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Abstract
Guinea-Bissau is a small West African country listed among the poorest countries in the world. After 530 years of European colonial rule, became independent in September 1973. The first 7 years following the independence showed a rapid growth in all societal areas, including the health sector, essentially due to the combination of East-West International cooperation, that started during the colonial war (1963-1974). Following the 1980 coup d’etat, lead by the military, conditions deteriorated from infrastructures to the provided social services. Moreover, the solutions implemented by the International Monetary Fund and the World Bank failed, particularly in the health sector. The service deteriorated and a large part of the population lost access to free healthcare provided by local and expatriate officers. In this study, the environmental situation and key diseases indicators (malaria, diarrhea in both adults and children) were studied in Bolama, the former colonial capital, located in the island with the same name in the Bijagós archipelago. The regional hospital occupies presently former Portuguese army barracks after the destruction of the large colonial hospital c.a. forty years ago. The present infrastructures cares for about 10,206 inhabitants of the Bolama sanitary region, but has no running water, no electricity, no operation theatre, no imagiology, although a basic clinical lab exists. A sink latrine (open pit) is located in the backyard, caring for the entire hospital. In the case of need, patients are evacuated by private boat, a journey that can last between four and eight hours, depending on the tide. Raw health data used for this study were manually retrieved from the Bolama hospital logbooks for children and adults. Access to data was granted by the clinical directors from 2006 to 2010. Data were assembled in a spreadsheet and organized by years and months. Meteorological data for the study period in Bolama city was supplied by the head of the Bolama regional Meteorological Service. Several health centers are aggregated to the regional hospital of Bolama, headed by basic health agents (ABSAgentes Básicos de Saúde), women and man that have some literacy and basic health training, and are able to fill logbooks and prescribe medicines from antimalarial drugs to paracetamol and antibiotics. The hospital is headed by a medical doctor, usually absent, and care is eventually provided by an expatriated doctor but not on a permanent basis, and also by health officers with four years of medical training abroad, and by nurses graduated in the country. The sub-Saharan location of Guinea-Bissau is not favorable in the present climate changing process. Two clear seasons occur in what precipitation is concern - a dry from December to April, when rain is less than 2 mm, and a wet one during the remaining months of the year. The rain usually peaks in August, but increased values may occur in July, as in case of 2008. The hottest month of the year is generally May and the coldest January. Important year-to-year precipitation variability was noticed during the study period. The year 2010 was particularly wet (2,260 mm). In what temperature is concerned, the values were rather stable, the mean annual temperature ranging from 24.5°C to 29°C. Most of the population has no access to running water and the available is of doubtful quality. Rivers and streams, most temporary, are not a source for water and the population relies on hand-dug or bore wells. Several of them dry during the hottest period of the year, increasing the burden of daily life. Malaria, the major cause of morbidity in the country had no clear seasonal pattern when analyzing the five years framework. On the other hand, diarrhea followed a clear seasonal pattern. Numbers peaked systematically at the on set of the wet season i.e. in May to June when the first rains occurred. Usually, a smaller peak was found at the beginning of the year, when the temperatures dropped. Also, the country is periodically ravaged by cholera outbreaks leading to epidemics that can spread over several months, as in 2008.
In conclusion, the study of the number of disease cases (malaria, gastrointestinal and others) and its possible correlation with the two different seasons, could lead us to draught some possible solutions, framed in the socio-economic reality of the population, in order to help them to achieve more quality of life and a better health.
