Tag Archives: Health

A woman collects dumping fees at Bantama. Her child stays with her at the site.

Day Cares and Dump Sites: Sanitation Problems in Kumasi

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This week, my colleagues and I decided to examine urban sanitation and the associated health issues for Ultimate Radio’s Morning Show. We knew of several waste sites around town that were particularly concerning, so we went out to find them – recorders and cameras in hand.

First, we visited a garbage dump in the residential neighbourhood of Bantama, where no one has come to collect the rubbish for over a month. The woman who takes dumping fees at the site told us that nobody knew who exactly was responsible for removing the rubbish, or why they had stopped.  We also spoke to local residents and food vendors, who expressed concern over the smell, sight, and the possibility of food contamination there.

Next we went to the “Wewe” stream, which feeds the city’s main waterworks. The stream has been turned into one of Kumasi’s major drains, and its banks are covered in garbage. We noticed some Kumasi Metropolitan Assembly (KMA) workers cleaning the roads nearby. They were employed to sweep away dust on the side of the road while, meters away, no action was being taken to clean up the stream.

We followed the water up to the neighbourhood of Ahinsan, where we found a refuse site, measuring 50 by 40 meters and about 10 meters high. It is used by nearby market workers and local inhabitants, as well as fishmongers who smoke their fish there. It is enormous, and sits right on the banks of one of the city’s major drains.

Perhaps most worrisome, however, was the daycare centre we found just meters away from this dump. Comfort and Alexon Kidd-Darko opened the Comkid Daycare Centre years before the site became a refuse dump, but now they must spend a great deal of their time–and money–on fighting the authorities over it.

“Because of the children, I’m not happy with this. When we came, there was nothing like this. If the place had been like this, I wouldn’t have put money here,” said Mrs. Kidd-Darko.

She also noted the damage that the site has been inflicting on their business.

“Now the children are not coming because of this, and my work is down. So now we are helpless,” she told me.

She said, however, that the centre takes every precaution to keep the children safe and healthy. They have fenced the place in and installed netting around the building to keep flies and mosquitoes away. They also never let the children play outside of the compound.

This is important because, according to Doctor Franklin Asiedu-Dekoe, children are especially at risk of illness resulting from sites like these.

“Children like to play on these refuse dumps,” he said. And they are more likely to fall ill, he explained, “because children are less likely to wash their hands with soap and water before anything enters their mouths.”

He also noted that malaria could spread in the area, if garbage prevents the stream from flowing properly and creates a build-up of still water.

We spoke to an official of the Ahinsan Market Committee – the ones in charge of managing the dump, according to the Kidd-Darkos. But he blamed the KMA members for the site’s mismanagement.

“We would be grateful if the Assembly officials could get this dumping site well managed or even get it relocated for us,” he said.

But he later admitted that his committee is in fact responsible for managing the site, and that all proceeds made from the dump go to them–not the KMA.

According to Doctor Asiedu-Dekoe, everyone is responsible for the maintenance of such urban waste sites – even the individuals who choose to dispose of their waste there.

Mrs. Kidd-Darko expressed a hope that the relevant authorities would soon be held accountable for the dumping site. She said its removal would not only be in the best interests of her daycare, but also of all the residents and market vendors in the area.

“It’s not healthy for even the residents here, and the market itself, let alone the children,” she said.

Secret Women

In Chichewa, the widely-spoken language of southern Malawi, being pregnant or “kunkhala ndi pakati” translates to being in the middle of life and death.  For many pregnant Malawian women, however, death comes much sooner.

As the African country with the second highest maternal mortality ratio, Malawi is struggling to eradicate a crisis that in 2006 claimed the lives of would-be mothers at a rate of 807 deaths per 100,000 live births.  And while 2006 figures showed an improvement on those of 2004 – 984 deaths per 100,000 live births – the 2010 Malawi Millennium Development Goals Report has already projected that Malawi will not achieve the targets of the fifth MDG to improve maternal health by 2015.

Contributing factors identified in the 2005 Ministry of Health (MoH) “Road Map for Accelerating the Reduction of Maternal and Neonatal Mortality and Morbidity in Malawi” include shortage of staff and weak human resource management, limited availability and utilisation of quality maternal health care services, and weak procurement and logistics systems for drugs, supplies and equipment.  Underlying such problems of infrastructure and resources, the report reads, are harmful social and cultural beliefs and practices.

Naswit Chitalo of Namila Village in Traditional Authority (T/A) Mlilima in Chikhwawa District is easily able to recall a time when “most pregnant women were dying from pregnancy complications” because of social and cultural beliefs, which include the belief that the firstborn child should be delivered by a traditional birth attendant (TBA) in the home as opposed to a health facility.

