Tuesday, November 19, 2019

Gynaecologists call for safe abortion as part of essential health package for women

Gynaecologists call for safe abortion as part of essential health package for women

By DAVID MAFABI


Doctors perform checks on a pregnant girl who wants to undertake abortion (PHOTO/Courtesy)
KAMPALA – “When the doctor told me that we needed to discuss the results of my pregnancy test, I already knew I was pregnant; because I was just recovering from rape,”
Oliver tested for pregnancy and the result was positive. It was hard for her to accept the news, since she saw this as an end to her dream of becoming a teacher.
Yes, I watched that line turn blue and I felt sick to my stomach because I knew, without doubt, that I would be expelled from school and be banished from home by my parents.

“I spent days in agony, thinking about what to do, I sat in the same spot and suddenly, I felt only grim determination to get everything out as quickly as possible.

“Yes, I would rather live daily with the knowledge that I ended a life, not because it posed any risk to my own but because I simply didn’t have the emotional strength to cope with a child of rape,” I told myself.

She said not even knowing the deep joy of being a mother could change her mind at that moment.
I could not go to the hospital because I knew that abortion is illegal in Uganda, so I confided in a friend who took me to a Traditional Birth Attendant for an abortion.

She made a concoction of some herbs and told me to take a full mug and she got a wire pushed it through my vagina, pricked something and suddenly I felt sharp pain, blood started oozing out of my private parts and I lay unconscious.

“And when I came back to my senses moments later, I found myself in the hospital with a doctor around me while my mother lay on my bed near my head, I was admitted,” said Oliver.
“My mother told me that I had bled to near death and that when they were called, I was unconscious alone in the hospital and that the people who had taken me there had fled to avoid being arrested,” she added.

Oliver is not alone many girls who get pregnant against their will, usually seek unsafe abortion services from TBAs and nurses but when things run out of hand, they [TBAs and Nurses] abandon them [patients] and flee for their lives.

Dr Charles Kiggundu, the President of the Association of Gynaecologists and Obstetricians, says Uganda records about 1,500 deaths from unsafe abortions daily and that the consequences of unsafe abortions cost the country about Shs7.5 billion annually.

Dr Kiggundu said this may not be indicative of the actual rate “as abortion is commonly hidden in haemorrhage and sepsis figures due to stigma.

There are over two million conceptions in Uganda every year, 200,000 to 300,000 of these miscarry or abort spontaneously but 350,000 abortions in Uganda are induced

“90,000 of these induced abortions end up with severe complications but only half of them are able to access post-abortion services at medical centres but many others die and those who survive end up with chronic pain, anaemia, infertility among others,” said Dr Kiggundu.

“Safe abortion services are available for the rich but hidden from the poor. You must be connected and well-oiled to access the services, I know of many rich people who fly to South Africa to terminate pregnancies and return,” added Dr Kiggundu.

Although Oliver lives today, but she will never bear a child because she suffered incomplete abortion, haemorrhage (heavy bleeding), infection, uterine perforation (caused when the uterus is pierced by a sharp object), and damage to the genital tract and internal organs (by inserting dangerous objects).

WHO says that Maternal morbidity and mortality due to complications of unsafe abortion constitute a major public health concern in many African countries and that unsafe abortion is one of the top five causes of maternal mortality, along with post-partum haemorrhage, sepsis, complications from delivery, and hypertensive disorder.

According to WHO and Guttmacher, at least 22,800 women die annually as a result of complications of unsafe abortion; and between two million and seven million women each year survive unsafe abortion but sustain long-term damage or disease (incomplete abortion, infection (sepsis), bleeding, and injury to the internal organs such as puncturing and tearing the uterus.

Mr Moses Mulumba, the executive director Centre for Health, human rights and development [CEHURD], says safe abortion is one of the Sexual and reproductive health and rights that are fun¬damental to people’s health and survival, to gender equality and to the well-being of humanity.

He revealed that according to World Health Organisation, sexual and reproductive health is a state of physical, emotional, mental and social well-being in relation to all aspects of sexuality and reproduction, not merely the absence of disease, dysfunction or infirmity.

Mr Mulumba explained that a positive approach to sexuality and reproduction should recognize the part played by pleasurable sexual relationships, trust and communication in promoting self-esteem and overall well-being.

“All individuals have a right to make decisions governing their bodies and to access services that support that right,” said Mr Mulumba.

Human rights Activists intend that government provides access to safe abortion services and liberalize abortion laws where necessary, ensure adolescents have access to sexual and reproductive health information and services without discrimination, address sexual and gender-based violence through policies, services and prevention programs and engage men to support women’s health, rights and autonomy and address the SRHR needs of men.

