Assessment of Reproductive Health for IDPs
Angola, February 15-28,
2001
Kuito, Bie
Kuito is the provincial capital of Bie. Bie province
is located in the center of Angola and southeast of the capital
Luanda. Kuito is considered to have suffered the most
severe damage from conflicts of the civil war, particularly during
an assault in 1998 during which the town was almost completely demolished.
The physical devastation is still visibly evident as very few structures
have been reconstructed and those few that have are housing international
aid agencies or government officials. Kuito's population has almost
tripled from 200,000 before 1998 to over 500,000 due to the influx
of IDPs from the countryside where conditions are worse. There are
approximately 20 IDP camps in and around Kuito. On the day of our
visit almost 150 new arrivals came to Chissindo camps after having
walked for four days from their village. The new arrivals looked
ill (e.g., skin rashes, open sores), weak and were barely clothed.
There are health posts in 9 of the 20 camps. The health posts provide
only the most basic RH services such as prenatal check ups. Most
RH needs must be referred to the provincial hospital. In 1998 this
hospital was destroyed. The hospital is already at 105% capacity
so MSF has monitoring as their main focus to avoid an epidemic such
as cholera or tuberculosis.
Safe Motherhood
Malaria is one of the most common problems for pregnant
women here, leading to miscarriage and death. Some of the most common
illnesses among IDP babies are malaria, respiratory disease and
diarrhea. The one maternity in the provincial hospital is not enough
to serve the entire population within Kuito, much less the entire
province. The maternity is in need of equipment, supplies and trained
personnel. The maternity is from 1 to 7 kilometers from any given
camp. There is only one ambulance at the hospital and this does
not meet the needs of the population. The surgeon doing cesareans
at the hospital is from MSF. In relation to reproductive health,
MSF works mainly out of the hospital maternity ward and also trains
nurses and TBAs to recognize obstetric complications and make timely
referrals to the hospital. MSF staff said the second highest reason
for admission to the hospital is maternity-related. MSF wants to
invest more on prenatal consultations. MSF has a surgeon in the
hospital who does cesareans, amputations and trains other to do
so. Nutrition is considered to be an emergency situation. MSF staff
described the most common ailment of IDP babies as malnutrition
and its effects. MSF works in 2 of the 20 camps, but mainly supports
the hospital and monitors the overall health status of the population.
MSF's camp program is mainly monitoring the crude mortality rates
for under fives. Of the 11 women in the post-partum rooms of the
hospital maternity, 3 were IDPs. One of these IDP women had just
had her eighth baby.
Family Planning
An MSF nurse midwife told the assessment team that
family planning is not very accessible to the poorest people. The
MSF staff was not sure why more women do not access services, but
said it was probably due to lack of education and information. There
are only two health centers that provide family planning services
in all of Bie province. The midwife also said that some women rely
on traditional methods that may or may not be very reliable.
HIV/AIDS/STDs
There is a Ministry of Health (MOH)-supported HIV
program in Bie province but due to shortage of supplies the main
activities are awareness raising among the military and civilians.
This program includes the distribution of condoms and t-shirts.
The program would benefit from bicycles to help with outreach to
the IDP camps farther outside of town. HIV tests are only done at
the hospital and only on blood for transfusions.
SGBV
MSF staff would like to have a supply of emergency contraception for cases of rape. MSF has a nurse working in the camps and she is going to do a survey to determine what agency, if any, is distributing emergency contraception. If none are, then MSF will start. First they would have to be sure there are trained staff to administer the emergency contraception and provide the appropriate follow-up care. Rape perpetrators are mainly military who came to the area in 1998 and stayed. There is great stigma attached to victims of SGBV. Domestic violence is said to be commonplace, but as outsiders it was difficult for the assessment team to engage in candid discussions on this topic.
