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The Republic
of Guinea Bissau in West Africa is one of the world’s poorest
countries. Bordering Senegal and Guinea, its coastline faces the
Atlantic Ocean. The country’s troubled history dates from
Portuguese conquest in the 15th century to recent military unrest
in 2010. Although Portuguese remains the official language of the
republic, founded in 1973, only 14 percent of the population can
speak or understand it. Slightly less than half of the population
speaks Kriol, a Portuguese creole tongue, and the rest speak
indigenous languages. Given its position near the equator, the
temperature of Guinea Bissau remains warm year-round, with a rainy
season from June to October. The country is largely flat savannah,
with mangrove swamps along the coastline.
Given its extreme poverty and limited development, it is no
surprise that life expectancy in Guinea-Bissau is very low; 47
years for males and 51 for females. Although lower than the
regional average, Guinea-Bissau’s burden of communicable disease
is very high by global standards. HIV infects 25 of every 1,000
adults and tuberculosis affects 305 of every 100,000 people.
Guinea Bissau’s annual health expenditure per capita is only USD35
per person, which is less than one fourth of the already low
African regional average spend. This figure represents 6.1 percent
of GDP, which is USD520 per capita. Reliable National Health
Accounts (NHA) data are not available from the WHO, but health
care funding is heavily dependent of overseas aid and out of
pocket spending, with few options for local health insurance.
There is also serious inequity in the provision of care, with poor
rural Bissau-Guineans having much more limited access to health
care services.
Guinea-Bissau’s health care workforce is shockingly understaffed,
with only 5 doctors and 55 nurses and midwives for every 100,000
inhabitants. As with several health indicators in the country,
these represent fractions of the already low African norm.
Bissau-Guinean utilisation of antenatal, birth and infant health
services is also substandard. Only 39 percent of births are
attended by skilled health care personnel. Thanks to concerted
efforts of various international health organisations and the
Ministry of Health, 76 percent of one year olds have received
measles immunisation, but this figure is still quite low by global
standards.
Investment in public health measures is also limited; only about
60 percent of Bissau-Guineans have access to improved drinking
water sources, and less than half of rural residents can access
clean water, although there has been a ten percentage point
improvement over the past two decades. Access to sanitation
facilities is also extremely weak. Fewer than 10 percent of rural
Bissau-Guineans have access to any kind of improved facilities,
massively increasing risks to public health in these areas. Even
in urban areas, less than half of residents have access to
improved sanitation facilities, and only a very small fraction of
these would resemble modern amenities. Poor sanitation has led to
a series of major cholera outbreaks in Guinea-Bissau, most
recently in 2008 when over 100 fatal cases were reported. The
outbreak was exacerbated by lack of access to health care in rural
areas, which were disproportionately affected.
In response, the WHO’s Country Cooperation Strategy (CCS) Brief
2009 – 13 has prioritised investment in public health with
programmes designed to support interagency cooperation in disease
prevention and amelioration. The WHO Country Office in Bissau has
divided into three teams: technical support; policies and systems;
and WHO presence. Each of these collaborates with other aid
agencies and local partners to improve the provision of health
care in Guinea-Bissau.
Guinea-Bissau is rarely considered a tourist destination, but for
adventurous travellers, the US Center for Disease Control has
drafted guidelines for prospective visitors. The CDC strongly
encourages a visit to a health care clinic or physician
specialising in travel medicine within four to six weeks before
departure. It is important to ensure that routine immunisations
are up to date. Hepatitis A & B, typhoid and polio jabs should be
updated if needed. Yellow fever vaccination is recommended for all
travellers over 9 months old, and is required for travellers from
countries where yellow fever is prevalent. Meningitis and rabies
shots should be considered, depending on the season and itinerary.
As in most tropical environments, malaria is a major health risk.
Insect repellent, long sleeved clothing and mosquito bed nets are
advised. Prophylactic doses of anti-malarial drugs should also be
considered. Atovaquone, proguanil, doxycycline and mefloquine are
usually prescribed and should be procured before making a trip to
ensure safety of supply. Note that chloroquine is not effective
against malaria in Guinea-Bissau. Other insect borne diseases such
as dengue, river blindness and African sleeping sickness are all
common to the region. Lassa virus, spread through inhaling vapours
emanating from rat urine or faeces, is also a health risk.
Inhabitants of traditional dwellings are particularly at risk.
Bissau-Guinean health care resources are universally poor and
substandard, and extra precautions should be made before making a
trip. Given that there is no local private health insurance,
arrangements must be made before travel. Given the lack of care
options, expensive emergency evacuation by air will be required
for situations requiring serious medical attention; to prepare for
this possibility, insurance and other arrangements must be planned
in advance.
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