first person

The NHS has much to learn from Angola, incredible though it may seem, writes Amanda Pritchard

It may seem extraordinary to think the NHS could learn anything from a country like Angola, where for every dollar spent on social sectors such as health and education, $93 are spent on defence and security. But we can and we should. It is precisely because of this situation that the Angolans and their international partners have had to find new ways to provide healthcare, and it is why they have so much to teach us.

I have just returned from Angola, where I spent the three-month elective part of the NHS management training scheme. This allowed me to explore what healthcare means at its most basic level. It also taught me that inspiration can come from the most unlikely places.

The underlying unrest in the country between the MPLA government and UNITA rebels has recently spiralled into a state of civil war. Even before this there were already an estimated 8-10 million landmines in the country - and up to 70,000 amputees. But these are not the mines' only victims. In Angola's war, it is people's homes and villages that become battlefields in a conflict fought without boundaries. The mines left behind cut off whole communities from access to clean water, to fields, to markets and towns.

In a hospital in Saurimo, in north-east Angola, I saw a man lying on the wooden trestle that served as the emergency room bed, having a gunshot wound in his head cleaned. His breathing was violent and noisy and the blood coming from his leg wounds seemed unstoppable.

The best example I saw of the Angolans' imaginative approach to maintaining a health service was in the north-east, where the charity HMD Response International is working with local people to provide an integrated programme of curative and preventive healthcare in its widest sense. The project combines mine clearance and mines awareness with the rehabilitation of a local hospital and the establishment of a primary care service. The value of this type of approach is now being acknowledged in Britain, where The New NHS white paper and the green paper Our Healthier Nation have recognised that it is impossible to improve people's health without addressing the broad spectrum of factors that affect it.

In its first year, the programme has trained and equipped 23 Angolans as mine clearers, more than 20 as skilled manual workers and another six as paramedics. By next year, this number should have more than doubled. The importance of this was illustrated when local government authorities asked for help with a newly formed camp for people who had been displaced from their homes. People in the camp were thought to be suffering serious health problems, and reports of unexploded munitions around the camp also required urgent attention.

The team was able to respond quickly and effectively by sending in paramedics and mine clearers to assess the situation and work out what services were needed. The paramedics can accompany the mine clearance team to villages, where they establish clinics. These provide treatment and health promotion advice, and are the base from which surveys of health need can be conducted.

The mine clearers can gather information about the location of mines from those who attend the clinics. I was enormously impressed with what I saw. I met people of vision, commitment and determination who were not prepared to let three decades of conflict destroy their communities. I encountered partnerships between the international aid community and local people which were based on a willingness to be creative and take risks because the potential benefit to the population was worth it. And I realised that, even with all its advantages, our NHS can still learn from somewhere like Angola.