Life as a Social Outcast - Part 2 of 4 - Angola

Below is the story of a 17 year-old fistula patient at the Clinica CEML. She was quite open about her experiences and very appreciative of the opportunity to share her story with me. Please keep in mind that she is one of many fistula patients currently at CEML. Her story, while unique, is a representation of the lives of many women struggling with fistulas. She has allowed me to share her story with friends and family, but photos and names have been removed,

I have combined her responses to my questions into a story, as opposed to a back-and-forth dialogue. This interview conversation was in Portuguese, and I have translated it into English.

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Her Story:

I am 17 years old and was born on December 1, 1993. I used to live in a small town called Chitembo with my parents and three siblings. My parents do not work. My father has four children, while my mother only has three children. When I was younger, our family moved to Cavango, where we have been living ever since.

In 2008, at the age of fifteen, I became pregnant with my first child. My husband was two years older than me and fathered my baby. After nine months, I started having pains in my body. I remained at home for two days, hoping for the pain to go away. This was in early 2009. As the pain continued by the second day, I was taken to a hospital in Quito. There, I learned the news that my baby had already passed away.

At the clinic I was cut down below to make room for the baby to come out. But the cut was never closed. When my husband found out that my baby had died and I had a fistula – urine was constantly seeping out – he left me. I had a husband. But he didn’t want me anymore. So he left me. I do not speak to him anymore.

My illness began in 2009. I remained in Quito for some time before returning to Cavango. After a while, a family friend suggested I visit Dr. Steve [Foster] when he was visiting in Cavango. My friend had already had a successful operation and her family told me to come here with the same kind of illness.

I decided to go to the Cavango clinic with my father in April 2009. I had my first operation in Lubango with Dr. Steve in October 2009. A second operation happened in late October 2009 because the first operation did not close up the fistula properly. That was my second operation. I had a third fistula repair operation in March 2010. This too did not successfully repair my fistula. A fourth operation happened on June 17, 2010. Following my recent operation this month, I will have my catheter removed and will do a post-operative exam in July. I hope all will be properly repaired.

For the past eight months, I have been living in the patient’s village with my father. [Note: Several other women have expressed concern with her father’s excessive drinking in the patient’s village]. The classes that have been organized by CEML have been very good. I feel great. I really like these classes because I can learn a lot. I want to learn here. I am learning everything here – math, writing and reading. I also like to sew a lot. I have made my own purse, which I use to carry my hospital card and documents.

When I finish with my treatment at the clinic, I want to study math, science and Portuguese. I do not want a husband. I do not want any babies. I will continue to study so that I can be a nurse when I grow up.

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The next part of this series will be another story as another example of another woman who has come to CEML for a fistula repair operation.

Life as a Social Outcast - Part 1 of 4 - Angola

The following details and information about obstetric fistulas are based on an interview with Dr. Stephen Foster, medical and general director of the Clinica Centro Evangelico de Medicina do Lubango (CEML) in Lubango, Angola. Dr. Foster was born in Brantford, Ontario, but spent most of his childhood living in Zambia, where his father Robert Foster, MD, worked as a missionary surgeon. He completed his medical school at McMaster University in Hamilton, Ontario and later completed his general surgical training through the University of Toronto’s Gallie Course. He returned back to Angola over 30 years ago, where he has been serving as a surgeon at his CEML clinic and numerous other hospitals. Earlier this year, Dr. Foster received one of North America’s highest honours in the medical field, the 2010 Royal College Teasdale-Corti Humanitarian Award.

What is a fistula?
A fistula is an abnormal communication between normal structures. The bladder, vagina, urethra and rectum are all normal structures in the body. When there is an abnormal communication between any of these normal structures, this can lead to urinary incontinence or an inability to control the release of stool. A fistula is just a technical term for an “abnormal connection” in the body.

What are the most common causes of obstetric fistulas?
Usually the most common cause of an obstetric fistula is a prolonged labour period for women. Most women do not have frequent medical consultations during pregnancies. Women tend to experience pain, particularly during the process of birth.
During labour, forceful uterine contractions or the pressure of a baby’s head against soft tissues can lead to obstetric fistulas in women. Adolescent pregnancies also tend to increase the risk of fistulas. Pregnant girls between the ages of thirteen and eighteen do not have fully developed female reproductive organs.

