Sexual and Reproductive Health Services: Access is Good But Quality is Better.

Wow! How time flies. I can’t imagine I am year older (again), thought I this morning when I received an SMS from a friend I have long lost sight of. It read thus; “Happy Birthday and many more years” This is a classical birthday message that anyone will send to a friend or even an unknown person, you might be thinking. But this is not the case for me because unlike in the previous years when I will just receive these messages and file, I have this year decided to carefully study these Birthday messages before filing or even deleting and as well carefully look through all the Birthday  messages I have been sent at each one of these occasions.

Though written in different styles and strongly influenced by the nature of my relationship with the sender of the birthday message, there is a wish that was omnipresent in all the messages: Wishes of Good Health; which is what my friend’s, “Many More Years” in the above extraction from his birthday wish message to me seeks to express The result of this crazy study revealed to me how much Cameroonians care about their health.

The health of the average Cameroonian, like that of any normal human being in the world, is very important to him/her. What would vary might be the approach to ensuring that they stay healthy and maintain an equilibrium that is necessary for them to live a life worth living. Important as being healthy might be to Cameroonians, they are not unaware of the barriers to staying healthy. Talking about barriers to staying healthy in Cameroon, if you ask any Cameroon what  the greatest barrier to  staying healthy  is, you would likely  hear  him/her answer   ‘ACCESS’.

While it is clear from all indications that access to health is a stumbling block to Cameroonian’s staying healthy, it should be noted that even where these health facilities are available, users complain bitterly of the quality of the services rendered. Thus, it is common place to see a health practitioner sarcastically questioning   a teenage girl about the reason for her pregnancy and making fun of her pregnancy by using very insulting and violent language. Worst still, it is common place to get a health practitioner who openly discusses results of the medical test of his/her patients without any sense of guilt or fear. The judgmental nature and lack of confidentiality in Cameroon’s health services is so widespread and across all spheres of society that a government minister recently declared that a journalist who had been tortured to death while in detention had died of HIV/AIDS.

With judgmental attitudes like these from health professionals and lack of confidentiality, no wonder an ever increasing number of pregnant teenagers  refuse to go for prenatal checkups. To stay clear of insults and other traumatizing language and behaviours, they thus decide to stay at home with the risks that this carries.

It is high time the quality of health services in existing health facilities be improved so that patients, especially young persons, can have the best possible experience and not be afraid, for instance, to get an  HIV test because they are not sure the results will remain between them and the health professionals.

The quality of health services, though often ignored, is an important factor in reinforcing the access of   young people in particular and society at large to health facilities and should be considered as such by policy makers and health professionals. The availability of health facilities that have little or no consideration for the quality of the services offered creates more problems than it solves.

                                                       

As government leaders, policymakers, healthcare professionals, NGO representatives, corporate leaders, and global media outlets gather in Kuala Lumpur to attend the Women Deliver 3^rd Global conference to hold from the 28^th-31^st May 2013, it is  my  greatest desire that  the quality of health services as they are now be carefully studied and appropriate action taken to make them  less judgmental, more efficient, and more youth friendly.

Survival on Lies: Do People Living With HIV/AIDS have to lie on their Serological Status to avoid Stigma?

A few weeks back  I listened attentively to ‘SOS Doctor’, one of the best health programs that be on Radio in Cameroon. As I listened, I got very happy at the great job that Dr. Dion Grace, a member of the National AIDS Control Committee of Cameroon was doing to educate Cameroonians on anti-retroviral drugs. She eloquently and insightfully answered every one of the questions that were posed to her by listeners who called-in and am sure her intervention in the program was a timely one. Everything was fine until when a listener called-in to ask what is it that could be done to reduce stigma on people who are on anti-retroviral drugs. Dr. Dion as usual gave a very insightful answer to this question going as far as citing the example of Ivory Coast where the drugs are put in anonymous packages so that they can be taken by patients without fear of stigma by the people around them. She went ahead to cite cases where some special containers of various doses is been used in some countries to reduce stigma. This was quiet interesting to know, but when she started advising people on anti-retroviral that they could tell people around them that they are taking vitamins or pills in order to avoid stigmatization I grumbled the following to myself: Do I have to be so ashamed of my status that I have to lie to others?

I have no statistics on this but I can assure you that having to lie on your HIV status is the order of the day in Cameroon especially amongst young people to avoid stigma and discrimination.  Well, this to an extend is understandable given that People Living With  HIV/AIDS(PLWHA)  are considered as being punished by God for either their sisns or those committed by their family. But when telling a lie to avoid stigma is a behaviour that is reinforced health professionals, I have reservations and clearly doubt how efficient this approach could be.

I am utterly convinced that a problem can only be solved if its root cause(s) is/are carefully tackled. As a young person living in a society where most PLWHA are young persons, I compare telling a lie on your HIV/AIDS status to survive to deliberately refusing to tackle the problem from it’s source and launching an attack on its leaves instead. 

"1200 000 People Died of AIDS in Africa in 2011. Millions of  these deaths being avoidable", says this bill board, at the heart of Douala-Cameroon' most populated city

 

 To reduce stigma in the most sustainable way possible, education rather than lies is required.Young  People, their families, and the communities in which People on anti-retroviral drugs have to be educated on the dangers of stigma and on the importance of accepting PLWHA. Ban Ki-moon, the United Nations’ Secretary-General,  vividly spelt out society’s responsibility to PLWHA when he declared that,  “We can fight stigma. Enlightened laws and policies are key. But it begins with openness, the courage to speak out. Schools should teach respect and understanding. Religious leaders should preach tolerance. The media should condemn prejudice and use its influence to advance social change, from securing legal protections to ensuring access to health care."