A GUTTMACHER-LANCET COMMISSION report 2018 ON SEXUAL AND REPRODUCTIVE HEALTH AND RIGHTS to accelerate progress on sexual and reproductive health rights for all says gaps in sexual and reproductive health and rights (SRHR) take an enormous toll on individuals, communities and economies around the world.

IPAS, an Ipas an international organization solely focused on expanding access to safe abortion and contraceptive care  says the gaps in sexual and reproductive health and rights require a holistic approach to close them that encompasses the right of all individuals to make decisions about their bodies—free of stigma, discrimination and coercion—and to have access to essential sexual and reproductive health services.

The Guttmacher-Lancet Commission’s vision of universal access to SRHR is affordable, attainable and essential to the achievement of health, equitable development and human rights for all.

Mr Meddie Mulumba, the Uganda Human Rights Commission Commissioner says that although abortion is legal to preserve the life or mental or physical health of a woman and in cases of sexual assault, many people—including health care professionals—are under the impression that abortion is illegal.

He explained that as UHRC, they are pushing for legal abortion in the country as a human right for every woman and girl for to ensure that legal abortion is treated as a basic human rights issue.
“The content and scope of Uganda’s abortion laws needs to be clarified and publicized if health care providers are to be able to provide the critical reproductive health services that are every woman’s fundamental human right.

According to GUTTMACHER-LANCET COMMISSION, essential sexual and reproductive health services aligned with the new definition must meet global standards for medical ethics, public health and human rights, including the “availability, accessibility, acceptability and quality” framework of the right to health.

The Commission recommends that essential package of sexual and reproductive health interventions, comprehensive sexuality education, counselling and services for a range of modern contraceptives, with a defined minimum number and types of methods, antenatal, childbirth and postnatal care, including emergency obstetric and newborn care, safe abortion services and treatment of complications of unsafe abortion.

Ms Sarah Opendi, the State Health Minister said the ministry is seeking post-abortion management policy, detailing the circumstances under which medical workers can manage safe and legal abortions in hospitals.

According to Ms Opendi, the new policy is intended to provide for comprehensive management of post-abortion complications.

“And our laws are also clear about abortion, it is criminal but allowed under certain circumstances. We shall stick to the law but guide our country and the guidelines will also help us towards achieving essential sexual and reproductive health services,” said Ms Opendi.

However, Emma Ainebyoona, the Ministry of Health Senior Public Relations officer said the ministry has never passed the policy and guidelines on abortion and that abortion remains illegal according to the penal code Act and the constitution.

What the Ugandan law says
In Uganda, termination of pregnancy is prohibited but is permitted only under circumstances intended to preserve life, mental and physical health of a pregnant woman but many medical personnel are not aware of this exception.

Some of the scenarios under which abortion is allowed under the provisions above include; when a woman is raped, when the child she is carrying was as a result of incest, when the health of the mother and the unborn child is in danger.

Article 22(2) of the Constitution says: “No person has the right to terminate the life of an unborn child except as may be authorised by law.”

Section 141 of the Penal Code states punishment for any person who abets abortion in any form, it says: “Any person who, with intent to procure the miscarriage of a woman whether she is or is not with child, unlawfully administers to her or causes her to take any poison or other noxious thing, or uses any force of any kind, or uses any other means, commits a felony and is liable to imprisonment for fourteen years.”

The same Penal Code Section 142 says a woman who procures her own miscarriage commits a felony and is liable to imprisonment of up to seven years.

 

