Hope for Those with No Healthcare

(Recent blog post from Dr. Nicholas Comninellis, visiting doctor to CEML Hospital)  This morning a father arrived at the CEML hospital in Angola with his son, Josifas, whose photo is as shown.   This boy of eleven was leaning over a cooking fire when his shirt erupted into flames.  Living in the bush, his family simply covered the wound with strips of cloth, linen that became stuck to the wound such that it could not be removed.  The results of these tight contractions of skin are that he cannot close his mouth and his speech is indiscernible.

Is there hope for Josifas?  Indeed.  We will give him an anesthetic, release the contracted skin with multiple incisions and place skin grafts over the newly exposed tissue.   After the skin grafts are well-attached, he'll begin physical therapy to increase the motion of his neck and mouth.  Three or four months from now, Josifas, with lots of courage and coaxing, will be speaking and swallowing and even looking more like a healthy child. 

Check out Dr. Comninellis' blog http://inmedblog.us/nicholascomninellis and website for more information on international medicine:  INMED    www.inmed.us 

Angolan Albinos: Living with Health and Social Challenges

Albinism is a genetically inherited condition which affects some 2000 Angolans, according to World Health Organization statistics. While in Europe and the United States albinism affects about one in 20,000 people, in some parts of Africa the rate is as high as one in 1,100.  The prevalence of this rate is mainly attributed the ritual intermarriage practices of Africans to people within their own tribe, thus propagating the condition.

Genetically, albinism is passed from parent to child, in which the body does not produce the pigment melanin. Albinos are born with pale skin, light hair, pinkish eyes and and impaired vision. Melanin is the skin’s own natural protection against the sun’s rays and lack of melanin puts albinos at risk for many types of solar skin damage, including deadly skin cancers. The risk is of skin cancer is especially great for albinos living in sub-Sarahan African regions like Angola, where ultraviolet rays are high because of the close proximity to the Equator.

Inherent to Africans born with this genetic condition, comes social segregation and discrimination because of the obvious appearance dissimilarities and the long-held tribal superstitions about the powers that albinos are perceived to possess. While albinos in Angola appear to not face overt violent attacks because of cultural norms, reports from countries like Senegal and Tanzania tell how albinos face grave and even life-threatening discrimination.  Albinos have been murdered in Tanzania and Burundi, apparently being targeted because of the belief  peddled by some witch doctors that albino's blood or body parts have magical qualities that can bring riches or cure disease. 

In Angola, the lack of adequate health care, the difficulties accessing education and employment, and social marginalisation mean many albinos have their sight and skincare conditions exacerbated unnecessarily.  In the rural areas of Angola, this often relegates albinos to live in destitution with very few options for employment or healthcare. (adapted from WHO, UNHCR Refworld Report, Hatsforskinhealth.org)

Testing a Doctor's Pediatric Skills!

Angola has some of the highest infant mortality rates globally, which are attributed to the unimproved social and healthcare conditions.  Visiting doctor, Dr. Nicolas Comninellis, recently submitted the following report of his day of pediatric consultations at the CEML Hospital.

"Here at CEML it is the nurse practitioners that first attend to those coming for care. Paulo and Miguel are skilled, thoughtful, and can manage most individuals just fine. For me, they save the more complicated cases. Today, first, these included a four-year old girl who was growing normally until struck with cerebral malaria. She suffered a stroke and has been quadriplegic ever since. Second, they sent me an eight-year old girl with sudden liver failure, jaundice and ascites – all of unknown origin. Next, a two-month old with imperforate anus who was passing stool via his urethra. And finally, I received this eight-month old with hydrocephalus. Just a typical day of complicated pediatrics"

Check out Dr. Cominellis' blog inmedblog.us/nicholascomninellis and website for more information on international medicine - INMED  www.inmed.us

Battling Malnutrition Problems

(ANGOP May 12)   The UNICEF (The United Nations Children's Fund) representative in Angola, Koenraad Vanormelingen, released current research results that show that 8.2% of Angolan children under 5 years old, a total in the order of 300,000 children, suffer from acute malnutrition.

