Realizing rights to health and privacy in Malawi

Guzani Banda is a visually impaired person in the area of Senior Chief Mwadzama and he is currently living positively after he was diagnosed as HIV positive at Benga Health Centre in Nkhotakota.

Although he is currently living positively, the man says he was irritated with medical staff who conducted his HIV testing and counseling.

“I was admitted to Benga Health Centre when I fell sick in 2013. Whilst there, one of the medical staff members at the healthy facility approached me and inquired if I was willing to undergo HIV testing,” he says.

Banda says he responded that he was willing to undergo the testing. He says the staff member went on inquiring from him as to what could be his reaction if it turned out that he was positive.

“I responded that there would be nothing wrong as I would get to know my status and how to protect my life.

“The staff member told me that since I am visually impaired, I had to wait for 15 minutes and I would be furnished with the results. After the elapse of the specified period, I was told that I was HIV positive,” he says.

Banda says he was assured that the issue was private and that he would not hear about his HIV status from anyone.

“I was told to be going and getting ARVs and I agreed to. As time went by, I was bewildered to observe the news of my HIV status had spread like wild fire.

“Several people were approaching me and saying sorry to me, citing that they had learnt around the health centre that I had been diagnosed as HIV positive,” he says.

Banda says even when he had gone to church, people were asking him of the same matter and were wishing him all the best.

He says he was overwhelmed by the spread of the story considering that nobody knew the matter apart from the health staff who assured him of observing privacy.

“I was aware that the staff member who conducted the testing was the backbone of the spread of my story because I live alone and I had told nobody about my status.

“I was very furious with the development such that I wanted to take a legal action against the health centre but some people advised me to let the issue die down,” he says.

Banda says issues of invasion of privacy were paramount at Benga Health Centre because even prescriptions were done in presence of other clients thereby invading one’s privacy.

“The situation is improving following formulation of by-laws after intervention of Benga Radio Listening Club [RLC] which advocates for enjoyment of right to health among community members,” he says.

Benga RLC is one of the five RLCs in Nkhotakota which Development Communications Trust (DCT) and Malawi Health Equity Network (MHEN) established under ‘Tilimbikitse umoyo wabwino’ project. Other RLCs include Mpamantha, Mwansambo, Msenjere and Ngala.

DCT project officer Zione Mayaya says the project uses development through radio approach by mobilizing communities into RLCs to empower them to know their rights and demand good health services from duty bearers.

“We seek to empower women, youth, people living with HIV and AIDS (PLHIV) and people with disabilities to demand quality health services from duty bearers focusing on accountability, responsiveness and inclusiveness,” says Mayaya.

Benga RLC secretary Chikaiko Malambo says they got to know the issue of Banda for them to intervene after they conducted sensitization meeting about right to health targeting Benga support group to which Banda is a member.

“After enlightening them on the right to good health, the support group members started sharing their experiences, which infringed their right to health, at the health centre. One of the issues which we heard was that of Banda,” says Malambo.

Malambo says apart from people with disabilities, expectant women around the catchment area of the health centre were also shunning the healthy facility by opting for Alinafe Mission Hospital.

“They were against delivering at the health centre because it had no placenta pit and the women were very suspicious with the disposal of the placenta with some suspecting that they were sold to fishermen to use as means of catching plenty fish,” says Malambo.

The secretary says after bringing the matter to the attention of health centre advisory committee and Chakaka village development committee (VDC), the community secured cement and constructed the placenta pit since the VDC already had bricks and sand.

“We did this in order to encourage the women to be delivering at the health centre because some women could not manage getting enough cash to pay at the mission hospital. As such, some were delivering in unsafe places thereby putting their lives in peril,” Malambo says.

Benga Health Centre medical assistant Sangwani Mwafulirwa says following various reservations from members of the general public, the by-laws were formulated to guide both the service providers and the clients.

“There are about 12 by-laws but the crucial ones are three. The first one is to do with the time of opening and closing the health centre whereby we agreed that it is supposed to be opened at 7:30 am and closed at 4:00 pm.

“Regarding privacy of clients, it was agreed that the health personnel will be attending to one client at a time and not as a group as previously used to be,” says Mwafulirwa.

The medical assistant says another pertinent issue was to do with safe motherhood whereby healthy personnel noted that expectant women were coming to the health centre too late.

“This situation coupled with the fact that after arriving at night, they have to go and call a nurse or medical assistant to assist in the delivery, it was too late as most of the times the nurse or medical assistant was arriving when the woman had already delivered.

“Thus, the by-law is about the expectant women to be coming to the health centre in good time,” says Mwafulirwa.

MHEN project officer McDonald Phangwe says the project has assisted in creating good relationship between service providers and clients.

“There was tension between the two parties. community members had unfounded accusations towards healthy personnel. For instance, sometimes nurses were insulted but this emanated from the fact that community members failed to understand socio-economic factors.

“Community members now appreciate the supply chain of drugs. As such, some people have realized that it is wrong to be throwing away Panado they have been given at the health centres in frustration that Panado only was not enough treatment they expected to get at the health centres,” says Phangwe.

Mayaya says community members including vulnerable groups like women, PLHIV, people with disabilities and children are experiencing change due to the empowerment.

“For example, at Mwansambo Health Centre, PLHIV used to be receiving ARVs in corridor but this stopped while at Mpamantha Health Centre, clients were not accessing ARVs and had to travel to Nkhotakota District Hospital but they are now accessing ARVs at Mpamantha.

“Some PLHIV at Mpamantha also had to work in fields of health staff for them to receive supplementary food but it also stopped,” says Mayaya.

Through such interventions, vulnerable people like Banda are enjoying their right to health and their vulnerability is eased.

“I don’t have a proper shelter and I struggle to fend for myself since I live alone and I am visually impaired,” says Banda.–Mana

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