what he had available to work with on the other, would think his bosses were mocking him. But Grace Missions has already arranged for and bought all the lab tests listed in their protocol except one which is important but just too expensive. We have been trying to get all the medications they listed too, enough for the first 100 cases, but some are still unavailable because of high international demand.
But Mozambique doesn't have the resources to implement it.
The Ministry is even using the exact oxygen delivery methods I proposed, different from the way advanced countries handle COVID patients – nasal cannula at first, graduating to non-rebreather masks (like in passenger airplanes) up to a maximum of15 liters per minute. Short of intubating people, this is the most efficient use of supplemental oxygen which in Mozambique is costly and limited in supply. If the authorities had looked at my protocol and the protocol worked out by their international advisors, they would have seen I was advocating exactly what their experts were advocating, except that my protocol included inexpensive vitamins and minerals that are also useful in treating viral illnesses.
The Ministry of Health agrees with me about oxygen delivery methods.
Help From Supporters
My protocol was developed thanks to input from many supporters helping from the States - respiratory therapists, physical therapists, nurses, physicians carefully studying COVID though not treating it themselves, doctors combatting COVID in the thick of NYC’s crisis, academic MD's engaged in cutting-edge COVID research, interested laymen who have directed me to useful resources, and a family of COVID victims suffering for weeks from the sequela of the virus passing through their home. The latter have become lay experts in the disease and sent a slew of helpful medical articles and contacts. They put me on to a well-known COVID specialist in Virginia who grew up and trained in Africa and knows well our limitations despite spending his professional life in academic centers in England and the U.S. This busy department head and critical care researcher proof-checked my protocol adapted for Africa and made further recommendations before I sent it to the Ministry. 

I could give credit to a long list of people, but the bottom line is that through a host of resources all arranged through our supporters, God clearly has led us to the right treatment plan for the moment, and is now arranging the means needed to carry it out.
Dr. Charles converses with the governors
We now look to the two provincial governors and the national Minister of Health as important allies.
My protocol was compiled based on information sent by many American friends.
So that is what has broken loose just in the last few days. I am convinced that the Lord is moving in the hospital ministry today, and suddenly we are flying forward in a very high gear. This string of events was never envisioned by me when I offered the hospital to the government. I just thought we had a moral obligation to give up what we had for whatever benefit the government could wring from it. Notwithstanding the present pace of events, we must not take progress for granted now that God is moving, but must pray that He will carry things through to completion, knowing that our prayers are one of His appointed means to that end, and knowing that there is an incredible task ahead.
God seems to be moving remarkably.
Funding
Especially, pray for the funding needed to capitalize on this opportunity to help our community for the sake of the gospel! I said we have already purchased many things needed to provide good care for our patients – but we are arranging only the infrastructure and then enough supplies for the first one hundred cases. Merely priming the pump is going to consume $60,000 of the funds formerly reserved to open the hospital and keep it running for at least a year, and that figure may soon climb to over $100,000. Depending on how the virus behaves here in Africa and how many people journey to Nampula for care, we will need much more.
We are depleting the financial reserves intended for opening the surgical hospital.
I had expected the hospital to serve only the 1.2 million people of Nampula city – but already COVID people are coming from far away seeking help at the regional hospital downtown, which then sends the ill patients to us for admission. Half the patients now in the hospital are not from our province, let alone our city. I expected to provide care for a projected 550 inpatients from the city’s 1.2 million people, giving a hospital census of 34 patients daily for five months, but that number will grow if we have to take in a larger catchment area. There are 5.8 million persons living in the province, and the number increases to 12.2 million people if you include the bordering two provinces as well! If every symptomatic COVID patient from three provinces came to the regional hospital in our city for screening, the number of people referred to us for admission could be overwhelming - though we have contingency plans for treating up to 300 inpatients in tent infirmaries. 
We might receive many more COVID patients than I anticipated.
Beyond this, I expected 240,000 people to contract the virus just in the city, though the vast majority of them would not even know it and therefore would not be our concern. But then I learned in the past week that anyone needing to deliver a baby or to be hospitalized for a fractured limb or to undergo an emergency operation who also tested positive for COVID, even though asymptomatic, would also be treated at our hospital! COVID patients cannot mix with non-COVID patients. So now we have to get surgical and maternity services geared up as well, together with all the requirements of a general hospital - not just a surgical center as was designed by us at the beginning.
Setting up the tent infirmary
Our welder erects the iron framework for the oxygen lines in a tent infirmary
And we must supply the general medical needs for the entire asymptomatic COVID population.
Based on prices from our suppliers, the medical costs of treating a COVID patient for ten days in our hospital will be $763 for oxygen (but only $5 once our oxygen plant arrives), $40 for lab tests, and $92 for medications, or a total of $137.00 excluding purchased oxygen. The government is providing the staff, building maintenance, utilities, meals, laundry, and PPE (while it lasts). 

Knowing the burden on the health system for meeting the needs of the entire country with their limited resources, Grace Missions is prayerfully taking on the task of 1) obtaining the oxygen, medications, and lab tests for ensuring that patients receive good care, and 2) of protecting the workers, fabricating old-fashioned re-useable PPE as was employed 40 years ago when I was a surgical resident.
Lab tests and medications for one patient will cost only $137.
Any help our friends can arrange would be much appreciated and would make a big difference here.
Can you help?
Concluding Remarks
God has done remarkable things in the past two weeks preparing our hospital to meet this challenge. Contemplating what has happened so recently, I feel encouraged and confident, but looking at what may lie before us, I feel extremely weak and needy. God must do great things by one means or another, or the coming months will be a disaster for the patients and for us!
We look to the Lord to complete the work He has begun here.
This week three people on the work team organized a makeshift sign for our property which I am attaching. In view of the blessings of recent days and the challenge that lies ahead, the name says it all.
Hospital sign
Our new sign says it best:
Hospital of Grace!
Hospital of Grace!
Grace Missions logo
Grace Missions | 210-865-6700 | gracetomozambique@gmail.com | www.gracemissionsministries.org