“I actually know of three women we lost in 2009 because they sought the services of elderly women from the village instead of rushing to the hospital,” said Chitalo, adding that TBAs would use herbs to make pregnant women “feel so confident about the outcome of their pregnancy” that professional maternal health care would be neglected altogether.

According to Malawi Health Equity Network (MHEN) Executive Director Martha Kwataine, these kinds of social and cultural beliefs surrounding TBAs have done more harm than good when it comes to maternal mortality in Malawi.

“There have been several researches whose results have shown that traditional birth attendants have made cases on maternal death high because they are not properly equipped,” said Kwataine.  “We tried to train them so that they should handle referral cases but they did not comply.”

President Joyce Banda has also added her voice to the case against TBAs; on June 18, after laying a foundation stone for a maternity holding shelter at Mulanje Hospital, the first of 130 holding shelters pledged as part of the Presidential Initiative on Safe Motherhood launched in April, Banda told TBAs to stop offering delivery services to expectant women.

“Traditional birth attendants must stop giving delivery services,” she said at the function, adding that “traditional birth attendants can have a good role to play… because they are experienced they can be referral point.”

News of the ban on TBAs has been met with both controversy and commendation throughout the country.  But to women like Chitalo, the rationale behind the ban is not news at all; as one of the T/As where the Centre for Alternatives for Victimised Women and Children (CAVWC) has been working to realize the MoH Road Map objective of improving obstetric care, a new, “good role” for TBAs is already one of Mlilima’s best kept secrets.

Former traditional birth attendant Dalia Issa stands with her husband outside of their Namila Village home. In 2010, with training from the Centre for Alternatives for Victimised Women and Children, Issa stopped offering village-based delivery services and took on a new role as a Secret Woman. Photo submitted.

In 2010, CAVWC identified two women in each village of T/A Mlilima and T/A Kasisi to be “Secret Women.”  The women, many of whom had been working as TBAs, attended three days of training on maternal health using a standardized MoH handbook.

According to CAVWC Project Officer Talimba Bandawe, women like Chitalo were trained to take on four main roles and responsibilities: referring pregnant women to antenatal facilities by carrying out door-to-door campaigns; educating women on family planning; collaborating with Village Health Committees to form Community Safe Motherhood Task Forces and conduct awareness-raising community meetings; and recording how many pregnant women deliver in the community or in a health facility.

“We depend on these Secret Women because they have been trained; they can convince a woman on the importance of delivery at a health facility with a skilled attendant, because in the rural areas they are used to having TBAs,” said Bandawe.  “We’re trying to change that mindset – that anything could happen with a TBA so it’s better to deliver at a health facility.”

Bandawe said the women are called “Secret Women” because of the social and cultural beliefs and practices surrounding pregnancy in Malawi.

“When you talk about traditions and beliefs, the pregnant woman is vulnerable,” she said, adding that traditional beliefs in witchcraft scare some women off of sharing how many months they are into their pregnancy.

“The concept of Secret Women is based on that whatever you talk about with a Secret Woman should be kept confidential,” she continued.  “Whatever issues that you discuss, the Secret Woman is not expected to go and disclose that anywhere because some of the things can be really private.”

According to Esnart Dzoma, who has been volunteering as a Secret Woman in Namila Village for two years, “the most important thing is confidentiality.”

“If I begin to shout that ‘so and so sought this help from me’ they will inform each other, and we will have the health problems that used to compound issues such as pregnancy again,” said Dzoma.  “I have an obligation to help these women with compassion, and without malice… the secret to being an effective Secret Woman is to be open-minded.”

Based on principles of compassion and confidentiality, Bandawe said the Secret Women project has helped to address some of the harmful social and cultural beliefs and practices, “especially through the door-to-door campaigns” as pregnant women have been comforted by and more likely to accept confidential counselling.

A bicycle ambulance donated by the Centre for Alternatives for Victimised Women and Children being used in Namila Village. Photo submitted.

“The Secret Women were really successful in that a number of women were referred to the hospital,” she said, adding that other Road Map interventions such as the provision of bicycle ambulances and village bylaws enforcing fines for births that take place outside of a health facility have also contributed to the success of the initiative.

The data collected by the Secret Women also speaks to their success; in 2009, when CAVWC was working to reach out to practicing TBAs and provide safe-birthing training and equipment, approximately 30 percent of pregnant women in the two T/As were reportedly giving birth at a health facility.  In 2012, the Secret Women are reporting that 54 percent of pregnant women are now giving birth at a health facility.

