Clandestine clinics offering illegal abortions are one of the prime causes of unnecessary maternal deaths across Africa. The lack of facilities for safe procedures makes the statistics worse.
When the pain started, I called him. I begged him for help.I was bleeding so much. The pain became more and more severe. I could not sit,or stand or lie down. I could not move. He told me not to contact him again,that it was not his problem. He told me to go to hospital if I have problems. After that, I never got hold of him again.”
This is the story of Megan Naidoo (not real name), the survivor of an illegal backyard abortion procedure. Naidoo was seven weeks pregnant when her boyfriend forced her to have an abortion.
She lived with him and her father in a small two-bedroom flat on the outskirts of Kimberley in the Northern Cape province of South Africa. There are not many institutions providing safe abortions in Kimberley and Naidoo was afraid of shaming her Muslim father.
So, she took a bus to Johannesburg in search of a way out of her desperate situation. She had only about $144 for the trip. Her boyfriend gave it to her when he put her on the bus to Johannesburg and told her to return with a clean body.
As she walked through the city searching for someone to direct her to a designated facility, she came across a flyer, stuck to a lamppost. The flyer was advertising safe and painless abortions. At first, she did not realize what the flyer suggested. Then, she saw more flyers decorating electricity boxes, lamp posts, traffic lights and sidewalk walls; they were everywhere around her. “Safe 30-minute abortions, no pain guaranteed” the flyers beckoned her; “Phone ‘Dr Nick’ to make appointment”.
Although she was afraid of judgment, she managed to make the call. Back home in Kimberley, her family would have, in God’s name, stopped her from killing an innocent baby for selfish reasons. This is also what the nurse said to her when she first approached the local hospital in Kimberley for help.
But, this was not the reaction she got from the quack, ‘DrNick’, whose number was on the flyer. He told her there was nothing to be scared of and that he would make sure “everything is out” and she would have no pain at all.
She met Dr Nick in front of a dilapidated building entrance on Rissik Street, in Johannesburg’s gritty central business district. He told her to hand over the cash in an unnoticeable way.
Fortunately, she had set aside about $50 prior to their meeting. He handed her four tablets; two to put under her tongue, the third one was a suppository to be inserted immediately. He told her she would start to bleed after four hours and instructed her to then take the last tablet. She might experience a little pain, he advised, but nothing more than normal period pains. He told her to phone him if she needed him and then he left.
With nowhere else to go, she returned to the bus station. She took the tablets, and locked herself in the cubicle of a public toilet, near the station.
Four hours later, intense pain began. Six hours later, she started bleeding. The pain grew more intense with time. Naidoo phoned Dr Nick but he told her to go to hospital.
He also instructed her to tell the hospital staff that she had been to Marie Stopes, an international non-governmental organization (NGO) that provides safe abortion services. The third time she phoned, Dr Nick’s phone was switched off and he never answered again.
Naidoo had eventually bled out pieces of her uterus when she was found by the bathroom cleaners who assisted her, in the seventh hour of the severe pain.
They took her to a nearby clinic where health workers were unwilling to assist and reprimanded her that she deserved the pain because of what she had done. The cleaners then took her by taxi to the Charlotte Maxeke hospital nearby. A gynecologist on duty said that Dr Nick’s tablets forced Naidoo into induced labor that eventually lasted 10 hours.
She is one of thousands of women across Africa who nearly died at the hands of illegal abortion providers.
In South Africa, reportedly, only 7% of the country’s health facilities provide abortions. This is due to the lack of trained staff and the conscience objection right given to all South Africans by the Constitution,which enshrines the freedom of conscience, belief and opinion.
Often times,women are chased away from hospitals due to hospital managers being against abortions. Access to safe abortions is hampered as often, there are fewer facilities that provide abortion services to women in their second trimester.
In Africa, only Cape Verde, South Africa and Tunisia permit abortions without restrictions as to reason.
As a result, the influx of pregnant women from across the continent seeking safe abortions, adds to the increased need for designated abortion facilities.
To top that, various African NGOs that have been providing the service were recently choked by American president Donald Trump’s implementation of the Global Gag rule.
This ruling caused all funding for safe abortion facilities, across the developing world, to dry up completely.Hundreds of NGOs and outreach programs providing services and information, in especially poor countries across Africa, had to close their doors and halt awareness campaigns. Also, any NGO receiving United States-aid and funding is not allowed to co-operate with an NGO if the latter is pro-abortion.
This means that pro-choice women in countries such as Malawi and Zimbabwe have nowhere to go to have safe abortions. In Zimbabwe, family planning clinics that provided various services including safe abortions, had to close down. Not only did this result in a lack of medical services in rural parts of Zimbabwe, women can no longer get their contraceptive medication from these clinics.
In Zimbabwe, Zambia, Botswana, Mauritius and Namibia,abortion is only available in certain circumstances. In Seychelles, Tanzania, eSwatini (formerly Swaziland), Malawi and DRC, abortion is only available in extremely limited circumstances. Abortion is totally outlawed in Lesotho, Angola and Madagascar.
By all estimates, the more African states fail female citizens, the more money is pocketed by fake doctors and other backyard abortion providers. The more money is spent in this underground market, the more backyard providers are attracted to the trade.
