Tag Archives: human rights

Unavailable and underfunded: mental healthcare in Ghana

The Accra Psychiatric Hospital only has a capacity for 600-800 patients, but currently houses many more.

Like much of the developing world, mental healthcare is lacking in Ghana. Mental illnesses are deeply stigmatized and widely misunderstood, and access to mental health professionals and infrastructure is limited. Although the recent passing of the innovative Mental Health Bill lays the legal framework for the required changes, steep challenges remain.

Ghana spends 2.58 per cent of an already small health budget on mental health. Accordingly, Ghana has only three publically-funded mental health hospitals. The hospitals are all old, overcrowded, and located in the southern part of the country. Consequently, they fail to provide adequate care for the estimated 250,000 people that need treatment in the country.

Pantang Hospital, the newest in the country, was built in 1975 and is located just outside Accra. Ankaful Hospital was built in 1965 and is located in Cape Coast, 150 km outside Accra. The largest hospital, the Accra Psychiatric Hospital, was built in 1906 and is located in the centre of the capital. It only has a capacity for 600-800 patients, but currently houses close to 1,000. It’s a condition that “compromises the comfort and general well-being of patients and constitutes an appreciable strain on [the hospital’s] resources, staff and funds,” according to the hospital’s website.

There are also only twelve psychiatrists working within the government system, many of which perform only administrative duties. There are fewer than 500 psychiatric nurses, more than half of which are located in the mental hospitals, leaving the rest of Ghana wanting.

The result of the widely unavailable care is that many rely on traditional healers, especially in the more rural and impoverished northern parts of the country. Their methods vary from prayers to exorcisms to human rights abuses.

“We’ve seen people who have cuts on their bodies that have festered into sores… It’s all under the guise of treatment,” said Peter Yaro, the Executive Director of BasicNeeds Ghana, an NGO that seeks to “ensure people with mental illnesses and their families live and work successfully in their communities,” according to Yaro.

“We have seen people who are shackled and left in the open, rain or shine for days. We’ve seen people who have been locked in rooms for days, months, and years. They ease themselves there, they eat there, and they sleep there. And nobody bothers to do anything about it until it’s reported to us,” he added.

The garden inside the Accra Psychiatric Hospital.

BasicNeeds has been operating in Ghana since 2002 and has since expanded to six out of Ghana’s ten regions. It strives to improve access to appropriate treatment, teach people with mental health conditions to support themselves, give people suffering from mental illness a political voice, and address the fiend that exacerbates all mental health problems in Ghana – the monstrous social stigma that surrounds the issue.

In Ghana, people with mental health issues are widely misunderstood and mistreated. People view mental illness as anything from a deserved consequence of a spiritual transgression to a contagious condition that will infect anyone who works in the field. As a result, they are discriminated against and marginalized, Yaro explained.

“The moment you are seen as mentally ill you are seen to be less human.… People think you can’t even feel,” he said. There is also little understanding of, or interest in, proper treatment.

“For those who know about the hospitals, they come and dump you there. For those who don’t know about the hospitals, they dump you at the traditional healer so they can move on with their life,” Yaro said.

The social stigma also affects the professionals who work in the field. Unlike other medical specialties, psychiatry is not prestigious. “It’s not attractive. It has no status, socially,” said Yaro. Because of this, and the fact that many people still think mental illness is contagious, few choose careers in the field.

The Mental Health Bill – the government’s plan to address these pressing issues – was finally passed on March 2, 2012. Originally drafted with help from the World Health Organization, the Bill meandered through parliament for eight years.

It emphasizes community based treatment over institutionalization. This is very important because up until the Bill was passed, the legislation that guided Ghana’s mental health service plan had changed little since the colonial Lunatic Asylum Ordinance made in 1888, explained Yaro.

“The national health policy under which mental health services are provided is not only arcane, but very bad,” he said. “We’ve come a long way towards understanding what mental health issues are and the law needs to be retrofitted.”

The Bill also introduces regulations for both public and private care providers need to adhere to, legally protecting patients’ rights. It also calls for a decentralization of care centers and and seeks to battle the stigma through public education campaigns.

It is estimated that more than 250,000 people in Ghana need psychiatric treatment.

The passing of the Bill marked the ratification of the UN Convention on the Rights of Persons with Disabilities. Ghana was one of the original 80 countries to sign the convention in 2007 and activists and mental health care professionals eagerly awaited its ratification since.

“I don’t know how to express my joy. Eight years of anxiety, apprehension and patience- that is how I can describe my feeling now. If we knew that the bill would be passed today, we would have come here with buses full of people and thereafter paraded through the streets of Accra to exhibit our joy and appreciation,” said Dr Akwasi Osei, the Chief Psychiatrist of the Ghana Health Service, at the time of the Bill’s passing.

