Monday, December 17, 2012

My World AIDS Day commemoration with Alliance Zambia


For most people, the commemoration of World AIDS Day (WAD) which falls on December 1 each year entails march pasts and listening to speeches filled with frightening statistics on the high levels of HIV, I celebrated the day with staff at Alliance for Community Action on HIV and AIDS (Alliance Zambia) who observed the day in a unique way by sharing their personal experiences with and about the disease.

The organisation which deliberately commemorated WAD on December 3, 2012 so as to coincide with World Disability Day also saw staff spend part of their afternoon visiting Cheshire Homes for the Disabled in Kabulonga where they donated baby caps and clothing to care-givers.

With staff gathered in the conference room, the day started early with a preview of the short South African film “The Sky in her eye”, a story about a young girl who loses her mother to AIDS and as the film progresses, she has  to deal with discrimination not only from her peers but elders in the community. This was followed by a general discussion on lessons learnt from the movie and alternative ways of how to better take care of children orphaned by the disease and those living with it.

From the discussion it was interesting to note, that while staff agreed that financial help to those orphaned with HIV and those living with it is key to limiting some of the problems they have to endure, the consensus was that a stable family structure offering hope and love was even more important. In such a set-up, challenges like discrimination would be handled more effectively and pave way for open discussion on matters relating to HIV and AIDS.

Interestingly enough, soon after the discussion, members of staff were asked to take a 45 minute break to reflect on how HIV had impacted their personal lives. To express their emotions, they were tasked to write stories or draw pictures.

Being a naturally inquisitive person, I was tempted to walk over to their tables  so I could find out before hand what their story  or picture was about, but their facial expressions told me, they needed that alone time. As I wrote my own story, what came to mind was the courage that people living with HIV exhibit on a daily basis. I thought about a woman like Clementine Mumba who has lived positively for more than 12 years. I have never met a woman so determined to live life despite the many challenges she has had to face in the past and may continue to face in the coming years.

I thought about children born with HIV, especially those who are now in their teen years. Unlike other children who have nothing to worry about except look forward to growing up, they have to worry about their health, and how to deal with love and relationships; to pretend otherwise about their status or tell the truth and risk discrimination. But even with such challenges, they somehow find the strength to wake up each day and go on. Without realising it, the exercise had led me to deal with some of the unresolved issues I had regarding HIV and how it had impacted my life.

  Later, when we all gathered back in the conference room and began to share our stories and pictures, I realised that everyone else had experienced the same thing. Most of the members had dug deep within and shared stories about losing relatives to HIV and those living with HIV. As I listened each person read out their story and explain the messages behind the pictures, I realised just how true the phrase “If you are not infected, you are affected” applies to every person living in this world today.

A drawing of a mobile phone presented by Alliance Zambia Executive Director, Jillian Johannsen particularly caught my attention. In her explanation, simply looking at her cellphone was a reminder enough of the impact HIV had had in her life as some of the numbers belonged to friends and colleagues, she will never call because they had passed on after succumbing to the virus.

World AIDS Day articles and drawings by staff members stand as
At the end of the presentations, they were teary eyes around the table and not much to say. We were all soaked with different emotions at the reality of just how devastating HIV had been in each one of our lives. Although it had clearly affected us in different ways, the impact was the same.

However, while the session may have been emotional, a quiet time of reflection was exactly what the team needed. For people whose daily work involves dealing with different issues relating to health including HIV, it is very easy for one to get caught up in work and neglect ones family and even themselves.

Perhaps timely, the session was followed by another South African documentary, ‘The Moment.’ The funny and honest film features, people from different backgrounds who share their most personal thoughts about courtship and sexual behaviour. The discussion tackles the process of sex from the “moment you meet, the moment you connect, the moment you seduce, the moment you kiss, the moment you take your clothes off and the moment before penetration.” Unfortunately, for all the participants in the documentary, the “moment to wear a condom never came.”

By the time we left Alliance Zambia premises and all drove in a convoy to Cheshire Homes, we had all relaxed and looked forward to what lay ahead. Although we found the children had gone marching to commemorate World Disability Day, the sister in-charge gave the team a tour of the facility before presenting clothing and baby caps to the care-givers.

Sister Marjorie, thanked the team for the donation making note that while the centre has received donations in the past, none were ever directed for staff, something she greatly appreciated.

Thankfully, the children arrived back in time for us to say hello. As we drove back to Alliance Zambia, I remember thinking just what a privilege it was for me to work with such an amazing group of people.PYM