How widespread is this issue?
Some sources suggest that there are about two million women in sub-Saharan Africa that live with fistulas. Hundreds of women in Angola suffer from obstetric fistulas. For every woman who presents with a fistula during medical consultations, there are many more women suffering from the same problem. These women are sometimes in the rural areas of Angola, far from clinics, medical posts and other health care facilities.

Presence of fistulas outside of sub-Saharan Africa
In North America and Europe, a fistula is usually a complication of an obstetric misadventure, which can include challenges with Caesarean sections and tearing. Most of the fistulas in this region are caused by lack of proper attention during the birthing process. Globally, it is estimated that 50,000 to 100,000 women are diagnosed with an obstetric fistula annually. This problem affects women of all ages – young and old. However, in North America and Europe, these situations are quite rare.

Women and their communities
Women are usually considered to be outcasts when they have fistulas. In sub-Saharan Africa, including here in Angola, cultural habits result in families marrying off girls at very young ages.

The use of “traditional and bush medicine” to “treat” women
The use of herbal medicines usually results in extended uterine contractions in women. Sometimes this “treatment” works like a charm. But more times than not, this can destroy the uterus.

Cost of Fistula Repairs
For the year beginning July 2010, the Fistula Foundation has provided CEML with a grant that covers 100% of each fistula patient’s operation and associated expenses – travel, lodging in the patient’s village, a weekly food stipend and treatment at the clinic. At present, the total cost for each fistula patient at CEML is about USD $1100.

Fistula Repairs at CEML
It is possible to prevent fistulas. Adolescent girls, and all pregnant women for that matter, should have medical consultations in order to make sure pregnancies move along smoothly. This can avoid surprises during labour periods. 90% of women who have fistulas have a possibility of having simple surgeries to repair the fistulas. These fistulas can be repaired. When he first started, Dr. Foster had about a 50% success rate on a woman’s first repair operation. After having done over four hundred fistula repairs in Angola, his success rate has significantly increased. For some of the patients, the 10% of women requiring more complicated surgeries, Dr. Foster has not been willing to call it quits on them, believing he should try and try again.

From July 2009 to the end of June 2010, CEML has done about 80 fistula repair operations. The recent grant from the Fistula Foundation will fund about 100 more fistula repairs between July 2010 and July 2011.

CEML has only hit the tip of the iceberg. Awareness about the work at CEML is spreading through Angola, and more and more women are finding their way to the clinic for proper treatment.

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Photo credit: Seth Cochran, Founder at OperationOF

The next part of this series will focus on the story of a 17 year-old fistula patient at CEML.

Life as a Social Outcast: The Story of Vesico-Vaginal Fistula Girls

Over the past fourteen days, I have seen over twenty women that share the same problem – vesico-vaginal fistulas (VVF). Each woman not only shares the same medical diagnosis, corrected by an operative procedure, but also the challenges of exclusion and abandonment by families and communities.

When I last traveled to Angola from January to March 2009, the number of VVF cases was particularly astounding. Women of all ages and social classes traveled from across Angola to receive operative treatment for their urinary problems.

The issue was one that I was aware of and had learned about a great deal. However, I never thought of sharing the story of a VVF patient. This time around, while I am back in Lubango, Angola for two months, I have decided to share this story. I have been back for less than two weeks and I have already seen pre-operative consultations, VVF operations, post-operative check-ups and recovery patients. This is a story that needs to be told.

Over the next two weeks, I plan to share this story in a four-part interview series. The first part of this series about vesico-vaginal fistulas will be an interview with Dr. Stephen Foster, a medical doctor and surgeon based in Lubango, Angola to introduce the issue, the extent of its spread across Angola and its impact on lives. The second and third parts of this series will explore the lives of women affected by VVFs and discuss personal issues and societal challenges faced. The final part of this series will take a look at the work of two volunteer workers – a primary school teacher and a labour and delivery nurse and their tireless efforts to help these VVF women integrate back into society.

Journey to Khorog - April 11, 2009

So it's been about three days since I arrived safely into Khorog and the journey has definitely been quite the adventure...

As soon as I got to the bus station, a few people came to take my bags onto a small taxi - an 11-seater mini-bus... not a jeep or heavy-duty LandCruiser – as I’d been advised to take. Things happened really quickly, and the bus seemed to be the only vehicle traveling to Khorog - so I let it happen. Although worried, I decided to stay focused, be strong and go along with it. There were 10 people in the bus, including the driver - all Ismailis from the Gorno-Badakhshan Autonomous Oblast (GBAO) region. I paid the 180 Somoni fare and took my seat in the first row directly behind the driver, so I had a window seat to enjoy the beautiful scenery. Finally, when everyone was seated and the luggage had been piled onto the top of the bus (covered with a tarp with several small holes to prevent rain), the bus took off from the Dushanbe station by around 10:00am.