“The way the Bill is drafted means a revolution,” said Yaro. Although the Bill received Presidential Assent on June 8 and became law, the revolution is still coming.

The massive investment required for the full implementation of what is in the Bill seems unlikely in the near future. Ghana is a Lower-Middle Income country and its economy is largely dependent on foreign aid, which makes up 11.7 per cent of the country’s GDP, according to the Organization for Economic Co-operation and Development. Its public health care system battles both corruption and a “chronic shortage of funding,” according to a 2008 Austrian Centre for Country of Origin and Asylum Research and Documentation (ACCORD) report.

“We have to be optimistic, however one should not lose sight of the [challenges],” said Yaro. In the meantime he is happy with the progress made so far and will continue working with BasicNeeds as Ghana moves forward with its mental healthcare policy.

Polio effects linger in Ghana despite vaccines

When Maclean Atsu Dzidzienyo contracted polio as a nine-year-old, his symptoms worsened to the point where his nerves were affected and his legs became paralyzed. Now an athletic 26-year-old, he expertly maneuvers his wheelchair around the dusty compound of the Accra Rehabilitation Center (ARC), where he is completing his year of national service in the Center’s financial department.

Complications caused by the poliovirus, such as paralysis, contribute to reports from the World Health Organization (WHO) that Ghana’s disability rate stands between seven and 10 per cent.

“The majority of the people [who live and work at the Center] became disabled through polio, and a few of them had accidents,” Dzidzienyo said. “Hardly you will hear of somebody who was born with his disability.”

Among other West African countries, Ghana has taken strong measures to eradicate polio in the country within the past few decades, and has made significant progress from the time when Dzidzienyo was a child.

No new cases of polio have been reported in West Africa in 2012, according to the Polio Eradication Initiative (PEI). Ghana’s last confirmed cases of polio were in 2009. That year, country health officials publically confirmed that eight children had contracted the virus, which was an increase by about five cases from the previous year. Before these comparatively minor outbreaks Ghana had enjoyed a period of being polio-free since 2003, according to the PEI.

This is a welcome change to Alexander Kojo Tetteh, the founder and CEO of the ARC. He also contracted the virus as a child and had his mobility impaired, though he still retains his ability to walk.

The desks at his primary school were very difficult to maneuver into and the set-up required that the children sit in pairs. No one wanted to sit next to him because they thought they could be infected by his disability, he said.

“Nobody was friendly. So I was not happy as a schoolchild,” Tetteh added.

Children can get inoculated in two ways: with an injection of a dead strain of the poliovirus, or take oral drops, which are typically the most popular in developing countries due to their ability to inoculate more people. The oral vaccine is less commonly used in developed nations because the efficacy of the vaccine depends on the strain of polio it is meant to eliminate, as it is a live culture. It can also change to the form of virus that can attack the patient, causing paralysis and nerve damage.

The poliovirus is now virtually eradicated in many countries around the world due to the development of polio vaccines in the 1950s and a global immunization campaign that began in the 1988. However, the virus can still be found in some countries in Africa and Asia. Ghana continues to have yearly mass polio inoculations. This year’s three-day campaign in March expected to reach about 5.8 million children under the age of five.

Zen and Goats: Last impressions of the little things in Tamale

I checked my phone – 9:30am. Half an hour had passed since my last meeting in Tamale was due to start. No sign of the big boss. Having waited up to 2 hours for meetings to start in the past, this was business as usual. This was my last day in Tamale and after a quick meeting with the principal it was back to packing, writing reports and saying goodbyes. I had planned for every moment to count, but this being Ghana, you have to go with the flow of the unexpected.

Rather than roll my eyes and carry on counting the goats in the courtyard, I figured this moment of calm in the warm Tamale sun on the balcony at my school was a keepsake of the bureaucratic tango of meetings in Ghana. “Remember this,” I whispered to myself.

“I am SOOOO sorry!”

I turned as I heard feet pounding and giant palms slapping the metal railing up the dusty staircase to the balcony I was leaning over.

“I had a problem with some guests. You know how they are, always rushing you around.”

It was the big man on campus, Al-Hajji Razak Saani, the recently appointed principal at the IIJ. I like Al-Hajji – he joined the school as principal at the same time I was preparing to leave.  I was gutted to have met such a welcoming man only to leave a few weeks later.  A man of the world, he spent much of his time in the US studying Communications, and the way he so authentically said “Chicaaaago” always cracked me up.

I assured him it was no problem. It had rained heavily the night before and the breeze was cool on the skin. I could have stood on that balcony for much longer, contently playing the tapes from my last six months in Tamale. But it was time for business.

