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Last Updated: Thursday, 7 April, 2005, 11:46 GMT 12:46 UK
Angola struggles to cope with virus
By Zoe Eisenstein
BBC News, Luanda, Angola

As Angola slowly tries to pick itself up, three years after the end of one of Africa's longest and most brutal civil wars, having to combat the Marburg epidemic is the last thing it needs.

A woman brings her child to a hospital in Luanda for testing following an outbreak of Marburg disease
Angola has stepped up efforts to combat the outbreak

So far, the death toll from the world's worst outbreak of the rare haemorrhagic fever - which can kill within days, and for which there is no known cure - has reached 159, from a total of 181 cases.

Officials admit that the high death rate can largely be blamed on the pitiful state of the health infrastructure.

"In hospitals like ours in [the northern province of] Uige where the quality is not so high, we have a higher mortality rate," said Deputy Health Minister Jose Van Dunem.

High alert

The Marburg crisis cast a shadow over celebrations marking three years of peace after the end of the 27-year civil conflict.

Residents of the capital, Luanda, have remained on high alert to the possibility that the virus could spread to their city of more than four million people.

"How can we celebrate the end of the war when we have this horrible disease killing our people?" asked Ana, a resident.

"We've had three years of peace, but our hospitals are still in a terrible state and look - they can't even cope with this emergency."

MARBURG VIRUS
Transmitted through extremely close contact with blood or other body fluids
Incubation period lasts three to nine days
Symptoms start with severe headache, muscle ache and fever, followed by diarrhoea, abdominal pain and severe haemorrhagic manifestations
In fatal cases, death occurs eight or nine days after onset of symptoms
Source: WHO

Meanwhile, the government has continued preparations in Luanda hospitals - and in other provinces considered at "high risk" - should the virus spread.

This includes setting up an isolation unit in the capital's Americo Boa Vida hospital, and training health workers and volunteers.

But some nurses, whose duties include dealing with suspected new cases, said they do not feel safe.

"We're still seeing no signs of the epidemic slowing down, so of course we're still terrified," said a nurse at the Centro de Katambor health centre in the Maianga district.

"We're lacking all sorts of equipment, including protective clothing to make sure we can't be contaminated in case we're in contact with infected patients. This is really bad," the nurse said.

Hospital fears

Bringing back confidence to the health sector is one of the priorities of a nationwide public information campaign to be launched this week.

"There are messages for health personnel to encourage and motivate them about the important role they have to play," said Mario Ferrari of the UN's children agency, which is supporting the campaign.

If I thought I had Marburg... the last place I'd want treatment would be Angola
Wife of expatriate oil worker

"The information will surely circulate among the public when things start to improve. In Uige, the population is already regaining confidence in health centres," he added.

But for now, many people are steering clear of hospitals, for fear of being exposed to the deadly virus.

"I know all the Marburg experts are here, but if I thought I had Marburg, malaria or any other illness for that matter, the last place I'd want treatment would be Angola," said the wife of one oil industry expatriate.

"I'd get on the first plane out of here," agreed one foreign aid worker.

Catalyst

Most Angolans do not have that option.

The country is sub-Saharan Africa's second biggest oil producer, but the vast majority of its 13 million people live in poverty.

Experts from Medecins Sans Frontieres help train volunteers in a hospital in Luanda
Health workers are helping to train volunteers in Luanda

There is just one doctor for every 13,000 people, 25% of children do not make it to their fifth birthday, and most deaths here are due to preventable diseases.

In remote provinces like Uige, where development after the end of the war has been slow, the situation is even worse.

Ironically, this killer epidemic could provide the much-needed catalyst for improvements.

"The bill is very high. [But] yes, it will help to reinforce the [health] system. We will have more skilled personnel, and an isolation area in Luanda for emergencies," said Mr Van Dunem.

The Marburg cloud may still come with a silver lining.


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