Thursday, December 27, 2007

Crocodiles Make Fetching Water a Life Threatening Experience

by Pilirani Semu-Banda

BLANTYRE, Dec 24 (IPS) - Many communities around the world may take water for granted; but for those living along Malawi’s longest river, the Shire, water is something to die for. The 400 kilometre long river is the main outlet of Lake Malawi as it flows south into the Zambezi River.

While the Shire River is the most convenient water source for people living on its banks, it is also home to killer crocodiles. Women and children, required by tradition to fetch water for their households, are most at risk from the crocodile attacks.

"In one area in Machinga, locals estimate almost three deaths a month," states the United Nations Development Programme’s 2006 Human Development Report on Malawi.

Agnes Wilson, now in her late 50s, survived a crocodile attack seven years ago while fetching water from the Shire River in the south of the country. She escaped with her life but lost the use of her right arm.

"The crocodile attacked me just as I dipped the bucket I was using to draw water into the river. The beast tried to drag me to the deep end (of the) river, but I was luckier than others who have died. I was rescued by some men who were passing by," she recalls.

Despite almost losing her life, Wilson braves the crocodiles every day to fetch water. There is no other option for her and her community; the borehole nearest to her village is 15 kilometres away.

"I have just accepted the risk I face every time I go to the river. Either I die of thirst or die while trying to fetch water...I may die fighting for survival if a crocodile attacks me again," says Wilson.

There are no statistics available for the crocodile population in Malawi, but people like Wilson claim there are many, especially in the Shire River.

Traditional leaders in the south of the country, especially those from the Lower Shire Valley, have accused government of caring more about crocodiles than human beings.

Malawi is a signatory to the Convention on International Trade in Endangered Species (CITES), which limits the culling of various animals, including crocodiles. Before the country signed up to CITES in 1982, it used to kill about 800 crocodiles annually; under the agreement, this number has now been reduced to 200 per year.

WaterAid, an international non-governmental organisation (NGO) that helps the world’s poorest people gain access to safe water, sanitation and hygiene education, indicated in a 2003 study that up to 44,000 people in the area had no access to safe water and had to resort to the crocodile-infested river for their water needs.

A programme officer for WaterAid in Malawi, James Longwe, says he knows of three women in Machinga who have been seriously injured by crocodiles while fetching water.

"One of the women lost an arm, while the other two have very deep wounds on different parts of their bodies following the attacks," says Longwe.

He says that some communities have lost count of the number of people who have been attacked by crocodiles.

Longwe adds that WaterAid, in partnership with local assemblies and a local NGO called Target for National Relief and Development, is helping communities at risk of crocodile attacks to have access to safe water by providing a gravity-fed water supply.

"We have managed to water to 18,000 people. We hope to reach every one of the 44,000 people in need of safe water by the year 2011," says Longwe.

Crocodile attacks are not the only dangers facing communities along the Shire River.

The water quality from the river is itself poor: waterborne diseases such as cholera, diarrhea and dysentery are perennial problems in the area.

The United Nations Children’s Fund (UNICEF) recorded over 4,000 cases of cholera, a disease associated with poor sanitation, and lack of hygiene and access to potable water, in the Shire region over a three month period last year.

In its planned Humanitarian Action Report for 2007, UNICEF says it is supporting cholera prevention awareness campaigns, helping construct and rehabilitate wells and sanitary facilities in 400 schools and 150 community-based childcare centres, and undertaking sanitary surveys of water sources.

The agency also says that it is providing buckets with messages in local languages about the safe handling of water and disposal of excreta and solid waste, providing soap and detergents -- and disseminating hygiene messages on prevention of cholera and other diseases.

The Malawi Millennium Development Goal (MDG) Report 2007 indicates that the country is making good progress towards reaching the MDG target which calls for the reduction by half of the proportion of people without sustainable access to safe drinking water.

The report states that access to water resources has significantly improved, from about 47 percent in 1992 to 75 percent in 2006.

"At this rate of change, the projection shows that by 2015 about 94 percent of the population will have sustainable access to an improved water source, which is above the MDG target of 73 percent," says the report.