According to representative Vanormelingen, these country totals are the major cause of morbidity and mortality in Angolan children under five years of age.  These research reflect that in other lessor levels of malnutrition; some 15.6% or one million children suffer from the basic level of malnutrition, while some 500,000 children suffer from chronic malnutrition.

The representative proclaimed that these statistics illustrate a problem of a lack of complete nutrition, not simply the problem of the lack of access to macro nutrients such as protein and sugar.

UNICEF defines acute malnutrition as the nutritional deficiencies that produce reduced Weight to Height anthropometric indicators; producing very physically lean or skeletal appearing body frames. Chronic malnutrition is defined as reduced Height to Weight indicators which will produce stunted growth and other physically limiting conditions such as mental development.

Wiping Out Sleeping Sickness

The incidence of sleeping disease, trypanossomiasis (try saying that quickly!) is decreasing in the most contaminated areas of Angola, most notably the seven endemic provinces: Malanje, Kwanza Norte, Kwanza Sul, Uíge, Zaire, Bengo and Luanda. Sleeping sickness threatens one third of the Angolan population and recent screenings carried out revealed a sharp decrease in positive cases. 

The disease is mostly transmitted through the bite of an infected tsetse fly but there are other ways in which people are infected with sleeping sickness; mother-to-child infection through the placenta and through mechanical transmission through other blood sucking insects,

In the first stage, the trypanosomes multiply in subcutaneous tissues, blood and lymph. This is known as a haemolymphatic phase, which entails bouts of fever, headaches, joint pains and itching.

In the second stage the parasites cross the blood-brain barrier to infect the central nervous system. This is known as the neurological phase. In general this is when more obvious signs and symptoms of the disease appear: changes of behaviour, confusion, sensory disturbances and poor coordination. Disturbance of the sleep cycle, which gives the disease its name, is an important feature of the second stage of the disease. Without treatment, sleeping sickness is considered fatal.

Sleeping sickness threatens millions of people in 36 countries in sub-Saharan Africa. Many of the affected populations live in remote areas with limited access to adequate health services, which hampers the surveillance and therefore the diagnosis and treatment of cases. In addition, displacement of populations, war and poverty are important factors leading to increased transmission and this alters the distribution of the disease due to weakened or non-existent health systems. In 2009, after continued control efforts, the number of cases reported has dropped below 10,000 (9878) for first time in 50 years. The estimated number of actual cases in sub-Saharan Africa is currently 30,000. (WHO Report 2011)

Angola Traditional Medicine: An Age-Old Cure

The use of 'traditional', 'alternative' or 'complementary' medicine is now a multi-billion dollar industry around the world. This type of medicine, when adopted by non-indigenous populations, is often labeled as the ‘medicine of the poor' and still an estimated 80% of the populations in some African and Asian countries depend on this traditional medicine for basic health care.

In Angola, the use of traditional medicine goes back around 4000 years, according to Rosário Fernandes, a traditional medicine researcher. She discovered that most of the practices originated in the primitive culture of the tribal communities called Sam (Hottentots) and the Bantu.

Some examples of traditional medicine: the tea from the Mbrututu root does not need boiling water, and is ideal as a cure for hepatitis;  a mix of honey and lemon is recommended for the flu and sore throats; other local-gathered herbal products have 'power' to cure, like tea from Caxinde, Chandala, Gipepe, and Ngandiadia; all initially labeled in the local people's languages.

For recent mothers, the Angolan pharmacist recommends “closing the wounds from the birth” with a bath made from a lukewarm infusion of the plant called capim de Deus ('God's grass'). For the new-born, drinking Mukumbi is good for colic. It is also a remedy for anemia and blood loss. Additionally, the bark of the ‘Timba-Timba’ tree is apparently the African version of Viagara.

Traditional medicine is defined as, 'the sum total of knowledge, skills and practices based on the theories, beliefs and experiences indigenous to different cultures that are used to maintain health, as well as to prevent, diagnose, improve or treat physical and mental illnesses.”

The basic theory underlying traditional medicine in Angola  “arose from the empirical observation of how man reacted with the environment. Primitive man watched natural phenomena and managed to create a conceptual structure that could be transposed to the human body."

