[DEBATE] : (Fwd) Cholera outbreaks in Angola

[Patrick Bond]

NY Times, June 16, 2006
In Oil-Rich Angola, Cholera Preys Upon Poorest
By SHARON LaFRANIERE

LUANDA, Angola, June 10 — In a nation whose multibillion-dollar oil boom
should arguably make its people rich enough to drink Evian, the water that
many in this capital depend on goes by a less fancy name: Bengo.

The Bengo River passes north of here, its waters dark with grit, its banks
strewn with garbage.

Two dozen roaring pumping stations suck in 1.3 million gallons from the
river each day, filling 450 tanker trucks that in turn supply 10,000
vendors across Luanda's endless slums. The vendors then fill the jerry cans
and washtubs of the city's slum dwellers, who buy the water to drink and
bathe in.

This is one reason, health experts here say, that Luanda's slums are now
the center of one of the worst cholera epidemics to strike Africa in nearly
a decade, an outbreak that has sickened 43,000 Angolans and killed more
than 1,600 since it began in February.

But it is only one reason. Cholera typically spreads through contact with
contaminated water or sewage, and in Luanda's slums, both are everywhere.
Neighborhoods here are ringed by mountains of garbage, often soaked by
rivulets of human waste. Only about half of slum dwellers have even an
outdoor latrine.

Children stripped to their underwear dance through sewage-clogged creeks
and slide down garbage dumps on sleds made of sheet metal into
excrement-fouled puddles.

Much of the city has no drainage system; in heavy rains, the filthy water
rises hip-high in some of the poorest dwellings.

One development group estimated that it would take 22,000 dump trucks to
clear away the trash. That was in 1994, when Luanda had half the population
of 4.5 million it has now.

"I have never seen anything like it," said David Weatherill, a water and
sanitation expert for Doctors Without Borders, which is leading the
response to the epidemic. "You see conditions like this on a smaller scale.
But I have never seen it on such a huge scale. It is quite shocking."

Angola is in the midst of a gusher in oil revenue, its hotels crammed with
oil executives and its harbor filled with tankers carrying away the 1.4
million barrels of crude pumped here each day. The economy grew by 18
percent last year. The government racked up a budget surplus of more than
$2 billion.

This year it is expected to take in $16.8 billion in revenue, well over
twice the $7.5 billion it received in 2004. Next year, revenue is expected
to rise by a third again, almost all because of oil.

Economists say the government simply has more money than it can spend.

Yet it seems powerless to address even the basic issues of clean water and
sewers that would make such epidemics entirely preventable — a paradoxthat
critics attribute to corruption, incompetence or the hangover of a 27-year
civil war that flooded the capital with refugees, or all three.

"We are talking about a government that has the means," said Stephan
Goetghebuer, East Africa coordinator for Doctors Without Borders. "There
are a lot of things they could be doing. The living conditions are really
terrible, and they are terrible even if you compare them to other places in
Africa."

Sebastião Veloso, Angola's health minister, said the scope of the problem
defied a quick fix. "We just do our best," he said. "The lack of
infrastructure is a very complicated administrative problem. We are doing
our part at the Ministry of Health, and the rest of government must do its
part. We are pressuring the government, because otherwise these epidemics
will continue."

Only one in six Luandan households is lucky enough to have running water,
and for many of them, it comes from a community standpipe, according to
Development Workshop, a nonprofit group in Angola. The often-contaminated
river water from trucks that roam the slums costs up to 12 cents a gallon —
a hefty sum in a nation where two-thirds of the people live on less than $2
a day, and up to 160 times the price paid in better-off neighborhoods with
piped water.

So the poor ration their water use, limiting themselves to about two
gallons a day per person for drinking, bathing, washing clothes and
cleaning. That is far below the five-gallon daily minimum recommended by
the United Nations — and one twenty-sixth the average use in Western
countries, according to Doctors Without Borders.

In an attempt to beat back the epidemic, the government, with the help of
the United Nations, is distributing a limited amount of free clean water.
The few distribution points are easy to spot. Hundreds of people rise
before dawn to set their plastic buckets in lines that stretch for blocks.
The crowds remain long after the water is gone.

One afternoon last week, dozens of people crowded around one empty plastic
water tank about eight miles from downtown. "They are waiting for the last
drop," said José Mateus, a neighborhood coordinator.

No one knows precisely why cholera arose out of the slums this year after a
cholera-free decade in Angola. Epidemiologists say the long absence of the
disease worsened the outbreak because the population had no 
built-upimmunity.

