The Challenges of Practicing Medicine In Africa

(Submission by Dr. Nicolas Cominellis, visiting doctor to CEML Hospital) "This morning I arrived to the CEML Hospital find this man, who arrived with a history of weight loss (check out the cheek bones), abdominal pain, and cough for three months.  One of the greatest challenges of 'practicing medicine' in this setting is the lack of testing available.  In North America, he would immediately have a CT scan, abdominal ultrasound, chemistry 100, and a host of bacterial cultures. But out here, where most people earn in the range of $50-$100 per month, such special exams are unaffordable and non-existent except for the rich who live in the cities.  So we virtually rely on history and physical exams, which are quite limited, but just the way medicine was practiced before the 1960s.  One of the greatest challenges for healthcare professionals who come out to such low-resources communities is learning to work with very little!"

The CEML Hospital is aiming to expand its medical services and equipment to meet these medical needs: planned additional medical services would include a state-of-art ICU unit, pathology lab and examination equipment.

Celebrating Angola's Mother Tongue

The Portuguese language is the national language of Angola.  Spoken by more than 200 million people around the world and often described as the 'fatherland' or 'motherland' in the Portugese-speaking world, commemorations of the language were celebrated recently on February 21, International Mother Language Day.

Portuguese is the official language of eight countries - Angola, Brazil, Cape Verde, Guinea-Bissau, Mozambique, Portugal, São Tomé and Príncipe and East Timor - in four continents - Africa, America, Asia and Europe. Thus, the language covers a vast area of the Earth's surface (7.2% of the planet), encompassing an extraordinary diversity of lives which is reflected in the variety of dialects. It is also the fifth most spoken language on the Internet, according to Internet World Stats, with around 82.5 million internet users.

Deceased in June 2010, José Saramago, the only Portuguese-speaking winner of the Nobel prize for Literature, said that “there is no Portuguese language, but rather languages in Portuguese ”

"The Portuguese language is a combination of all the people who speak Portuguese and it is this which makes it such an interesting language, with such great elegance, elasticity and plasticity."  (Global Voices, 2011)

'Giving' to 'Grow' the Angolan Economy

In this age of integrating micro-financing into third-world countriesto help bolster struggling economies, Angola has its own system named, KixiCrédito.  KixiCrédito was the first microcredit system to offer small low-cost loans to people in Angola and has since grown from a charity to a self-funding microfinance business operating in six provinces with a loan portfolio of over $9 million. The finance system has been quite successful to date, helping many people change their lives for the better. It is not considered aid, but about giving people access to services so they can make their own way.

In the Kimbundu language, one of two Bantu languages, kixi means “giving”. In the old tradition of kixiquila, people would lend each other money or labour, knowing the favour would be repaid to them.

This principle still runs at the heart of KixiCrédito, with two-thirds of loans given out through solidarity groups of up to 15 people from a local area. “Lending to groups works well because there is trust and honour in communities,” said Joaquim Catinda, executive director of KixiCrédito, which has a default rate of only 6 per cent, much lower than the banks.

“If one person can’t make their repayment, the others have to step in. Each week every member pays a fee of, say, 200 kwanzas [about $2] on top of their repayment and this money is kept and used in case someone defaults. We have rules that people from the same family can’t be in the same loan group because if there is a death or difficulty in that family, it means two people might default and that impacts heavily on the group.”

KixiCrédito borrows money from commercial banks and then offers its clients loans ranging from $100 to $10,000, with typical monthly interest at around 3 per cent. The average loan is $900, and most people use this money to fund retail stalls at markets or service businesses such as clothes repairers or small restaurants.

“We see many people who used to sell things in their homes getting credit and being able to open small shops and restaurants,” said Catinda. “There is a real entrepreneurial spirit in Angola because people have needed to make their own way and earn a living.”

Cultural Traditions: The Bride Price

In Angola, there is a still a strong cultural tradition of the asking of the hand in marriage, the alambamento or bride price.  Considered by some as more important than the civil or religious marriage, the alambamento consists of a series of rituals, like the delivery of a letter with the request for the hand of the bride, which often comes with a money offering.

When the young couple decides to marry, it is necessary to have the approval of the bride's family and this is only possible if, during the request, everybody is in agreement that the marriage should happen. The young couple sets the date of the request. This date is agreed upon by the aunt and uncle of the bride, as it is necessary to bring together the whole family and a list is delivered to the groom of all the things he must get before the day of the request.

The day of the request is set and the groom goes out in search of all the materials so that nothing is lacking on the day.  And what is on the list? First is an envelope with money, potentially 300-500 dollars depending on what the uncle stipulates.  It could also be the height of the bride in cases of beer, the height of the bride in cases of Coca-Cola or juice, a goat, a suit for the uncle or some shoes for the mother.