According to the researcher, before the arrival of the Europeans who disembarked on Angolan shores, the local peoples (Hottentots, Bantu, and others), solved their own health problems, including the plague, epidemics, spiritual and emotional illnesses, by recourse to traditional medicine. “The Imbanda (practitioners), could diagnose, prevent, treat and cure illnesses that occurred in their times, whether hereditary or otherwise. (adapted from TAAG Austral Magazine)

New Sickle-Cell Initiative Draws Medical Partnership

March 22, Luanda — The Angolan Health Ministry (MINSA), the US Oil Company "CHEVRON" and Baylor International Pediatric Aids Initiative (BIPAI) from Houston, Texas announce the creation of a sickle cell anemia screening program in the country.

Sickle-cell disease usually presenting in childhood, occurs more commonly in people (or their descendants) from parts of tropical or sub-tropical regions where malaria is or was common.  One-third of all indigenous inhabitants of Sub-Saharan Africa carry the gene.  Angola has one of the highest rates of infection of falciform anemia (sickle-cell disease) in the world. It is estimated that 10,000 Angolan children are born every years with the disease, which contributes to the aggravation of the death rate of children less than five years of age. 

United Nations statistics record that 220 out of every 1000 Angolan children in the country are born with sickle cells anemia and die before reaching five years of age. Sickle-cell disease, usually presenting in childhood, occurs more commonly in people (or their descendants) from parts of tropical and sub-tropical regions where malaria is or was common.  One-third of all indigenous inhabitants of Sub-Saharan Africa carry the gene. 

Sickle cell anemia is a disease passed down through families in which red blood cells form an abnormal crescent shape. Red blood cells are normally shaped like a disc.  Sickle cell anemia is caused by an abnormal type of hemoglobin called 'hemoglobin S' which distorts the shape of the red blood cells, especially when exposed to low oxygen levels.  Almost all patients with sickle cell anemia have painful episodes (crises), which can last from hours to days. These crises can increase the prevalence of strokes and affect the bones of the back and the chest. Patients with sickle cell disease need ongoing treatment, taking supplements of folic acid, antibiotics and vaccines to prevent bacterial infections, and blood transfusions to ultimately treat a sickle cell crisis. 

The screening program, as part of Chevron's social corporative responsibility in Angola, will start in late in 2011 with an estimated USD $4 million budget. (Angop, UN WHO Reports 2011)

Stemming the HIV Tide

With an estimated 2% of the adult population living with HIV, at the moment Angola has one of the lower HIV prevalence rates in sub-Saharan Africa as deemed by UN health agencies.  During the 1975–2002 Angolan civil war, cross-country travel was nearly impossible, impeding the spread of HIV/AIDS. Since the war, however, movement has become less restricted, and the likelihood of HIV reaching once-isolated communities has increased dramatically. In 2009, UNAIDS estimated that 200,000 people in Angola were HIV positive.

With a relatively young population, coupled with widespread high-risk sexual behaviors and an ambivalence toward safe health practices, puts Angola in danger of a more severe HIV/AIDS epidemic.

This trend was experienced first-hand by Dr. Nicholas Comninellis, visiting doctor to CEML Hospital.  He writes:

"I first worked in Angola during its civil war and encountered all the injuries and disease of poverty one can possible imagine: gun shots, land mines, measles, malaria, typhoid fever.  What i did not see was HIV disease.  While the rest of Africa was being ravaged by HIV, Angola was spared - largely because no one from neighboring nations had any reason or courage to travel to Angola.  But now peace has come, so has commerce and tourism, and HIV.  For several days I've been caring for Paula, a young woman with TB infection in her lungs. Her vomiting has been constant, and malnutrition worsening day by day.  Her arms and legs are literally skin and bones.  I'm treating her with TB medications and IV fluids, but she's just not getting better.  This morning I tested Paula for HIV, and her positive result helps explain why Paula continues to decline.  Some in the US are lured into thinking that we're overcoming this disease - but its true of wealthier nations. Here the epidemic continues to be explosive.  Indeed, life in Angola is far better than during the war, but HIV reminds me that both peace has its costs, and peace also allows us to effectively mobilize again this and the other heartbreaking diseases of poverty!" 