Tuesday, December 11, 2012

Birth Attendants in Zambia to continue as escorts

For many years, Traditional Birth Attendants (TBA’s) were considered life savers, helping pregnant women, especially those living in rural areas, to deliver safely.
Statistics from the Ministry of Health indicate that Zambia functions on a limping health staff of 33, 000 as opposed to the required 60,000, therefore, TBA’s filled the gap in the healthcare system. Their role included paying expectant mothers periodical visits to educate them on the importance of delivering with a trained person and the importance of attending ante-natal.
However in December 2010 government made a shocking announcement putting an end to the main role that TBAs had been known for; they would no longer help pregnant women to deliver. Instead their new role would involve educating women on the benefits of delivering at health care facilities as opposed to home.
Under the new rules, traditional birth attendants are to give information to communities and women on the danger signs in pregnancy, the need to go for ante-natal, testing for HIV and all other reproductive issues that maybe necessary. They are also to escort the pregnant woman to health facilities to deliver.
At the time Ministry of Health spokesperson, Dr Kamoto Mbewe told the press that because TBA’s were unable to address complicated and life-threatening complications such as excessive bleeding which can occur during birth, they were contributing to high levels of maternal mortality rates in Zambia.
He said such complications needed the attention of qualified medical personnel. Unfortunately,  because of women’s dependence on TBA’s due to long distances to health care centres and limited staff, they were shunning healthcare centres were they could receive comprehensive check-ups, treatments and care, during ante-natal, actual delivery and post-natal.
The World Health Organisation (WHO) estimates that out of every 100, 000 women who give birth, 591 die. And for each woman who dies, an estimated 100 survive child bearing but are afflicted by disease, disability or physical damage caused by pregnancy-related complications.
In addition, while ante-natal coverage in Zambia currently stands at 94 percent, only 47 percent of births are attended to by a trained midwife.
Government’s decision to halt the delivery of babies by TBA’s was highly criticised, more so in rural parts of Zambia where people have to walk long distances to get to health centres where they would have to wait in a long queue before being attended to. That is, if the health post was lucky enough to have trained medical staff.
Some people living in remote areas such as Mungule in Chibombo district, feel instead of saving lives as intended by government, realigning the duties of TBA’s from delivering to being mere escorts, has led to increased fatalities among pregnant women and their babies.
“Since the ban, the situation has become worse. Many women are dying. Some people live very far, and it’s worse during the rainy season. How do you expect a heavily pregnant woman to jump on a flooded river, most of these health centres do not have shelters so you can’t expect a woman to come weeks before delivery,” noted a former TBA who preferred anonymity.
As an alternative to discontinuing part of their services, she said they should have been offered additional training to help them cope with rare complications which sometimes occur during delivery.
She was trained back in 1996 by UNICEF and says she has delivered more than 300 babies in rural areas.
“A woman who has gone through labour knows the pain of labour, but when a mother delivers and hears that first cry from her baby, she is overwhelmed by joy. Unfortunately, there are now fewer women experiencing that joy. In our community, we are seeing more women and their babies die during delivery.”
Without the availability of trained birth attendants, pregnant women have been left with no choice but to rely on family members who have no training.
She described a recent incident where both mother and child died during labour. The neighbour who had been called upon to help with delivery accidentally pulled the umbilical cord too hard that it cut.
“Such an incident could have been avoided. We have been trained to handle such unexpected occurrences. If it was something we could not handle, we tried our best to get the woman to a health centre, or get a health staff to the woman,” the TBA explained.
It is because of such incidences that she has gone against governments regulations and helped women deliver. Some women gave birth on their way to the health centre while others simply lived too far to travel.
“If a woman comes to me for help, I cannot chase that person away because if I did their blood will be on my hands. I know what the law says but I can’t bear to see a woman in such pain and do nothing,” she said.
Despite these concerns, government says it will not rescind its decision. But, in emergency cases, such as when a pregnant woman is ready to deliver while being escorted to a health facility, the TBA can help with the birth.
“We understand that sometimes it’s difficult to find transport in time. Some people also find it difficult to tell when they are about to deliver. During those emergency cases, there is little anyone can do. The TBA can help deliver but it must be emphasized that we want all deliveries in a health facility,” explained, Dr Mbewe.
He said when TBA’s were introduced the idea was to help in the reduction of maternal mortality, but it was later discovered that they were unable to manage the five major causes that lead to death.
They are; hemorrhage (bleeding) during or after pregnancy, hypertensive disorders, unsafe abortion, infection and obstructed labour. Malaria in pregnancy, anaemia and HIV are other indirect causes that can lead to death.
“If you look at all these causes, if a woman is bleeding, the TBA will not be able to stop the bleeding. If she has an infection, again the TBA will not be able to manage the infection. It was with that realisation that we are now encouraging as many women as possible to deliver in the health facility.”
Another concern was that while in the past experts believed they could tell a woman whose pregnancy was at risk, recent data shows pregnancies considered to be at higher risk experienced recorded fewer deaths.
For example, a woman who had delivered at least five children would have been said to be at higher risk of bleeding after delivery, because of undergoing too many deliveries, the uterus may become flabby and not contract well after delivery.
At low risk were women who had never been pregnant before.
But overtime, results have shown that most of the deaths occurred in women between ages 20 and 29, women considered to be at low risk.
In a developing country like Zambia where access to emergency obstetric care is not readily available, for a woman who has delivered and starts to bleed, she only has two hours or less to seek medical attention. Those with obstructed labour can last upto 72 hours.
Dr Mbewe added, “If she is in hospital and is bleeding, the nurse will give the women a drug to stop the bleeding, if it’s a tear in the birth canal, we can suture, if the placenta has gotten stuck, we have trained the staff to conduct manual removal of the placenta. They can actually push in the hand and remove the placenta. Nurses are also trained on how to manage incomplete abortions e.g women who have had miscarriages or induced abortions. All these things can’t be done at community level.”
In 2010, government launched the Campaign on Accelerated Reduction of Maternal Mortality and formed Safe Motherhood Action Groups (SMAGs), where TBAs have now been incorporated.
A 2011 report on the Planned Parenthood Association of Zambia’s Global Poverty Action Fund “No woman Should Die While Giving Life,” a project funded by the UK Department for International Development (DFID), SMAGS are trained to assist women during their pregnancy.
They disseminate information to community members about pregnancy, childbirth and family planning, and work to challenge local awareness on maternal health, sensitise the community on the importance and benefits of seeking early ante-natal care, and educate people on the benefits of birth preparedness and transferring to a healthcare centre in advance to seek skilled and specialised care once in labour and during labour.
However, the overall objectives of the SMAG programme are; to strengthen community participation in maternal, newborn, child health. To improve community knowledge on safe motherhood and issues through health education, enhance the community’s utilization of reproductive health services, increase male involvement in safe motherhood activities and also strengthen partnerships between the community and health system.
Government is also up-scaling the training of midwives to meet the country’s demands.
“We have introduced direct entry into midwifery whereas before they had to train as a nurse and work before going for the midwifery course, they train for two years. We have also increased uptake of nurses and doubled in schools, all this in an effort to increase the workforce,” said Dr Mbewe. 
In addition, in its 2013 budget, government has allocated K3.6 trillion, equivalent to 11.3 percent of the budget to health, and it intends to recruit not fewer than 2, 000 front line medical personnel.
The topic of whether or not, TBA’s contribute to the reduction of maternal and mortality remains a hot-button issue in many African countries.
In 2007, TBA’s were banned in Malawi, but reinstated later in 2010, with Malawian president Mbingu-wa-Mutharika admitting the Ministry of Health had made a ‘grave mistake.’
UNICEF Zambia recommends the involvement of traditional birth attendants to create demand for government-led maternal and child health and nutrition services, including encouraging pregnant women to go for ante-natal care.
Chief of Communications, Patrick Slavin said “TBAs are part of UNICEF-supported Safe Motherhood Action Groups (SMAGs) in all 10 provinces of Zambia, an important approach to lower Zambia's unacceptably high maternal mortality rate. TBAs can also provide care for women when they are recovering following giving birth.”

