Luanda Sanatorium Hospital, which has a reputation as being Angola's leading tuberculosis (TB) treatment centre, should be a place of relief and recovery for patients with the disease in the capital, Luanda. But with a lack of protective materials for healthcare workers and crumbling infrastructure, the hospital has become a dangerous breeding ground for TB, infecting both staff and patients.

A survey of 119 of the 400 workers at the healthcare facility found that 70 percent of them were infected by Mycobacterium TB, the bacterium that causes the disease. One in three of these workers will develop active TB and become infectious. "We have workers [that are] infected and sick," the hospital's clinical director, Afonso Wete, admitted.

The survey participants also agreed to be tested for the HI virus. "It's clear that there are some cases of HIV, which are being followed up and put on medication," he told IRIN/PlusNews.

When someone's immune system becomes compromised, for instance by HIV, people infected with TB bacteria are likely to develop an active form of the disease or be more susceptible to infection. TB is a leading cause of death among people who are HIV-positive.

Precarious conditions

Twenty-seven years of civil war led to the almost complete destruction of services and infrastructure in Angola. When hostilities ended in 2002, the country experienced rapid growth, mainly in the oil sector, where exports have grown by 90 percent. Despite one of the highest growth rates in Africa, many of its services and much of its infrastructure are still in poor shape.

The precarious conditions at the Luanda Sanatorium Hospital, now 40 years old, were a primary cause of the vicious cycle of TB infection. The overcrowded hospital, with dilapidated walls and cracked floors, has never been renovated.

The sewage system and basic hygiene measures practically do not exist. "There's a lot of contact between patients and workers," Wete said. "Even those working in administration are affected because they are in permanent contact with the patients."

Poor bio-safety was another aggravating factor, as healthcare workers had limited access to disposable gloves, masks and other materials. Recent studies have shown that more than 16 percent of hospital infections in Angola were caused by unhygienic conditions.

Ana Joana, who has been working at the Luanda Sanatorium Hospital for 18 years, is one of the staff members with TB. She takes care of the hygiene needs of patients, principally those who are most debilitated.

"I give them a bath, feed them when they can't feed themselves, wash their clothes; and I do all of this without a mask or gloves to protect myself," she said.

Joana's family has also been tested for TB and four of her grandchildren have the disease. "We are infected with tuberculosis, and the cause of contagion was right here," she said.

Roberto Brant Campos, a partnership and social mobilisation consultant for UNAIDS, said another obstacle was the absence of coordinated action to address the two epidemics. "There are also few measures taken for both TB and HIV at the same time."

Wete acknowledged that the situation was alarming. "If urgent measures aren't taken, workers run the risk of catching the disease."

The rates of TB co-infection with HIV at the hospital are about 29 percent among interned patients and 17 percent among ambulatory patients. Campos pointed out that there were few data available on the co-infection of HIV and TB in Angola.

To make matters worse, discrimination in Angolan society made it difficult for people to step forward and be tested for TB. "As a culture here, people tend not to go to the hospital; they stay in churches, they go to traditional healers," Wete said.

"People with TB are not diagnosed in time. When they get to the hospital they are already at an advanced stage of the disease, and that's why the mortality rate is extremely high."