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MSF in Angola, 2006
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After three decades of civil war, reconstruction of Angola’s health infrastructure is starting to take the place of medical emergency assistance. The country’s current health system, however, remains woefully inadequate and in February 2006 was challenged by the worst cholera outbreak ever recorded in the capital city of Luanda.
MSF, already present with numerous projects throughout the country, responded by setting up 10 cholera treatment centers (CTCs) in Luanda, receiving up to 400 admissions daily at the height of the outbreak. Another 15-20 treatment centers were set up to deal with the spread of the bacterial illness in other provinces. Treatment efforts were complemented by water and sanitation activities.
The required medical care for cholera includes the immediate replacement of fluids and electrolytes. MSF organized 40 “oral rehydration salt points” in Luanda, where patients could receive rehydration and more severe cases could be immediately referred to the closest CTC. This also helped reduce pressure on CTCs by offering effective treatment for those not needing hospitalization, whilst reducing time between cholera detection and necessary referrals.
An educational component was part of the emergency response, including a cholera song broadcast by national and local radio networks. The number of cholera cases began to decline by mid-May and MSF started handing over the treatment centers to the Ministry of Health (MOH).
More than 53,000 people were infected and an estimated 2100 people died between mid-February and early September 2006. During its intervention, MSF treated more than 26,000 people and sent more than 400 tonnes of medical and logistical supplies to affected areas.
Treating people with HIV/AIDS, tuberculosis and malaria
In the provinces of Malanje, Lunda Norte and Bié, MSF in 2005/2006 continued to assist thousands of people with HIV/AIDS, tuberculosis (TB) and malaria. MSF has also introduced new malaria treatment protocols using highly effective artemisininbased combination therapy (ACT) and is urging the government, who has adopted ACT as its new treatment protocol, to make the drugs available across the country.
MSF also supports the health center in Cuemba, Bié province, which provides medical care for approximately 84,000 local residents and Angolan refugees returning from other countries. In 2005, more than 40 patients were treated for TB at this location. MSF also supports the TB program at the provincial hospital in Kuito, which serves approximately 500 patients receiving directly observed tuberculosis treatment.
In Luau, Moxico province, MSF supports the 53-bed hospital, which conducted more than 20,000 outpatient consultations in 2005 and admitted approximately 125 patients monthly. MSF also provides assistance at five area health posts, using mobile medical teams in this sparsely populated area. During 2005, teams performed over 30,000 medical consultations.
Numerous projects close
The country’s stabilising situation has led MSF to hand over many of its activities, including projects in Mussende, Kwanza Sul province (March 2006); Kuvango and Vikungo, Huila province (March 2006); Cangola, Uige province (July 2006); Macocola and Buengas municipalities, Uige province (December 2006); Caxito, Bengo province (January 2006); Mavinga, Cuando Cubango (September 2006) and the Luau transit center (September 2005).
MSF has worked in Angola since 1983.
Inside a Cholera Treatment center Luanda, Angola, March, 2006
Photo © Paolo Pellegrin / Magnum Photos
The atmosphere inside the cholera treatment center (CTC) is somewhat chaotic. All the beds are full and some patients have to share a bed. Both medical and logistical staff are working flat out, the logisticians hastily putting up another tent to house twenty more beds, but the truth is they are running out of space. The CTC itself is quite basic: at the entrance there is a disinfection area where everyone is sprayed with chlorine, to kill the bacteria that cause cholera. Cholera is highly contagious so it’s crucial that infected people are isolated and anyone who comes into contact with them is disinfected. There is also a triage area for newly arrived patients, a pharmacy, water points, latrines, and several large tents with rows upon rows of beds. Each bed has a hole in the middle and two buckets underneath, one labelled ‘vómito’ the other ‘excremento’.
It would be easy to be shocked by the indignity of it all, but the only way to treat cholera is to allow patients to flush the bacteria out of their bodies and to rehydrate them as quickly as possible. For those who reach a center in time, recovery is fast.
Most patients at the center are put on intravenous drips containing Ringer’s lactate f luid to rehydrate them. MSF staff work around the clock putting people on these drips, a doctor might do up to fifty IVs in one morning. Once patients are on the drips they must be constantly monitored. If too much is given to a young child, there is the risk of flooding their lungs. If it is not given quickly enough to an adult, they could die from dehydration.
When a cholera outbreak is first suspected, stool samples are used to diagnose the illness. By the time that a CTC is set up, such tests are hardly necessary. The majority of people coming to the center will be infected, with the most severely affected easily identifiable by what one nurse describes as ‘cholera eyes’ — sunken eyes that show no recognition of the people around them, or their surroundings.
Most patients in this center are from Boa Vista, one of Luanda’s biggest slum areas where the cholera outbreak has been most severe. Yet parents such as Florinda Mateus, whose five-year old son is receiving treatment, find that with limited public transport, getting to the CTCs is not always easy: “I saw the notices on TV about cholera so I knew to bring Nelo here, but the normal buses wouldn’t take us so I had to call a taxi. They charged me 1500 kwanza, much more than usual, because they knew my son was ill.” Other patients reported they were too scared of being robbed to come to the center at night, so each morning the CTC sees a surge in patient numbers. Often this delay means patients are so dehydrated when they arrive at the center that little can be done for them.
Public education is integrated into a cholera response, to help prevent the spread of the illness, but unfortunately cholera prevention is not just a question of knowledge. As Julia Parker, who helped organise such education in Angola says “The people we’ve been talking to in Luanda know they should wash their hands and treat their water but the conditions here just don’t favour good hygiene.”