He said UNICEF is also advocating for more mothers shelters in the country, which are urgently needed.PYM

Tuesday, December 4, 2012

Mungule women hatch new family plan for 'overbearing' hubbies

By Meluse Kapatamoyo

When couples get married, they become one, literally meaning all decisions and plans made are done jointly and in consultation with each other. But, when it comes to matters of family planning, the women of Mungule have no say. The men plan the family and choose the kind of birth control method to use disregarding the women.

There is a case of a young woman in Mungule who had three children within a space of five years. She bore her first child at age 16. Before she turned 18 she had her second and the third one came when she was celebrating her 21st birthday.

There are a lot other women who have similar situations of having that many unplanned children in the area.

During Alliance Zambia’s community dialogue at Mungule Rural Health Care, mothers aged between 17 and 43 testified that despite being the ones that carry the pregnancy, the decision of when to get pregnant was made by the husbands - many of whom unfortunately, have not embraced the different birth control methods available at health centres.

In areas like Mungule, the old belief that a man is defined by the number of children he has, still very much exists. Even when the man agrees to use condoms during the first few months after delivery, the rubber is put aside as soon as the child turns a year old. Thus many women find themselves pregnant soon after, as their spouses do not allow them to be on birth control.

One woman shared her that: “my husband demanded I get pregnant soon after my baby turned six months old. He said by the time I delivered, the child would be old enough to have a sibling. I insisted that we needed to wait until the baby was at least two years. He refused and threatened me with divorce. I got pregnant two months later and delivered my second child when my first born was 1 year 7 months.”

The consensus among the group was that given a choice, women would have preferred to have waited at least three years to allow for the proper growth of their children before getting pregnant again. They worried about their inability to provide their children with good nutrition and a good education.

Having realised the benefits of child spacing on the family, especially on the children, the women have taken a more aggressive approach to prevent further pregnancies.

They are now using different and discreet birth control methods without the knowledge of their spouses. Injectables, are quiet popular. Unlike contraceptive pills, the mothers say the possibility of the man finding out about the injections was zero.

One woman explained that for some who prefer contraceptive pills, they have devised interesting ways of ensuring that the tablets are well hidden from their husbands.

“I have dug a hole outside in the field. They are wrapped in a plastic bag just in case it rains. Sometimes it’s difficult to take the pill especially when he (husband) decides to stay home but most times I take them freely. I plan on telling him when the time is right. Maybe if he realises that I am not getting pregnant, he might accept that the six children we have are enough. Right now, we are struggling to feed, clothe and educate them,” she said.

And in Malupande Village, located about 4 kilometres from Mungule Rural Health Centre, the story was the same. The women, too, have had to find clever ways of keeping their husbands from finding out that they were using birth control.

They hide the contraceptive pills under rocks or with neighbours. Those afraid of being seen at the health centre, rely on a traditional herb called Nkankalamba, also popularly known as Kalulalula. The herb is soaked in water and the juice consumed soon after sexual intercourse.

While some women are willing to go to extremes to ensure they do not become pregnant, others have avoided using family planning methods because of the belief that they cause various tumours and diseases such as cancer. Others simply believe family planning methods as advocated at health centres do not work. Some of the mothers revealed having friends who got pregnant despite being on birth control.

