In Angola, health does not follow wealth

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It's a beautiful new hospital, gleaming and modern, befitting the wealth of the oil-rich nation of Angola.

Its rooms are furnished with X-ray machines, gurneys, chairs and pharmacy shelves. The signboards are up. The parking lots are ready. The grounds are immaculately landscaped with flowers and plants.

Yet the 125-bed hospital in the provincial town of Matala has sat idle since it was finished by Chinese construction workers late last year. It lacks an electricity connection. It lacks a road to the front door. And most importantly, it lacks staff. Of the 248 staff that the hospital needs, only 44 are available - and they would have to be pulled from existing health posts, leaving clinics elsewhere stretched even thinner than before.

"I don't believe it will be possible to run the hospital with our available staff," admits Daniel Cambungula, the district health director. "I'm very concerned with the situation. It's a brand new hospital and we need to staff it properly."

This, in a nutshell, is Angola's dilemma: plenty of money and not enough health care; magnificent new buildings, but no doctors to fill them. Like many other developing nations, it has discovered that oil wealth is not the solution to its problems.

The figures are stark. Angola's economy is booming, with annual growth of more than 7 per cent since 2004, and has almost the same proportion of its population in the middle class as China. The government's annual budget of $35-billion (U.S.) is one of the biggest in southern Africa. Yet this hasn't translated into good health. The average Angolan can expect to live only to the age of 42, one of the worst life expectancies in the world.

Angola's child mortality rate is among the highest in Africa, with children still dying from preventable causes like measles, tetanus and cholera. It is the only country in the world where cases of urban polio are still recorded. Angola's child survival rate is as bad as that of Sierra Leone, even though its average income is eight times higher. Two-thirds of its rural population has no access to safe drinking water. And the income gap between rich and poor is among the worst in the world.

Much of this is due to the devastating wars in Angola over the past four decades, beginning with a 14-year war of independence, and then a civil war that raged on for 27 years after independence in 1975.

Since the end of the war, Angola has become a massive producer of oil, rivalling Nigeria as the biggest producer in Africa. This has generated billions of dollars in revenue, not just from oil sales but also from multibillion-dollar loans. China has gained access to Angola's oil wealth by lending $8-billion for new roads, railways and hospitals, built largely by China's own companies.

The Chinese-built hospitals - including the empty one in Matala - are impressive showcases for the new Angola. But some health experts are calling them "white elephants": unnecessary and costly. Instead of showcase projects, the country desperately needs to solve its shortage of doctors, nurses, midwives and other health professionals.

The district around Matala has a population of 230,000, yet it has only a single doctor - a Russian physician named Aydar Nuretdinov who volunteered to serve in Angola because he had always dreamed of working in Africa. He has been in Angola for three years, but he isn't sure how much longer he will stay.

In the main clinic in the provincial capital, Lubango, there are no Angolan doctors either. Instead the city is dependent on Cuban doctors who are assigned to Angola under a contract between the two countries.

At the health clinic in Lubango, officials say the Cuban doctors are not a good solution. They leave the clinic at 12:30 p.m. every day, after less than five hours of work. They lack specialized training in malaria and HIV/AIDS, which are much more common in Angola than in Cuba. And their two-year contracts give them hardly enough time to understand Angola's health conditions before they are on their way back home.

But if not for the Cubans, there would be scarcely any doctors in the entire country. Angola currently has 650 Cuban physicians, with hundreds more on the way.

Eight of the Cuban doctors will be assigned to Matala, a two-hour drive from Lubango. The main health clinic in Matala is badly overcrowded. Patients and nurses bump into each other in the small rooms, with little privacy for anyone. The patients begin arriving every day at dawn, waiting hours for a chance to be seen. "You can see the queues," said Birgitta Long, a Finnish doctor who volunteers at the clinic for three months every year. "We are very overloaded."

The new hospital is "a lovely building," she says. "The Chinese built the hospital in a year, but it will take five or 10 years to train people to work there."

Angola's Health Minister, Jose Van Dunem, says the country lost 70 per cent of its public infrastructure during the wars of the past few decades. "Destroying is easier than rebuilding," he said.

The shortage of doctors and nurses is "enormous," he acknowledged. But he said the country is rapidly expanding its health training at universities and private schools, and is sending 100 students to Cuba every year to study medicine.

There are some signs of progress. Angola's rate of child malnutrition has been cut in half in the past decade, and child mortality seems to be improving.

The United Nations Children's Fund, Unicef, is urging the Angolan government to double its spending on health care. It is helping Angola to expand its immunization campaign and distribute millions of mosquito nets to fight malaria, the biggest killer in the country.

"We have a tremendous window of opportunity for children to benefit from the oil dividend," said Koen Vanormelingen, the chief representative of Unicef in Angola. "If we do things right, we could have a real success story in Angola over the next 10 years."