Where in the world is Julie?: Angola Visit 1, January 2008

I spent the last half of January in Luanda, the capital city of Angola, doing preliminary work for a survey that I conducted during the month of March.

The objective of the survey was to find out what the actual burden of malaria is in Luanda. According to clinicians and lab logs, there is tons of malaria - I'll elaborate later. If you look at the mosquitoes caught during routine surveillance, hardly any of the mosquitoes that transmit malaria were found in Luanda. There was also data from a population-level survey that showed a very low percent of healthy children in Luanda (5.5%) had parasites in their blood, compared to about 30% in some of the rural parts of the country. (In contrast, in some places with high malaria transmission, more than 80% of healthy people have malaria parasites in their blood at any given time - they just build a sort of semi-immunity to them so they can tolerate more parasites without being sick from them.) Anyway, so there was a mystery to be solved.

Angola is one of the President's Malaria Initiative countries, and there are two resident advisors for PMI there - one for USAID (Francisco, from Mozambique) and one for CDC (Jules, from Rwanda). Both of them are absolutely terrific to work with and I was pretty much dependent on them, since they know both the language (Portuguese) and the political landscape.

I spent most of my two weeks with Jules, presenting the protocol to the USAID mission director, the CDC chief of party, the National Malaria Control Program, and the Provincial Health Department, and collecting necessary information to finish planning the survey. We spent a lot of time with Dr. Alexandra, the malaria coordinator for the Provincial Health Department reviewing the protocol, talking about how to do it, and visiting health centers to pilot our questionnaire, observe, and get information. Here is a picture of Dr. Alexandra interviewing a mother to test out our questionnaire.

I wanted to share a few things that strike me about Luanda as it's unlike anywhere I've ever been in Africa. First, a little background: in 2002, Angola finally signed peace accords after a bloody 29 year civil war, financed by oil and diamonds. As soon as the war was over, money and expats flooded into Luanda, which now has a population of 5.7 million who fled here for safety during the war, packed into a fairly small city. Demand for space, hotel rooms, homes, and commodities far outstrips supply, and prices rose astronomically - Luanda is ranked the most expensive city in the world. I reserved a hotel room 2 months in advance, it was the only hotel that still had rooms for the time I was there (there were a few days there were no rooms in any hotel and I stayed with Jules and his family), and it was $330 per night for a fairly ordinary hotel. Some people are rolling in it, many others are just surviving, with little middle class. It is a city of unbelievable contrasts. Angola is a country under reconstruction, mostly by the Chinese (they trade road building for oil), and there is construction EVERYWHERE! oh.... and the traffic is absolutely unbelievable -- some days, it takes Jules 2 hours to drive the less than 1 mile home during "rush" hour.

Everywhere you look, there are giant cranes, and office buildings (mostly banks and oil companies) and luxury apartment buildings and hotels going up.

From some places, such as the balcony of Jules' house, the city looks beautiful. Just to put it into perspective, a nice western style house such as the one the Embassy provides him, costs $12,000-18,000 per month to rent, and rent is due in advance for a year!

There are nice beach clubs where those that have resources can come and relax on the weekend (just don't try to order anything more than a Coke!)

Oh yes, and the traffic.....

Another interesting aspect is the local economy - in a once communist country, everywhere you look, people are selling something. The bad traffic lends itself to, and is sometimes caused by, men, women, and children (called zungeiras) walking up and down the streets between vehicles selling everything imaginable - phone chargers, car parts, clothes... I once saw someone selling a kitchen sink. This young man appears to specialize in bright colored wash cloths.

Soft drinks are relatively less expensive (compared to clothes and housing) than in most of Africa. This young man is a "vending machine" - ice cold soft drinks in a sturdy plastic bag, umbrella for shade, tire to sit on, and you're golden. These guys are everywhere!

This is Jules and his family - he has a lovely wife and three beautiful daughters, who are fluent in 5 languages - since I stayed with them for awhile, I got to know them fairly well. The last day I was there, we went to the old Portuguese fort overlooking the bay, which is now sort of a museum of military history.