Launch of the New CEML Hospital Website

BREAKING NEWS!  Today marks the initial relaunch of the website for the CEML Hospital based in Lubango Angola.

The new site features a fresh design, focused on:

• Current stories of patient's physical transformation;
• Highlights of CEML's services throughout Angola;
• News concerning pertinent medical crisis in Angola; and
• Provision of an online donation venue.

The website is formatted for both desktop and mobile devices.
 

Please click this link to explore the new website:    www.ceml.org

We hope that you will enjoy navigating the new CEML website and will forward the new website link to others to broaden CEML's exposure.

Drought Contributes to Cholera Outbreak in Southern Angola

DECEMBER 5, 2013 (IRIN) A protracted drought followed by the onset of the rainy season in southern Angola has triggered a sharp increase in cholera cases, mainly concentrated in Cunene province, around the provincial capital Ondjiva, where over 1,000 infections and 48 deaths were recorded during a two-week period in November, according to figures from the Ministry of Health.

Cholera is a highly contagious disease associated with poor sanitation and access to safe drinking water. It is endemic in Angola, where nearly half of the population live in conditions conducive to the spread of the illness, according to the World Health Organization (WHO).  A year-long outbreak that started in the slums of the capital, Luanda, in February 2006 and spread to 16 out of 18 provinces, resulted in over 80,000 reported cases and 3,000 deaths.

So far, the current outbreak has remained almost entirely confined to Cunene, although neighboring Huila province has also recorded some cases. Since January 2013, the country as a whole has recorded just over 5,600 cholera cases and 190 deaths, about 70 percent of them in Cunene.

A drought that started at the end of 2011 is now affecting over 1.8 million people, with five provinces in the south worst affected, among them Cunene. Acute malnutrition rates as high as 25 percent in areas experiencing food shortages due to the drought have left children highly susceptible to waterborne illnesses including cholera, notes a November statement from the UN Children's Fund (UNICEF).

Angola Dental Health Challenges

(Post from visiting doctor to CEML, Dr. Nicholas Comninellis)

What's the importance of dental care? This child arrived at Lubango Evangelica Medical Center, in Angola of southern Africa, with an abscess draining from under his chin, and with infection racing down his neck and into the chest. The source of his infection? A tooth abscess. The risks of his infection? Loss of his jaw and even death. Fortunately his case my esteemed colleague, Steve Foster, drained the infection and today on examination this sad face is only for show. He's well on the way to recovery. But Angola - like all low-resource nations - has few dentists and concepts of oral hygiene are poorly grasp. Who among you would like to take on this challenge?   

(See Dr. Comninellis' site at www.inmed.us)

The Science of 'Washing Your Hands'

On the first-ever Global Handwashing Day sponsored by UNICEF on October 15, students and teachers from more than 700 participating schools across Angola engaged in symbolic acts of handwashing and listened to government leaders speak out about the importance of using water and soap.

Attending the launch of Global Handwashing Day was UNICEF Representative in Angola Angela Kearney.

“Today only marks the beginning of a major push to promote handwashing with soap as a natural and necessary habit – in schools, in the family, in institutions. We know it can save children’s lives so we cannot afford to take it lightly,” she declared.

At least two million cases of diarrhea are recorded every year in Angola, with 30% of cases recorded in children under the age of five years.  This has resulted in an average 20,000 child deaths per year.

Improvements in access to safe water and adequate sanitation, along with the promotion of good hygiene practices (particularly handwashing with soap), can help prevent childhood diarrhea. In fact, an estimated 88 per cent of diarrheal deaths worldwide are attributable to unsafe water, inadequate sanitation and poor hygiene.

UNICEF maintains that washing hands with soap can save lives and reduce about 47% of the infantile death rate, caused by diarrhea, due to the lack of hygiene.