Most of the passengers did not speak much English beyond the basics like, "Are you alright?” so I stuck to what became two good companions - the window and Greg Mortenson's book *Three Cups of Tea*.

The roads were good, relatively speaking, they were paved and there weren't too many potholes and at least the dirt-pebble roads weren't full of large rocks.

I really had no idea what the big deal about mountains was... all I saw was lush green rolling hills – absolutely breath-taking – the grass as green as a golf course putting green – for miles into the distance. It was a magnificent view of small gently rolling hills... however, no mountains whatsoever anywhere in sight.

The sun was shining so I wasn't worried about my luggage on the roof getting a nice shower. And so we continued… on our way.

About two to two-and-a-half hours into the drive, the bus had started to head in a generally uphill direction towards what seemed like the top of a hill. At around 1:30pm, our bus stopped for lunch at a small walk-in "restaurant." By now, our driver had managed to finish at least half to three-quarters of his first pack of cigarettes. Thankfully, he left his window open when he smoked, thus allowing most of the smoke and smell to leave the bus.

I did not know what the restaurant’s menu was for lunch, but remembered being told that everyone usually eats soup and bread for meals. So I asked for that and thankfully, one of the passengers understood and assisted with my order. Tea comes with everything, and so I gladly drank up the weak-tasting (herbal, I think) tea to warm me up. The soup was the first dish to come... and I realized that other passengers had ordered dumplings or pilof (or pilau)….ah, well.
The soup had carrots, potatoes and beef pieces, and blotches of oil inside the soup mix. And it's not like there were 2-3 drops of oil... it was more like 10-12 drops of oil scattered through the small bowl. Ah…but, it tasted so good….I enjoyed the soup with the nice soft bread and warm tea. That was lunch, cost 6 Somoni.

Before the bus departed for its continuing journey, a couple of passengers toasted vodkas while the driver managed a couple of quick cigarettes… leaving behind two butts and lots of candy wrappers on the ground… soon, the wheels turned and the bus drove off.

We went through 5 or 6 checkpoints where the driver had to stop to show his documents. However, at around 2:30pm, the bus was pulled over and our driver taken away for questioning for about an hour. We sat and waited patiently. Upon his return, there were no explanations offered and no one asked… the journey continued. At 4:00pm, another checkpoint... another 30 minutes wasted… this time, someone in the bus explained the problem - "Driver no documents"… definitely not very comforting news! Even worse, the police officer climbed into the bus… which meant, a passenger had to move over to our seat – squeezing four of us onto a three-person seat.

At around 5:00pm, we arrived at the police station where we were all asked to disembark. Waiting in complete confusion, with no idea of what was going on, I stood for about 1.5 to 2 hours with the other passengers, waiting apparently for the document issue to be resolved. Finally, as the sun disappeared behind the houses across the street and my watch beeped 7:00pm, the driver called us over with keys in-hand – his documents had been prepared or something to that effect and he was able to drive us onwards.

Meanwhile, another car – a heavy duty 10-seater van – also on its way to Khorog had stopped to wait with us and help us out. Together, our two-van/bus envoy carried on towards Khorog. As the sun had now set, it started to get quite chilly... and the open window in front of me didn't help any. Yet, I’d rather suffer the cold than sit in a warm but smoky van.

This almost 2-hour wait was our second bit of excitement - the first had been a sudden 20-minute stop on the side of the road about 3 hours into the trip because a rubber rotator (no idea what it is) had snapped in the engine. At 9:00pm, we stopped for dinner at a small-house-cum-restaurant. For me, dinner was soup and bread again – except, this time there were spaghetti noodles in the soup instead of potatoes. Customarily, a weak black tea was served with the meal. This time, the same meal cost me 7 Somoni.