In Angola, tuberculosis (TB) co-infection with HIV is a major concern. TB is the leading cause of death among people who are HIV positive. After decades of civil war, the country’s health infrastructure is not adequate to address the TB epidemic. In 2008, TB incidence was 290 cases per 100,000 population, according to the World Health Organization (WHO). Nineteen percent of newly diagnosed TB patients are also HIV positive. (USAID Angola Report 2011)


Check out Dr. Cominellis' blog inmedblog.us/nicholascomninellis and website for more information on international medicine INMED  www.inmed.us

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.

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.

Truly a Hard Life

(Submission by Nicolas Cominellis, visiting doctor to CEML Hospital) "A short time ago in the hospital, I was talking with a 35-year old Angolan lady who 10 years earlier lost her left leg to a land mine. Angola was once home to the highest per capita concentration of land mines in the world! During the recent war years, this lady lost 8 of her 10 children to fever and diarrhea. No one knows her own diagnosis for sure because medical care facilities from her district are sparse. Without the support of her husband, who was lost to combat during the civil war, she somehow managed to escape starvation. Then a few days ago this remarkable lady fell, could not get up and was brought to the CEML Hospital with pain in her only remaining right leg. Check out the X-ray below!"

Sadly, similar cases as these are all too common within CEML's rural outreach area of southern Angola. The Hospital is aiming to expand its medical services to meet the great exent of these needs.

New Bid to Halt Polio in Angola

(BBC News - Oct 1, 2010)  A mass polio immunisation campaign is starting in Angola in a bid to vaccinate all children under five.

The campaign is part of a series of programmes aimed at stopping a polio outbreak that has paralysed 24 children this year alone. Over 7 million vaccine doses are set to be delivered.  The World Health Organisation (WHO) says previous attempts to stop the virus circulating failed because too few children were vaccinated.

This outbreak in Angola started in 2007 and the WHO now considers it the greatest risk to Africa's polio eradication efforts.

Polio is a highly infectious virus which mainly infects young children. It is transmitted through contaminated food and water and once it enters the intestine it multiplies and can spread into the nervous system. "The good news is that we know this outbreak could be stopped very rapidly”  Oliver Rosenbauer,  Global Polio Eradication Initiative.

In the worst cases, polio causes paralysis which is often permanent. Current vaccines are highly effective in protecting children against infection. This outbreak, despite previous vaccination campaigns, has now spread to the Democratic Republic of Congo.

The virus can only be stopped if all children receive the vaccine. The WHO estimates that in some areas of Angola more than a third of at risk children have not been immunised. Oliver Rosenbauer, spokesperson for the Global Polio Eradication Initiative at the WHO said: "Children across Angola, and indeed Africa, will continue to be paralysed by this awful virus, and it's completely needless because it could so easily be prevented.

The Plight of Fistula in Angola

Report from Dr. Nicholas Comninellis; visiting doctor to CEML.
One of the saddest health problems in all the developing world is vesicovaginal fistula (VVF). It’s a hole created between a woman’s bladder and her vagina, resulting in a constant, uncontrollable flow of urine out the vagina. As a result, many these women - and often children under their care - are outcast by their husbands and their communities.

At CEML, Dr. Steve Foster is performing the necessary, but often complicated surgical repair for a large number of women. But how about prevention? VVF is caused by complications of the normal birthing process. When the baby descends too slowly, undue pressure is placed on the mother’s bladder by the baby’s head, resulting in death of that tissue, and a subsequent hole. The solution? In short, provision of modern obstetrical care, where failure of the natural birth process is diagnosed and treated immediately.

While providing this vital surgery to many Angolan women afflicted with this malady, CEML is also commited to training midwives in efforts to improve the healthcare of birthing mothers.

Biting Back Against Malaria

In my December 27, 2009 blog post, I outlined the efforts made in combating malaria in Angola, the country's main medical killer; the principal cause of morbidity and mortality in the country especially among children under 5 years of age and pregnant women. Yet despite its shocking prevalence, there is a simple and effective way to begin to control the disease from spreading:  sleep under a mosquito net.