Dusting off the couches with a flick of the rag, we sat down and asked each other about our families, the last meals we took and if our houses had survived the rains. All the boxes were checked.  I made a move for my bag and told him I had a gift. I handed over the tactile culmination of my time at the school: a curriculum document and guide for the jhr chapter for the next semester.

“I’ve been working on this for a couple weeks and I think it could be really useful for the school and the chapter. You guys can reference it and keep up the amazing work you’ve started.”

He brushed the cover with his hands and turned to take mine. I was taken aback but held on to see where he was going.

“You have given us so much. This book is so important to us, I can’t thank you enough.”

Being someone who is almost allergic to one-on-one praise, it was all I could do to squirm in my seat and just return the sentiments. I made a move to open up the book and walk him through it but his giant palms pressed it firmly shut.

“This program you are working on, I can’t thank you enough for the vision you have given our students. The worst thing in the world I could imagine would be to have this momentum come to a close.”

“So would I,” I said.

A montage of our workshops, brief moments in the hall, laughter, taps of chalk on board all came flooding back to me. I would have burst into tears if I hadn’t  bitten my lip so hard. “You guys have given me more than anything I could have asked for,” I stammered. “If you can keep this program going, then we will have all done our jobs.”

“I will do just that. Now tell me about this curriculum thing,” he said.

Just like the breeze on the deck and the taking of someone else’s hand in an unscheduled moment of zen, it’s the little things that have taught me can bring the biggest impact. While there was many a moment I was unsure of my impact, of what I were here to do, I’ve learned from my time in Ghana that no act is too small. Just as much, it has been in the little things, the little gestures and comments that have lead me to believe that jhr is making an impact on the lives of those it works with. Not always as grand and not always in the manner you expect, but if you keep your eyes and ears open like every good journalist should, you’ll see it.

Slow and unsteady: Ghana’s Freedom of Information Bill

The entrance to the Parliament of Ghana. The Freedom of Information Bill has, in one form or another, been meandering through Parliament since 2003.

July 7th marked the 30th anniversary of the day Canada’s Access to Information Act received royal assent, becoming law. Within a year the law had come into full force and Canada had joined dozens of other countries committed to government transparency and press freedom. As of January 2012, 90 countries have established nationwide laws ensuring the public’s right to request and receive government-held information.

In 2000, South Africa became the first African country to pass Right to Information legislation. Since then, seven other nations, including Nigeria, Uganda and even Zimbabwe have followed suit. Although Article 21 of Chapter 5 in the 1992 Constitution of Ghana states, “All persons shall have the right to information, subject to such qualifications and laws as are necessary in a democratic society,” making one of a few constitutions that guarantee a fundamental right to information, no right to information law exists.

There have, however, been attempts to adopt such a law; the latest of which is sitting motionless in Parliament. The Right to Information Bill, as it was called at the time, was first drawn up in 2003, and went through the drafting and a public consultation process that year. It became stuck in cabinet and lapsed in 2004. The next year the processes had to start again. It wasn’t until 2009 that the second attempt, the Freedom to Information Bill, was finally submitted to Cabinet. It was forwarded to parliament in March 2010, where it has remained, inert.

Such stagnation contradicts a string of political promises. During the 2008 election, the now ruling National Democratic Congress promised Ghanaians that, if elected to government, they would pass the Freedom of Information Bill as soon as possible to demonstrate a commitment to fighting corruption.

The sun sets on Independence Arch in Accra. Ghana’s 1992 Constitution is unique in that it guarantees a fundamental Right to Information.

Parliament Majority Leader, Cletus Avoka, promised that before parliament rises on July 27, 2012 for a three-month recess the bill will be passed. However, he has since reneged, stating in May that “Passage of the Freedom of Information Bill was less important and for that matter, not a priority among various bills currently under consideration by Parliament for passage.”

Now, with only two weeks before a recess that will last until late October, and with only one month of parliamentary sessions left until it dissolves again for December’s election, it is clear the bill will not become law anytime soon.

“They [the government officials] have reservations about the widening transparency and the widening accountability that would come with Right to Information Legislation,” said Nana Oye Lithur, executive director of the Human Rights Advocacy Centre and the convener of the Right to Information Coalition in Ghana. The Right to Information Coalition was created in 2003 and is comprised of journalists as well as members from the National Media Commission, religious bodies, non-governmental organisations, and the Ghana Bar Association. It seeks to mobilize public support for the bill and advocate the government to expedite its passage.

“There’s just no political commitment,” she added.

This is a major problem, as activists and journalists agree Ghana needs the Freedom of Information Bill.

“I think that [the Freedom of Information bill] is a very
positive development which will go a long way to enhance the battle against corruption…it will strengthen the Ghanaian journalist to expose the many corrupt institutions that we have in this country,” said Richard Sky, the parliamentary reporter at Citi FM.