But despite their success, Bandawe said that the new role for TBAs has not been implemented without resistance.

“Some women still resist the counseling of the Secret Women, and sometimes even the husband can be a challenge,” she said.

“There are some materials that the hospital recommends that you should have when you go to the hospital – a plastic paper, a razor blade and a basin.  Some of the husbands don’t welcome this idea, so (the Secret Women) have a negative reception from some of the families.”

For their part, Bandawe said that CAVWC will “revive the Secret Women” by holding refresher training courses at the end of June.

“It is really important to have these sorts of people in the communities, mainly in the rural areas where literacy levels are low,” she said.

“Maybe after there has been a lot of sensitization, when everyone even in the rural communities is aware of the health benefits of delivering at the hospital and when we have managed to reduce the maternal mortality ratio, that’s when we can do without the Secret Women.  But right now, they still have a major role to play.”

***

With files from Richard Chirombo and Madalitso Musa

Malaria: not just a disease, but a way of life

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It’s the most dangerous killer in West Africa, the top issue on Ghana’s health priority list, and carries a whopping price tag of up to US$ 60 million a year.  Yet for all the apparent hazards attributed to malaria, the disease is still seen in a relatively casual light in Ghana.

One of the first things people had to say when I told them I’d be working as a journalist here was, “Watch out for malaria!”  Also common were “Have fun, but don’t get malaria,” and the ever-popular “Beware of mosquitoes – they carry malaria.”

Malaria, malaria, malaria.  It seems Canadians can’t escape the idea of it, that mysterious exotic disease that mixes flu symptoms with diarrhea and eventually, if left untreated, leads to death.  It’s the Avian Flu, Black Plague, and SARS all rolled into one, that misunderstood medical monster that all hapless Canadians traveling overseas to warm climates should take the greatest pains to avoid contracting.

Before leaving Canada, my doctor told me I’d be traveling to an “extremely high-risk zone,” and urged me to do any or all of three things: purchase the most expensive of malaria medication; double up on mosquito netting for maximum protection; reconsider my trip.

My colleague at Kapital Radio, Muftaw, saw me writing this post and chuckled.  “I like your headline,” he said.  “Malaria, a way of life.  So true.”

I ended up going with the cheapest medication option known as Mefloquine, a medication whose listed side effects read much like the expected effects of LSD – hallucinations, lucid dreaming, and vivid nightmares.  Personally, I’ve never slept better.

As far as mosquito netting goes, well, I do as the locals do.

“I have a mosquito net,” said Muftaw.  “It’s brand new.  I have never used it.  It’s in my wardrobe.”

Mine too sits at the bottom of my rucksack, unpacked, unused, and ultimately, unnecessary.  I sleep in the comfort of basketball shorts, and really, the mosquitoes have largely left me alone.  They rarely venture indoors anyway.

And as for reconsidering my trip?  Well, it’s too late now, but really, for what reason?  We in North America live in such a culture of fear – of recession, of crime, of people, of spiders, of disease – that we’ve limited our opportunities to experience by simply shutting ourselves into protective bubbles.  I took so many precautions just on malaria alone before I got here, only to find that it’s a commonly contracted disease easily treated at the local pharmacy with medicine.

When I asked him how many times he’s had malaria, Muftaw shrugged.

“Too many to count,” he said.  “I thought I had malaria last week but it turned out to be just a viral infection.”

However, I’ve learned not everyone can afford to be so cavalier.  While most cases of malaria are a quick fix in the cities, there are enormous amounts of people, particularly in the north, without access to proper healthcare.

“It’s a problem, the high risk for those in the rural areas where there are no clinics, no hospitals,” said Dr. Joseph Oduro, Deputy Director of Public Health for the Ashanti Region.  “While we have the medicines to treat it, malaria can be very dangerous if you can’t actually access the medicine.”

Aside from the rare fatality, this danger presents itself in malaria’s long list of side effects, which range from anemia to complications during pregnancy.  Treating the disease can also be a heavy financial burden for many families, who all too often turn to traditional medicines as a cheaper, more familiar option.

“Many people claim they have medicines that can cure malaria, but what research has been done?” said Dr. Oduro.  “People take them and then come to the hospital with many complications.  It’s a real challenge here in Ghana… ignorance is high.”