In the last decade, a massive drive has been underway throughout the whole African continent to distribute millions of free nets.  In 2005, the USA set up the President's Malaria Initiative (PMI), run by USAID and Angola was selected as one of the first countries to be targeted.  Since then, the PMI has spent more than $63 million on fighting malaria in Angola, including the distribution of three million nets.

The results so far have been positive. A 2006 survey showed that usage of insecticide-treated nets in Angola increased from less than 2% in 2001 to over 18% in 2006. 

As the number of nets distributed goes up, so the number of cases malaria and deaths related to the disease is going down.  According to Filomeno Fortes, the national coordinator for the Angolan government's anti-malaria campaign, there were 3.1 million cases of malaria in the country in 2009, down from more than 3.4 million in 2008. Deaths are also down from 25,000 in 2003 to just over 7,000 in the last 12 months.

Dr. Koenraad Vanormelingen, Unicef representative in Angola, says that mosquito nets not only protect those sleeping under them, but also help reduce the number of moquitoes in the region.  "Communities with large-scale coverage of insecticide treated nets have 50% less malaria, but also 80% fewer malarial mosquitos.  So if you sleep under a net, you are actually helping to reduce the number of mosquitos in the environment." (excerpted from Sonangol Universo Magazine, June 2010 edition, Nina Hobson)

A World Class Physician Serving in Angola

The CEML Hospital Medical Director, Dr. Steve Foster, just received a distinguished award from the Royal College of Physicians and Surgeons of Canada.  This award, given in evaluation by a consortium of honored physician-peers in Canada, exemplifies one of the highest honors of  the North American medical field.

The Teasdale-Corti Humanitarian Award, acknowledges and celebrates Canadian physicians who, while providing health care or emergency medical services, go beyond the accepted norms of routine practice, which may include exposure to personal risk. The recipient's actions exemplify altruism and integrity, courage and perseverance in the alleviation of human suffering.

Below is the Award biography story of Dr. Foster:

Stephen Foster, MD, FRCSC, has devoted his life to improving health care in Angola.
Even when armoured plates had to be installed under his car, the 2010 Royal College Teasdale-Corti Humanitarian Award winner continued providing high-quality medical treatment in a country ravaged by more than 27 years of civil war.

“Despite the apparent dangers, I’ve had more fun here than I would have had anywhere else,” Dr. Foster said. “The average general surgeon in Canada does five or six different types of operations. I do more than 100 procedures, 1,400 times in any given year.”

Dr. Foster, 60, was born in Brantford, Ont., but spent most his childhood living in Zambia, where his father, Robert Foster, MD, worked as a missionary surgeon. In 1971, the young student had just completed his second year of medicine at McMaster University in Hamilton, Ont., when he decided to spend the summer working at a central Angola clinic.

Overcoming Angola's Doctor Shortage

Since its inception in 2006, the CEML Hospital has been staffed by resident and visiting expatriate doctors and medical personnel, who are able to operate a consistent and growing medical service to the southern region of Angola. In a strategy to create sustainability in operations and personnel, CEML is concentrating on training and implementing Angolan non-physician clinicians to meet the immense healthcare needs in the rural areas.

A Canadian newspaper, The Globe and Mail, recently published a revealing article outlining the extreme situation in Angola, where government hospitals have been built but with no doctors or medical staff to operate them.  Read this interesting article on this website..............

Malaria's Toll on Angola

The CEML Hospital is committed to providing prevention solutions to the blight of the deadly malaria virus; still the number one killer on the continent of Africa.   The recent statistics concerning malaria infections and deaths confirm the need for our continued efforts.

The co-ordinator of the Programme of Combat to Malaria, Filomeno Fortes, said this Monday in Luanda that Angola registered 3.1 million cases of malaria during the year 2009, which resulted in 8,000 deaths.

The official was speaking about the situation of malaria in Angola and the national strategic plan in a forum about the role of journalists in the fight against malaria. He said that the transmission of the disease in not uniform, having added that the central, coastal Benguela province was the most endemic of the country's 18 provinces with 28% of the cases of 2009.

