By Jesus Okello Ojara

ACHOLI: Although a number of disabled women bear children, little or nothing at all is being done to provide basic prenatal health services to such women and worse in the remote rural settings of Acholi sub region.

For many poor and disabled women in Acholi sub region, accessing maternal health care remains a nightmare and this is curved out of stigma, discrimination, negligence, ignorance and inaccessible health facilities’ equipment.

This however has combined to make it very difficult for the disabled women to receive safe childbearing and child care assistance both from the health facilities and the communities thus forcing many of them to have unsafe birth and this leads to maternal death and other maternal health related problems.

Nighty Akwero, a resident of Patwol ward in Anaka town council, Nwoya district who among the many women in the rural areas of Acholi sub region was struck by polio at a tender age but today, she is a happy mother of five. She had her first delivery on the floor of Anaka General Hospital since she cannot manage to climb the high delivery bed.

In pain, Nighty trekked to Anaka General Hospital where she was welcomed by health workers who were subjected to all sorts of odd questions and insults from the medical workers.

She disclosed that during her first delivery, she struggled and went to Anaka General Hospital and the midwife left her on the delivery bed alone where she struggled and safely delivered her baby alone without any assistance.

With tears rolling down her chin, Nighty narrates her sad story and disclosed that the midwife shouted at her saying why did you deliver alone? Do you want me to lose my job? While insulting her with words like Why do you want to give birth if you know that you are disabled?

Struggling to hold back her tears, she revealed that with her second delivery, she went for antenatal, no one attended to her.

“I went to the hospital, no one attended to me and a doctor from Gulu was the one who worked on me. In that same year, I went for delivery at the hospital, they say climb up the delivery bed, I cannot climb the bed, I silently picked and laid my plastic delivery mat on the floor and delivered from there. And my caretaker started arranging my belongings.”

“The midwife came and I had delivered, she wanted to inject me to control blood flow. She wanted to inject my lamed right leg, I told her that since childhood, this leg has never been injected. She furiously asked, where do you want me to inject? Turn that leg here! And I silently turned my leg to her.”

Concy Apiyo, a mother of two children who has also lost both legs to landmines in the early 2000’s disclosed that during her first birth on 24th May 2014 at Anaka Hospital, she experienced great difficulties and she had to go through an operation which was not easy.

“I have one major challenge that prevents me from going to that hospital to deliver again, we share one latrine and shelter with abled people and for me who have no legs and I usually find it hard to crawl on the shelter’s floor to ease myself.”

“Giving birth to my second baby was not that hard but I also had to go through an operation which was successfully done on 27th May 2019 from St. Mary’s Hospital Lacor in Gulu city, but my fellow disabled women face a lot of challenges especially harassment from health workers and also mobility problems.”

“One of my friends told me that one health worker mocked her, and insulted her during her delivery from the health facility. She asked me to climb the high delivery bed yet I have no legs. The Midwife asked me, how did you climb that bed while enjoying the man? You climb here the way you climb that bed?”

She however further disclosed to me that apart from the numerous insults and harassments, they are also challenged with the unfair public transport means which usually do not favour them.

Margret Auma, a disabled woman with hearing problems in Patwol village, Palaro Sub County in Gulu district and a mother of four children disclosed that she finds it very hard to move to the health centers to receive medical services.

“I have a problem with long distances to the health facilities and also I have no money to pay for transport fares from my home since they charge us high prices especially us with hearing problems.”

‘’Even the health workers do not respond to us on time, they wait when you are struggling in labour pain and they come to your rescue. They normally refer us to other facilities yet we may not have the transport money to these distant health facilities,’’ Concy narrates her sad story.

Christine Aciro 49, a mother of four children and a resident of Pader district disclosed that she also finds a lot of challenges with the mobility problem.

“I was confronted by one midwife during my fourth delivery with harassment and insults. She says, woman do you still want to give birth at this age?” What for? Can you see that you are a disabled woman who should not give birth to many children. But I had made out my mind to have four children and this was my last child.” Christine disclosed.

Clare Joyce Ajok, a midwife at Oroko Health Center II in Gulu district disclosed that women with disability face a lot of challenges right from conception till childbirth and also some health workers have negative attitudes towards disabled women.

“Some disabled mothers fear to come to the facility for maternal health services because of stigma, and even some health workers neglect the disabled women who come for maternal services. During delivery, our delivery beds are also not friendly to the disabled and we sometimes use supportive stands to help these mothers.”

“We have a challenge with sign language interpretation to help us communicate to persons with hearing impairment. We therefore appeal to the government to equip health workers with the skills and knowledge of sign language interpretations. If possible, the government should organize training in sign language for us.”