Another problem is those who rely on traditional medicine also go unregistered in government records, therefore skewing national statistics concerning the disease.  A report released by the World Health Organization announced an estimated 3.7 million cases of malaria in Ghana in 2009.  However, that figure is deceivingly low considering how many cases annually go unreported, and consequently, untreated.  Pregnant women and children under five are especially vulnerable, with UNICEF reporting roughly 20,000 malaria-caused fatalities in Ghana among children under five every year.

The numbers are staggering.  And frankly, avoidable.  While there are dozens of government and NGO malaria-specific initiatives at work in Ghana, the fact remains: malaria is killing people in this country.  ITNs (insecticide treated nets) and anti-malarial vaccines are helping, but more can be done.  More needs to be done.

“It’s a serious threat,” said Dr. Oduro.  “Malaria is the commonest cause of morbidity and mortality in Ghana… it’s a matter of concern for us.”

I could stand to be less dismissive about not using my mosquito net.  Reality is, that net could be saving a life right now.

A poster at the Kumasi Centre for Collaborative Research in Tropical Medicine (KCCR) detailing malaria’s attack cycle

Malawi recognizes World Malaria Day

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It’s April 25 and 12 year old Blessings Phiri traveled, by foot for hours from his village to sit in the waiting room of Kamuzu Central Hospital in Lilongwe, Malawi. This time around, malaria has hit him hard.

Blessings experiences the typical symptoms – nausea, headache, high fevers, periodic chills and sweats, muscle aches and a loss in appetite.

“I think that dying is sometimes better than going through this,” said Phiri.

Malawi’s Ministry of Health reports that malaria remains to be one of the key health problems facing the nation. Currently, up to 325 people in every 1,000 Malawian suffer from the illness every year according to last year’s figures.

“It’s the worst feeling in the world,” said Phiri, who sits with his hands covering his face.

Coincidentally enough, April 25 was World Malaria Day. It marked the height of global efforts to build awareness of the mosquito-borne parasitic disease. During this day, the Ministry of Health specifically emphasized to Malawian on the need of using insecticide treated nets to prevent being bitten by malaria-laden mosquitoes.

“I don’t have a mosquito net for my bed. No one in my family does,” said Phiri.

According to UNICEF, many children do not sleep under insecticide-treated nets. If malaria is recognized early, it can be cured, however, UNICEF stated that many Malawians are not able to access treatment within 24 hours of onset of symptoms.

Although malaria is both preventable and treatable, many people in Malawi cannot afford the treatments due to poverty.

The Ministry of Health said that support from development-partners remains a significant resource to ensure access to life-saving and cost-effective malaria interventions.

“Continued investment in malaria control will propel Malawi, a malaria-endemic country along the path to achieve the 2015 Millennium Development Goals, especially those relating to improving child survival, maternal health, eradicating extreme poverty and expanding access to education,” according to the press statement released April 25 by the Ministry of Health.

Millions of lives depend on the strong support and the Ministry of Health is optimistic that living a malaria-free life is an attainable goal.

“You are doing great job” : feedback from stakeholder in Tamale

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“How long we waiting?”, Lucy asks, as we sit under a small mango tree.

We are sitting outside the Cienfuegos Suglo Specialist Hospital, an obstetrics hospital in Tamale, Ghana and my patience is growing thin.

The hospital’s director, Dr. Barnabas B. Naa Gandau, is yet to arrive for the day and it’s already 3 p.m. .
We got here at 11 this morning. The head midwife, Hajia Fati Mahama, welcomed us to the nursing station and let us watch as they cleaned instruments and filled charts. But they won’t speak to us “on the record” until the hospital administrator arrived. Like most institutions in Ghana, we are side-lined by endless bureaucracy.

Lucy, my pupil, is impatient to leave while I try to stall. A nurse runs out after us, just in the nick of time.

“He will be here soon. You will see.”
As if it was summoned, a gleaming silver SUV pulls down the red, dirt road. It pulls into the makeshift garage, under a small gazebo awning.I leap to the SUV’s doors, to intercept Gandau.

Soon we are being ushered into his office with its sparkling floor and top of the line computer. As soon as we sit down, Gandau asks for our credentials. I stammer.

“How do I know you who you say you are?” Gandau asks, skeptically.

We write down our names and contact information on scraps of paper, as a form of shotgun business card.

I quickly start explaining our intent. We’re here to do a story on Ghanaian attitudes about labour and delivery.
I tell Gandua I’m a human rights journalist and his ears perk up.

He lists the steps to gaining access to the hospital. First we will need a letter of introduction, printed on the station’s letterhead. Then we will need to file a list of questions we want to ask. This could take weeks. I persist that we need to speak to the nurses now. Eventually, he acquiesces.

