Assessment of Reproductive Health for IDPs
Angola, February 15-28, 2001
Luena, Moxico
Luena is the provincial capital of Moxico in the southeast
of Angola bordering the Democratic Republic of the Congo and Zambia.
Luena is considered to be one of the most isolated provincial capitals
in Angola due to the heavy military presence in this province and
complete lack of road access. Other than the small amount of food
that can be cultivated in gardens and small fields within Luena,
all food and supplies must be flown in, making everyone in the province
extremely dependent upon the World Food Program flights' food deliveries.
This makes Luena, despite its rural and simple environment, a very
expensive place to live and visit.
Maternal and Newborn Care
The assessment team visited the central maternity. This maternity is separate from the hospital. It is a beautiful new building, freshly painted, very clean, airy and with many windows that provide ample natural light. Despite the outwardly impressive appearance of the maternity, we found that there was a serious need for supplies, staff and staff training.
| All maternity patients are expected to provide their own sheets in order to have one of the beds/cots and food must be provided to patients by family members. This means that IDP women, whether pre- or post-partum, may lie on the floor and may go without food during their stay at the maternity. Maternity staff said the IDP women with delivery complications often arrive too late at the maternity for help. This is due to the lack of trained TBAs to recognize complications in time, as well as a lack of reliable transportation that may delay their arrival. | J
is 17-year-old internally displaced Angolan who has just had
her second baby. She came from the IDP camp where she resides
to the hospital in the provincial capital of Luena after what
appeared to be obstructed labor. She had to travel 7 kilometers
to the hospital. Upon arrival at the hospital maternity she
was assisted by the nurses to safely deliver a baby girl.
When the baby did not take easily to breastfeeding the nurses
told J that she was likely too malnourished to provide her
baby with breastmilk, despite the fact that it is only in
acute cases of malnutrition that breastfeeding is not possible
and J appeared to be only mildly malnourished. The nurses
then began to feed the newborn baby a pablum of millet flour
and sugar water. Although the baby was born 6 weeks ago, she
appears to be only a day or two old by her very small size.
She is lathargic and unresponsive to her mother's continued
attempts to breastfeed. J is lucky to have a bed as other
IDP women are forced to stay on the floor while in labor and
post-partum because they often do not have sheets to put on
any of the available mattresses. Because meals are not served
in the maternity, many IDP women must go without food because
they have no family and friends able to the visit them from
the IDP camps. |
Maternity staff said that their greatest need is for even the most
basic equipment such as stethoscopes
,
speculums and forceps. Due to the lack of equipment and qualified
doctors, there is no surgery at the maternity so women must be referred
to the hospital for cesarean sections. The assessment team toured
the surgery facilities at the central hospital. Here, too, supplies
and equipment were very much lacking. Hospital staff are unable
to properly sterilize surgical instruments which leads to high rates
of post-partum infections. The hospital doctor reported that just
the week before a woman had died as a result of such an infection
and we saw an IDP woman in the recovery room with a post-cesarean
infection whose baby was still born. MSF used to have a doctor posted
at this hospital but removed the doctor because it was determined
that the supplies and equipment were not adequate to perform safe
surgeries.
The hospital has no refrigerator to store blood so can only call upon donors when blood is immediately needed for transfusions.
33% of the population of Luena is internally displaced but only
10% of hospital patients are IDPs. This suggests that IDPs have
little faith in the services provided and the treatment they will
receive. Many IDPs, having come from very rural areas, are unaccustomed
to accessing health services and think of a hospital as a place
where people go to die, rather than to be healed. MSF has a safe
motherhood program in Luena but it is limited to prenatal care and
vaccinations for children and infants. The MSF Maternal and Newborn Care program
does not include family planning (e.g., to support birth spacing).
The MSF representative in Luena explained: "Family planning, is
always nice if someone can do it, but it won't be us."
Family Planning
At the maternity the assessment team visited the family planning consultation room. This is the only family planning center for the entire province but family planning services are also sometimes provided in two camp health posts and one general health facility as well. The consultation room consisted of an examination table, a stack of posters communicating messages regarding use of condoms and prevention of HIV, and a metal tray - nothing else. When asked to see the contraceptive supplies we were shown to a room down the hall. They had stock outs of Depo Provera (as in every other health facility we visited) but did have supplies of pills, IUDs and male and female condoms.
Maternity staff said that women much prefer Depo to any other method, though, so they wait until supplies of Depo arrive rather than using other methods during Depo stock-outs. This visit took place during the week and the family planning center was empty of clients. Maternity staff said that the vast majority of the clients they do have are local women, not IDPs.
A ministry of health representative said she had conducted an awareness raising campaign for the female condom in Luena in August 2000. The maternity staff were trained as trainers in how to use the female condom and expected to train others in the community and inform people to go to the maternity to obtain the condoms. The trained staff did not keep records of the condoms distributed and the program was not evaluated to determine how effective the training had been.
During this MOH training the maternity was also supplied with emergency contraception but all these supplies were gone. The maternity staff said that the emergency contraception was mainly used by local women who had had unplanned sex (perhaps women married to military men who have boyfriends when their husbands are away), rather than for cases of rape.
IMC will be starting a family planning project for IDPs and the
local community.
STDs/HIV/AIDS
There are no STD drugs available in any of the camp health posts. Patients must get a prescription and go to a pharmacy in town, the cost of which is prohibitive for most IDPs. Even the hospital lab is unequipped to test for STDs and HIV and there are no STD drugs at the hospital, even for syphilis. The hospital can only guess at STD diagnoses by observation and symptoms and then treatment must be bought at the pharmacy or in the market.
The hospital doctor believes that the rate of STDs is high and
that HIV is steadily climbing. He believes the spread is due to
the forced movement of so many people around the country, as well
as the influx of refugees from the Democratic Republic of Congo.
He added that now movement is restricted but when the roads finally
open and people begin to move freely about, there will be an explosion
of STD and HIV transmission.
Sexual and Gender-Based Violence
MSF said that they had facilitated the relocation of one of the camps further outside of town for safety reasons. Usually camp residents are very reluctant to move - especially to a remote area - but in this instance they welcomed the relocation. It was discovered that there was a military base very near the camp and that many IDPs had complained of harassment by the military. This is expected to be the reason for the IDPs' eagerness to relocate to an even more remote area further from town and necessary services.