Washing one’s hands with soap is an important barrier to transmission and has been cited as one of the most cost-effective public-health interventions. Research suggests that handwashing with soap is effective even in overcrowded and highly contaminated slums in the developing world; washing hands with water alone is much less effective in preventing disease than using soap. Soap breaks down grease and dirt that carry germs and disease-causing pathogens. Using soap also increases the amount of time spent washing hands, compared to water alone, yet lack of soap does not seem to be a major barrier to handwashing: it has been found that 95 per cent of mothers in developing countries have some sort of soap product at home.

To better understand ways to promote hygienic behavior, UNICEF research has been carried out regarding consumers’ handwashing habits and factors that motivate change. This research shows that key triggers for handwashing are feelings of disgust, nurture, comfort and desire to conform, rather than health concerns alone. These findings are being used to create more effective hygiene programs. (UNICEF, ANGOP)

Ensuring Angola's 'Food Security'

Luanda — The Republic of Angola recently received USD $100,000 from the country of Brazil to the UN Infant and Children Education Fund (UNICEF) to assist children and women in situations of food shortages. Brazil is joining the UNICEF in providing for initiatives of reinforcement of food and nutritional security in Angola, particularly in drought hit regions covering ten of the country's 18 provinces.

With the Brazil's funds, UNICEF will reinforce the Angolan Government initiatives to overcome the challenges of nature, thus ensuring food security, through prevention and treatment of malnutrition, supply of drinking water for affected children and their families in the provinces of Zaire, Bié, Kwanza Sul and Huíla.

Currently, some 10% of Angola's population are subject to food insecurity, as outlined in the OCHA (Office of the Coordination of Humanitarian Affair of the United Nations) diagram below. According to the latest WHO data published in April 2011, malnutrition deaths in Angola reached 9,095 or 4.35% of total deaths; one of the highest death rates for this cause worldwide. 

The World Food Summit of 1996 defined food security as existing “when all people at all times have access to sufficient, safe, nutritious food to maintain a healthy and active life”.  Commonly, the concept of food security is defined as including both physical and economic access to food that meets people's dietary needs as well as their food preferences.

Food security is built on three pillars:

• Food availability: sufficient quantities of food available on a consistent basis;
• Food access: having sufficient resources to obtain appropriate foods for a nutritions diet;
• Food use: appropriate use based on knowledge of basic nutrition and care, as well as adequate water and sanitation. (AllAfrica.com, OCHA

Angola Celebrating Polio Reduction

After being plagued by a re-emergence of the polio virus in 2005, Angola has not experienced any new cases of the crippling disease for a full year - moving the world a step closer to the final goal of global eradication, United Nations agencies recently reported. 

Laboratory results have confirmed that the last case of the wild poliovirus was a 14 month old child from Uige Province in the African country's north-west in July 2011, following years of concerted efforts by the Government and its partners to halt the outbreak, which had spread to neighboring countries, according to a joint press release from the World Health Organization (WHO), the United Nations Children's Fund (UNICEF) and the Government of Angola.

"This success is the result of the improvement in the quality of polio campaigns round after round," said the acting WHO Representative in Angola, Jean-Marie Yameogo, who also credited the "high commitment" of Government officials at all levels and the engagement of civil society.

Other factors included improved surveillance of the disease, improved routine immunization and the coordination of efforts in neighbouring countries, along with greater access of populations to safe water and sanitation, according to the joint release.

Primarily funded by the Government, the country's massive vaccination campaigns deployed thousands of health workers and volunteers door to door and at crossing points, main streets, markets and water points, reaching 95 per cent of children under the age of five.

The decline of new cases from 33 in 2010 to five in 2011, with none as yet in 2012, is significant, UNICEF's Representative for Angola, Koenrad Vanormelingen, noted, while also warning against complacency.