We interview nurses, new mothers and a few gurgling babies. We get insightful and interesting tape. Lucy and I are ecstatic.

We rush back to the station and as I’m uploading the mp3s, I quickly check my email. The subject reads “trial” and there is no text. It’s from Gandau at the hospital.I send a reply; thanking him for letting us visit the hospital, making sure my jhr signature is attached.

A few days later, I get the following email:
“Just visited ur [sic] website and realize u [sic] are doing great job. God Bless you all.
Stay [sic]Blesed. -Dr. Barnabas B. Naa Gandau”.

See pictures from the Cienfuegos Suglo Specialist Hospital.

Collateral damage: Police report policy delays treatment for accident victims in Malawian emergency rooms

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You’ve been in an accident in Malawi – where do you go?  If you said the emergency department you could be wrong.

A few months ago my editor at Blantyre Newspapers Limited’s Sunday Times made this “mistake”, taking a small boy who had been in a traffic accident to Queen Elizabeth Central Hospital (QECH) for emergency treatment.  The boy, playing with a friend alongside of the highway, had run head-on into an oncoming SUV.  He was severely bruised, crying, and required treatment, but when they reached the hospital the staff at the registration desk turned the boy away on the basis of a policy that requires a police report before care can be administered to an accident victim.

Nurses and doctors affirmed the police report policy to the boy and the editor and it was only after they drove to the police station and were escorted by an officer back to the emergency department that the boy received treatment for the traumatic experience he had endured – nearly two hours after initially arriving to the ward.

Three weeks ago, that same editor witnessed a similar episode when a transport truck struck a small car.  At least one passenger was killed on impact, and when another bloodied passenger was brought to the hospital in hope of emergency treatment he was forced to wait in agonizing pain until a police report could be acquired.

When questioned on the policy, chief administrator of QECH Themba Mhango said a victim of a traffic collision would “definitely” be treated right away because “it is a human rights issue.”

“Now with the multi-party system, human rights came in and people started realizing their human rights.  You can’t do that to a person now – say ‘no I won’t give you treatment,’” Mhango said.

However, a subsequent visit to the hospital’s emergency room registration desk involved no mention of human rights.

In contradiction to Mhangos’s comments, a desk attendant said that while critical injuries are treated as soon as possible, “when an accident victim arrives a police report is required.”

While “there are serious cases in which you can’t do otherwise but treat the victim,” the attendant matter-of-factly said the majority of individuals who seek treatment following a collision have suffered “minor injuries” and therefore require a police report.

Southern Region Police Public Relations Officer Nicholas Gondwa also confirmed the hospital procedure of requiring a police report prior to treating injuries sustained in an accident and said the policy exists as a kind of collateral, because “hospitals fear that the person may not be an accident victim but rather a criminal who got injured while committing acts of crime.”

“It cannot be known whether the person was really involved in an accident or was injured while committing acts of crime,” he said.

The point is moot.  Under Article 16 of the African [Banjul] Charter on Human and Peoples’ Rights, which Malawi ratified in 1989, “Every individual shall have the right to enjoy the best attainable state of physical and mental health” and, “States parties… shall take the necessary measures to protect the health of their people and to ensure that they receive medical attention when they are sick.”

The African Charter on the Rights and Welfare of the Child and the Universal Declaration of Human Rights contain similar clauses.

Because Malawi uses a socialized system of health care, “with the goal of providing access and basic health services to all Malawians” and to “raise the level of health status of all Malawians by reducing the incidence of illness and occurrence of death in the population,” it is the responsibility of the Ministry of Health to address this unjust policy – take necessary measures to protect the well-being of their people.

Considering the fact that it is already difficult to get necessary health care in Malawi – transportation to clinics and health centers is problematic, and when a person is able to reach a health centre or hospital it is not uncommon to find that there is no medicine – added delays to accessing appropriate care such as this hospital procedure of requiring a police report are undue, unjust and inhumane, and contradict the state of emergency for which the health department in question exists.

In the meantime, Malawians should be advised to keep a first aid kit on hand as well as a police officers’ phone number on speed dial – you will need both before you can access appropriate treatment for injuries sustained in an accident at Queen’s hospital.

With files from the Sunday Times’ Ruth Mputeni

A Silent Shout: Marital Abuse in Ghana

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Breaking the silence is the greatest hurdle to ending marital abuse.

Flashy, kitsch and heinously dubbed – soap operas are the window of entertaining escape from the day to day in Ghana. In an episode I witnessed last week, our heroine was trapped by fate in a loveless marriage, unable to bear any children of her own. Raped by her husband and ostracized by her family, she is too afraid to admit to misdeeds in her past that made her barren. Would she go to jail? Would she ever escape the clutches of her husband? Before any questions could be answered, the power went out.