But Isaac Phiri the facilitator of the dialogues from Bwafwano Integrated Services (BISO) advised the women to seek medical advice from trained health experts at clinics and also Neighbourhood Health Committees (NHCs).

He assured mothers that none of the family planning methods available at health centres caused tumours or different types of cancers as was the fear by some women.

Mr Phiri also warned the women against burying contraceptive pills in the ground as the temperature in the ground was likely to interfere with the effectiveness of the pill.

The community dialogue in Mungule was organised by the Alliance for Community Action on HIV and AIDS (Alliance Zambia), with support from Save the Children Sweden (SCS), under the project, “A Concern for All: Maternal and Child Health Interventions Towards 2015.” PYM

Friday, November 30, 2012

Should epileptics be allowed to drive?

By Meluse Kapatamoyo

Should epileptics be allowed to drive? That was the question onlookers at the scene of a recent accident in Lusaka asked as they stood by and watched a motorist who had had a seizure behind the wheel ram into another car.

The more conscientious among the bystanders helped him out of the car he was driving and laid him on the floor next to a hardware shop as he twitched and foamed at the mouth.

Thankfully, no –one was injured in the accident and the driver of the care he had hit into made a compassionate decision not to press charges.

But his decision did not absolve the epileptic motorist from blame for driving when the unpredictability of his condition posed a risk to him and a greater risk to motorists and pedestrians alike.

But Epilepsy Association of Zambia president Anthony Zimba has a different point of view about whether or not those who suffer seizures should be licensed to drive.

EAZ President Anthony Zimba
He says frequency of the seizures, epileptic or non- epileptic, what time they come and whether the patient is on medication or not, determines whether the patient should get behind the wheel. 

“If someone has active seizures, meaning they are frequent and come during the day and that person is on medication, such people are not supposed to drive. But if the seizures only come at night, we may have a discretion and allow that person to drive,” he explained.

People, whose seizures are irregular and only come once a year or once every six months, can also be given a go-ahead by medical practitioners to get on the road. But, they can only drive light vehicles and not passenger vehicles such as mini-buses or trucks.

People with irregular seizures and not on medication, should not drive.

RTSA has recorded 600 deaths in the third quarter of 2012
However, while these precautions can mean life or death, for the driver and other road users, these are not laws. Health practitioners can only advice. The final decision is with the patient who has the right to decide whether to drive or not. Unfortunately, many get on the road.

Mr Zimba said, “If there were regulations, which we do not have in this country, in a situation as the one at Millennium Bus stop, if it’s confirmed epilepsy, that persons licence can be suspended until such a time when the seizures have stopped completely and they have been on treatment for two and half years. Only then can their licence be lifted. With any laws, all we can do is for now is plead with our patients not to drive, some do, but because the majority of people hide their condition even from employers, they end up driving.”

Zambia is one of the many countries in Africa that have no regulations for persons with epilepsy or seizures. But, countries like South Africa have formulated some guidelines.

According to the South African National Road Traffic Act, you are not permitted to drive if you have uncontrolled epilepsy. Nonetheless, they too have left the final decision of whether to drive or not to the individual concerned and their health doctor.

In addition, Epilepsy South Africa, has formulated the following guidelines for people with epilepsy; if you change or stop your medication suddenly, stop driving until your doctor advises it’s safe to do so. If you have a seizure for the first time in years, stop driving and consult your doctor. Don’t drive when you’re tired, stressed or ill, as you’re more likely to have a seizure at such time. Never drink and drive.

Unfortunately, ‘epilepsy can happen anywhere and at anytime,’ early this year, a man was killed when he crashed into a primary school in SAs Cape Town, apparently while suffering an epileptic seizure. Two children were also injured.

The incident drew a lot of national interest, with condolence messages going to the deceased family and speedy recovery messages to the two kids who were injured. Concerns were also raised as to whether the man should have been driving given his condition.

In the United Kingdom, the Driver and Vehicle Licensing Agency (DVLA) is the condition that licenses cars and drivers for driving on public roads. Its guidelines say if you have a driving licence, by law it is your duty to tell the DVLA about any medical condition which may affect your ability to drive, including epilepsy. This is a condition of holding a driving licence.

According to the Epilepsy Society, “if you have a driving licence, and have a seizure of any kind, the DVLA regulations say that you must stop driving. You are responsible for telling the DVLA and returning your licence to them.

“The regulations cover all epileptic seizures: auras and warning, seizures where you are conscious, myoclonic jerks, and seizures where you lose consciousness.”

In Zambia, every expectant driver must conduct a medical test for audio and visual capacities, where obvious disabilities are also noted, Road Traffic and Safety Agency (RTSA) Principal Publicity Officer says, “Problems such as epileptics cannot be diagnosed, unless the person reveals on their own that they suffer from this condition. And then evidently RTSA would not give a license because such a disease is not planned for any attack.”

Conducting drivers test involves a theoretical test that requires knowledge o the Highway Code involves a practical test that requires ones skills such as reversing, turning right, left and simply propelling the vehicles. Road skills such as getting into the reality of driving where there is traffic are also conducted with a RTSA examiner.

“I am not sure what type of machines can determine someone's driving skills except to have tests that take the drivers on the road and they are practically tested by examiners. RTSA has never recorded or received any reports of seizures as causes of accidents on the road,” said Khozi.

