Physiotherapist Suzanette dos Santos helps a patient at Luanda's Centro Neves Bendinha.
Credit: IRIN
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At just 32 years old, Jose Brinco should be in the prime of his life. Instead, he is a victim of Angola's most horrifying legacy of war - landmines.
Partially sighted and without his lower left leg after treading on a mine 10 years ago, Brinco, his clothes caked in dirt, is reduced to begging on the streets for a living. At night, on those same streets, he makes his bed.
"I can't think too much about what has happened to me, otherwise my head goes crazy," he said.
In 1994, a young Brinco and his wife were working hard in their maize fields. When he stepped on the anti-personnel mine, it was inevitable that his wife should try to help him. She didn't make it. She set off another mine and was killed instantly. "I survived but she died. I still feel bad about it," he said.
Now, maimed and half blind from the flying shrapnel, homeless and unemployed, he has very little hope left for the future: "She was all the family I had. Now I have no-one."
An estimated six million mines laid during 27 years of civil war still litter Angola's countryside. They have left a trail of physical destruction - disabling one in every 415 Angolans - as well as psychological trauma.
Apart from the effects on the individual, landmines also remain a serious impediment to Angola's social and economic reconstruction, blocking access to water points, hampering the recovery of the country's agriculture sector and creating a climate of fear and tension.
"Every Angolan knows that somewhere there is a mine with his name on it. We are trying to postpone that meeting for as long as possible," one villager told the development agency, Handicap International.
There is some good news. Physical rehabilitation is not in short supply for those living in the cities and major provincial centres, although those in the heart of the bush may be unaware of the services on offer, or be unable to get to the centres for treatment. Yet for those young enough and strong enough, the free prostheses and physiotherapy offered there can help them to physically lead a normal life.
At the Centro Neves Bendinha in the capital, Luanda, Mambo takes a break, playing with her doll after a morning of physiotherapy.
"I like Luanda and I like learning how to walk by doing all the exercises on the equipment," she said shyly. "Afterwards, when I get my new leg, I'll be able to play more and dance and go back to school."
Just 10 years old, Mambo has not yet developed the fear of stigma and is confident she faces a bright future. But a sense of fatalism among many victims, particularly older mine survivors, can create problems when it comes to reintegrating into society.
"Victims often think that all they can do after a landmine accident is to go onto the street and beg - they don't see any other way of earning money to live; lots of them come to the cities to beg," said Emmanuelle Rioufol, programme director for Handicap International France.
Medical experts and aid workers believe there is a real shortage of both psychological skills to help deal with the trauma of losing a limb, as well as life training skills to help victims realise they still have a future.
"Physical rehabilitation is just one piece of the puzzle; assistance to landmine survivors is much more complex," explained Tracy Brown, country representative of the Vietnam Veterans of America Foundation (VVAF), an NGO that has been running rehabilitation programmes for landmine survivors in the eastern region of Angola since 1997.
"Most amputees with good rehabilitation don't have to be disabled and incapable of leading a normal life. However, there is very little in the way of other services that address psychological impact, post-trauma support and life skills training which helps integrate landmine victims," she said.
VVAF runs "Sports for Life" programmes in Angola's war-affected eastern Moxico province, involving landmine survivors in team sports like soccer on crutches and wheelchair basketball. Brown says those who take part have seen a huge improvement in self-esteem and confidence.
"We think this type of programming is critical to social reintegration, being able to take advantage of any training opportunities, and eventually getting a job," Brown commented.
But this kind of moral support scarce. In her 15 years at the at the Centro Neves Bendinha, physiotherapist Suzanette dos Santos has done her best to offer some psychological as well as physical help, but she too believes there is an urgent need for more holistic support.
"Some patients suffer from mental trauma. They need someone or something to give them strength and courage, otherwise they will just end up on the streets with their hands out," she said. "Physically they can drive, they can walk, they can work, but it's a question of mentality."
The centre's director, Celestino Tenda Daniel, agrees and is hoping next year to bring in a psychologist and some form of social assistance for the patients.
"It's a significant deficiency because, although we offer the patients a chance to live normally and independently by giving them prostheses, sometimes they leave here without much confidence," he said. "It is possible for them to walk, to work, to do anything a normal person can do, but often the problem is in their own head."
For Brinco, hoping the occupants of the next car will give him 10 or 20 kwanzas (a few US cents), any form of help would do.
"I have a pain in my heart when I think of my old job, working in the fields. I'll never do that again, but I don't know what else I can do," he said. "I have no money. I have no hope."
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