At 122, Ms Mutuwa could be the oldest person in Uganda

At 122, Ms Mutuwa could be the oldest person in Uganda

Ms Mutuwa during the interview in Bulambuli (PHOTO/David Mafabi)
BULAMBULI – On the morning of 27 September, I travelled to Bulambuli district, on the slopes of Mt Elgon to celebrate the World Tourism day.
This was a special one under cultural tourism organised by Elgon Tourism Network [ETN to celebrate the oldest people in the Elgon sub-region.
And although the tourism fraternity converged in Gulu to mark World Tourism Day, I joined ETN to celebrate the day with the oldest people in the Elgon sub-region.
World Tourism Day celebrated globally every year is meant to raise awareness of the importance of tourism.
And just as I entered the compound, my eyes meet Ms Yunia Mutuwa, at 122 years, she could be the oldest person living in Uganda
Even in her advanced age, Mutuwa is neat, her short, grey-haired head is well trimmed and she remembers everything that happened during her youthful stage in the early 1920s.
Although she looks frail and weak from the way she does her things, the greatest weapon she has is a good memory and the only weakness she has is failing sight and hearing.
From the interview I hold with her, I notice that she remembers all her 12 children she gave birth to even the dates even when most of them are dead apart from one daughter Ms Penina Mukiite, 86.
Mutuwa smiled and waved at us as we approach her for an interview, she welcomed us and then searched for what she could sit on before she told us to startMutuwa gives answers to my questions without thinking but they turn out to be the right answers to most of my questions because she has good memory about most things to do with her long life.
Most of Ugandans aged over 50 years can tell their age from a birth certificate but at the time Mutuwa was born, there was no birth certificate then and most children were never born in hospitals.
“I don’t know my age but what I know is that I was born at the time Semei Kakungulu [colonial agent] came here with Bagwere and Basoga chiefs [1898] and I remember very well that I got married in 1924 to my late husband Mr Ibrahim Maswere,” said Mutuwa
“And I have one daughter living and I got married when Mr Koliabu Maswere, 103, was in P4,” she added making Mr Maswere to nod in appreciation.
She explained that she was born in Buwanyanga village in Busano sub-county and that her clan is called Bashisa.
She said although she is saved and goes to church regularly today, she was just looked for with a cane, taken to Nabumali church of Uganda, taught Christianity and later baptized in 1932 and wedded the same year.
She explained that she was baptized and wedded by Rev Crabtree in 1932.
She said although there were no hospitals then to teach mothers about family planning, she spaced her 12 children by three years.
“There was that man called Kakungulu who moved with chiefs from Bugwere and Busoga, he forced people to plant Coffee and trees. And so every family also ensure that there were Kimitoto [type of tree] in Coffee gardens for better production,” said Mutuwa.
She said a war between Bugisu and the Banyole [Butaleja] over boundary was settled by Kakungulu with his chiefs by digging a deep hole and pouring ash in it and that marked the boundary that exists up to now.
Asked about her peers who are still living, Mutuwa said most of them were killed during tribal war and others died a natural death but there are those who went out to Buganda for settlement.
“There was that hunger we called here Bikutiya [1918-1919] after World war one, this when people started moving out of Bugisu,” said Mutuwa.
The secret of staying for many years
Mutuwa says has stayed for many years because she believes in God and that God wants her to stay this long before starting to sing in Luganda.
“I am saved, I am not like other people who get saved because of food and I also love my God, I pray and you people don’t want to pray. That is the secret of my long stay,” she said.
I also eat well mushrooms, local Sodium hydro carbonate, matooke, yams, Cassava, Blood from animals [cooked], a lot of greens of all types, beans without cooking oil.
Medication
Mutuwa says that although she has been taken to hospital against her will, she uses local herbs whenever sick because I fear western medicine.
“I remember one time around 1960s, I was told to go to the hospital, I just went and hid at my sister’s home and came back home to use herbs,” said Mutuwa.
She added that she has no stress even when my husband died long ago. People usually go early to the grave due to stress, I take herbs for treatment, they are around me and even the vegetables we eat as source but this is what most people have relegated these days to oily foods and a lot of meat.
Ms Mutuwa centre listens to his grandchild while at her left is the only surviving child Ms Mukiite [White] (PHOTO/David Mafabi)
Entertainment She said as young girls and boys who lived before the 1920s, the most popular means of entertainment was the flute.
“Men would play the flute and we would dance throughout the night but none of us ever went out with a man unless you were sure that was your husband,” said Ms Mutuwa.
Ms Mukiite, 86 her daughter and the only surviving child says her mother has profound memories of her past and that occasionally she communicates to them.
“She takes local herbs to be strong and she has lived a type of life without conflict, she didn’t move from one man to another like most girls these days even after the death of my father, her husband,” said Mukiite.
She revealed that although her husband [my father] later married another wife, there was no stress and no conflict as they were trained to cook food and serve the entire family with your co-wife and husband in turns.
Mutuwa’s tips for a long life
Mind your own business
Stress is a silent killer. It can take years off of your life, and in some cases, it can end it. I focus on my own life and I do not compare it to that of my peers or neighbours.
Avoid junk food
Dr Stephen Mungoma, the chairman of Elgon Tourism Network said to live long people must avoid eating junk food.
“And it is not a good idea to fill your mind with junk thoughts or your day with junk energy or your life with junk people. Fill your plate with natural foods and you will go from overweight to overjoyed. I eat vegetables with every meal and I eat beef twice a week,” said Mr Mungoma.
‘Plans are underway to establish Junia foundation for all the very old in Mt Elgon sub-region, have all religious and cultural sites for protection,” said Dr Mungoma.
He explained that Elgon Tourism Network together with Falling Sky Resort and tours will make this an annual even where the old people will be brought out to teach people about their longevity.
The Executive director of Falling Sky Resort and tours Pastor Robert Khaukha said the target is to make Mt Elgon a global tourism destination in Uganda.