Once it began, not even the tidiest slum household could halt it.

It first hit Boa Vista, a shantytown minutes from downtown. Ombrina
Cabanga, a 20-year-old mother of a 2-year-old girl, did everything to
protect herself, said her sister-in-law, Oriana Gabriel. She washed
vegetables, rinsed plates and cleaned the latrine the family shares with
three others. As the Health Ministry recommended, she used bleach to
disinfect the drinking water she bought from the neighborhood vendor.

But her house is a few feet from a giant trash-filled gulley. Her latrine,
like everyone else's, drains directly into it. And she sold soap every day
in the city's famously squalid outdoor market, a job she hoped to escape by
taking adult literacy classes.

One Tuesday in late March, she came home and vomited into a bucket. Two
nights later, she was dead.

"I am just a working man, I don't know why the government doesn't help us,"
said her husband, Vieira Muieba, 27, a construction worker. "I don't know
where the money goes. We become angry but we don't know what to do."

 From Boa Vista, the epidemic moved along the major highways to all but 4
of the nation's 18 provinces. Maria André lost her 15-year-old daughter,
13-year-old niece and 4-year-old nephew in the span of two days. Five other
children in the household were also taken ill but recovered.

Ms. André is racked with guilt nearly three weeks after the deaths. "I
don't know what happened," she said. "I heard about the disease on the
radio, and all of a sudden, it was here. They were all healthy and now,
they are dead.

"It is not easy to lose three children all at once."

Angolan government officials say there is no overnight solution to the lack
of basic water and sanitation. In late May, President José Eduardo dos
Santos promised new measures to improve conditions, including moving
Luandans out of the most appalling slums.

But the government's plans are in their infancy and, despite the gusher of
oil revenues, short on financing.

Consider the government's plan to take over some of the provision of water
to Luanda's slums. Four months into Angola's cholera epidemic, 20 trucks
have been ordered — minuscule compared to the fleet of more than 300
private trucks now supplying the poor. As of early June, Mr. Veloso, the
health minister, was still waiting for the first delivery.

The government's harshest critics blame corruption for the abysmal living
conditions. Transparency International, which promotes good governance
worldwide, ranks Angola as the world's seventh most corrupt nation. The
State Department said in a 2002 report that Angola's wealth was
concentrated in the hands of a tiny elite, in part made up of government
officials who had enriched themselves on an enormous scale.

Other diplomats and analysts say Angola's ruling party is still trying to
get on its feet after a civil war that raged almost nonstop from 1975, when
Angola gained independence from Portugal, until mid-2002.

Dauda Wurie, a project officer for the United Nations Children's Fund, said
the war had eviscerated the government's corps of competent managers,
leaving disarray.

"I am not defending them," he said of the government officials. "They buy
big cars. They live in big houses. But it would be wrong to expect that
everything will turn around just because war stopped."

Doctors Without Borders officials say the government response to the
outbreak has been woefully slow and underfinanced. A crisis committee began
work only two and a half months after the epidemic began, and the
government has set aside a mere $5 million in emergency money to fight the
disease.

Assessing the water taken by private truckers from the Bengo fell to
Doctors Without Borders. Last month it issued its report: laboratory tests
in April showed the raw river water was unsafe to drink.

But only one in 10 truckers chlorinated water tanks; the others simply
delivered untreated water to the city.

Presented with those findings, the government did nothing, the report
states. So Doctors Without Borders organized the distribution of free
chlorine. It now plans to insist that the truckers pour chlorine crystals
into their tanks while inspectors watch, lest they sell them instead.

How much those truckers — and the neighborhood vendors they supply —earn
in profits is unclear. But Janetta Jamela's bedroom in eastern Luanda is
one hint. Fifteen bags of concrete are stacked against the wall — to add
three new bedrooms and a new kitchen and bathroom.

Since she and her husband scraped up $200 to build an underground water
tank three years ago, she estimated, she has earned about $235 a month
selling water — $75 a month more than her husband earns as a government
security officer.

"But you have to have the $200 to start with," she said.

The cholera epidemic is now waning, having run what epidemiologists call
its natural, devastating course. But without an improvement in slum
conditions, said Mr. Weatherill, the group's water and sanitation expert,
the respite may last only until the next rainy season.

"Unless things change, we probably will be back the next year," he said in
a telephone interview, "and the year after that."