“When it comes to parliament there are so many things that are held out of the public view…once you can have access to information, information is a weapon. Once you have it, you can use it in so many ways to kill this rather monstrous institution of corruption that we have in this country,” he added.

Nana Oye Lithur agrees. The bill will empower Ghanaian journalists and citizens to demand answers and fight corruption.

“It will enhance transparency and accountability. We have serious issues with corruption…[within] every regime we have had some bribe and corruption related cases,” she said.

“Research has shown that with access to information regimes there comes a reduction in corruption… we need to ensure the little resources we have as a country are actually optimized and used to improve the lives of the people of Ghana, and not to go into a few pockets.”

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

Lucius Dimiano of Kafupa Village.  Roughly translated, "kafupa" means "hard as bone".  Photo by Karissa Gall.

“Mind the gap” – The crippling impact of HIV/AIDS on family composition and elderly Malawians

The old “respect your elders” adage has customarily been an important part of Malawian culture, with the elderly able to depend on the social and economic support of their children and the community.  However, the HIV/AIDS epidemic has had a crippling impact on family composition and tradition.

While the 2012 Malawi Country AIDS Response Progress Report found that from the start of the epidemic the number of deaths per annum had been reduced from nearly 100,000 to approximately 48,000 in 2010, the report also found that the number of children orphaned by AIDS has been on the rise.

Antenatal Clinic sero-surveys (surveys of blood serum) found that the number of children orphaned by AIDS increased from 576,458 in 2010 to 612,908 in 2011.  And with over half of orphans being cared for by their grandparents, men like Lucius Dimiano of Kafupa Village will be celebrating their 70th birthday before that of their retirement.

At 68-years-old, Dimiano is still working three jobs to support six grandchildren orphaned by AIDS.  He works as a guard from 6 p.m. to 6 a.m. at a nearby church, goes to the garden to get maize for his family, weaves baskets to sell at the market and then, does it all over again.

“I cannot sleep, so it’s hard,” Dimiano said.  “As a night guard, I need to always be awake because sometimes there are thieves in the dark.

Still working three jobs at 68-years-old to support six grandchildren orphaned by AIDS, Lucius Dimiano of Kafupa Village demonstrates panga knife techniques he uses as a night guard. Photo by Karissa Gall.

“When I knock off in the morning I go to the garden, when I knock off in the garden I eat and then I start making baskets so I can make more money, but it’s still not enough to care for all six grandchildren.”

In the same township of Chigumula, 55-year-old Mrs. Kandikole has also lost children to AIDS; her oldest daughter passed away in 2005 orphaning one grandchild, and her second oldest daughter passed away in 2010 orphaning three grandchildren.

“I’m the one who’s left looking out for them,” she said.  “And not only those four; I have other grandchildren at my home who have only a mother but not a father.

“It’s very difficult for me to look after these children because I’m very old.  I’m not working,” she continued.  “Things are very expensive here in Malawi.  Food is very expensive.  I cannot manage to buy clothes for them.  It is very difficult for me to take them to the hospital.  To get good medicine, one needs to pay money at private hospitals, but I can’t manage to do all those things.”

Kandikole said she had been working at a nursery school, but had to quit when her daughters died because “(her) grandchildren were alone, so (she) had to look after these children all by (herself).”

She said her husband, 57, is still working as a telephone operator but “he makes very little money.”

“I don’t think he will be able to continue working much longer because he is now 57 years old and his body is very weak.  He is very sick,” she said, adding that they both suffer from chronic bouts of malaria.  “Before, we could manage to do all those things, but not now.”

Without the proper means or support, Kandikole said she “couldn’t manage to send (her) grandchildren to school, because when you want to send a child to school these days, even a government school, you need to buy a uniform, pencils, exercise books and the child needs to eat porridge.”

She said her grandchildren “were just staying at home” until they were accepted at the Jacaranda School for Orphans in Limbe, a free primary and secondary school in Malawi providing education and daily meals to orphans.

“If we did not have Jacaranda, these children would just be doing nothing at home,” she said.  “They go to school without taking anything.  If Jacaranda didn’t provide porridge I don’t know what we could do.  Before, I thought my children would go to school up to college and help their children by themselves.  But their deaths brought everything down.”

The late Nelley Daniel M’maligeni of Che Mboma Village suffered in the same way.

Deaf and blind, M’maligeni struggled to care for herself yet alone her grandson, Vincent, who was orphaned by AIDS.  In March, at the age of 105, M’maligeni passed away and Vincent lost another primary caretaker.

The late Nelley Daniel M’maligeni of Che Mboma Village waits with her daughter-in-law for her grandson Vincent to return from school. Photo by Karissa Gall.

