27 April 2006

Press Release : Cholera in Angola
AS NUMBER OF INFECTED PEOPLE REACHES 20,000, THE RESPONSE TO THE EPIDEMIC REMAINS INSUFFICIENT

© Paco Arevalo/MSF

Luanda: Ten weeks after the first case of cholera was confirmed in Luanda, some 20,000 people have been infected, around 900 people have died, and the disease has spread throughout most of the country. Tuesday (25 April), saw the highest daily toll to date, with 929 new cases and 25 deaths. Yet measures put in place for halting the outbreak remain grossly insufficient. Medecins Sans Frontieres (MSF) urges the Angolan government and international relief organisations to increase their efforts for stemming the epidemic.

“Everybody has been slow to respond,” says Richard Veerman, head of mission for MSF in Angola. “Many factors have conspired to make this cholera outbreak one of the worst ever seen in Angola. But with what we know today there can be no excuse for not doing everything humanly possible to prevent the death toll from climbing much higher.”

This week, MSF saw an average of 30 newly infected people and one death every hour. In one of MSF’s treatment centres in Luanda alone, 240 new patients came in over a 24-hour period. The team quickly erected two new tents to expand the capacity of the already overcrowded facility.

The majority of cases of cholera are usually detected after an outbreak has peaked (the peak being the period in which the number of new cases per day is highest). “Today we have not yet reached the peak of this epidemic. Even based on conservative estimates, the toll of this epidemic will be extremely high,” says Veerman.

Luanda was spared major outbreaks over the past ten years. Outlying parts of Angola saw no cholera for even longer; as people hardly travelled the country during the war the disease had little chance to spread from the shantytowns in the capital. As a result, there is little resistance among the population against the bacterium that causes cholera. Awareness of what people can do to protect themselves and their communities from infection is also very low.

“By all measures, this outbreak is out of control,” says Luis Encinas, MSF emergency coordinator for the cholera outbreak. “It is crucial that the authorities define and implement a national strategy for containing the spread of the disease, ensuring access to treatment facilities, guaranteeing availability of safe drinking water free of charge and improving sanitation. They should also set up a reliable system for collecting epidemiological data, and dramatically expand their campaigns for educating Angolans on the disease, particularly outside the capital.”

MSF has ten cholera treatment centres in Angola: six in Luanda, one in Benguela, one in Malanje, one in 'Ndalatando, and one in Caxito. The organisation has 55 international staff and 330 national staff working on its cholera projects. To date 11,700 have been treated in MSF’s centres.

For additional information and interviews, please contact James Nichols on 0407 525 700.

Florinda Mateus, Saturday 8th April at Boavista Cholera Treatment Centre
I came here yesterday with my son, Nelo, who’s five. We live in Petro Ango (spelling?) in Sambizanga. Yesterday I left Nelo with my sister when I went to the Rocque market to sell food. At around ten o’clock in the morning my neighbour came to get me saying that Nelo was vomiting and was very ill. I have seen 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 1,500 kwanza, much more than usual because they knew my son was ill. My husband and I stayed here last night with Nelo. He had a very bad night last night. He still has a lot of pain in his head and can’t sit up.

Teresa Francisco, Saturday 8th April at Boavista Cholera Treatment Centre
I started to feel ill yesterday morning. I had bad diarrhoea so I went to the Ana Paula health centre and they gave me some paracetamol and some oral rehydration solution. They told me to go home and if I got worse I should go back to the centre. They didn’t say anything about cholera. Then I started vomiting so I went back to the centre at about eight p.m. They told me to come here, but I had to walk as they did not give me a car or an ambulance. My brother-in-law came with me so I wasn’t scared and now my mother is here looking after me. When I got here I was put on a drip straight away. I’m feeling much better now so the nurses have taken out the drip but they have told me to wait for a while to see if it’s okay for me to go home.

The MSF Cholera Treatment Centre, Luanda
As medical staff work to treat the increasing numbers of people coming to the Cholera Treatment Centre (CTC) in Luanda, MSF is also focusing on educating and informing the local communities about the disease in an effort to prevent it spreading. Cholera is highly contagious so information, education and communication work is a key part of any outbreak response.

In Luanda MSF is working with Angolan student volunteers who go out to the worst affected areas distributing information and conveying the key messages of cholera prevention: wash your hands, treat all water with chlorine and bleach if possible, and wash all food and fruit with treated water. The government of Angola has also been broadcasting public health notices on television and radio advising people how to prevent cholera and what to do if they suspect that they, or a family member, may have cholera.

Julia Parker has been helping to co-ordinate and evaluate these activities.
Working with two other Angolan staff she has been visiting the slum areas of Luanda and trying to find out whether the messages of cholera prevention are getting through. As she explains, “There is no doubt that people in Luanda are receiving information about cholera, but the numbers of deaths reported seemed very low. Quite often when there are outbreaks people are scared to come to a health centre and don’t report any deaths to the authorities. So we were worried that people were dying from cholera at home and weren’t reporting those deaths, which means that we may not know the true extent of the outbreak. It also poses a major health risk – if the bodies aren’t properly disinfected with chlorine then cholera can spread and potentially kill more people.”

Over the past 10 days Julia and her team have spoken to over one thousand people. As Julia explains at one level the results are encouraging, “In general the people we’ve been talking to know a lot about cholera. They know that they should wash their hands and treat their water. It’s not a question of knowledge, it’s more that the conditions people live in in Luanda don’t favour good hygiene. There are no latrines, nowhere for people to put their rubbish except for on the streets, and clean water points or treated water are hard to come by. So even though people seem to be quite well informed the spread of cholera in Angola will continue until authorities and communities take steps to tackle these issues.”

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