''Foreign Traders Are Taking Our Jobs''

By Pilirani Semu-Banda

LILONGWE, Dec 19 (IPS) - Foreigners working illegally as small-scale traders are increasingly being regarded as a threat to their local counterparts in Malawi. The outsiders are setting up businesses which, local Malawians believe, are displacing them.

Nad├Ęge Shabani, a refugee from Burundi, is a successful businesswoman plying her trade in Malawi’s capital, Lilongwe. She owns a thriving beauty salon, restaurant and a clothes shop.

She is an example of the foreigners who are being accused of ‘‘taking away’’ business opportunities from locals. Malawians believe that the foreigners possess business strategies and skills which most native traders lack.

‘‘I came to Malawi in 2004 to escape war in my home country. I used the money I came with to set up my businesses here,’’ says Shabani. She started her business with 6,000 dollars. Her ventures are now carting in a profit of about 2,500 dollars per month.

Shabani’s earnings seem like a fortune in a country where up to 45 percent of the population is classified poor, according to the 2007 Malawi Millennium Development Goal report.

When it comes to Malawian businesswomen, only five percent of them are aware of available trade opportunities, according to a 2007 study conducted on behalf of the Common Market for Eastern and Southern Africa (COMESA) by the Federation of National Associations of Business Women in COMESA.

In contrast, Shabani is knowledgeable about different marketing methods and able to identify the most lucrative trade opportunities. ‘‘I am trying to make a living here so I have to be as shrewd as possible. I just have to work hard and employ every strategy which can see me live a better life,’’ she says.

But native Malawians are unhappy with people like Shabani. Grace Kalemera, who owns a beauty salon close to Shabani’s, complains that the Burundian ‘‘stole business from her’’ by establishing her shop so close to Kalemera’s.

‘‘Customers are more interested in sampling foreign services. They go to Shabani’s beauty salon because most of her employees are also foreigners,’’ claims Kalemera.

The Malawian businesswoman blames lack of vigilance by the authorities in effecting laws. ‘‘A lot of foreigners are left to take part in informal trade at the expense of indigenous business people,’’ laments Kalemera.

Trading spots that are close to refugee camps in Karonga in northern Malawi, Dowa (about 45 km north of the capital Lilongwe) and the capital itself are the most popular outlets among refugees.

Last month, police in the north of Malawi intercepted 71 illegal immigrants from Ethiopia on their way to the country’s capital.

But refugees are not the only group of foreigners perceived to be encroaching on small-scale businesses in Malawi. Nationals from China, Tanzania, Pakistan, India and Nigeria have also been accused of trading illegally in the country’s main cities of Blantyre, Lilongwe and Mzuzu.

In October this year, the Malawian government launched an operation to address the problem of Chinese and Nigerian traders accused of operating unlawfully.

Trade and Commerce Minister Ken Lipenga was quoted in the media as saying the operation was ‘‘to flush out illegal foreigners’’ and that the influx of Chinese and Nigerian traders was causing a big problem.

According to the government, most of these traders are contravening business licensing procedures for investing in a business by foreigners. A minimum of 50,000 dollars is required before the issuance of a trade permit to a foreigner.

A number of shops owned by Chinese nationals have since been closed down in Lilongwe. ‘‘It is imperative that foreign traders follow the country's investment procedures,’’ Lipenga said.

Between November 26 and December 1, 2007, the immigration department arrested 90 illegal immigrants in a routine exercise which happens every quarter of the year.

The exercise took place in the capital and at the tourist destinations of Zomba and Mangochi in the southern region, according to the immigration department. Traders from Rwanda, Tanzania, Burundi, China and India were arrested in the operation.

The department says all the Rwandans and Burundians have since been returned to a refugee camp in Dowa as they were found doing business without permits. The remaining foreigners were sent to court to formally be charged with the offence of contravening permit conditions.

According to the immigration department, being found doing business without a legal permit is met with one of two legal responses: the foreigners could have their permits cancelled or they could be deported.

There are over 8,000 refugees in Malawi, according to deputy minister of home affairs, Vuwa Kaunda. He says most of them are in the 18 to 25 age group.

