Revitalising rural health care

Remote health posts providing basic primary health care in Angola's Bie province are saving lives among many of the country's rural poor. Run by the Angolan Ministry of Health with the support of the international medical NGO, Medecins Sans Frontieres (MSF), the posts are having a particularly positive impact on the health and wellbeing of children in Angola's central highlands province. But the deeper medical workers go into the countryside, the more they are faced with disease, death and inadequate medical services. In the isolated village of Muinha, around 100 km northeast of the provincial capital, Kuito, patients arrive early to line up for a session with an MSF "tecnico medio" - a nurse qualified to give consultations. Aurola Ngueve, with her sick baby daughter strapped to her back, had walked to the sparkling white health post which stands out from the nearby shanty homes, because she was worried about Rosalina, who had a fever and chronic diarrhoea. Landia Barata, an MSF tecnica medio, says most of the patients are children, with the vast majority suffering from one or more of the three big child-killers - malaria, acute respiratory disease and diarrhoeal infection. The UN Children's Fund believes these three diseases are chiefly responsible for Angola's appalling rate of child mortality, with one child in four likely to die before its fifth birthday. "The majority of the consultations are with children, and they tend to be suffering from malaria, breathing problems, diarrhoea and tuberculosis," Landia said, adding that in the rainy season, 70 percent of children contracted malaria. Since mid-March, the Angolan Ministry of Health in Miunha has benefited from the extra expertise and drug supplies of a mobile team from MSF. For many Angolans this is the only access to health care for kilometres, and it is not uncommon for them to walk for hours or even days to reach it. "Last week we had two or three people who walked all through the night and they arrived at the end of the following day. To come that distance is exceptional, but for patients to walk two or three hours to get here is quite normal," said Landia. "The population was here for a long time without any health assistance whatsoever," she explained. "Here, there is a lot of sickness. In the beginning there were many patients, sometimes more than 100 a day, but now it's quieter. Our treatments are having an effect and the workload is becoming more normal. Now we're getting around 60 patients a day." With malaria an ever-present threat, the rapid tests introduced by MSF have proved to be a big attraction, particularly for concerned mothers like Ngueve. Landia took a tiny blood sample from Rosalina's finger, and in less than 15 minutes knew she was dealing with malaria - Angola's biggest child killer. But Ngueve was more relieved than concerned. "I'm happy, because now I know what is wrong. I know that malaria is very dangerous. I know it can kill my child, but here at least we can get treatment," she said. The health posts also offer weekly pre-natal consultations to monitor the pregnancies of local women, quickly transporting mothers-to-be to the MSF-supported hospital in Camacupa, 20 km to the south, in cases of complications. All children are also weighed and measured to check for malnutrition - another major problem in poor, rural areas. A pharmacy attached to the consultation room dispenses drugs in plastic bags with picture instructions to make sure the largely illiterate population take the right amount of medicine at the right time. Fernando Celestino, a government health worker, has been at the Muinha health post since it was renovated over a year ago and says it has made a huge difference, particularly since the arrival of MSF's expertise and equipment. "There is a lot of sickness here because of the poverty, but now we have the medication, which we didn't have before. We can find solutions for many illnesses - not everything, but for a lot of things, like malaria," he said. Although Angola has entered its third year of peace following a devastating 27-year civil war, around 60 to 70 percent of the interior remains without basic health care. The government said recently that there was one doctor for every 13,000 Angolans, but that average figure is boosted by better coverage in the more prosperous coastal cities. In Bie, which was once at the heart of the fighting, there are only four Angolan doctors to look after one million people.