 

Lies do nothing but contribute in amplifying the myth around HIV/AIDS in the Cameroonian society. People on anti-retroviral drugs do not need to lie on their status to survive stigma, they need to accept themselves as they are and deserve the care and protection that every other human being is due by the society in which they live.They deserve to live a real life and not a life of lies.

The Stigma of Childlessness

Rarely in Cameroon does a week go by without one hearing of an attempted child theft or of the disappearance of a child. The most popular of this is the Vanessa Tchatchou affair((Read my blog post on this affair at:www.amplifyyourvoice.org/u/Gastonkwa/2012/312/vanessa-Her-Stolen-Baby-and-the-plight-of-women).The theft of Vanessa’s baby is not an isolated case in Cameroon, in the past 2 months the local media has reported  more than 2 cases of child theft(http://www.cameroon-info.net/stories/0,31995,@,douala-equinoxe-tv-aide-a-retrouver-un-bebe-vole.html, http://news.jetcamer.com/index.php?option=com_content&view=article&id=581). This rising rate of acts of child thievery in Cameroon exposes the ugly face of a phenomenon that has eaten deep into the fabrics of the Cameroonian society.

While poverty, greed, impunity, and illiteracy are to blame for these rampant and scandalous acts of child thievery, the stigmatization of women who have not given birth or cannot conceive and bear children carries an even heavier blame as illustrated by the declaration of Thérèse Diane Mouli Nguetti to the press. Caught with a child she had stolen, she declared that,"At 18, I had a child who died three months later. Since that time until when I stole the baby, I was childless. I was told this was the consequence of a bad fate that was thrown on me "(http://www.cameroon-info.net/stories/0,31995,@,douala-equinoxe-tv-aide-a-retrouver-un-bebe-vole.html)

CHILDLESSNESS: MORE THAN A BURDEN;A BONDAGE

Cameroon has the second highest rate of childlessness in the world. Demographic and health surveys carried out in Cameroon between 1994 and 2000  revealed that 7.3% of women  were childless with 22% of this cases identified among women aged 25-49 years(http://www.who.int/reproductivehealth/topics/infertility/DHS-CR9.pdf)

Given the importance attached to having children and the fact that, not been able to conceive and bear children in Cameroon is often attached to witchcraft and largely seen as been a punishment from God (or a supernatural force), women   who are suffering from primary or secondary infecundity are subjected to all sorts of treatments and are victims of the worst form of abuses that anyone can possibly imagine.

In fact Demographic and Health surveys carried out in Cameroon (1994-2000) revealed that 38 Percent of women were divorced or separated because they were childless, primarily sterile, or secondarily sterile. These surveys also revealed that 69 percent of women in a polygynous first union were childless or primarily sterile. The rate of divorce and marrying of another wife by men for reasons related to their female partners being childless or sterile are only a visible tip of the ice berg as these women are often repudiated by their husbands (most marriages in Cameroon are not legalized so the law on divorce will not apply in cases like these), not allowed to participate in some community activities, and even buried in a disgraceful way-behind the house and with a small stone in one of her palms. As if to wipe off memories of their existence from people’s mind and tell the dead person that since she was not able to procreate, the only way to thank her is to give her that small stone.

WHEN CHILDLESSNESS TURNS INTO HOPELESSNESS

Thus humiliated and abused, these women are willing to do anything to get a child, including stealing one and all means for them  are right to disentangle themselves from the bondage of guilt that society has plunge them into. The means could thus range from adopting a child, as does 53% of childless women in Cameroon (according to the above mentioned Demographic and Health survey), or simulate a pregnancy at the end of which they either pay people to steal a new born baby in one of Cameroon’s poorly equipped and unsafe maternities or do this themselves(as has been the case of 2 of the cases reported by the media recently).

STIGMA IS THE REAL CULPRIT

While Vanessa continue to weep and hope to one day hold her baby in her arms again, everyone in Cameroon seems to be looking for the culprit. While this is the right thing to do, I believe the attention is elsewhere and that if nothing is done more children like Vanessa’s will be stolen and the culprits never brought to book.

The real culprits of this acts of child thievery are not  in my opinion their perpetrators but stigma attached to not being able to conceive and bear children, discrimination,  poverty, illiteracy, the government, and all who watch this happen  without doing anything for this evil practice to be eradicated.

EDUCATION IS KEY TO ERADICATE STIGMA

Should we fold our arms and watch? I strongly believe NO! Indifference to the suffering of others is not to be tolerated in this age. Gone are those days. Today is Vanessa’s turn, who knows whose turn it is next? There is hope and there is a possible way out of child theft. That solution is to be found in the eradication of practices and change of policies that stigmatizes and discriminates against women who can’t conceive and bear children as well as retard development.

In its 2011 Rural Poverty Report, the IFAD (International Fund for Agricultural Development) revealed that despite growing urbanization, 70 % of the world’s poorest people still live in rural areas with a majority of them women. Given the high level of illiteracy in these communities and the predominance of traditional and religious beliefs that  are hostile to childless women, I am convinced that there exist no better way in my opinion to eradicate despicable practices such as those described above and change mentalities than through education. 

Educating and sensitizing rural community dwellers on the ‘true’ causes of in fecundity is not only providing them the tools, strategies, and means to become active citizens through shunning the above mentioned practices, but above all contribute in raising their awareness on how some common causes of infertility could be prevented and that infertility  is no death sentence.

Through education and sensitization, inhabitants of communities where childbearing is considered as the main function of a woman, will come to understand that women are meant to do much more than bear children and this will go a long way to increasing their esteem for the great works and intellectual contributions of women to the progress of humanity.

This article was first published on amplifyyouvoice.org and can be read at: http://www.amplifyyourvoice.org/u/Gastonkwa/2012/4/12/The-Stigma-of-Childlessness