According to the physician, Angola has two of the most violent species of mosquito of the world, the giant anopheles mosquito and the anopheles spontaneous mosquito, which can adapt to various circumstances living inside and outside residences and can also feed from animal blood.

The Angolan Government wants to gain control and reduce the disease by 2015 and eradicate the disease by the year 2030. To reach this goal, the Ministry of Health aims at reducing the cases of malaria by 60 percent, by the year 2012, and cover 80 percent of children below the age of five and pregnant women with malaria.

The treatment of pregnant women through quick tests, the use of mosquito nets and an integrated control are the objectives of the CEML Hospital and the Health Ministry. In 2008, the country registered 3.45 million cases of malaria.  (Angola Press, April 19, 2010)

Angola's New War: Against TB

Wednesday March 24 marked 'World Tuberculosis Day' and during the Angolan celebrations the coordinator of the National Tuberculosis Programme, Conceição Palma, suggested for the Health Ministry to integrate this sickness as its priority project, as she considers it a national emergency.

The official added that tuberculosis must be considered as a primary health issue, because it is interlinked with HIV/AIDS, deficient feeding conditions and access to medicines.  Coordinator Palma informed that in 2009 alone, 42,380 cases of TB were registered throughout the country with the significant cities of Luanda and Benguela marking more than 30 percent of all cases.

Tuberculosis (TB) is a contagious disease. Like the common cold, it spreads through the air. Only people

Rural Healthcare

Recent statistics and surveys show that almost 40 - 50% of Angolans have no access to local healthcare.  In the many cases Angolans must travel many days, often on foot, to reach an organized healthcare facility.  This state of healthcare and the amount of travel has been documented by the CEML Hospital, often receiving patients from other far off Angolan provinces who are in need of specialized healthcare or complicated surgical operations.

In some of most remote areas of Angola, local churches have taken the initiative to start healthcare stations to meet the immediate and basic healthcare needs of surrounding people.  In one instance, the national, evangelical church in Mavinga started a small clinic/hospital as pictured at the left.   The Portuguese previously called this part of Angola "the end of the world"; from Luanda, the nations capital, it is located over 1200km away and over 800km from the CEML's base in Lubango.

The majority of the healthcare workers in these clinics have received basic training from the CEML medical staff.  Additionally, CEML doctors regularly travel to these outposts via Mission Aviation Fellowship aircraft in order to conduct more intense medical and eye examinations.  While major surgery cannot be performed in these conditions and locations, CEML's opthamologist is able to perform cataract surgeries with his mobile surgery unit.

Though meeting a great need of basic healthcare in these remote areas, realistically these small clinics will never be able to meet the mounting medical needs of the people.  It is encouraging to see the investment that the Angolan Government is making in these areas to rebuild the municipal hospital which were either destoyed or abandoned during the lengthy civil war.

Angola AIDS Watch

All sub-Saharan African countries in this era have a great concern about the effects and destruction that the AIDS virus causes on their own individual societies. (This region has some 22.5 million people with HIV- the highest percentage in any region worldwide).  Angola's worries concerning the spread of this are not unfounded especially as the government opens the borders and interior with massive reconstruction.

Recently, the Angolan Health Minster stated that though "27 years of civil war in Angola caused much bloodshed and destruction, the corresponding isolation served as a protection against the deadly AIDS virus which now threatens to spread across the country."  With the reconstruction of roads and bridges, the threat of AIDS in Angola may worsen with the facilitation of the movement of people from neighboring countries: 20% of the neighboring Namibia population is infected with HIV.

Currently only 2.1% of Angolans are HIV positive.  But in the southern Cunene province which borders Namibia, some 16% of the inhabitants carry the virus.  Other provinces bordering or near the Republic of Congo in the far north of Angola have also shown steady increases in the number of AIDS cases.

Though the Angolan government has pledges multiple billions of dollars towards the education and fight against the spread of AIDS, I am hopeful that the Evangelical National Church in Angola will have an impact in changing the lifestyles and mindset against the personal actions that spread the HIV virus.