"These investments demonstrate the importance of building strong primary health care for all the country's children," he said. "We have a duty to protect and ensure that all children are born and developed in a healthy polio-free environment, which means we can not stop until every child is fully vaccinated." (United Nations News)

Orthopedics in the Rough - A Doctor's Story

(From visiting doctor to the CEML Hospital, Dr. Nicholas Comninellis) Senhor Eduardo was riding his tiny motor cycle down one of Angola’s “unimproved” roads when he struck a pot hole and landed on a boulder.  What results was the injury in this X-ray above. Most concerning is that this fracture occurred five months ago. Eduardo was treated with 3 months flat on his back in traction to hold the bones in position for healing.  This 1950’s style orthopedic management is usually successful. But in Eduardo’s case the fracture failed to healed.


Last night I took a break from my normal public health and primary care duties to assist our surgeon, Annelise Olsen, with an internal fixation of this fracture.  Four hours later the bones were properly aligned with screws and a metal plate.  Add a couple of months to heal, plus some physical therapy, and chances are that Eduardo will be once again be able to walk on this leg.  He’s a very fortunate man, for such standard surgical orthopedic therapy is essentially unavailable in this nation. (www.inmed.us)

Angola Nutrition Analysis

(World Bank Report, May 9) Despite remarkable economic growth in the past decade, undernutrition remains a serious public health problem in Angola. High rates of child stunting and micronutrient deficiencies are contributing to an under-five mortality rate of 161 deaths per 1,000 live births, limiting the growth and development of children, hindering productivity, and preventing the country from reaching Millennium Development Goals 1 and 4.

According to latest estimates from the 2007 National Nutrition Survey (NNS), nearly 30% of children under 5 are stunted, more than 8% are wasted, and 15.6% are underweight. Micronutrient deficiencies are also pervasive: 30% of preschool children and more than half of pregnant women are anemic, almost two-thirds of preschool-aged children are vitamin A deficient, 20% of young children are at risk of developing iodine deficiency disorders, and almost half of the population is at risk of inadequate zinc consumption. Furthermore, infant and young child feeding practices are poor with less than one-third of infants being exclusively breastfed for 6 months of age. Although the prevalence of undernourishment in the population has been declining in the past decade, child stunting remains high at nearly 30%, and more than 50% of people consume less than three meals per day.

High priority problems include the dearth of up-to-date, reliable, and comprehensive information on the nutrition situation in the country, severe shortages of trained nutritionists, and an exclusion of nutrition from community-based health activities.  The nutrition policy agenda is slowly gaining momentum in the country. The National Food Security and Nutrition Strategy released in 2009 include nutrition actions for Children Under 5. (World Bank Report)

Angolan Goals to Eradicate Malaria

The Angolan Government recently set goals to eliminate malaria in Angola by the year 2020, through the use of a vaccine against the disease, as outlined in the capital Luanda by the deputy director of the National Program to Fight Malaria, Nilton Saraiva. 
The official was speaking during a November 17 meeting organized by Pathfinder International in partnership with Esso Angola, called "A healthy life without malaria", which was attended by senior officials of the Angolan Ministry of Health

Saraiva commented, "The malaria vaccine has is being tested in Africa. In Angola, can be developed over the next five or seven years and it will be an important method for our ultimate goal of eliminating the disease in the country over the next ten years.  While the whole country is endemic, a special concentration will be placed on malaria prevention amongst pregnant women.’

The maternal mortality ratio in Angola—1,400 women die per 100,000 live births—is the highest in Africa and the third highest in the world. Despite the toll that malaria exacts on pregnant women and their infants, it was, until recently, a relatively neglected problem. The Ministry of Health recently reported that malaria accounts for approximately 25% of maternal mortality and is the cause of nearly 10% of pregnant women’s hospital admissions.

Working with Pathfinder International, oil company Esso Angola is contributing greatly to this malaria eradication plan and has supported the fight against malaria in the country since 2002 by investing more than $ 24 million. Their contributions have improved patient care, reconstructed hospitals and implemented advance health care to combat malaria. (ANGOP, Pathfinder International)

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)