Cholera plagues the capital

An ambulance speeds up to the entrance of a Cholera Treatment Centre (CTC) in Cacuaco, a municipality north of the Angolan capital, Luanda, and a ten-year-old boy is carried into the facility on a stretcher by the attendants.

A few hours later, Antonio Jaime is already showing signs of recovery from the waterborne intestinal infection, which causes acute diarrhoea and vomiting and, if left untreated, can cause death from dehydration within 24 hours.

"We've been rehydrating him intravenously and giving him antibiotics," Emilia Diero, a nurse at the centre told IRIN. "He's going to get better."

At the only CTC in Cacuaco, Jaime is one of about 70 patients lying on camp beds in tents, where they are treated with oral or intravenous hydration and, in severe cases, antibiotics. The workload of Angolan doctors and nurses is eased by staff from the emergency medical nongovernmental organisation, Medicos del Mundo (MDM).

The centre has been running at close to capacity after recent heavy rains caused extensive flooding in the capital and surrounding areas. Cacuaco, where about 700,000 people live, was severely affected. A surge of cholera cases has strained the existing medical infrastructure, making it necessary to set up emergency treatment centres.

In 48 hours, 200 cases of cholera were reported in Luanda province, a third of them in Cacuaco, compared to an average of about ten to fifteen cases a day in Luanda and a handful from Cacuaco a few months earlier.

Although only a few deaths have been reported since the beginning of 2007, health workers believe many more people may have died, or be dying at home, and fear family members may have become infected, especially from the traditional practice of hugging and kissing the dead before they are buried.

Cholera is easily treated with rehydration salts to replace lost fluids, or antibiotics. But the disease needs to be treated quickly, because it kills quickly.

Cacuaco's Kikolo neighbourhood is where the cholera epidemic has been at its worst, but transport remains the biggest stumbling block to treatment. In light traffic, Cacuaco is just over a 30-minute car journey from Kikolo, but the roads are usually clogged with vehicles, and the trip for those with transport has been dramatically increased by flood damage to the roads.

Although it has not rained in Kikolo in the past four days, parts of the crowded neighbourhood are still flooded and pools of stagnant water have formed beneath and around piles of household rubbish littering the neighbourhood - a perfect breeding ground for cholera.

"In Cacuaco the situation is stable, but in Kikolo the number of cases is increasing. They have bad sanitary conditions, lack access to clean water and have a large population," said MDM doctor Daniel Cobos. "Things there are very bad."

In an effort to offer people in Kikolo better access to treatment, MDM is working with the local authorities to establish a CTC in the heart of the community. Like other cholera emergency treatment facilities, camp beds will be set up in tents on open ground in the poverty-stricken neighbourhood, with doctors and nurses on hand to quickly assess and treat cholera victims.

Cholera education

Cholera treatment is one aspect of combating the outbreak in the aftermath of the flooding; education is the other, because many people in the neighbourhood are ignorant of the symptoms of the disease and how it is spread.

It is not uncommon to see residents collecting surface water just outside their houses - a cheaper option than buying it - and children playing in the shallow lakes created by the heavy rainfall. Many people, not knowing that someone is sick with cholera or unable to get to a CTC, will also try to treat a patient at home, sometimes with disastrous effects. More than two-thirds of the country's roughly 16 million people live on US$2 or less a day, and four million of those survive on US$0.75 or less a day.

Antunes Evaristo, an Angolan health activist in Cacuaco, tells the story of a mother of two who gave her children industrial disinfectant and garlic because they had acute diarrhoea and were vomiting, which are classic symptoms of cholera. "Both of them died within hours," Evaristo said. "Not from cholera, which is what they had, but because of the lethal mixture their mother gave them - it's not the first time I've seen a case like this."

Cholera has acquired a stigma because people do not understand it or realise how easy it is to cure. "As well as the issues of transport and bad roads, many people are ashamed to come to a CTC," said Cobos. "It's a very stigmatised illness. Last year we even saw some health workers not wanting to touch patients - they don't know what the illness is or how it's transmitted."

Providing information about how to avoid contracting cholera and better access to medical treatment are reactive measures, the challenge is to eradicate the disease. This includes improving basic sanitation, making clean drinking water accessible to all by installing a distribution system in areas without piped water, and strengthening the health infrastructure.

Angola, sub-Saharan Africa's second biggest oil producer after Nigeria, has been in the throes of an oil-fuelled economic boom since the end of its 27-year civil war in 2002. Critics say the government needs to use more of its riches to improve the country's devastated infrastructure and healthcare system.

"When you see a child die of cholera, and you see the country making so much money from oil, it's a bit hard to swallow. How can you have a country with so much wealth struggling to deal with an illness like cholera, which is so easy to eradicate?" said one worker at a nongovernmental organisation in the capital, who declined to be identified.

"The government needs to be more involved on a day-to-day basis. We can't rebuild the waterworks - that is their job. They need to do more if they are serious about putting an end to this epidemic."

ze/go/he