Continuing our journey to Khorog, we drove along the mountain edges. Now, the road started to get worse. Thankfully, the road was relatively wide - enough for two cars. I managed to catch a bit of rest for about 1.5 hours after dinner, resting my head on the headrest and keeping my legs on the small leg rest (the space was smaller/tighter than an airplane flight!). I woke up when we hit a bump in the road… looked out the window and saw fast-flowing rivers and streams about a foot deep. Somewhere along the night – at around 11:30pm - our minivan/minibus drove directly under a waterfall in the mountainside… I know it sounds exotic, but you’ll recall, our luggage was sitting on top of the bus – under a tarp filled with tiny holes… thankfully, my bags remained dry.

Around midnight, we arrived at a narrow pathway that had been closed off by an army truck for the night because it was not safe to cross in the middle of the night. So, there was no alternative but to rest – a tad difficult to do that when you are so tightly packed. At around 5am, the sun had started to come up and the other passengers started to awake. It was 6am by the time we were given the go-ahead to continue on the "12% uphill incline" (according to a sign). Here, the road was very, very narrow, just enough for one car. Visualize this – on one side, we had the rocks on the face of the mountain and on the other side, was a steep cliff dropping straight into the river that formed the border between Tajikistan and Afghanistan.

Although it was a breath-taking, beautiful view, I was 100% preoccupied with the perilous drive ahead. To move forward, we had to get around the trucks that had come from the other side… but the road was so narrow… one slight misjudgment and the bus could go tumbling into the river... passengers never to be seen again. To add to the confusion, it was impossible to reverse / turn back on this narrow and dangerous road. Our valiant driver slowly inched forward and past the trucks, creeping less than a foot away from the cliff edge… this was – by far – the most terrifying experience of the trip. If there was any time I thought I'd be saying my goodbyes, it would have been then. To add to my state of panic, I had just read in Greg Mortenson's book that ‘if there was anything he'd die from in Central Asia, it wouldn't be bombs or bullets... it would most certainly be the road’... or something to that effect. I could most definitely relate!

As our drive continued along this narrow roadway...we could see Afghanistan on the other side – a stellar view… the houses are made of mud, some built into the mountain sides, and the greenery is absolutely breath-taking. The green lush grass gives the impression that the land is very well irrigated through the region. At one point I saw a school of about 50 children sitting on the floor in white clothes with one teacher at the blackboard... in the outdoors. The sight reminded me of a friend working in the schools in Afghanistan, and I wondered where, amongst those rolling hills and mountains, they’d be…

Fast forward a bit...and the fabled snow-peaked mountains came within sight – now we were surrounded 360 degrees by the majestic mountains and the river – all in close proximity. This was our breakfast stop... sitting outside for tea and bread and yogourt. It really didn’t matter what I ate – the sight was all that important.

Off we were again, and I thought it would likely be another 2-3 hours only. Well, another adventure awaited us. A few kilometers ahead, we saw a small car pulled over on the side of the road and I learned that a rock had fallen off the mountain and hit the car... the rear window was completely shattered and broken glass lay everywhere! Plus, the car wasn't properly working either. So, we tied the car to the rear and gave it a tow. Every 30 minutes or so, the wires broke off and the cars stopped to reconnect. At around 5:00pm – after a journey of 31 hours – we finally arrived into Khorog.

As we entered Khorog, I saw the most beautiful sign ever etched into the mountains on the Tajik side. It said "Welcome Hazir Imam". On the Afghanistan side, another sign – "Golden Jubilee."

The view was priceless….indeed, I had arrived.

Stories Through Pictures

An Extraordinary Experience

Because of the dangers of fire, burns among children are quite frequent. 6 year-old Gabriel had a burn scar on his left elbow that substantially minimized his range of motion. And not too long post-operation...



...Gabriel had a huge smile because his range of motion had improved and he could go home!

8 year-old Samuel arrived at the clinic on his mother's back, unable to properly walk as a result of osteomyolytis which is an infection of the bone - a condition very common among children and adolescents. 7 weeks post-operation, Samuel has gone through a myriad of post-operative conditions - possibilities of infection, rapid recovery and bone regrowth. Although he comes in daily for dressing changes, he rarely ever complains about the pain.

The children that live in the sparse conditions of the patients' village while family members undergo treatment at the neighbouring clinic never seem upset. The tough lifestyle, small meals and tight living quarters do not appear on the face of the children, as they smile and laugh at every possible occassion.

Looking over the city of Lubango in the background; standing at the edge of the Cristo Rei statue on the mountain top. Children tend to hang out around the area because of visiting tourists. Clearly, Toronto Maple Leafs fans have visited Lubango and left their mark!