According to M’maligeni’s daughter-in-law, M’maligeni and Vincent had been sleeping in a small hut.

M’maligeni’s daughter-in-law said her family was able to give extra food to M’maligeni and Vincent once a week, but “sometimes it (was) hard because there (was) not enough money.  Sometimes M’maligeni (could) not eat.

“Sometimes we just (bought) panado, because panado is cheap,” she said.

Dimiano, Kandikole and M’maligeni are each representative of the ways that elderly Malawians are struggling to survive in the wake of the HIV/AIDS epidemic.  According to the Catholic University of Malawi’s December 2010 report “Impact of HIV and AIDS on the elderly: a case study of Chiladzulu district,” 59 percent of the enrolled elderly people had difficulty sourcing money for school uniforms, food and hospital bills for orphaned grandchildren; 55 percent were affected through the sickness and death of their children; and 22 percent had to halt their own development to take care of orphaned grandchildren, spending their reserved resources to make the lives of their grandchildren better while impoverishing themselves in the process.

When asked if there can be greater relief for elderly Malawians struggling to care for themselves and their orphaned grandchildren than panado, an over-the-counter pain medication, Finance Minister Ken Lipenga said that government has put in place safety net programmes that target both the elderly and other vulnerable people in the 2012/13 National Budget.

“These programmes are aimed at assisting the poorest in our communities to cope with life,” he said, adding that during the 2012/13 fiscal year  programmes will be scaled up to capture those that may have fallen below the poverty line due to devaluation.

“A total of K27.5 billion has been provided for four programmes, mainly the Intensive Public Works Programme, the School Feeding Programme targeted towards 980,000 pupils in primary schools, the Schools Bursaries Programme targeting 16,480 needy students, and the Social Cash Transfer Programme which will reach over 30,000 households across the country.”

Lucius Dimiano of Kafupa Village. Roughly translated, "kafupa" means "hard as bone". Photo by Karissa Gall.

But until social cash transfers can be expanded to cover the whole country or non-contributory pensions can be provided to ensure income security for the majority of elderly Malawians who have never worked in the formal sector, government will continue to miss men and women like Dimiano and Kandikole who are fighting for the survival of their family and against the intergenerational transmission of poverty, often without sufficient resources or physical strength to do so.

As Dimiano put it: “If I still had children that could help me, I could have just stayed home, but there is no one to help me, I’m only working because of my grandchildren.

“The only ones who can decide if I stop working are my grandchildren.  Maybe they will see that we are very old and cannot work anymore and they will help us.  But maybe they will finish school and go away.

“At the moment, I do not know.”

 

With files from Richard Chirombo.

Defending sexual minority rights

Homophobia is endemic to much of Ghanaian society.

“Pedophiles or other sexual deviants are not welcome in Ghana.”

The sign loomed over me as I stood, waiting to get my passport stamped, in line at the Kotoka International Airport in Accra. It was my first, and perhaps most jarring, experience with exactly how different the Ghanaian culture is from my own.

In Canada, the prevailing Ghanaian attitude towards homosexuality would undoubtedly be called homophobic. The attitude, however, is characterized less by phobia and more by a vitriolic hatred.

In Ghana, Christian and Muslim communities converge to condemn homosexual activity; a notion that is reflected in social, political, and legal discourse.

Although litigation is rare, homosexual activity is illegal. The Sexual Offences Article 105 in the Ghana Criminal Code reads, “whoever is guilty of unnatural carnal knowledge” is guilty of a misdemeanor, and can be sentenced to up to six months in jail.

Chapter 5 of Ghana’s 1992 Constitution guarantees the protection of all human rights for Ghanaian citizens “whatever [their] race, place of origin, political opinion, colour, religion, creed or gender,” but does not mention sexual orientation.

There have also been calls to criminalize homosexuality. In June 2011, the minister of Ghana’s Western Region, Paul Evans Aidoo, described homosexuality as “detestable and abominable,” and advocated for homosexuals to be immediately arrested.

Later that same year, President John Atta Mills reiterated his government’s position.

“I, as president, will never initiate or support any attempt to legalize homosexuality in Ghana,” he said in October, 2011.

The leaders’ attitudes reflect that of the citizenry. In March, 2012, a group of young men brutally raided a party with suspected homosexuals, beating them in the Accra neighbourhood of Jamestown.

It is a social climate Samuel, the deputy director of the Centre for Popular Education and Human Rights Ghana (CEPERHG) who used only his first name to protect his identity, is all too familiar with.

“Growing up, I had a lot of friends who are MSM [men who have sex with men]. They faced so many troubles and, knowing their troubles, I was like ‘wow,’” he said.