Monica Akello, a midwife in charge of maternity ward Awach Health Center IV in Gulu District disclosed that none of these mothers with disability comes to the health center for antenatal visits because of many reasons they are facing in the community.

“None of these disabled women reaches the eight antenatal visits as required by the Ministry of Health and the World Health Organization. There is also no special care given to these disabled women like special delivery beds, special rest beds after delivery among other things. We therefore request the government to provide adjustable beds which can be adjusted up to the ground so that these disabled women can climb and safely deliver on the bed, not on the floor, which is not good for the health of the baby and the mothers.”

Annet Aber, midwife In Charge maternity ward at Bar – Dege Health Center III noted that the relationship between the health workers and disabled women are at stake since they do not know how to communicate to these disabled women especially those who cannot hear.

“Giving them health education is very hard especially for the deaf and it is also very hard for them to share with us their problems and for us to give them the full health packages as required by the ministry. Government should train us in sign language interpretations.”

Eunice Oyella, a midwife at Langol Health Center III disclosed that some disabled women lack essential materials and assets that could help them right from conception to giving birth.

“One of them told me that it is hard for her to get the necessities to enable them access better maternal health services. She says she cannot afford materials like basins, children’s clothing among other essential materials in these government health centers.”

“We wish the government and well – wishers to come in and support these disabled women with materials like basins, clothing and other essentials just right from the time these women conceived, during their visits until delivery even after birth services.”

Lakwonyero Denish Ocen, Councilor V representing persons with Disabilities at Gulu district local government urges the communities to come out and start advocating for equal treatment of persons with disabilities within the district and region at large.

“We have to come out as a team, all stakeholders and implementing partners, let’s support this common course to see that we people with disabilities receive equal treatment both at the health centers and in the community.”

“It is very sad to see a disabled woman dying during delivering, hearing that a disabled woman is raped, being evicted from her own land and marriage. Together we can make a difference, let’s start today not tomorrow.”

Patrick Ojok, the project coordinator Gulu Disabled Persons Union disclosed that a baseline survey conducted in December 2009 in Kamuli district, 78 percent of the women interviewed said they avoided going to health units for maternal health care and this also applies to Northern Uganda.

“We see disabled mothers in the rural areas of Acholi sub region struggling to safely give birth. We community members should change our negative perceptions on persons with disabilities. We are all equal.”

Ojok noted that for those with hearing impairments, getting care is even harder because health care workers in many cases don’t understand sign language, we are urging you to come to the union and get sign language interpretation skills and knowledge.

“All stakeholders including government and local leaders, let us interest ourselves in training the local community and sensitize them about maternal and reproductive as well as join hands in advocating for favourable services in health units.”

In 2010, CEHURD, under the Regional Network for Equity in Health in East and Southern Africa (EQUINET) conducted a desk review of the constitutional provisions on the right to health in fourteen countries in the region (Mulumba et al., 2010) which include Uganda.

The organization found out that the Government of Uganda (GoU) decentralized its health system as a way of empowering its citizens to participate in the process of development and improve their livelihood in critical sectors such as health and this decentralization of health services created two levels of health sector administration, one at the central government and the second as local government.

Though the Government Health Policy states that health centre IIs are supposed to be in every parish, this is largely not the case because most parishes have no health centres II which were meant to do referrals to Health Centre IIIs, which are meant to be in every sub county and health centre IVs serve counties and are mini hospitals which should have the capacity to admit patients and conduct surgery under the care of senior medical officers. However, many of them are non-functional units due to the lack of beds, water and electricity.

The UN Convention on the Rights of Persons with Disabilities states that States parties recognize that persons with disabilities have the right to the enjoyment of the highest attainable standard of health without discrimination on the basis of disability. States Parties shall take all appropriate measures to ensure access for persons with disabilities to health services that are gender – sensitive, including health – related rehabilitation.

The convention further mandates the States to provide persons with disabilities with the same range, quality and standard of free or affordable health care and programmes as provided to other persons, including in the area of sexual and reproductive and population – based public health programmes.

Provide those health services needed by persons with disabilities specifically because of their disabilities, including early identification and intervention as appropriate, and services designed to minimize and prevent further disabilities, including among children and older persons, provide these health services as close as possible to people’s own communities, including in rural areas, required health professionals to provide care of the same quality to persons with disabilities as to others, including on the basis of free and informed consent by, inter alia, raising awareness of the human rights, dignity, autonomy and needs of persons with disabilities through training and the promulgation of ethical  standards for public and private health care and the states shall prohibit discrimination against persons with disabilities in the provision of health insurance, and life insurance where such insurance is permitted by national law, which shall be provided in a fair and reasonable manner and prevent discriminatory denial of health care or health services or food and fluids on the basis of disability.

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