Zambia: Fighting AIDS and cholera

Zambia has one of the worst rates of HIV infection in the world: more than 20 percent of adults are estimated to be HIV-positive. MSF also responds to other emergencies in the country, such as a recent outbreak of cholera. In October 2003, MSF handed over responsibility for a health project in the Maheba refugee camp to local authorities after the majority of the camp's Angolan refugees had returned to their own country. AIDS care Since 2002, MSF has worked to provide comprehensive care to those living with HIV/AIDS in the Nchelenge district of Luapula Province in northeastern Zambia. One in four people is estimated to be infected with HIV in Nchelenge, and many have minimal access to medical care. In addition to education and prevention, decentralized voluntary counseling and testing, care and treatment of opportunistic infections, MSF began treatment with life-extending antiretroviral medications (ARVs) in February 2004. MSF also carries out operational research in Zambia, documenting the success of comprehensive HIV/AIDS care in poor, rural settings. By May 2004, 48 patients were receiving ARVs, and MSF staff were already seeing an improvement in the patients' health. MSF hopes to have 400 patients on ARVs in Zambia by the end of 2005. Fighting cholera outbreaks Cholera is endemic in Zambia, and outbreaks are common during the rainy season which lasts from October to April. In January 2004, MSF responded to an outbreak of cholera in the capital city of Lusaka. The disease first appeared in Kanyama, one of the city's slums. In collaboration with the Ministry of Health and the World Health Organization, MSF helped establish seven cholera treatment units and train local staff. The MSF team focused on two of the cholera treatment units located in Matero and Chawama, installing latrines and showers, conducting education and sanitation activities in nearby neighborhoods and providing direct patient care. During the epidemic, MSF worked closely with the district health management team of Lusaka. When MSF identified possible sources of contamination, such as a textile factory north of Lusaka, the factory was closed down temporarily as part of the fight against the spread of the disease. Halting a cholera epidemic in an open area such as Lusaka is very difficult, due to the many possible sources of water contamination. (In Lusaka, there are 2,500 possible water contamination points.) Before the end of the epidemic, nearly 6,500 cases of cholera had been registered and 205 people had died. Despite the challenges, the MSF team and their local partners fought to save lives and prevent the disease's spread until the epidemic began to decline with the end of the rainy season. MSF handed the project over to the local authorities in April 2004. Handing over the refugee project Following the recent peace in Angola starting in April 2002, thousands of displaced Angolans began to return home from neighboring countries, including Zambia. MSF began working in Maheba refugee camp in Zambia in 1999, when Angolan refugees fleeing the civil conflict nearly doubled the size of the camp to more than 50,000. MSF oversaw the provision of water in Maheba camp, and provided support to medical clinics in it. The MSF team also assisted the United Nations High Commissioner for Refugees' (UNHCR) official return program by providing medical screening of returnees. In October 2003, MSF handed the project over to the Zambian Ministry of Health.