Thursday, July 26, 2018

Communities Guard Health Rights if they Know How

By Esther Nakkazi

His only choice was to travel back home.

Geoffrey Bagenda, 40 years, had a combination of HIV and TB, and he wanted to go back to Namutumba, where he was born and raised.

He knew he was sick but suspected witchcraft which he battled to heal using all his life savings. His illness took a fierce hold on him. He could not walk. He would not eat. His family abandoned him. His own mother who lives in the same homestead never cared for him.

His family wished he could die and he did too.

He was abandoned in a small, dark room on the family land. Community members who always passed by Bagenda’s house because it is beside a narrow road on their way to a water source turned their noses up and speeded up to escape the horrible stench. They spoke in low tones about him as they did with others who suffer from HIV.

The community knew his mother and his other siblings very well. He worked at the central market in Kampala, carrying heavy 100-150 kilogram sacks of food that were brought in from the farms.

He should have been a strong man with a big body. But now his cheekbones were protruding, his eyes sunken and when he walked he had to hold onto his now too big trousers that were almost falling.

“I did not have anyone to help me out. My house was smelly. My appetite was gone. I was asking God to take me,” said Bagenda who came back to die where he was born. “I had a wife but.... She left. We had no children,” he said staring in space.

He could not have suspected the knock on his door. It persisted but he had no energy to call out for the visitor to open. Eventually, the door opened.

“A lady came in and asked me how I was doing. She promised to come back,” he narrated.

Hadijah Munabi heard the story about Bagenda at a community dialogue. She attends these because of her work. She was trained as a paralegal by the Uganda Network on Law, Ethics, and HIV/AIDS or UGANET. Munabi also has palliative care knowledge after being trained by the Palliative Care Association of Uganda (PCAU).

With support from TASO-Global Fund, the Uganda Network on Law, Ethics, and HIV or UGANET, is working in 18 districts of Uganda to engage duty bearers and stakeholders on how to respond to Gender-Based Violence through different interventions.

“When UGANET trained us they taught us to identify such cases because that is violence,” said Munabi who identified this case as emotional violence because Bagenda was discriminated and stigmatised. She was also trained on other forms of Gender-based violence, which is rampant in this community.

“UGANET has helped me advocate for human rights and helped us fight against stigma in our daily work plan,” said Munabi.

When she went back to Bagenda’s house the next day she had a bucket, gloves, antiseptic detergents and a broom. She cleaned the house and they talked about his health.

Although he told the UGANET team he thought it was witchcraft, Munabi said Bagenda actually knew his HIV status but had skipped taking his anti-HIV drugs for a long time, making the disease to take a fierce turn and unfortunately getting a co-infection with TB.

Her first instinct was to go and report the case to Susan Achen, a UGANET legal aid officer based in Namutumba town. They both rode back to Bagenda’s house to assess the situation and map a way forward.

“Madam Susan looked at me and asked how I was feeling. I told her I was in a terrible condition and didn't have anyone to care for me,” said Bagenda. Achen assured him that everything would be taken care of.

Indeed, the next day Munabi came with a boda-boda guy (motorcycle) and they took him to a health facility where he was given a TB and HIV test, which were both positive. However, the anti-HIV drugs at the facility were out of stock so Bagenda was promised to start medication on his second visit due two weeks later. He was started on TB drugs.

UGANET acts as a link of patients of this nature to the facility. One of our roles is human rights and palliative care. Although our major role is to give legal advise it is difficult if the clients are in pain,” said Achen.

As a UGANET community paralegal, Munabi had to pick TB drugs for Bagenda, she took him some porridge, cleaned his house and asked after his health. She spent weeks on these tasks every other day making her way to his house and telling him the same thing; you will be fine but you have to take your drugs diligently.

From 29 kgs when he started treatment to 36 kgs and now 43 kgs Bagenda is gaining weight. His Tuberculosis is gone and he is not infectious anymore. He can wash his clothes and dig away the bush that had grown in-front of his front door step.

UGANET gives legal advice to people who suffer from violence; 
Achen also visited occasionally but the UGANET office where she is in charge provided the funds to facilitate Bagenda to go the health facility and Munobi to do her work.