I had my quota of full body gasps and furrowed brows for the day and got up to leave. Halting my exit, my friend Wasila quickly explained that while the details might be far-fetched, the theme is a reality for many women in Ghana. She believes that a woman’s ability to negotiate safe sex in a marriage can be hard to come by. People may be willing to talk about it as it happens on TV, but few bring it up personally.

“When I was growing up, there were many instances where a woman, often below 16, was given to a man,” says Saratu Mahama, programme director for the International Federation of Women Lawyers in Tamale. “At night, when a man was holding her, the woman would cry out loud and no one would come closer because they already knew what was happening. Nobody will talk about it. There are still girls being betrothed against their will today.”

For many victims of marital rape, Mahama says, “the moment you are married, your body becomes the property of the man. He can use it, as and when he likes.”

In 2007, Ghana introduced the Domestic Violence Act, a bill meant to protect the rights of those most marginalized by abuse in the household. However, Mahama explained that public opposition and a desire to speed up the passing of the bill left a controversial clause from the Ghanaian Criminal Code of 1960 unchanged. The clause states that the act of marriage is grounds for consent. If a spouse refuses to consent to sex and a rape occurs, in the eyes of this particular clause, consent was already given, voiding the case against the accuser.

Inspector Lawrence Adombiri, Metro Coordinator for Tamale’s Domestic Violence Victims Support Unit, says that in a year he has never seen a case of marital rape brought to their office. “It is a silent issue,” he says.

Even without the specific mention of marital rape in the Domestic Violence Act, many cases fail to even reach the courts. Societal pressure and threats directed at the victim deter many of these cases from seeing redress.  Adombiri believes that the community must support the process of the victim before the laws can react accordingly.

Mahama echoes his concern, attributing the lack of reported cases to stigma attached to women in the domestic setting.

“[Society] feels that a woman should bear it, especially when it has to do with sex,” she says. “All other things can be mentioned, but not sex.”

An absence of women’s shelters, the cost of obtaining a doctor’s report confirming instances of rape and the bureaucratic nature of police follow ups to cases were other issues Mahama described that deter women from vocalizing cases of marital rape.

“Most women do not have money to feed themselves, let alone pay for such medical bills. Because of the fee, they are deterred and the cases go unreported or are not followed up,” argues Mahama.

While soap operas may see a happy resolve before the credits roll, many women fear to bring their cases to light. Talking to Mahama and Adombiri, it becomes clear that the issues of marital rape extend beyond the courts to underlying issues of patriarchy and discrimination reflected in Ghana’s traditional domestic structure.

In a report by ActionAid, one woman details her experiences being given to her sister’s brother-in-law at an early age. “I reluctantly went into the room because I was tired of sleeping outside. I was then about fourteen. He forced me to have sex with him.”

Overpowered by her husband and ignored by her family, the recurrent rapes gave way to three children, and left her HIV positive. “I should have fought harder,” she says. Her struggle fell on deaf ears, being told that abuses such as these “are what all women go through”.

Abdallah Abubakari, programme manager of ActionAid, in Northern Ghana, acknowledges that women’s abilities to negotiate terms within the household are affected by structures of patriarchy. He advocates that women must be given more opportunities to express leadership in the household.

“Where women are empowered, the men get awareness,” says Mahama. “They should appreciate the situation of the woman, and there can be change. But when you keep silent but keep the law in place, it still won’t work.”

In the fight against malaria, it’s not just about mosquito nets

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The Ministry of Health, in collaboration with donor countries, is working with local volunteers to both distribute mosquito nets and educate the public on how to use them correctly. Photo by Blantyre News Limited.

The World Health Organization (WHO) announced in October that nearly a third of all countries affected by malaria are on the path of eliminating the mosquito-borne disease over the next 10 years.

Malawi is one of them.

Elimination, of course, depends on whether or not current efforts are sustained.

But due to flaws in the country’s healthcare system and, more recently, given the fragility of the global economy, it seems that the fight against malaria is likely suffer a few setbacks in this country.

According to the Global Fund (GF), which is an international initiative against malaria, tuberculosis, and HIV and AIDS, approximately 95 percent of Malawi’s population of 14 million, is at risk of malaria infection. Two groups are particularly vulnerable to the disease: women (51 percent of the population) and children under the age of five (17 percent).

But malaria isn’t just a severe public health problem; it also has a direct impact on the country’s economic and social development.