The agency recorded 8, 801 accidents, in the third quarter of 2012, that  led to 600 deaths.PYM 

Tuesday, November 20, 2012

As long as homosexuality is criminal, ‘zero new infections’ of HIV will not be achievable

By Dr Mannasseh Phiri

Dr Mannasseh Phiri

At the beginning of last week, the world received the news that our neighbours in Malawi had suspended laws against same-sex relationships pending a parliamentary decision on whether to repeal the laws or not. Police have been ordered not to arrest anyone involved in homosexual relationships or acts, until the laws have been reviewed. The Malawian government hopes that the suspension of the laws will spark off national debate which will help parliament guide the country as appropriate.

Back in May 2012, newly installed President Joyce Banda had said in her maiden ‘state of the nation’ address to parliament that laws regarding indecent practices and unnatural acts would be repealed. In suspending the laws, President Banda has taken a very bold step in a country that, like Zambia and most countries in Africa, has strong conservative views opposed to homosexuality.

In Zambia, the government has not given us any leadership or guidance save for a non-committal and glum statement by the then Information Minister and Government Spokesman Fackson Shamenda during the fierce public debate that followed UN Secretary General Ban Ki Moon’s visit to Zambia in February 2012. Mr Shamenda was reported to have said Zambia has laws on homosexuality, and will follow those laws. By implication this meant that Zambia’s official stand was not to follow Ban Ki Moon’s advice that Zambia should respect the rights of gay people.

Another raging public debate took place in the lead up to the Presidential elections in 2011. The ruling MMD came across and published some ‘evidence’ that PF President Michael Sata had told foreign journalists that when his party came into power they would review the laws on homosexuality. A ridiculous political circus followed, fuelled by the state print media. Michael Sata was demonised as a gay-loving presidential candidate who would legalise same-sex marriages if voted into power. The debate was so heated, filled with hate and laughable homophobic rhetoric and Zambians saw through it and voted for Sata as President. Unfortunately, neither Sata nor anyone in his government has said anything about the need to review the laws against homosexuality.

In Reflecting on AIDS on June 3rd, inspired by President Joyce Banda’s announcement to parliament, I lamented: “With our neighbours to the east and to the south having spoken out at the highest political level (about homosexuality), albeit in diametrically opposed directions, where is Zambia’s leadership on the spectrum between Malawi’s
legalization and Zimbabwe’s homophobic rhetoric? Don’t you so wish we could at least hear from President Michael Sata or Dr Guy Scott where they want to take Zambia on this subject? I do.”

There still has been no comment or reaction from the venerated gentlemen and their colleagues. (In fact there has hardly been any official comment on any major HIV issues – especially from the top most political echelons. Since he came into office, the President has hardly said anything at all - ad lib or otherwise - about HIV and AIDS in Zambia (let alone MSM and gay rights. He has also not acknowledged or denied that he said in an interview that he would review laws criminalising same-sex relationships. –– in one year plus. The interview (if indeed it did take place) has not been published in Zambia. National collective head-in-the-sand homophobia continues as we watch and marvel as the courageous lady leader next door suspends the law so that it can be re-visited, and reviewed sans pressure.

Official government documents on the shape and character of Zambia’s HIV epidemic identify one of the Key Drivers of HIV infections in Zambia as ‘vulnerable and marginalised populations (including MSM and prisoners). Despite it being criminal, men are having sex with other men in Zambia in prisons and outside. We also know there is a ‘significant’ gay community in Zambian cities and towns. Their activities have a bearing on the general epidemic and if they are not investigated and new infections continue to arise unabated and uncontrolled among them, we shall never get to ‘zero new infections’.

We also know that recently government approved studies on HIV and AIDS in our prisons that prisoners (men especially) are acquiring HIV in prisons in significant numbers. In 7 provincial prisons surveyed, the HIV prevalence is double what it is outside prison. Where is the legality, logic and culpability if our systems are condemning people to prisons where we know some of them will be infected with HIV? Where, as certainly as the Zambezi River flows into the Indian Ocean, some of them will be released, come out and infect their partners with the virus?

Where is the legality, logic and culpability if our prison systems do not provide condoms freely and openly inside the prisons so prisoners can protect themselves against infection? Where is our collective national conscience when we have been provided the facts and continue to look away?

I once had then Information Minister Given Lubinda as my guest on TalkingAIDS on JOY FM. I asked him the straight blunt question: “On whose hands is the blood of people who are sentenced to prison and die of AIDS after being infected with HIV inside the prison?” His answer was equally straight and blunt: “The Government”! And I thought, “Touche!”

If we are serious about Zambia achieving “zero new HIV infections”, we must find and expose all the nooks and crannies where new infections take place. Is the illegality of homosexuality making people afraid to seek HIV testing care and support?

We must, like Malawi, boldly suspend the laws against same-sex relationships for research be done, and for our legal minds and parliament to review the laws and inform us if these laws are even legal. We must do this however unpleasant, unpalatable, unacceptable, un-Christian, ‘un-Zambian’ or ‘un-African’ we think the practice is.

Like Malawi, this needs bold political leadership. I challenge President Michael Sata to lead us forward in this specific issue because I know he can.

Wednesday, November 7, 2012

Pregnant? 4 could save your life


In most African societies, pregnancies are rarely planned, and as a result it takes women a few months before they can make that all important first trip to a health institution for Ante-natal care (ANC).