Angolan's Love of the Strategic Game: Chess

Angolans love their game of chess and perhaps it should be no surprise that they are so good at the game.With five International Masters and a host of players on the brink of qualifying for this prestigious title, Angola is one of Sub-Saharan Africa’s strongest chess nations.

Some say Angola’s love of chess was inspired by the Cuban troops in Africa during the conflict years. Che Guevara was known to be a keen player and members of the Angolan national team had a Cuban coach for a number of years, which some say laid the foundations for their strong performances.

Among this hall of fame is Adérito Pedro, an International Master, the 2007 Vice African Champion, and currently Angola’s best chess player. He started playing at 15 with a homemade board and plasticine pieces.  What began as a hobby, however, fast became a serious talent and within two years he had won the African Junior chess Championship. In his 20s Pedro won a scholarship to the Anatoly Karpov International School of Chess in Switzerland. Since then he has toured the globe, playing some of the world’s best players.

Raising the profile of the game is part of Angola's Deputy Prime Minister Aguinaldo Jaime’s plan; Jaime is also a chess fanatic and former head of Angola's Chess Federation. “Sponsorship tends to go to the most popular sports like football, basketball and handball and I think some companies might overlook chess because it seems elitist,” he says.

 

Why does he think Angola is so good at chess?

Angola Humor 3

See another example of a daily comic page from Journal de Angola, a daily Angolan newspaper.  This comic strip highlights the humorous trend of blending of modern technology with traditional dance amongst the many traditional Angolan dance groups.

Translation:  "This is tradition and modernism together."

Conquering Leprosy in Angola

January 31st marked the 57th World Leprosy Day as observed by the International Federation of Anti-Leprosy Associations (ILEP).  Statistics have tallied more than 250,000 cases of leprosy in 2010 in 118 countries. ILEP's Enhanced Global Strategy has a new global target for leprosy to reduce the rate of new cases with grade two disabilities per 100,000 population by at least 35 % by the end of 2015.

Leprosy remains a major public health concern to Angolan authorities as the country is among the countries which continue recording over a thousand cases, despite having reached the elimination goal recommended by the World Health Organisation (less than 1 case / 10.000 citizens). Angola recorded 1,048 leprosy cases at the 2010 year end.

Leprosy (also known as Hansen’s Disease) is a chronic, infectious disease involving the skin and nerves of infected individuals. Pale patches on the skin are usually the first sign of the disease – they are painless and do not itch, so are often ignored by the patient.

In the past, nerve damage and other complications occurred as the disease progressed. The numbness and lack of feeling in the limbs often led to festering wounds on the hands and feet, and then to the characteristic deformities of the face and limbs. In many communities this led to stigma towards those affected and their families, causing them to be shunned and even excluded from everyday life.
 
Fortunately, antibiotics can now quickly kill the bacteria (germs) that cause leprosy, so the disease can be completely cured with a few months of treatment. If this is started at an early stage, most patients need never suffer the terrible complications which used to be common.

What's for Breakfast? Cassava Porridge!

In rural Angola, the cassava plant is one of the most important foods because of its availability and adaptability to the Angolan environment.  This root vegetable can be transformed into flour, tapioca or even alcohol. Cassava porridge is a common Angolan breakfast.

Cassava is a potato plant that grows to a height of 5-8 feet. It is grown in most of Africa’s countries and other tropic countries in the world. The root is very starchy and that is the portion of the cassava plant used for human consumption. The Cassava root varies from 50-70 cm long. It grows in clusters of 2-6 and is covered with a brownish bark fibrous that is removed by peeling.

The cassava roots are peeled, washed and cooked, boiled or grated and squeezed dry, fermented and then toasted, made into cassava bread or processed into foofoo, a moist foodstuff. Foofoo is prepared by boiling the starchy cassava flour to a thick paste or porridge in water and mixing until the desired consistence is reached. The roots are also used for animal feed and the starch for laundry starch and glue.

Cassava can also be sourced in North America and in Europe . Following, I have added a common North American Cassava Porridge Recipe from TriniGourmet.com

INGREDIENTS:

1 cup cubed cassava
4 cups water
1/2 teaspoon salt
1/2 teaspoon vanilla extract
1 tin condensed milk
1/4 teaspoon nutmeg
1/4 teaspoon cinnamon

METHOD:

1. Blend cassava with 2 cups of the water.
2. Boil the other two cups of water with the salt.
3. Slowly pour in the cassava liquid and lower heat.
4. Simmer until creamy (whisk rapidly until the texture thickens and the liquid appears glossy. Don’t be surprised if translucent ‘bits’ appear to settle at the bottom, they are tasteless and can easily be reintegrated through extra whisking or putting the mixture in a blender before continuing to the next step) recipe.