The Ministry of Health reported that there were over six million malaria cases in 2010. Economically speaking, this means that the country’s workforce lost between 15-25 days of productivity due to malaria alone.

Furthermore, most families spend about 28 percent of their yearly income (approximately CAN$170) to treat it.

Still, experts affirm that progress is being made in Malawi.

The Ministry of Health, with the support of the GF and the President’s Malaria Initiative (PMI) from the United States, have since 2005 distributed across the country insecticide-treated, non-toxic mosquito nets, which have proven to be highly effective when it comes to reducing transmission of the disease, as they can kill mosquitoes for up to three years.

And according to the Ministry of Health, Malawi has seen a 50 per cent reduction in malaria transmission ever since.

Global statistics confirm this positive trend.

The latest report of the United Nations and World Bank supported-initiative, Roll Back Malaria (RBM), reveals that malaria deaths have dropped globally by an estimated 38 percent in the last 10 years, with an impressive 43 out of the 93 countries identified and included in this initiative – including Malawi – cutting malaria cases or deaths by half.

Wanting to continue with this success, Malawi’s Health Strategy Plan for 2011-2016 places malaria’s reduction as a top priority, along with HIV and AIDS.

However, Malawi’s generally underfunded and fragile healthcare system, and the uncertainty of any future external funding from the GF, and donor countries including the United States, the United Kingdom and other European countries, due to the world economic crisis, threaten to make those achievements accomplished so far moot, while putting at risk the implementation of future initiatives and programs.

The Global Fund announced in September that it has halved the estimated amount of money available in its next round of funding, from US$1.5 billion to US$800 million, the disbursement of which has been delayed until 2013.

This is worrisome as the Global Fund accounts for two-thirds of the malaria, tuberculosis and HIV and AIDS response in Malawi, and the balance comes from the donor countries. Malawi has been assured of Global Fund money until about June 2014 but has been warned to look for sustainable financial models to continue its programs.

And while Malawi’s National Malaria Strategic Plan has stated its aim to have 60 percent of the country’s health centres equipped to perform diagnostic testing for malaria, the Global Fund reports that Malawi is far from achieving this goal.

And even where diagnostic testing is available, both laboratory staff and hours are limited, with some facilities seeing more than 200 cases of potential malaria cases each day.

These studies also show that more than half of the patients that tested negative for malaria were still prescribed antimalarials, suggesting that health workers have very little confidence in laboratory test results.

When it comes to malaria in Malawi, significant gains have been achieved and lives have been saved; but without sustained financing to consolidate these accomplishments and enable the continuation of initiatives for malaria treatment and against its transmission, the progress that has been made may quickly backslide.

Children denied medical treatment in lieu of prayer

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Some parents in Malawi, including Yesaya Mussa (above), refuse to seek medical attention when their children fall ill, believing instead that prayer will heal them. Photo by Denis Calnan.

By Rhodes Msonkho and Denis Calnan

Interpretations of the Bible are keeping some parents in Malawi from accessing medical treatment for their children, according to police spokespeople.

Yesaya Mussa’s is one such parent. His two-year old daughter was burned in an accident and kept from medical attention while he and others prayed for her to get better.

Mussa runs a small hardware shop in the Zomba market and says he has not done anything wrong.

“The Bible says that whoever believes in God can be healed through prayer,” Mussa explains in the local language, Chichewa.

He is upset at the current government for infringing on his freedom to practice his beliefs.

“We never go to hospitals – we are still sticking to what God is saying,” he says, “We are facing numerous challenges with the current government.”

Mussa recounts the day the police came to his house to take his daughter to the hospital and him, to prison. Mussa stayed behind bars for one night, before being released on bail. He was later given a 15-month suspended sentence in order to return to his daughter as her guardian.

Nicholas Gondwa, the police spokesperson for Malawi’s Eastern Region, says the situation of parents refusing medical attention reached a critical point during a measles outbreak in 2010. Parents were urged to get their children vaccinated against measles, but some refused

“It came as a surprise,” says Gondwa, “[because] we had so many cases.”

After getting the disease, Gondwa says several children were isolated in their homes as their parents prayed for their recovery. The police were tipped off by neighbours – but not before children died from the disease.

Tomeck Nyaude of the Zomba Police recalls a case where a father was arrested after denying his son medical attention when the boy fractured a bone in his leg playing soccer. The police were informed by one of the boy’s siblings seven days after the incident.  Sadly, the easily treatable fracture led to the leg being amputated.