CEPERGH was established in 2003 to promote sexual minority rights in Ghana. They “envision a liberal society that provides friendly, sexual and reproductive health rights services for all persons regardless of sexual orientation, age, tribe, [and] religion,” according to their mission statement.

Although it now provides a variety of programming, including self-defense courses and HIV/AIDS outreach, CEPERGH started by putting on small, secretive “human rights” workshops for sexual minorities.

“These workshops are aimed at educating sexual minorities on their human rights, to make them feel that they are also humans and that they deserve to live like every normal human being. They have the right to association, they have the right to information… they have the right to live as every heterosexual person lives,” said Samuel.

But it is a very hostile environment in which to advocate sexual minority rights.

In 2006, in a response to a rumour that the group was trying to organise an international gay and lesbian conference in Ghana, one of their staff members was badly beaten. They also had to relocate their head office and, under a constant threat of violence, their director fled Ghana for six months.

“I don’t even want to talk about it… [the people] use such harsh words: ‘they should be broken, they should be killed’ they say,” said Samuel.

“It’s not all that bad though. Over the years, some people have come to be accommodating about the situation. We’ve helped people and we’ve changed some minds,” he added.

“The whole thing is dedication. We are poised to do the work, so no matter what the situation is we will still do our work.”

When beggars should be choosers – How the promise of remuneration is heading off freedom of movement and free choice of employment in Malawi

Not long after cutting their teeth, North American children are encouraged to call forward their dreams and consider the question, “What do you want to be when you grow up?”

The kindergartners’ query is not a foreign concept in Malawi – in fact, up to December 2010 Blantyre Newspapers Limited’s (BNL) Saturday paper Malawi News regularly ran a “When I Grow Up” piece encouraging parents to help their children picture and pledge their ambition for the future.

At the same time the query is not yet ubiquitous – as a country that ranks in the lowest group on the Human Development Index (171 out of 187 countries in 2011), problems such as poverty and underdevelopment mean that for many, filling their stomach is difficult enough to do without considering the most fulfilling way to do it.  And for 21-year-old Alinafe Phiri and her friends at the Nkhata Bay boma, it means that when you ask what they want, they simply tell you how it is instead.

According to Phiri, it isn’t uncommon for girls to be taken from their homes in Nkhata Bay to “faraway places” where they work as house girls.  Others are taken from their homes to work in bars.

“This is considered normal because they are paid something at the end of the day,” she said.  “Isn’t it normal for someone to be taken from their homes for work in faraway areas?  What about those that leave their villages and work elsewhere in cities or otherwise?”

No mention is made of the use of force implicated in being taken to faraway places for work – a form of human trafficking – or of unrealized universal human rights to free movement and free choice of employment.

On May 16 Norwegian Church Aid (NCA) held a public discussion at the Nkhata Bay Conference Centre to discuss where and why human trafficking occurs in Malawi. Photo by Karissa Gall.

To raise awareness of such rights abuses, Norwegian Church Aid (NCA) held a public discussion at the Nkhata Bay Conference Centre on May 16.  Three panellists were on hand: Youth Net and Counselling (YONECO) District Manager for Nkhata Bay Wezzie Mtonga, Nkhata Bay Police Station Community Policing Coordinator Brown Ngalu and NCA Programme Coordinator for Human Trafficking Habiba Osman.

During the discussion, Mtonga said that the area is a “hotspot of instances of human trafficking” for the purposes of labour, sexual exploitation, organ removal, or domestic servitude, and that Malawian women like Phiri are the most vulnerable to being victimised “because of their vulnerability when it comes to economic issues.”

“One of the reasons people fall victim to human trafficking is they are looking for greener pastures, and when they go there, things are different,” she said.  “Malawians are vulnerable and they don’t have access to (anti-trafficking) laws.”

Osman, one of the commissioners involved in the drafting of an anti-trafficking bill in 2007, took the opportunity to stress that “the bill is ready, cabinet approved it, so what we need is parliamentarians to discuss it and pass it into law to give us a framework on what should be done and who should be doing what.”

Norwegian Church Aid Programme Coordinator for Human Trafficking Habiba Osman. Photo by Karen Msiska.

“The problem is huge, it is diverse,” she said.  “We need awareness, we need a lot of capacity building not only for the police but other service providers, and we also do need proper data collecting mechanisms.

“We do not have people coming to report on cases of human trafficking because they have been not been trained to collect data, they have not been trained to identify the victims; they have not been trained to identify the traffickers,” she continued.  “Even our parliamentarians also need training on these issues.

“A new cabinet means that new people are in place.  We need to put pressure on them to tackle these issues.”

