Where the road ends, logistics continue

Where the road ends, logistics continue. Here, an ox cart is the only reliable way to get drugs and medical supplies to the health center in Mongu, Western Province, the District Health Office hires an ox cart—the only reliable transport through the flooded plains between December and June. The journey takes no less than six hours.

Report By DOREEN NAWA

Delivering basic needs especially quality healthcare services  to millions of citizens spread out over remote, rural areas of Zambia has proven to be challenging. 

Systemwide barriers impede health care delivery in the country.

With the rainy season here, the people of Zambia's wetlands like the Lukanga Swamps, the Barotse plains, the Bangweulu swamp and many more are not having it easy.

With the shortage of drugs in many health centres and the looming food shortages, the already difficult daily lives of the inhabitants of these areas have worsened considerably over the past three months since the onset of the rains. Simply going to school or to a health centre, or to farmlands or the market has become more difficult.

"Some families no longer have grain reserves, and worse enough, access to medical care for those that are sick is a nightmare. Others can no longer go work in their fields, which they had to leave behind as they find their way to their destination in the waters with hunger," said Akufuna Mukela, a Mongu resident.

"We have to expect that the situation will be further complicated as the water levels continue to rise which will make it difficult to move about for the next two months."

"Reaching the places in the wetlands, in the waters, far from everything, despite the dangers along the way is a daily challenge," said Ms Mukela.

Ms Mukela said, "Fortunately, the use of ox cart to transport basic requirements like drugs and food stuffs has really helped us. Every rainy season, most of the wetlands here in western province are not accessible and the only option are the ox carts. Given the scope of the needs, however, that's still far from enough."

In Ndele, a remote village in Mongu on the floodplains and in towns around Zambia's wetlands, delivering goods and services is a challenge  and far more worse in the rainy season.

Yearly, families lose their homes due to flooding.

"Access to care has worsened considerably in the this area, and the situation is even more serious in remote areas of the swamps," said Mr Kennedy Mubuyaeta. 

"Women are giving birth in the bush, and men, women and children are dying of minor illnesses for want of treatment," said Mr Mubuyaeta.

Over the years, residents of these wetlands have had serious seasonal flooding. In the past people knew when the next high floods were coming and would prepare, but since 2000 with the changes in climate, floods and sometimes even partial drought occur often and take people by surprise. The canals, clogged by silt, grass and soil, also overflow and flood the fields before crops mature.
The unpredictability in weather patterns makes it difficult for people to plan their livestock, fishing and farming activities. The weather shocks destroy housing, infrastructure and roads as well as crops, the investment people make in agriculture can literally be washed away.

Abortion: Pro-life or pro-choice?

December 18, 2013

By DOREEN NAWA
YOU may abort a foetus that could have ended up being President.
The battle is between the pro-life and the pro-choice.
Those who are against abortion in most cases are labelled as pro-life whereas people who believe that a woman is entitled to an abortion if she so wishes have adopted the pro-choice title.
But it is not as simple as that, the issue is highly emotive.
“The topic of abortion comes with questions that cannot easily find answers because it is an emotive issue,” First Lady Christine Kaseba said in her keynote speech at the launch of a documentary titled ‘Conversations on Abortion’ by Ipas Zambia in Lusaka recently.
Ipas is a global non-profit making organisation that works towards eliminating deaths and injuries emanating from unsafe abortions and increasing women’s ability to exercise their sexual and reproductive health rights.
The documentary depicts Zambian women and girls who have undergone unsafe abortions or unsafe termination of pregnancy and the impact this has had on them and their families.
The main objective of the documentary is to assist in sensitising people and generate discussions by different target audiences that view it and draw lessons from it.
“The long hidden crisis has started to emerge publicly as women’s groups, physicians and human rights advocates push for a change in the mindsets of citizens on interrupting a pregnancy,” says one of the victims in the documentary, whose identity has been withheld.
During the launch of the documentary, Dr Kaseba acknowledged that unsafe abortion still remains a crisis in Zambia.
“Social attitudes towards the issue of abortion have contributed to the increase in unsafe abortion cases. Remember that it is not easy for a woman to opt for an abortion.
“Women go through a lot before deciding to abort, and it will be unfair for society to judge them before getting to know why such a decision was made,” Dr Kaseba says.
The First Lady, a consultant obstetrician and gynecologist, says religious and traditional beliefs are the major challenges in promoting safe abortion.
“Women and girls have been victims due to these challenges, forcing them to abort secretly by using unsafe methods under the fear of being recognised while forgetting the risks of taking the action,” Dr Kaseba says.
Despite having legal provisions on the termination of pregnancies, women have continued using unsafe methods of removing pregnancies leading to complications and premature deaths.
The subject of abortion in society is considered taboo with widespread stigmatisation and criminalisation by both non-professionals and professionals, leaving women with few options but to resorting to clandestine and backyard unsafe methods of terminating pregnancies.
“We are aware that some of the societal norms subject many women to unsafe or unwanted sex and this results in unwanted pregnancies. Additionally, overall family planning coverage remains low and put together, these factors lead to a high number of unsafe abortions,” the First Lady says.
Currently, statistics indicate that unsafe abortions contribute up to 30 percent to the maternal mortality rate in the country.
But Ministry of Community Development, Mother and Child Health permanent secretary Elwyn Chomba says deaths as a result of unsafe abortion among women and girls are avoidable and unnecessary in a country where there is an abortion law in place.
Professor Chomba says it is her wish that her ministry be given a mandate to go in communities and sensitise the people on various issues surrounding abortion in the country.
World Health Organisation country representative Olusegun Babaniyi says unsafe abortions are one of the leading causes of maternal death and illness around the world and yet they could be prevented.
“The terrible effects of unsafe abortions go well beyond the individual woman. Losing a mother and caregiver devastates the lives of children and families, and losing a healthy woman’s contributions to society reduces productivity and weakens her community,” Dr Babaniyi says.
To ensure an end to the crisis, Government and its cooperating partners like Ipas have taken steps to design appropriate strategies to prevent unsafe abortions through prevention of unwanted pregnancies.
The push comes as reports of unsafe abortions increases in both rural and urban areas. Ending unsafe abortions has been recognised as an urgent public health and human right imperative.
Furthermore, advocacy for increased access to safe legal abortion is needed in order to mitigate the ever increasing cases of unsafe abortion related deaths.
In Zambia, despite the existence of the Termination of Pregnancy Act No. 26 of 1972 and several other policies and guidelines that are intended to prevent unwanted pregnancies, unsafe abortions remain a major concern and cause of maternal deaths.
While these are all regarded favourable by the people who know about them, very few Zambians are aware of the Act, policies and guidelines on prevention of unwanted pregnancies.
Abortion is legal in Zambia but women and girls are losing their uteruses and their lives as they turn to clandestine and deadly ways of terminating their pregnancies.
And unfortunately, these unsafe abortions are leading to a public health crisis in a country with one of the world’s highest rates of unintended pregnancies, experts say.