However, while the woman waits to come to terms with being pregnant, she may be putting her life and that of her unborn child at risk.

Effective ANC which includes a minimum of four visits to a health care centre, has been cited as an effective way of reducing mortality in mothers and children.
A pregnant woman attending ante-natal/ Photo by UNICEF

Dr Mulindi Mwanahamuntu, a gynaecology consultant at the University Teaching Hospital (UTH) said the four visit minimum requirement as recommended by the World Health Organisation (WHO) is enough for a clinician to identify at least 80 percent of problems that occur in a pregnancy.

“This recommendation is a compromise from having a woman coming every other week to burden the health-system. Sometimes the clinician will ask the woman to be coming to the clinic every other week depending on the problem she may have. But a minimum of four visits has been shown and proven to reduce maternal and child deaths,” he said.

“Opportunities for Africa’s Newborns”, a report by the World Health Organisation (WHO) states that to achieve the full life-saving potential that ANC promises for women and babies, four visits providing essential evidence-based interventions should be adhered to.

The essential elements of ANC include identification and management of obstetric complications such as pre-eclampsia, tetanus toxoid immunisation, intermittent, preventive treatment for malaria during pregnancy (IPTp), and identification and management of infections including HIV, syphilis and other sexually transmitted infections (STIs).

“ANC is also an opportunity to promote healthy behaviours such as breast feeding, early postnatal care, and planning for optimal pregnancy spacing,” says the report.

Zambia is among countries in Southern Africa battling maternal and child mortality, caused by lack of commitment by pregnant women to attend ante-natal where diseases such as malaria, sexually transmitted infections (STIs) and HIV can be screened early.

WHO estimates that 900,000 babies die as stillbirths during the last twelve weeks of pregnancy. And babies, who die before the onset of labour, or antepartum (bleeding) stillbirths, account for two-thirds of all stillbirths in countries where the mortality rate is greater than 22, per 1,000 births-accounting for nearly all African countries.

Four ante-natal visits could save the life of your unborn child
In addition, maternal mortality remains equally high in many countries too. In Zambia, the UN organisation estimates 830 maternal deaths per 100, 000 live births accounting for one in every 120 pregnant women.

And according to Dr Mwanahamuntu, in Zambia, despite 94 percent of women especially those in urban areas attending ante-natal, less than 75 percent of them deliver in some form of health institution.

“In this case, the whole purpose of the earlier ante-natal visits is defeated. For rural areas where visits drop to almost zero, simple conditions that can be picked up by clinicians are missed. If we are to win this battle and succeed, we must emphasise on institutional delivery of babies. Child birth is a physiological undertaking and women should not die from something that should be normal.” said Dr Mwanahamuntu. PYM

Monday, October 22, 2012

Neighbourhood health committees out to reduce maternal mortality


The day is September 25, 2012 and I am at Chaisa Health Centre to be part of a Focus Group Discussion (FGD) on Maternal and Child Health being held by Alliance for Community Action on HIV and AIDS in Zambia (Alliance Zambia), with Neighbourhood Health Committees (NHCs).

Despite it being a windy day, as soon as I step out of the vehicle, am greeted by a strong stench emanating from a nearby sewer. Fortunately my attention immediately shifts to a large crowd of women and children attending an Under-Five Clinic. What is even more striking is that the majority of these mothers are still children themselves.

Before my brain can process the situation and begin to ask the necessary questions, my focus is drawn to a screaming baby. I curiously watch as the young mother struggles to calm the child down.  Looking somewhat embarrassed and irritated by the child’s screaming, she starts to remove the baby’s clothing, signaling that perhaps the September heat could be the reason for her Childs discomfort.

But that doesn’t calm the child down, forcing one elderly woman to ask if the child is sick. Her response, ‘This is the way she cries. She will stop on her own. I am used to it.’  The woman suggests that she should perhaps try and breast feed the baby. Having drawn everyone’s attention already, the young mother reluctantly gets ready to feed but the young mother lamentably struggles to hold on to the breast and at the same time hold on to the child. It is clear that she is yet to grasp the art of breast feeding. 

Luckily for her, she gets a free lesson from the elderly woman who teaches her how to hold the baby’s head comfortably, while holding on to the breast to prevent chocking. In just a few minutes, the child’s screaming is replaced by the normal noise of other children, running around the clinic compound as the crying baby falls asleep.

“That is a daily occurrence around here. We have children, having children. And when these children have children, they have no idea of what it takes to be a mother. The situation is made worse because most of them miss out on ante-natal where they can be taught some of these things such as the importance of nutrition. Instead of attending ante-natal the girls try by all means to conceal their pregnancies,” says one NHC member when I shared the story of the young mother and her breast-feeding dilemma during the Focus Group Discussion. 

“About two months ago, an 18 year old girl gave birth just outside the clinic. She had kept the pregnancy hidden until she went into labour, by the time they got here, it was too late. They couldn’t get her inside the clinic. It’s a difficult situation, we are dealing with mothers who not long after delivery start to live the child in the care of younger siblings or old grandparents, depriving the baby of breast milk and motherly care,” added another NHC member. 

According to the NHCs, as high as the turn-up of mothers who bring their children for under-five clinic at Chaisa Health Centre may seem, the number of women that stay away was equally high.  The clinic covers three catchment areas; Marapodi, Chaisa and Mandevu.