UGANET in partnership with PCAU promotes the health rights of palliative care patients in communities. It may not be legal but Achen knows that this cannot be ignored and that is part of her job.

“Many palliative care patients have concerns with their children, estates and want to deal with the question of their property. We sit with them and help them write a will,” said Achen.

The after effect of this has been noticed by their health providers. They say these people are happier because in a way they have made peace that they might not be around much longer, explained Achen.

But integrating legal aid into palliative care has its challenges. Not many people think that palliative care patients have rights, that they have a right to be heard and make decisions themselves. Often times caretakers tend to influence them.

So the first step is to get rid of the pain because when caretakers control who comes in to see a patient who is confined to a bed or a house, they dictate to them what they can say, said Achen. At this point, the patients are unwell, tired and have no knowledge of what is going on.

Sited outside his clean house and his washed clothes drying on the wash-line, Bagenda has enough energy and appetite. “Now I can stand and sit outside my house. I eat and I feel better,” he said.

“Now the community knows that a sick person can have his health restored but he needs to be supported not abandoned,” says Munabi.

This feature was produced by Esther Nakkazi for UGANET highlighting domestic violence and health rights

Wednesday, July 11, 2018

Listening into a Healthy Life

By Esther Nakkazi 
How radio links up with village health clubs to educate communicates on healthy living.

Haruna Amooti is a radio presenter at Life FM, a community radio station that broadcasts mainly in the local languages of Runyoro and Rutooro.

Once every week, for an hour, from 7.15 to 8.15 pm, Amooti at the Life FM studios in Fort Portal, presents a program to listeners in seven districts of Kyegegwa, Kyenjojo, Kasese, Ntoroko, Kamwenge, and Kabarole, the estimated reach of the radio.

The young man speaks fluent Rutooro and Lunyoro although his program is broadcast in Rutooro.
For the content that is broadcast on his program, Amooti attends a village health club meeting every month. 

In there, he records live voices of the proceedings of the meeting. Sometimes, Amooti visits the various projects that the clubs have put up which are all supported by the Malaria Consortium project in Uganda.

Some clubs have formed money-saving schemes or SACCOS where each member makes a monthly contribution and on a rotational basis and they lend to contributing members. Others have established development projects like piggery and poultry or started drama groups that perform songs and skits with health promotional messages.

“I listen to Amooti’s program every Wednesday. I never miss it. It teaches us about diseases and how to improve our incomes,” said Teopista Namalembeko, a member of the Kitalesa health club that has a piggery project with twelve pigs. It was after hearing Amooti’s program that she joined her village health club.

Amooti’s most memorable meetings were in clubs in which members united to form a SACCO and had financial independence or projects like Teopista’s Kitalesa Club.

“Some members have been able to construct permanent houses and move out of grass thatched ones. While others have used this money from SACCOS to buy land or boost their businesses, which has improved their families’ finances and health,” said Amooti.

He said he was also impressed with the way some clubs use enforcement techniques to improve health. For instance, a village club head and the local community leaders after a meeting, chased away the tenants from rental houses until the landlord constructed a befitting toilet. !

In some instances, Amooti has hosted some of the village health club facilitators on his program. He asks them what they have done as individuals, or collectively as a club, how effective they have been, what more health interventions they need from the government, Malaria Consortium Uganda, the implementing agent, and from the community.

“When the community leaders and members hear their own speaking on the radio they get very excited. I think with good mobilization and partnership with district leaders this village health club concept can be very successful and be well replicated,” said Dr. Julius Bahinda, the Kyegegwa District Health Officer.

Lawrence Businge, the Kyegegwa District health educator has been hosted on the show a dozen times. He as well thinks this concept can be rolled out in every district in Uganda because it is ‘workable’.

In his appearances, he has come with designed health messages, which highlight the achievements of some of the clubs and further educates the communities about the three target diseases; malaria, diarrhea, and pneumonia. Sometimes they also discuss and promote government health programs.

“The radio talk shows amplify our messages because not all members can attend the club meetings,” said Businge. He says the clubs have created a positive impact, mostly they have united communities that can now work togather to take care of and control communicable diseases.