“When you are enjoying your own rights and freedoms,” says Nyaude, speaking about the freedom to religion, “make sure that you do not involve and injure somebody [else’s] rights.”

Nyaude remembers the case of Mussa and his daughter, which was brought to his division’s attention by one of Mussa’s neighbours. When his police unit arrived in the community, they found the church elders praying for Mussa’s daughter. Nyaude says the father claimed in court that he realized he had done something wrong and was therefore released on a suspended sentence.

Mussa gives a contradicting story, saying he was released because he was a first-time offender and continues to stand by his belief that if his child is sick or injured again, the only attention she should receive is that of prayer.

“We are doing this based on the faith we have and what the scripture is saying,” says Mussa. “I am encouraging those who are discouraged and might think of bowing down to this pressure, that we should not allow that. They should persevere during this trying time.”

Scrap dealers and health hazards: Welcome to Korle Lagoon Ghana

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Scrap dealers extract valuable metals like silver and copper from burnt electronics in Korle Lagoon, Ghana. The fumes from the burning plastic cause serious health risks, including lung cancer. Photo by Davis Ollennu.

This article originally appeared in Faces of Old Fadama, a magazine produced by students at the African University College of Communications in conjunction with the Daily Guide and Journalists for Human Rights in Accra, Ghana. The project was led by jhr intern Laura Bain.

By Daniel Bannah and Naa Lamley Lamptey Abibat

The sound of tools smashing and crushing metal is deafening. Dozens of young men, covered in dark grease and soot stains, sift through heaps of discarded appliances and pieces of rusted metal scavenging for anything valuable. An unpleasant smell rises from the nearby Korle Lagoon and we choke on thick clouds of smoke blanketing the area. This is the scrap yard at Old Fadama, Accra’s largest slum community.

The informal scrap metal business in Ghana is a relatively profitable venture for many young men from the northern part of the country and neighbouring countries residing in Old Fadama. However, the job comes with massive health risks. And since government authorities consider Old Fadama’s residents illegal citizens of Ghana, they are not protected under national labour laws.

Plastic burns in Accra's Korle Lagoon, a digital dumping ground. Photo by Davis Ollennu.

The nature of scrap dealing is very demanding. Each day scrap dealers walk long distances under the scorching sun to and from shops, homes and landfill sites in search of discarded metal and used electrical gadgets like televisions, computers, microwaves and radios to sell to individuals and business owners.

Groups of scruffy young men huddle around heaps of discarded gadgets, dismantling and extracting metallic components, iron, silver and copper by burning the pieces with fire and strips of worn-out car tires. They inhale dense black smoke without any safety gear, at great risk to their health.

The toxic smoke is not only a dreadful threat to the men who are directly involved in this business, but also poses a serious danger to people within the immediate environment who have nothing to do with scrap business.

The scrap dealers themselves do not seem to be aware of the health hazards they are exposed to in their business. “I’m not sick. I’ve done this for two years,” says James, a scrap worker.

Yusif Anda, a 40-year-old Burkinabe scrap dealer who has been involved in the trade for much longer, explains through a translator that although he is not visibly sick, he often coughs up black phlegm.

Jake, an ex-farmer who has worked in the scrap business for two years, says his doctor advised him to quit his job because continuous exposure to naked flames and toxic fumes could result in fatal respiratory conditions. He says he knows the health risk is unquestionable. His income is hardly better than a tomato farmers’ wage.

All this work is done to benefit large industrial steel companies like Western Steel and Forging Limited in the harbour city of Tema in Accra.

The companies buy the scrap metal for GH¢ 560.00 per tonne, or about $400 CAD. The income is distributed amongst the many men involved in the industry—a salary they wish would be higher considering the risk of their job.

Many of the scrap workers we spoke to could not even identify the companies they sell to because they say their main concern is making money on which to subsist. They also hardly speak nor understand any widely accepted Ghanaian languages, which hinders their right to negotiate fair incomes or protect their rights. They simply collect the scrap metal and collect their payment.

Ghana’s National Employment Policy states its main objectives are to “promote the goal of full employment in national economic and social policy, and to enable all men and women who are available and willing to work, to attain secured and sustainable livelihood through full productive and freely chosen employment and work” and to “Safeguard the basic rights and interests of workers.”

Therefore, it is hard to imagine why anyone would willingly engage in the risky industry of scrap dealing. But, since the government does not recognise Old Fadama’s residents as legal Ghanaian citizens, they do not have access to job training or skill development programmes. So, they are compelled to take up the job.

“We have families to take care of and remit our parents back in the villages, says James. “The government simply does not care about us, but we must survive.”