Shocking view of once green Mt Elgon

Shocking view of once green Mt Elgon

DAVID MAFABI

The shocking view of Mt Elgon land in Kween district cleared for growing Barley, Wheat and Irish potatoes, the environment has been left bare (PHOTO/David Mafabi).
By David Mafabi
KWEEN – A bird’s-eye view of what is left of the Mt Elgon forest in Kween district, one of Mt Elgon’s water catchment areas, is shocking.
Kween, part of Mt Elgon National Park was formerly grassy, with various trees that lay unperturbed by man’s activities – the trees stood out and the hills remained green.
Today, the forest now looks like baldheads, standing one after another, only comforted with thin patches of hair lining around them to cover the shame of their destruction.
A visit at the slopes of Mt Elgon in Kween reveals an open area with little regeneration; grazing on either side of the forest edge in combination with tree-cutting for firewood, farming and settlement appear the main forces eroding the forest edge and keeping these areas open.
The lush-green canopy that made Mt Elgon a water catchment area in East, a powerful ecosystem in Uganda, is fading, interrupted by open fields of barley and wheat, drying timber, settlements and bare land, fighting to redeem itself from fresh tree destruction.
Inside the Benet village that lies inside the forest in Kween district, evidence comes to sight that the persistent reports of its depletion are real.
Mt Elgon known for more than 197 species of indigenous trees; the depleted area has also lost the fruit trees that are supposed to be food for the primates that include White calabash monkey, red tail Monkeys and Velvet Monkeys.
The area used to have mixed forest/bamboo, bush land, grassland, the Elgon teak, Mahogany Neoboutonia macrocalyx and Podocarpus latifolius and other medicinal trees, all these are facing extinction as man scrambles to settle and do farming.
A report by monitoring and research unit at Mt Elgon national park indicates that the communities adjacent to Mt. Elgon forests rely extensively on the forests for poles, firewood, medicines and honey production.
The report dated September 2019 reveals that the mountain known as an enormous watershed, with its slopes supporting a rich diversity of altitudinal vegetation areas that range from the lush Montana, the mixed bamboo-belt forest to the intriguing high open moorland, dotted with the really uncommon worldly plant species such as the large lobelia plus the groundsel plants unusual to Africa will be no more if government does not rise up to end encroachment.
Forest cleared and farming taking place at Nametsi in Bududa district at the slopes of Mt Elgon (PHOTO/David Mafabi).
The report reveals that a total of 8664 ha [87Sq Km] of land has been cleared off forest putting 3055 ha [about 30.5SqKm] in Benet, Kween district alone.
The encroachment;
Mr Peter Kamuron, an elder and former council Member for Sebei sub-region says one by one, the structures come up daily; the next occupier takes up the next available parcel of land, extending deeper into Mt Elgon forest.
He said they [Encroachers] then pave the way for whoever comes next, to dig deeper and help them cut down more trees.
“At first, they put up temporary structures, hundreds of mud-walled houses and those made from timber can be spotted littering the forest then shortly they put iron sheet houses with bricks and cement then the entire place is occupied for settlement and farming,” said Mr Kamuron.
He said they have marched hundreds of acres past the boundary marks, deep into the forest and that a good number of boundary marks have been broken down by their tormentors to erase the boundary, while others have been covered by vegetation grown around them.
Depletion Report
But the destruction at Mt Elgon did not start and end with Forest at Benet in Kween district. The tragedy has since befallen the entire Mt Elgon area– a mountain once blessed with a wide range of biodiversity.
Most Mt Elgon forests in Mbale, Bududa, Namisindwa, Bulambuli, Kapchorwa, Bukwo and Sironko districts are at the verge of disappearing completely.
The monitoring and research report says besides Benet, Bumayoka, Bubiita, Bulucheke, Bududa sub-counties in Bududa district, Buwabwala sub-county in Manafwa district, Wanale, Bufumbo, Busano sub-counties in Mbale, Bumasifwa, Busulani sub-counties in Sironko district, Bumbo sub-county in Manafwa district and Kapsegek sub-county in Bukwo district areas have all been destroyed by encroachers.
Mr Nelson Cheptoris, an Elder from Kween and former LCV chairman for Kapchorwa says part of Mt Elgon national park has been converted into gardens of maize and beans, barley, wheat, while others have been replaced by eucalyptus trees.
“It is unfortunate that those responsible to protect natural resources are the very persons responsible for forest destruction. The forest land is now for settlement and farming and district officials say the decision to cut the trees stemmed from government’s decision to allocate them land within the park,” said Mr Chelimo.
Mr Sam Chemisto, the district natural resources officer says that farmers cut mature trees into timber and firewood and that the rate at which trees are cut exceeds the pace at which they are planted.