‘‘Our rough statistics show that Malawi has 2,400 refugees from the Democratic Republic of Congo, 3,600 from Rwanda, 1,840 from Burundi and about 1,000 Somalis,’’ says Kaunda.

The government, together with the United Nations High Commissioner for Refugees (UNHCR), has just concluded a verification and registration exercise of all refugees and asylum seekers residing in the country.

The purpose of the exercise was to collect and verify information about refugees and their families in the country to ensure that they are known persons to both the government and UNHCR.

All adults are registered and will be issued with identity documents confirming their status as refugees, according to Malawi’s ministry of home affairs.

These identity documents will, among other things, protect refugees and asylum seekers from being confused with undocumented or illegal immigrants,’’ states a press release issued by the government. (END/2007)

Monday, December 17, 2007

Obstetric Fistula: A Medical Nightmare for Malawian Women

December 5, 2007

Pilirani Semu-Banda

Veronica Yakobe has been living a nightmare for more than two decades. Twenty-three years ago, during a prolonged labor when giving birth to her fifth child, the unborn baby was pressed so tightly in her birth canal that blood flow was cut off and the surrounding tissues died. Then a hole or fistula broke through the vaginal walls between the bladder and rectum. Obstetric fistula is serious medical condition which usually occurs during home births or in poorly equipped local clinics when access to emergency obstetric care is not available. Unfortunately, that was the case for Veronica. She has been unable to control her bodily functions since, and leaks urine and feces uncontrollably. In a bitter irony, after all that struggle, her baby was still-born.

These fortunate women await fistula surgery while many others go untreated. The destitute Yakobe, who comes from Malawi’s lakeshore district of Mangochi, became an outcast among her own community - no one wanted to get close to her because of the smell.
“I was forced to flee my own home. I settled on a plot adjacent to a cemetery on the outskirts of my village. I couldn’t stand the taunting from my own relatives and neighbors. Some were calling me a moving latrine,” says Yakobe. Despite her horrific medical condition, she has since given birth to three more children.

In this country where 40 percent of the adult population is illiterate, this middle-aged woman does not know how old she is.

What Yakobe does know is that in the last 23 years since the fistula developed, she has been to three government-run hospitals in the country trying to have the fistula repaired, but has been unable to find a competent surgeon.

Repairing a fistula is a delicate procedure that requires specially trained doctors. Then through a special initiative, a UN organization, the United Nations Population Fund (UNFPA), began providing financial and technical support to some hospitals in Malawi to offer fistula repair. Finally, in June, Yakobe found salvation from the tortures the fistula caused.
Dr. Mark Linden of Nkhoma Hospital, a mission medical center under the Church of Central Africa Presbyterian, restored Yakobe’s dignity through an operation. He was able to repair the damage that obstetric fistula had caused her.

“Some women have a combination of both these fistulas,” explains Linden. “They are leaking urine and/or stools continuously.” He worries, “They are often rejected by their spouses and community,”

Linden confirmed that obstetric fistula occurs due to prolonged pressure of the child’s head against a part of soft tissue between the mother’s pelvis. The soft tissue becomes necrotic (dies) from the lack of blood supply and breaks down.

The doctor says that obstetric fistula is preventable. So long as a laboring woman is monitored and transported to a suitable facility in the event of a problem, virtually nobody should have to suffer from it.

“Obstetric fistula is a serious problem in Malawi and repairs are only done in four referral hospitals: in Mzuzu, Blantyre, Lilongwe and Nkhoma,” says Linden. It is not known how many obstetric fistula cases there are, since no major survey has been carried out to assess its prevalence.

Fistula repairs started at Nkhoma in 2001. According to Linden, once they got UNFPA funding, they also began to get private donations and funding from the UK Department for International Development (DFID) which has enabled them to offer the treatment free of charge. He says the funds cover the patient’s hospital stay, food, and surgery as well as transport home.

Despite all the efforts by doctors like Linden, there is still some bad news: not all patients with obstetric fistula are successfully repaired. In 2001, Nkhoma hospital carried out repairs on 16 patients and 31 percent of those were not cured. Between 2002 and 2006, the hospital has recorded an average of 20 percent unsuccessful repairs.

