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Angola’s health system in tatters after decades of civil war

May 19, 1997

LUANDA, Angola (AP) _ Josina Machel Hospital stands as an elegant, pink colonial centerpiece in Angola’s capital. Inside, it is a monument to the misery wrought by two decades of civil war.

Walking down the stairs to the basement emergency room is a descent into a hellish stench.

``Are you sure you want to go down there?″ a doctor asks as he hurries by.

The 12-bed emergency clinic reeks of blood, sweat, urine and death. Victims of a bus crash in eastern Uige province lie on blankets on the floor, flies buzzing around open wounds.

Used cotton swabs and dirty bandages litter the floor, which has weeks of dirt because a water shortage prevents cleaning. Through the window comes the wailing of relatives mourning the dead.

``It is very frustrating,″ says Dr. Avelino Joao, head of the emergency room. ``We see lots of people dying who we know we have the medical training to save, if we only had the supplies.″

Twenty years of fighting between government forces and rebels of the National Union for the Total Independence of Angola, known as UNITA, killed a half-million people and destroyed the health system virtually everywhere but Luanda.

Despite the recent installation of a unity government incorporating the former foes, no money has been allocated to improve health services. The emergency room at Josina Machel is the only state-run facility operating in Angola.

That is why Victoria Daniel risked her life to slip past UNITA patrols and journeyed to Luanda with her ailing son. After seeing her husband and first-born child die of malaria and malnutrition, she wanted decent medical treatment for the skin cancer afflicting Moises, 14.

But when they arrived at Josina Machel, doctors told her they lacked the equipment or medicine to treat the boy. He will likely die within six months, they say.

``I have 50 cents left,″ the gaunt 38-year-old Daniel says with tears in her eyes. ``I must go out and beg.″

Such stories are commonplace in Angola. Widespread malnutrition and disease have given the southern African nation of 11 million people one of the highest infant mortality rates in the world - 195 per 1,000 live births _ and a life expectancy of 46 years.

Luanda, a city of 400,000 before the war broke out in 1975 on the eve of independence from Portugal, is now home to more than 3 million people. Basic services like water and sanitation have collapsed, turning once picturesque streets into open sewers.

Everything at Josina Machel is in short stock _ even basics such as bandages and antibiotics. A small child lying face down on a cot holds a severed ear in place with his hands.

Better facilities are available at private clinics, but the $60-$70 consultation fee exceeds what top civil servants earn in a month.

Nurses at state-run medical clinics, who have not been paid since January, ask for bribes before they will find patients a bed or dispense scarce medicine. Some steal supplies to set up their own practices from home, says Dr. Luis Bernardino, director of the pediatrics wing at Josina Machel.

The proliferation of small practices run by underqualified people has increased the mortality rate in the pediatrics wing to about 35 percent, he says.

``They make lots of mistakes, and when the children come here, they are already very sick,″ Bernardino says.

The biggest killer is malaria. Even when the hospital has medicine to treat children, their bodies are often so malnourished they lack the strength to survive.

But revamping the health system is just one of a host of challenges facing the new government inaugurated on April 11. It must integrate two rival armies, demobilize about 100,000 soldiers on both sides, extend state administration into areas still under UNITA control, build houses, open schools and create jobs.

Before the government can tackle any of these needs, its members must overcome decades of mistrust and learn to work together.

More than two years after fighting stopped in most of the country, military spending still accounts for about 15 percent of the national budget while only 6 percent goes for health, according to U.N. figures.

``The two parties must agree to develop the country,″ says Jose Caetano, spokesman for the World Health Organization. ``If each continues to blame the other for the country’s problems, there will be a crisis.″

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