“And this makes Mt Elgon area a site for possible ecological and environmental crisis of catastrophic proportions in the near future,” said Mr Chemisto.
Laxity
Seeing little resistance and pushback from the government, the Benet encroachers got comfortable and structures made from iron sheets started coming up.
As the authorities continued to look away, some became more courageous and started building more permanent structures.
Hurriedly, some put up structures hanging precariously on the sides of the hills, which can easily be washed away by heavy rainfall.
Part of the settlements at Mt Elgon after clearing the forest cover in Kween district (PHOTO/David Mafabi)
Mr. Chemisto says that in less than three years, it is impossible to tell there was once a canopy of trees covering the bare land that now stretches over the drying valleys and tributaries that feed into the main rivers that flow from Mt Elgon, some of which support several ecosystems in Kenya.
Effects
Although the percentage of tree cover destroyed is unknown to Mt Elgon, the area is already feeling the pinch of forest degradation.
Mr Charles Wakube, the Mbale District Environment Officer, says water springs and wetlands are drying up as a result of deforestation at Mt Elgon.
He says since most forests are river-lane, a decrease in the forest cover greatly affects water bodies in the district. “For instance, about 34 natural springs in Mt Elgon forest have dried up,”
He revealed that animals like Elephants, Buffaloes and birds that used to attract tourists to the Mt Elgon have migrated.
Ms Maria Namagidini, a farmer living at the slopes of Mt Elgon in Bugiboni village, says the entire Mt Elgon sub-region is experiencing more dry spells and erratic rainfall partners than before.
Uganda Wildlife Authority report 2016 indicates that clearing of the land for settlement and farming at Mt Elgon national park at Kween [London portion of the park], makes the area risk exposing the rivers, hence drying up in the long run and affecting hundreds of people in lower Sebei and parts of Teso.
The report adds that part of the London portion is a soft wood plantation worth sh45b at harvest time which would be affected when settlements are established in the neighbourhood.
The London portion is a sensitive part of the Mt Elgon ecosystem serving as a catchment area for rivers and several streams as well as being the source of two gravitational water schemes; it should, therefore, not be cleared for settlement and farming.
Politicians involved
Mr Robert Mangusho, a local leaders and councillor says some politicians legitimised the land acquisition by urging the people to slash the land at night.
“And today, it is impossible to see how these people can now be ordered to exit the forest, which some say has been their home for more than two decades and on the ground, the picture of the forest in the eyes of residents is quite the opposite,” said Mr Mangusho.
Mr Fred Kizza the Mt Elgon conservation area Chief warden says that because trees absorb carbon dioxide and turn it into wood, where the carbon stays bound up for hundreds or even thousands of years, living forests are an important part of the earth’s climate system. Growing trees soak up CO2 from the atmosphere and store it in their trunks, roots, leaves, and forest soils.
Mr Kizza revealed that the benefit of a well-managed and intact forest resource is that it provides a country with significant biodiversity.
“Because trees absorb carbon dioxide and turn it into wood, where the carbon stays bound up for hundreds or even thousands of years, living forests are an important part of the earth’s climate system and growing trees soak up CO2 from the atmosphere and store it in their trunks, roots, leaves, and forest soils,” said Mr Kizza
“We must begin a crusade of gazetting Mt Elgon forest and through this process we can be able to recover the forest cover losses which has been lost over past two decades,” Mr Kizza said.
Mr Paul Buyera, the National Forest Authority acting executive director said besides Mt Elgon, the country loses about 100,000 hectares of forest cover every year, a situation that is worsening the effect of climate change.
He added that the restoration of forest cover can be achieved through collective efforts from individuals, communities, corporate organisations and religious institutions.
The State Minister for Environment Mary Goretti Kitutu has said Uganda’s forest cover has been depleted to 8% up from 24% in 1990s, attributing it to human encroachment for different activities like agriculture and tree cutting for timber and charcoal.
She warned that once people don’t embrace conservation of nature, they will suffer climate change effects such as prolonged drought, floods and landslides.
“The rate of deforestation in Uganda is high and the country will soon become water-stressed if citizens do not pay attention to environmental management. We all ought to take part in planting trees as a priority to manage the climate change challenges,” said Kitutu.

 

Conquering Mt Elgon through Bushiyi trail; the shortest trail to Wagagai Peak

Conquering Mt Elgon through Bushiyi trail; the shortest trail to Wagagai Peak