Some of the reasons they absconded from accessing health care services at the clinic included; long queues caused by lack of adequate staff at the health centre and lack of family planning knowledge, which often leads to some mothers getting pregnant soon after delivery, making it difficult for them to live home and take all their children for under-five clinic. 

However, some women find taking a malnourished child to the clinic embarrassing. Instead they choose to keep the child hidden even from neighbours than admit they are unable to provide a proper diet for it. This is despite having knowing that through NHCs the clinic offers free nutritional supplements for malnourished children and also free cooking lessons.

While some of these challenges are being addressed by NHC’s in the area, others are beyond the committee’s capabilities and can only be handled by relevant authorities such as councilors, Member of Parliament (MPs), Ministers/Ministries.

Realising the important roles that NHC’s play in communities and the urgent need for these maternal health challenges to be addressed by authorities, a suggestion was born by Alliance Zambia, with support from Save the Children Sweden (SCS), to hold an  Advocacy training on Maternal and Child Health for Mungule and Chaisa NHCs. 

Together, and in collaboration with health centres in Mungule (Chibombo) and Mandevu (Lusaka) the two organisations are implementing a project that will see a two third reduction in morbidity rates for children under five years old in Zambia by 2014. The project is also promoting safe motherhood and is contributing towards improving maternal health in Zambia by 2014 and reducing maternal mortality by three quarters, thereby contributing to Millennium Development Goals (MDGs) 4 and 5.  

The two day training was held in Lusaka and attended by 10 participants from Chaisa and Mungule, an area where maternal health challenges are rampant and where two Focus Group Discussions were held prior to the training.  Each NHC was represented at the training by five participants.

Key points in the training included brainstorming major health challenges affecting women and under five children in Mungule and Chaisa and then depending on the particular issue, identifying targets they could advocate their problem to.

Although both areas faced similar problems, they chose different issues as the ones needing advocacy.

NHC Members Stanely Banda (R) and Leonard Mwewa during the
Alliance Zambia training.

“For a long time we have had major issues in our communities needing urgent and serious attention from our leaders, but didn’t know how to approach them. It was difficult to find ways of tackling these issues. The training has indeed opened my eyes to the many different methods we can use to air our views and most importantly get the attention of our leaders,” said Chaisa NHC member, Stanley Banda, enthusiastically, at the end of the training.

And Mungule’s Catherine Himoonga said, “Advocacy used to be such a strange and complicated word to me, now I understand it and how to go about it. I can’t claim to be an expert but it’s good that the team from Alliance Zambia have committed themselves to be available when we need help. We have always been silent and do nothing when things go wrong in our community but with this training, we now have an idea of how to go about it.” PYM. 

Thursday, October 11, 2012

Be a good neighbour, stop GBV


At only 12, the life of Brilliant Muyuwa was brought to an abrupt and brutal end when she was defiled and strangled early this year.

Brilliant's death made headlines in the media and also attracted the attention of high profile people like First lady Dr Christine Kaseba, who travelled to Masupelo village in Chibombo to attend her funeral.

Since then Chibombo has remained in the spotlight and many more cases of Gender Based Violence (GBV) have surfaced. However, civil society organisations are keen to see a reduction and eradication of GBV cases in the area.

Recently, the Zambia Social Forum (ZAMSOF) and its partners; Alliance for Community Action on HIV and AIDS in Zambia (Alliance Zambia), Action Aid, Sight Savers and Oxfam in Zambia held a National Forum aimed at making known the new Anti- Gender Based Violence Act  and raising awareness on GBV to people in Chibombo and neighbouring areas.

ZAMSOF is a network of civil society organisations which is part of the World Social Forum of Civil Society Organisations (CSOs), an open space for reflective thinking, democratic debate of ideas, free exchange of experiences and interests for effective action.

The national forum was flagged off with a march past led by the vice-presidents wife, Charlotte Scott, ministers spouses, representatives from the first lady’s office, members from various civil society organisations and community members. It was held under the theme ‘Gender Based Violence, Child Rights and Abuses.’

Issues on the agenda included, HIV & AIDS, maternal neonatal, children health and voluntary medical male circumcision, climate and environment, youth and labour, governance, human rights, including the right to land and women’s rights.

Mrs Scott said it was impossible to achieve any meaningful development amid a society which experiences injustice and violation of human rights due to GBV

“More police posts should therefore be equipped with facilities to ensure this is a reality. Distance should not be a barrier to the course of justice and recourse in our communities so that women and children are adequately protected. As Zambia celebrates its 49th year of independence, the commemorations need to move the country to another level of social justice and wellbeing should lead to reduced GBV cases,” said Mrs Scott.

For children who are victims of abuse and violence, which includes witnessing violence that is inflicted on other members of the household, this affects their mental, physical, and emotional development. It also affects their capacity to realise their aspirations and contribute to the development of the country.

Mrs Scott added that, “We know the role that women play in the country, not only in social but also economic development and if we are taking the people who are leading that process and we put them into lives of anxiety, of fear, of pain, of rights abuse then the country can’t go anywhere.”

Recent statistics from the Young Women Christian Association (YWCA) indicate that cases of GBV are still on the upswing. About 3, 733 cases were reported between January and June 2012.