Sometimes, during the radio program, they select a disease like malaria and discuss it, how to control it, what are the danger signs that come with it and at the end of each program, 15 minutes to the end are reserved for in-callers.

“For the fifteen minutes, callers from the districts that do not have village health clubs always request that they want to start them too,” said Amooti. Directly they call and ask him ‘Can you ask that Malaria Consortium group start village health clubs here because we also face the same health problems?’

Other callers request that Amooti alerts Malaria Consortium to include more than the three diseases of malaria, pneumonia, and diarrhea that are currently being handled by the village health clubs. The matter may be considered.

But for now, to further motivate the village health club members, Life FM in partnership with Malaria Consortium Uganda is going to hold competitions later this month to get the club that has practiced the village health clubs' concept best and the best performing village health facilitator.

“That will be the model that we hope shall be replicated all over the country,” said Amooti thoughtfully. But for all he knows now, his radio program has improved listenership and people are always eager to stay tuned because the information broadcast touches their everyday health issues and economic life.

This article was done for Malaria Consortium Uganda in 2015

Friday, July 6, 2018

A fifth of adolescents are overweight or obese due to the double burden of malnutrition in Africa

A new study from the University of Warwick blames macro-level factors for the double burden of malnutrition among adolescents in developing countries. The study lists war, lack of democracy and urbanization among factors to blame.

The double burden of malnutrition refers to the coexistence of undernutrition along with overweight and obesity, or diet-related noncommunicable diseases such as type 2 diabetes.
The authors have examined studies of almost 130,000 adolescents and also found that a fifth are overweight or obese and more than 10 percent had stunted growth due to double malnutrition and two percent were classed as both stunted and overweight.

A total of 57 counties were examined including Algeria, Benin, Ghana, Mauritania, Republic of Mauritius, Sudan, Swaziland, and Uganda.

The study entitled The double burden of malnutrition among adolescents: analysis of data from the Global SchoolBased Student Health and Health Behaviour in SchoolAged Children Surveys in 57 lowincome and middleincome countries suggests that factors including war, lack of democracy, food insecurity, urbanisation and economic growth are to blame.

The study was published in the American Journal of Clinical Nutrition (AJCN) and was led by Dr. Rishi Caleyachetty, Assistant Professor, Warwick Medical School.

His team found that the burden of double malnutrition is shockingly common and the researchers are now calling on governments and NGOs to identify context-specific issues and design and implement policies and interventions to reduce adolescent malnutrition accordingly.

The study set out to quantify the magnitude of the double burden of malnutrition among adolescents and explain the varying burden of adolescent malnutrition across low- and middle-income countries (LMICs).

Adolescence is a period for growth and development, with higher nutritional demands placing adolescents at greater risk of malnutrition.

They used data from the Centers for Disease Control and Prevention/World Health Organisation (WHO) Global School-Based Student Health Survey and WHO Health Behaviour in School-Aged Children surveys done in 57 LMICs between 2003-2013, comprising 129,276 adolescents aged 12-15 years.

They examined the burden of stunting, thinness, overweight or obesity, and concurrent stunting and overweight or obesity. They then linked nutritional data to international databases including the World Bank, the Center for Systemic Peace, Uppsala Conflict Data Program, and the Food and Agriculture Organization (FAO).

They found that across the 57 LMICs, 10.2% of the adolescents were stunted and 5.5% were thin. The prevalence of overweight or obesity was much higher at more than a fifth of the adolescents (21.4%). The prevalence of concurrent stunting and overweight or obesity was 2.0%. Between 38.4%-58.7% of the variance in adolescent malnutrition was explained by macro-level contextual factors.

Dr Caleyachetty said: “The majority of adolescents live in LMICs but the global health community has largely neglected the health needs of this population. At the population level, macro-level contextual factors such as war, lack of democracy, food insecurity, urbanisation and economic growth partly explain the variation in the double burden of malnutrition among adolescents across LMICs.

“The global health community will have to adapt their traditional response to the double burden of malnutrition in order to provide optimal interventions for adolescents.”