In Malawi, where up to 65 percent of its 13.6 million people live below the poverty line, there was no means of transportation for 32-year-old Jostino Frank when she went into labor.

With UNFPA support, the Government of Kenya is working to integrate obstetric fistula into the country's ongoing Safe Motherhood programs. © Sven Torfinn/Panos/UNFPA •Frank lives in a village in Dedza, Central Malawi. The nearest hospital is a two hour walk from her home. Her mother-in-law assured her that she would help with a home delivery, but she could not handle the delivery when it became complicated.
“After struggling with labor pains for close to 12 hours, my mother-in-law eventually took me to a traditional birth attendant, but I had already miscarried by the time I delivered,” says Frank. This was Frank’s fifth pregnancy. She gave birth to her first child when she was 18.

Following her ordeal, Frank could no longer control her bladder; the government hospital closest to her home had no medical solution for her problem.

“[All they could do is tell] me to not have sex for six months but this did not solve the problem,” says Frank.

Just like Yakobe, Frank was shunned by her community.

“Only my husband was supportive. He took me to neighboring Mozambique to see a traditional healer but I wasn’t cured. It was only when someone in my village advised me to go to Nkhoma hospital that I got real deliverance,” she says.

It has been nine months since she received treatment and Frank is now three months pregnant. This time, she has vowed to leave her village and camp at the hospital as soon as she reaches her eighth month of pregnancy.

Doctor Linden advises women who have been repaired to undergo a caesarean section if they become pregnant again.

Nkhoma Hospital indicates that one of the major challenges in treating fistula repair is that so few communities are aware that the problem can be treated successfully.

Frank agrees as there are a lot of cultural misconceptions associated with the condition. She says most women with fistula and their families believe that they have been bewitched, which is why they are rushed to traditional healers.

Incredibly, some believe that women who get obstetric fistula are being dealt spiritual punishment for being too lazy to push out and deliver the baby. Others are accused of infidelity.

However the Director for Reproductive Health in Malawi’s Ministry of Health, Dr. Chisale Mhango, blames the high prevalence of obstetric fistula on early marriages that lead to too-early childbirth. He also cites the country’s inadequate infrastructure for childbirth as another significant factor.

We’re failing to cope with maternity cases in this country. Most women have no choice but to give birth at home with no medical care. They only go to hospitals after everything else has failed,” worries Mhango.

He says the government is trying its best to increase infrastructure for childbirth. A related statistic shows that currently 28 percent of mothers say they had not wanted a baby when they got pregnant. He says poor access to family planning services is what leads to this kind of situation.

Mhango says the country is only able to carry out caesarean sections on three percent of pregnant women per year, as opposed to the World Health Organization’s analysis that five percent of pregnant women need it. A developed country such as the United Kingdom in contrast, has gone to the opposite extreme by carrying out caesarean sections on 23 percent of pregnant women every year.

The UNDP says that Malawi is struggling with far too high a maternal mortality rate (over 1,100 per 100,000 live births) and a devastating infant mortality rate of 94 deaths per 1,000 live births.

20-year-old Londina Isaki sits in a waiting ward at Nkhoma Hospital as urine drips down her legs. Ten other women are also waiting to be repaired – some have waited for over two weeks.

Dr. Linden says fistula repair is only one of the many services offered at his hospital and that service delivery has not been easy since the hospital has limited operating time and human resources. Combined with the fact that Nkhoma is a mission hospital, it has difficulties making ends meet and depends on donors for financial support. The medical personnel at Nkhoma are overburdened with every kind of medical case, as it is the only hospital facility serving the needs of a population of 60,850

Malawi’s people suffer terribly from the country’s critical shortages of medical personnel. Up to 120 registered nurses leave the country every year for the US and UK for better-paying jobs. The ratios are staggering: currently, there is one nurse for every 50 patients, but there are even fewer doctors - one doctor is responsible on average for 64,000 patients.

According to the World Health Organization, an estimated 50,000 to 100,000 women develop obstetric fistulas each year and over two million women currently live with fistula injuries. In the meantime, the many women who begin first pregnancies when they are still just young girls and who endure baby after baby in rapid succession until their vaginal walls give out, must just get in line behind all the other Malawians with medical needs.