I am now into my third month living in Angola. After these 2 months, I have settled into a routine that is becoming comfortable. Every day there is something new or different I may not have anticipated.
My job as the DOS (State Department) Health Practitioner is fluid. I had been concerned that I would find myself with little to do as there are not that many American government personnel with families here compared to other posts and most of them are healthy. Additionally, I am only to provide occupational health to the local staff. So far, although I do not see many ill people, there always seems to be someone stopping by for an issue or advice. The local staff consults with me regularly as they are unsure about the care they receive from the local clinics. Unfortunately, I cannot treat them but only provide advice. As I am running a small health clinic, I am responsible for the day to day operations including managing resources such as a small pharmacy, emergency equipment, medical records, review of the local staffs’ medical bills (we are self insured at this point) etc. The State Department also has much paperwork to keep updated and I must continually assess the local health conditions here.
The S. African nurse who has been the provider here for 7 years left for an extended vacation (6 weeks) 2 weeks after I arrived. As many people were also away for the holidays, it was a good time to take inventory of the operations. I managed quite well with the local staff despite my limited Portuguese (for those few who do not speak any English). They were quite suspicious of me as I was American and the local physician who had provided care to them was terminated. As I had mentioned before, there had been concerns of competence and ethics. She had provided care for them due to the lack of decent facilities for care. Now, there has been some improvement in the local facilities and the US government wanted to be out of the business for providing primary care for the local staff. During my time here, I feel I have made headway into their acceptance as they continue to request consultation with me. I have the luxury of spending time with them educating them about their condition. This is not a typical situation here and they seem to appreciate it.
In addition to providing care, I provide other types of programs such as health promotion classes as well as CPR and first aid. I sit on committees and may become involved in programs that are run by DOS, US AID and CDC. But first, I have the day to day operations to get under control.
As part of my training, I traveled to the American Embassy in Pretoria (S. Africa) to meet and be better acquainted with the Medevac Center there. When there is a medical condition that cannot be handled locally, DOS sends employees to another city with US type facilities or back to the US. My center is Pretoria which has top notch care. The health unit in Pretoria arranges and follows up with each person after treatment. It is well staffed by the Regional DOS MD along with a health practitioner and staff to make all arrangements. Coincidentally, I had to arrange a medevac of one of my patients at the same time I visited Pretoria, completing my experience. While there, I received helpful guidance and a nice visit with the RMO (regional medical officer) and RMO/P (Regional Medical Officer-Psychiatrist). They visit each health unit in their region 1-2 times per year as well as see patients in Pretoria and provide guidance from afar when needed.
Returning to S. Africa after many years was a pleasure; such a contrast from the rest of Africa. As soon as you arrive, you feel you have landed in Europe or the US; pristine landscape, homes and roads. As my previous trip occurred during apartheid, it was quite interesting to see the changes that have occurred since the dissolution. I saw a seemingly integrated black middle and upper class that was not present in the past. Yet, the poverty along with the cultural divide still exists and I know there must be the tension among the races. While there, I was treated to shopping and tasty meals all at reasonable prices (In contrast to Luanda) as well as a day in local animal reserves.
Yet despite the appearance, fear reigns in the country due to increasing very violent attacks. People are very cautious about where and when they travel and live behind high walls with electric fences. As is said about the difference between crime in S. Africa and Luanda—where in Luanda they will just try to rob you, in S. Africa they will rob, torture and then kill you. So, the Americans in Pretoria live in lovely homes in small protected compounds and lock themselves at night into their upstairs “cages”.
The second part of my training took me to Addis Ababa in Ethiopia to meet with another nurse practitioner who agreed to be my mentor. Glenda has spent many of her years as a health practitioner in Africa and provided needed direction and reassurance in operating the health unit. Like S. Africa, the embassy here is larger and busier. Life in Addis is a bit better for the staff than in Angola but there is always something that can cause issues for people. The city is situated at about 10.000 feet elevation which creates its own health concerns and adjustments. I found that while there are not as many cars, the old busses spew so much pollution into the along with residents burning garbage that a thick polluted haze settles over the city. Internet is not available in the homes yet and the speed in the embassy is quite slow. And much poverty exists.
I was content to return to Luanda after the trips. I have made friends among the staff both American and local and find myself with something to do most of the time. There are dinners or gatherings regularly. I do not go out to eat to restaurants due to the cost and proximity. In the future I may as I become more aware of the various places to go. At this point, I am ok, like at home, just to get together for dinner at someone’s home. I have been more successful in finding food-especially meat that is tasty enough. The wine is decent and affordable unlike other aspects of living here.
Additionally, I have had opportunities to travel outside the city. Once you leave Luanda, there are beautiful untouched and sparsely populated beaches where you can camp. Last weekend, I went south with the Ambassador and other embassy staff along with 2 US government turtle conservationist to assess the sea turtle population here. We monitored and witnessed sea turtles depositing their eggs at night. We stayed at a remote lodge which allowed for restful observations of sea and bird life nearby. There is a nature group here that has regular presentations and field trips which provides various opportunities to learn about the nature and political life in Angola, I have also traveled north and east on trips to view large waterfalls, mountains, and areas where the oil is seeping from the rocks and ground. This is a very beautiful and potentially bountiful country if the government and the people can recover from 30+ years of war.
I started driving the Land Rover I bought at the end of December. It was easier to learn to drive initially during the holidays when the traffic wasn’t so intense. The driving itself in what I describe as the “wild west” with the aggressive drivers isn’t as much of an issue as much as the stress trying to dodge pedestrians and weaving motor bikes around traffic. I worry I will hit someone I won’t see as they randomly appear without paying attention to the traffic. I have had opportunities to drive out of the city in some poor or no roads with large pot holes. Interesting experience for sure.
I have been able to keep up my regular exercise with almost daily walking on the Marginal--on the Bay of Luanda. While I have not kept up with my speed and long distances, I have been consistent. I recently started a Sunday bike ride with a group from the Embassy, borrowing a bike. It has been nice to bike, but, do find it challenging with the potholes and the traffic even on Sunday mornings at 6:30 am. I look forward to having my bike delivered sometime in the next few months--it is somewhere on its way.