The view from the top of the mountain overlooking the city shows a stark contrast between the city slums and affluent homes (sometimes across the street from one another)! Local parks, state hospitals, government buildings and the new Lubango shopping mall are all clearly visible on a clear day when the view stretches all the way to the mountains on the horizon.

The absolutely jaw-dropping scenery from a mile high - the Leba Cliff. The road towards the port of Namibe winds down the side of the mountain. It is so easy to get lost in the lush green hills under the bright blue sky with scattered white clouds.

On the way to the port of Namibe, almost every type of terrain imaginable is crossed... including a desert area! The rocks in the background have been "etched" by wind storms gushing through the area.

And there it is... the South Atlantic Ocean on the coast of Angola! Waves reached up to 6-feet high at times and came crashing against my back.

The breathtaking sunset from the hospital lasts about 120 seconds while the sun fully disappears behind the distant mountains!

This is a self-explanatory photo taken on the Kalukembe Airstrip. My three-month volunteer placement in Angola has come to an end, and I can definitely say it was an exceptional experience.

Angola - What is Lubango all about?

Arriving in Lubango

Landing in Lubango was a completely different experience from Luanda.
For one, arriving at a new destination in the wee hours of the morning can be slightly intimidating – and so it was for me when I touched down at Luanda airport. My arrival in Lubango during the day allowed me to adjust, more readily, to my new surroundings. Also, my sense of curiosity and anxiety is now replaced with a keen sense of adventure.

Instead of the concrete and bustle of city life in Luanda, I am now surrounded by nature’s beauty - mountains, hills and greenery as far as the eye could see. Stepping out of the small airport, I took in the fresh air and felt the sun beating down upon my face. I am enjoying Lubango – particularly the beautiful scenery and landscapes.

Lubango, for the uninitiated, is the capital city of the Angolan province of Huila. Population – approximately 100,000 – plus 1 now – me!


Centro Evangelico de Medicina do Lubango (CEML)

Located about 7 kilometres from Lubango, the CEML is situated on top of one of the hills. Driving up to the centre, once can view the city below – at night, it is a peaceful scene to behold – all lit up.

The CEML is a medical centre opened in 2006 and currently has over 40 beds. It has an outpatient clinic and also provides inpatient care in the areas of obstetrics, general surgery, ophthalmology and pediatric care. The CEML also has a rural clinic in Kalukembe, approximately 130 kilometres from Lubango, that provides medical services to an extremely poor and isolated community.

The Centre is staffed by Canadian physicians now living in Angola and assisted by visting short-term medical resources from Canada and the U.S.

I have been here only a few days now but my experience has been phenomenal! The kind of medicine I have been exposed to so far is very, very different from the kind of ailments you would encounter in a North American clinic. Here, there are few layers to separate you from the patients. So, every available and capable resource is fully engaged. It is an awesome experience.


Dentistry in Lubango

A dentist? Really? There are no dentists in these parts of Lubango, but right now, there are two Brazilian dentists volunteering here at the CEML and so it is fulfilling to see long line-ups of young and old waiting patiently to take advantage of the available dental care.

Some treatments take over an hour, but the people still wait – patiently - for hours. When they leave the treatment room, there are always big and fresh smiles :) Such a joy to behold!


Rainfall

When it rains, it pours. Currently, although we are in midst of the rainy season in Angola, we haven't had much rain so far. But when it did rain a few days ago, it was a constant downpour. We were surrounded by the resounding roar of thunder while monstrous dark clouds raged at mind-boggling speeds. This was our warning about 20 minutes before the first drops hit the ground. And when it started, everyone ran for cover because within minutes the ground was soaked and puddles had started to form. For me, the city guy, this was a new experience and the fresh drops of water hitting my face were nothing short of refreshing.


Sunset

Absolutely stunning. Beyong description. Initially a blue sky turns, in succession, first indigo, then red, and finally this stunning mix of orange and yellow. Imagine, trees in the distance below majestic mountains, a rapidly dropping sun and this palate of colour in the sky. My mind forgot all about the downpour minutes before. The beauty atop this hill is just magnificent!!!


Taxis or Public Transport?

Any distance traveled only costs 50 Angolan Kwanzas. Public transport here is very different – it is not a long bus and it is not a private car taxi or a van. It is a combination!! Picture this - the bus-cum-taxi holds up to 14 people – all with seatbelts! However, the taxi I took this weekend held, at times, 16 people. In this case, the additional two people - one passenger and the fare collector - remained standing against the door. Quite the experience.

