Is healthcare equally accessible for all?
by Meghana Raveendra.
Every year, the 7th of April is celebrated as World Health Day to create awareness and bring to the front important health issues across the world by the World Health Organisation. On this occasion I thought it is relevant to share about the lack of access to basic health care in the world we live in.
“Equity in health means access to healthcare, regardless of who you are, regardless of what you do. I’m convinced health is everyone’s right…” – Harriet Kamashanyu
Founder of Rhythm of Life and kanthari graduate
I will write about Harriet, but before I do so, I want to include a short abstract of Sabriye’s latest book ” The dreamfactory of Kerala, – learning to change the world ” in which she describes a visit to Harriet’s place of work.
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“When the opportunity arises, we also visit our graduates in their countries of origin. This was also the case for Harriet from Uganda. Till the day she married, she lived in a home for children of impoverished families. Harriet is the child of refugees; her parents had fled the genocide in Rwanda and could no longer take care of all the children.
The home is located in the outskirts of Kabalagala, Uganda’s largest red-light district. Some of the children she grew up with and went to school with were daughters of sex-workers. Some knew about their mothers’ trade; others only found out when their mothers were diagnosed with HIV. Often, sex-workers do not get proper medical treatment. “Prostitution is illegal in Uganda,” Harriet says. “Some doctors refuse to treat the women. My friends worried about their mothers. Sex work is dangerous; the clients can do whatever they want with them. If they do not want to use a condom, there are few women who will turn down a deal. The need is too great. The policemen also treat them with disrespect. They roam Kabalagala in the evening just for fun to arrest sex-workers.”
At the kanthari institute, Harriet developed a plan to train daughters of sex-workers as nurses. This way, they would have regular jobs and not have to follow in their mothers’ footsteps. In addition, they would be able to take care of the mothers later if they became ill with AIDS.
Even before Harriet started her initiative, she was internationally award for innovative ideas. “Everything seemed so simple at first. But when I came from Kerala and wanted to start working in the red-light district, I had a pretty tough time. The sex-workers rightly wondered what I wanted there. Did I want to spy on them? Was it all about the thrill? They left me out in the cold, and I couldn’t simply run after them and force their luck.”
Harriet was not discouraged. She had T-shirts made for herself and her team. On the front, along with the logo, was the name of her organization, “Rhythm of life.” And on the back, a text informing about her project. These T-shirts, which they always wore when they were out on the streets, helped the sex-workers gradually get used to Harriet and her team.
The breakthrough came the day we visited them. Harriet received a package from a pair of Swiss doctors she had met at the kanthari institute. The doctors, Walter and Jo Munz themselves had lived in Africa for a long time. They were the successors of Albert Schweitzer and ran a clinic in Lambarene. Both of them had taken a keen interest in Harriet’s project. The package contained a collection of femidoms (condoms for women), which women can use to protect themselves. Harriet invited us to accompany her on one of her forays into Kabalagala to bring the first femidoms to the sex-workers.
We were happy to come along, but quickly realized that we were only causing a disturbance, because the sex-workers regarded Paul, Marijn and Tomek as potential customers. So, we stayed in the car and observed the scene from a safe distance. Harriet, a bundle of temperament, explained with big gestures and a lot of wit how the femidom were to be used. Soon, the sex-workers were paying full attention and it wasn’t long before Harriet was surrounded by a throng of laughing women.
In time, she also got to know the sex-workers’ daughters and was able to place them with an aid organization where they are now being trained as nurses.
“It was particularly difficult to find a suitable office. Here in Uganda, without an office, your organisation doesn’t count . But I didn’t want to squander the painstakingly collected donations to be spent on rent. I asked churches if they had a shelter for us, but they did not want me. Sure, red-light district and church, that does not go so well together. Then I found what I was looking for at my old school. I made a deal with the principal: I teach the girls about sex education and HIV prevention, and the school provides me with space for free.”
In the meantime, the “Rhythm of Life” office has become a popular meeting place for schoolgirls, as well as for sex-workers and their daughters, and Harriet teaches in many schools around Kampala. But although she seems to have overcome the biggest hurdles, there are always new stumbling blocks. “There are aid organizations that see me as competition. That makes me wonder, what they are really about? If we want to solve problems, surely, we should work together. And then there are officials who accuse me of promoting prostitution. You can’t defend yourself against such accusations.”
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Uganda is one of the top 10 countries in the world with the highest HIV rate, with a 32.4% prevalence rate among sex-workers. It is also a country where sex trafficking of women and children is common including exploitation in prostitution.
The WHO’s constitution describes, “That understanding health care as a human right creates a legal obligation on the states to ensure access to timely, acceptable, and affordable health care of appropriate quality as well as to providing for the underlying determinants of health, such as safe and potable water, sanitation, food, housing, health-related information and education, and gender equality.” More than half the world’s countries have pledged to protect their citizen’s rights to health care. But are the citizens really protected irrespective of race, age, ethnicity, caste, gender and any other statuses?
Let us look at the example of Uganda. The alarming percentage of HIV rate in sex workers, tells us that there are some key problems when it comes to access of health care;
- Lack of awareness on Sexually Transmitted Infections
- Discrimination in providing access to sex workers due to the nature of their work
- HIV Stigmatization that stops women and girls from reaching out for support and health care.
These are not problems of just Uganda, but according to the World Health Organisation, half of the world’s population lacks basic access to health care. And hence, I believe it is not enough for countries to mention in their policies that healthcare is a human right. What is important is how they tackle discrimination and stigmatization of certain diseases or infections to ensure everyone is able to not just access health care but also have the right information about steps they can take to prevent them without any barriers.
Harriet’s organisation works on the ground with commercial sex workers on interventions which provide access to sexual and reproductive health services – an access which otherwise particularly due to stigmatization and discrimination is not available to them and girl children. Rhythm of Life takes health care services to these communities and provides an opportunity to the women and young girls to make their own choice about what health care they need and how they can protect themselves? This empowers them to take their health in their own hands!
Listen to the Giraffe Heroes’ Podcast – “Harriet’s Rhythm of Life – Working in a Red Light Area here – to know more about how they are working towards the goal of Health care being everyone’s right.
When I heard this podcast, it left me with a few questions in my mind. How do we really define Health Care? And is it enough for countries to pledge equal access to health care for all?
Sources of statistics and information:
http://www.rhythmoflifeuganda.org/