NGOCC Executive Director, Engwase Mwale noted that “It is an undeniable fact that GBV reinforces the inequalities and iniquities between women and men and therefore compromises, not just the health of the victims, but also the dignity, the security and autonomy of the victims.”

She said because women and children had continued to be victims of brutal killings, rape, defilement, incest and other forms of abuse, the fight against the vice needed commitment and concerted efforts from different stakeholders if Zambia was to see a reduction in such cases.

“We are here (Chibombo) to be able to commit to work with the traditional leaders that their voice is important to end the negative cultural practices if we are to win the fight against GBV. And as a women’s movement, we are requesting the traditional leadership to ban early marriages in their chiefdoms. Early marriages have repurcations on the girl-children because it keeps them away from schooling,” pleaded Mwale.

She called on government to allocate adequate resources in the 2013 national budget so as to address the issue of shelter for survivors of GBV and also resources that will go towards putting together a gender based violence fund that will cushion the survivors of GBV.

And Alliance for Community Action on HIV and AIDS in Zambia (Alliance Zambia) Policy and Advocacy Manager, Reverand Malawo Matyola directly called on women not to live in fear but report cases of Gender Based Violence to relevant authorities.

Charlotte Scott folds the Maternal and Child Health Poster presented to her by Alliance for Community Action on HIV and AIDS in Zambia (Alliance Zambia) Policy and Advocacy Manager, Reverand Malawo Matyola, as ZAMSOF chairperson, Mary Tembo-Mhango looks on/Picture by Nkandu Chikonde from Alliance Zambia

“In our African setting, your neighbour’s child is yours too. Because that is your child too, if you notice that child is showing signs of abuse, it is your duty to report the case to authorities and if possible take the victim to the hospital,” Matyola advised.

However, he also urged health workers to be tolerant and patient with victims of GBV.

Matyola condemned an incidence where a young girl was harassed by police on her way to the hospital to collect Ante-retro viral drugs (ARVs) when she was accused of promiscuity.

“Because of the long distance to the centre, this young girl started off to the clinic as early as 04:00 but was stopped by police who accused her of being promiscuous. Such situations should not be allowed to happen. The girls’ only response was ‘I wish I was the causer of this disease, but I was born with it.’ Colleagues in the police force and clinics, let’s be friendly and render the help these victims need,” he added.

Recognising the importance for Civil Society to address GBV, Child Rights and abuses in communities, Alliance Zambia places great importance on the rights of pregnant women and children under the age of 5, to ensure they are not abused.

With support from Save the Children Sweden (SCS) the organisation is currently contributing to Millennium Development Goals (MDGs) 4 and 5; to reduce mortality and morbidity rates for children under five years old in Zambia by 2014 by two thirds and to promote safe motherhood and improve maternal health in Zambia by 2014 and reduce maternal mortality by three quarters respectively. This project is being implemented in Mungule (Chibombo) and Mandevu (Lusaka) through close collaboration with the healthcentres in the respective sites.

In Zambia, cases of mothers miscarrying due to GBV and others who die while pregnant due to the same vice are common.

The National forum which was organised by Zambia Social Forum, under the secretariat of NGOCC, Women for Change (WfC) and Zambia Council for Social Development (ZCSD) also provided eye screening checkups, Voluntary Counseling and Testing (VCT) and testing, Sexually Transmitted Infections (STIs), Male Medical Circumcision and information on Economic Empowerment.

ZAMSOF has been successfully organizing the annual National Social fora in towns and communities of Lusaka, Choma, Kapiri-Mposhi, Monze, Mansa and Chipata since 2003.

One of its many objectives includes improving participation of the general citizenry in the policy making processes of the area Members of Parliament by ensuring those peoples’ voices are registered at the national, regional and continental levels.

“Our mission is to promote and facilitate sustainable, socio-economic Development through collaboration and networking among NGOs, Community Based Organisations (CBO’s) and other stakeholders,” explained ZAMSOF chairperson, Mary-Tembo Mhango. PYM

Monday, October 1, 2012

Male involvement in ante-natal care equals healthy babies


Enedi Malambo, 38, is a mother of seven and is currently carrying another pregnancy due in three months.

During all the previous seven pregnancies, her husband has never accompanied her to the Ante-Natal Care (ANC) clinic. But the eighth one is exceptional in more ways than one.

“Since my first ante-natal appointment (during this pregnancy), my husband has been coming with me to the clinic. Before, he used to refuse,” says Enedi of Kembe area, some 70km off the Great North Road in Chibombo district.

She smiles and adds that “not once did he escort me to the clinic when I was pregnant with my other (seven) children. But now that nurses insist on pregnant women coming with their husbands, he had no choice but to come with me to the clinic.”

Enedi is happy over the involvement of her husband in her current pregnancy. She says it has given him extra insight into the intricacies of pregnancy care and as such they  are now able to communicate better about her health needs.

In the past men were not obliged to accompany their pregnant wives for ante-natal check-ups. Currently most public health institutions are asking men to be fully involved in the affairs of their expecting wives. 

Pregnant women and their husbands undergo couple HIV Counseling and Testing services. In the event of both or either of them being found HIV positive, the couple can then be counseled on how to manage the infection and ensure they protect themselves from re-infection.

Where both of them are HIV negative, they are still encouraged to discuss their status and ways of ensuring they remain free from HIV infection and other sexually transmitted infections. PYM