In the interim, Osman cited Section 27 of the Malawi Constitution, which prohibits slavery, as a standing protection against human trafficking or “modern-day slavery.”  She also cited the Employment Act, the Penal Code, the Corrupt Practices Act, Immigrations policies and the Corrupt Practices Act as statutes that criminalise certain transactions appearing in the various forms of trafficking.

***

Despite Malawi having adopted the United Nations Protocol to Prevent, Suppress and Punish Trafficking in Persons in 2005 and making progress towards the guarantee of protections for children with the launch of a universal and compulsory birth registration process this March, the International Trade Union Confederation 2011 report for the World Trade Organization on Internationally Recognised Core Labour Standards in Malawi found that, “Trafficking is a problem and is conducted mainly for the purposes of forced labour for males and commercial sexual exploitation for females, as well as child trafficking which has also been steadily rising.”

“Typically the traffickers deceive their victims by offering them false promises of employment or education in the country of destination.  In Malawi there are also estimated to be between 500 and 1500 women and children who are victims of internal trafficking,” reads the report.

“In 2009 the authorities arrested and prosecuted child traffickers who intended to deliver boys to cattle herders.  Other usual destinations of internally trafficked persons are the tobacco plantations, domestic servitude, and small businesses.”

The United States Department of State 2011 Trafficking in Persons Report for Malawi further found that while government “is making significant efforts” the country still “does not fully comply with the minimum standards for the elimination of trafficking.”

“Adults in forced prostitution or forced labour and children exploited in domestic service and prostitution still did not receive adequate attention and the government prosecuted no such offences during the reporting period,” reads the report.

“While one trafficking offender received a short prison sentence, most convictions resulted in sentences of fines or out-of-court settlements with compensation to victims, both of which failed to provide an adequate deterrent.”

While comprehensive anti-trafficking law enforcement statistics were unavailable, the report found that some individual districts provided data on their actions, totalling 18 prosecutions, 11 of which concluded with convictions.

“Although the government prosecuted and convicted offenders using existing legislation, only one of nine convicted offenders served jail time and sentences varied widely across district courts,” the report continues.  “Additionally, labour inspectors and child protection officers were trained to seek remuneration for workers in labour dispute cases – including forced labour – rather than to refer to law enforcement for prosecution.”

According to the report, “the government’s continued failure to seek criminal prosecution of forced labour offenses with significant prison sentences hinders an effective response to Malawi’s trafficking problem.”

In Malawi, the Inter-Ministerial Taskforce on Human Trafficking, led by the Ministry of Gender, Child Development and Community Development; the National Steering Committee on Orphans and Vulnerable Children; and the National Steering Committee on Child Labour have responsibility for trafficking issues.

***

Individuals who are aware of any incident of human trafficking in Malawi can contact the YONECO anonymous National Help Line for assistance by calling 8000-1234.  YONECO encourages victims of human trafficking to call the help line as the centre will mobilise to free them and provide counselling and support.

***

With files from BNL-Mzuzu Bureau Chief Karen Msiska

Witchcraft forum focuses on gendered solutions

On May 19, the International Institute of Journalism and JHR hosted a community dialogue on the issue of witch craft allegations in Northern Ghana. Twenty IIJ students, members of the Ministry of Women and Children, local media outlets and NGOs debated the role of the media concerning allegations of witchcraft in the North.

Ghana’s Upper East and Northern regions are home to seven witch camps – more than any other region. The largest camp, Gambaga, was established over a century ago and is now home to 83 women and over 45 dependent children and grandchildren.

As guests began their presentations, the bottom line became clear: accusations of witchcraft are based on gender.

“The debate is beyond whether there are witches or not. The issue is that witchcraft allegations have become a feminized issue,” said I.P.S. Zakaria, of the Department of Women and Children.

Women, often elderly and widowed, are accused for misfortunes in their villages, leading to lynching or banishment to camps far from their communities. The banishment of these women directly affects their access to hygienic facilities, education and economic independence. For many women, discrimination and the emotional stigma attached to being accused limit their ability to speak out against the issue.

“When a woman is 30, she will fight the allegations with all her power,” explained Fati Al-Hassan, president of the Anti-Witchcraft Allegations Campaign Coalition (AWACC). “But when she gets into her 50s and 60s, she begins to accept these powers and confess to these allegations.”

Zakaria finds many women are unable to act independently from their husbands, keeping them vulnerable to allegations. Many widows are accused of witchcraft so they are not entitled to their husband’s inheritance.

“If it looks like you killed someone with witchcraft, you are not entitled to the use of the property,” explained Al-Hassan.

She is no stranger to allegations, having been accused of being a witch herself.

“I love my powers,” she said. “I love the assumption that people have that I have these powers, because it gives me motivation to do the work that I do.”