To get a taxi, you need to wave it down from anywhere on the street side There are no designated taxi stands or stops, so every few minutes the taxi stops to pick up more passengers. It is quite the experience sitting in the back of a taxi with music blaring while the driver speeds across an uneven and bumpy road. It is even more of an experience when you find yourself to be the centre of attention - similar to a tourist attraction - because you are a foreigner.


Open Market

I feel like I’m this freak show at the circus – all eyes just seem to be glued in my direction! Everyone must get a glimpse! It is unusual to find foreigners walking around the city or climbing into a taxi. So traveling with others is definitely a smart idea. When I entered the open market, my eyes started to water with blowing dust and dirt, my nose received a gust of urine mixed with burning diesel, and my ears rattled from the deafening rumbling of motorcycle engines. Litter and broken slippers clutter the dry dirt-road streets. Stores sell almost everything imaginable - fresh fruits, cellphone covers, phone credits, stereo systems, foam mattresses and more. There are also numerous people trying to exchange Angolan Kwanzas for US Dollars. Stores are set up in large, old storage crates - once used to transport materials across the waters. Vendors call out and try to get your attention, and although I understand most of their Portuguese comments, I decide to do the wise thing – keep on walking - I’m not quite ready to engage. The market experience was quite unique.


On the Road to Namibe

Only pictures, if even, can do justice to the natural beauty on the 3.5 hour drive from Lubango to Namibe. This city is on the coast of the South Atlantic Ocean with amazing beaches and crashing waves sometimes reaching up to 5-feet. On the well-paved road, we passed cliffs and valleys, winding back-and-forth through the majestic mountains.

Continuing further, we drove by oil drilling sites, stone quarries and open, barren deserts. Finally at Namibe, I watched the sun set while I dove into the waves of the South Atlantic Ocean. On the drive back, we spent about 20 minutes singing and dancing with local children under the moonlit sky. The smiles on their faces are a treat and their enthusiatic singing and dancing is definitely infectious.


Angola is a beautiful country. The people here are pleasant, happy and joyful. I have learned, both at CEML and in the city, that everyone has a story to tell.

No matter how preoccupied someone may be, there is always time to greet you with kindness and warmth.

No matter how many challenges they are facing, there is always time for a laugh.

No matter what the living conditions or how difficult the life is for the people here, there is usually a smile on every face.

So I say, to end this post... For 2009 and the years to come, let us all make an effort to share a laugh, exchange a warm greeting, and keep a smiling face.

Angola - Observations and Experiences

Gas Prices

It is possible to find a gas station every few kilometres in Luanda. However, the experience at a gas pump is far different from what I am used to in Toronto. Usually it is quick and smooth to insert a credit card, fill up gas, take a receipt and drive off. Considering Angola is the second-largest producer of petroleum in sub-Saharan Africa, it was phenomenal to see the lineups for gasoline at the pumps. But there is a reason for these lineups. Most of the petroleum produced in Angola is exported, so whatever is kept in the country is always at a premium. A gas station experience in Luanda is quite different. It can take up to three hours waiting in line (usually stretching onto the road for quite some distance).

The price per litre of gasoline is 40 Kwanzas. With an exchange rate of CAD$1 for 60 Kwanzas, that works out to about CAD$0.67 per litre (or USD$2.02 per gallon).


Fast-food Chains

There are two main fast-food chains: WIMPY's and Bob's Burgers. Similar to a McDonald's menu, Bob's Burgers serves everything from triple hamburgers to soft ice cream to nuggets and french fries. No matter where you enter, you are suddenly staring at smoke from the grills because ventilation is nowhere near requirements in North America. Prices are significantly higher than North America. Imagine paying about CAD$13-15 for a hamburger combo or CAD$6-7 for an ice cream sundae! But I'd say the one thing I appreciated about the fast-food chains in Luanda was the fact that all the nutritional information was on every food container (for french fries or a hamburger) instead of the underside of the paper sheet on trays in North America.


Belas Shopping Centre

There is one mall here that makes you feel like you are in North America or South Africa. Although it is only one ground level, and quite overpriced, it is a very warm and spacious building. There are shops, a food court, and a movie theatre with up-to-date movies. And when I watched a movie at the theatre, I wouldn't have been able to guess I was in West Africa!