Allegations follow similar trends, says Ken Addae of AWACC. Working with members of the witch camps since 2000, he has found allegations often occur in areas with high poverty levels and low education. The largest indicator is the structure of social and cultural systems that make women vulnerable, said Addae.

However, Al-Hassan finds this no reason for justify the accusations.

“Culture is dynamic,” she said. “We can’t cling to a culture and justify our actions when we abuse someone.”

Journalist Francis Npong echoed Al-Hassan’s concerns, targeting the media as those most responsible for influencing public opinion on the issues.

“The world is changing,” said Npong. “The role of the media or journalists now goes beyond just the traditional role of informing, educating and entertaining …This century needs more dedicated journalists than any other century.”

Panelists encouraged journalists to make their messages accessible to communities most likely to banish women for witchcraft. Addae suggested creatively engaging communities with traditional Dogon drum and drama troops to shift public opinion.

Addressing the crowded room of students, panelists encouraged the audience to be assertive and balanced with their reporting. They also emphasized the importance of minimizing harm.

A journalist herself, Al-Hassan envisions the media as the public face of the fight for human rights awareness.

“When people have rights, they must be made to see that they are working for them,” she explained.

The forum topic was chosen by the students themselves who have shown an interest in addressing and educating themselves on issues specific to their region.

Talking to the students, the impact of the forum is obvious.

“I have learned so much on how to report gender issues and women’s rights,” said Yakubu Gafaru, the JHR vice-president. “It was interesting to see the majority of the camps are within our region. Why not down south? It means there is something behind it, something we need to address.”

Others found the chance to work with prominent female journalists inspiring.

“We need more female role models like Madam Fati [Al-Hassan],” explained Yahaya Niamatu. “I admire the courage she has. I want to be just like her.”

The politics of being gay

On my first day of work, I was asked how I felt about having a gay president.

The question was referring to President Obama’s announcement in support of gay marriage; my reaction was some combination of nervous laughter, discomfort, denial and correction. It was the first of many conversations about Ghanaians’ attitudes toward homosexuality, which would unequivocally be deemed homophobic in North America.

It is getting close to election time here. The 2008 election had a high voter turnout – 72.91%, compared to the United States’ 56.8%. Mills’ peaceful victory was considered a redeeming display of African constitutional democracy after the corrupt elections in Kenya and Zimbabwe.

Does a high turnout and lack of military coup during elections translate to a fair democratic state? The Constitution claims to have a commitment to “the principle of universal adult suffrage” and “the protection and preservation of fundamental human rights and freedoms.”

There are various documented ramifications of being gay in Ghana. On May 21, Joy FM aired a documentary called “The Gay Next Door” which explores the gay community in Jamestown, Accra. After the recent discovery of a “lesbian party”, gay men and women were beaten, threatened and bullied. Police officers stood by, and when victims went to police headquarters seeking justice, they were refused.

“All these gay people who are making noise are doing so because there is no law that says that it is criminal. Parliament should look at that if possible,” one listener chimed in.

The broadcaster agreed. “If the majority of people feel that it is something that is wrong and it should be criminalized, you ask your lawmakers to amend the criminal code and add it to the sexual offenses act.”

Supporting gay rights in Ghana is political suicide. Official statements against homosexuality have been made by people at local and national levels of government. In 2011, the Western Regional Minister called for the arrest of gays, and President Mills has dismissed international pressures to legalize gay rights on multiple occasions.

“Ghanaian society frowns upon homosexuality and everybody has been telling us that democracy means governance for the people, by the people in the interest of the people,” President Mills commented.

On June 4, NPP Youth Organiser in the Ashanti Region, Collins Randy Amankwa, called for a harsher statement from Mills: “Ghanaians must open their eyes wide because our president may surprise us all just like Obama did to the Americans. He went there several times to seek for help before Obama made that declaration. What if he is given a huge assistance just so he will declare our support and recognition for homosexuality?”

Regardless of the religious and cultural contexts, publicly denouncing a faction of the constituency is a way to alienate certain citizens from the political process, and I wonder if this violates Ghana’s democratic principles.

In a background note published by the UN, Diana Ayton-Shenker addresses the potential conflict between human rights and cultural diversity. “The right to culture is limited at the point at which it infringes on another human right.”

Ghana will see a different political climate in fifty years – the same amount of time that made President Obama’s election possible. In Ghana’s relatively new democracy, I ask a question that few nations can answer affirmatively: is it possible for a publicly gay person to be elected to office?

My colleague – the staunch opponent of legalizing homosexuality who asked me the opening question – thinks it is possible.

“I’m sure, with time. The younger generation is more liberal than the previous one. In the next fifty years, we may not have a gay president, but we will have a community that generally accepts gay rights.”