According to Whitney Chinogweny, Head of Communications and Public Relations at Marie Stopes Sandton in South Africa, 52% to 58% of abortions in Africa are performed by illegal abortion providers, contributing to 12% to 15% maternal deaths across the continent. Without sufficient funding, NGOs cannot create awareness around the dangers of illegal abortions.
Sometimes illegal providers overdose women, giving them mixtures of laxatives, aspirin and medication used for stomach ulcers. At times,backyard doctors remove the foetus using household equipment like wire hangers and fire tongs.
Once these con artists have taken their victim’s money, they usually disappear, never to be found again. They cannot be tracked or traced. They change phone numbers and change locations.
If African governments do not amend abortion policies and facilitate the establishment of designated institutions, NGOs will continue to be forced to deal with the challenges weighed down by limited resources.
Local Solutions Can Boost Healthier Food Choices In South Africa
The crisis in health triggered by cheap food that’s high in fat and sugar is now well documented. Obesity related diseases such as cancer, heart disease and diabetes are rapidly overtaking HIV as the top causes of death in South Africa. A bad diet is a major contributor to this epidemic because people increasingly opt for unhealthier, processed and fast foods.
But how should countries like South Africa go about making sure that people – particularly poor people (where the burden of non-communicable diseases is highest) – have access to healthy food?
Recent research from the Wits School of Public Health, the Health Systems Trust and the University of KwaZulu-Natal sheds fresh light on the problem, showing a proliferation of unhealthy food, particularly in poorer communities.
This demonstrates the need for the government to intervene urgently. One possibility is to create new policies or adapt existing policies to promote the creation of healthy food environments. In particular, local governments have a unique opportunity to intervene.
What food’s available where
The research used a distinction between unhealthy and healthy foods drawn up by the Centres for Disease Control and Prevention. This categorises grocery stores and supermarkets as “healthy” and fast-food restaurants, for example, as “unhealthy”.
The research set out to assess differences in food environment based on socio-economic status. It focused on grocery stores and fast-food restaurants only, with full service restaurants excluded.
The analysis used a tool called the “modified retail food environment index” and show the proportion of food retailers in Gauteng that were “healthy” and what proportion were “unhealthy”.
The results showed how fast-food outlets, and the unhealthy foods they serve, vastly outnumbered formal grocery stores. In November 2016, there were 1559 unhealthy food outlets in Gauteng compared to only 709 healthy food outlets.
Strikingly, the distribution of these outlets are income-based. Most of the poorer wards had only fast-food retailers with no healthy food outlets. Conversely, grocery stores are concentrated in wealthy areas.
The research shows that many wards in Gauteng have high concentrations of unhealthy food – in other words, they have “obesogenic” food environments. This means the type of food available in this environment promote obesity, leaving their residents little choice.
This is a big problem. But it can be fixed.
One possible strategy is to introduce policies that limit the number of fast-food outlets in communities. But what would these policies look like, and who would implement them?
Local as well as national government structures have the authority to license and control food retailers.
In addition, local governments have extensive powers over planning and zoning. They could be required to consider the impact on the food environment when granting zoning approvals or business licenses.
This would require filling a gap in municipal bylaws. For example, the City of Johannesburg municipality has passed two bylaws regulating informal or street trading and one on spatial planning.
But neither of these link municipal planning obligations to the placement of food retailers. This gap can be filled by explicitly taking saturation or scarcity of different food retailers into account. This could include, for example, creating a zoning exemption or special approval for healthy retailers.
Alternatively, national level policies can better guide implementation at a local level. This would require governments to adapt existing business licensing and planning frameworks to take into account the lack of healthy food retailers in a particular area.
For example, the framework used to grant business licenses is set out in national legislation, the Business Act, but implemented by local governments. This framework might require conditions that are more stringent for food retailers before they set up shop.
Currently, businesses are required to submit a copy of the menu of a food trader and a zoning certificate when applying for a license. This means that municipalities are aware of what kind of retailer is applying for a licence and the nature of their food offerings. Municipalities could use this information to control the number of fast-food retailers in a given area.
Additionally, municipalities could streamline the process for licensing healthy food retailers, making it easier and faster for them to open in areas most in need. By creating a separate, simpler process of approval for healthy retailers, it would potentially encourage more of them to open. Alternatively, they could introduce a certificate of “need exemption”. This system could then allow a waiver of some requirements for a license if that business can demonstrate a need for healthy food retailers in an area.
Local governments have already exercised this kind of power to further public health. Cape Town passed a law that prohibited smoking within a certain distance of doors and open windows.
Municipalities could also put regulations in place that restrict the sale of unhealthy food near schools. In addition, they could incentivise retailers to move to under-served areas. Steps like this are already being explored and are set out in detail by the World Health Organisation guidelines.
The research shows that poor South Africans have little choice when it comes to purchasing healthy food in their own neighbourhoods. In addition, municipal governments aren’t doing enough to preserve and improve access to healthier foods.
This must change. There’s a plethora of options to select from if municipalities want to improve their food environments and can facilitate the right to access to healthy foods for the poorest and most vulnerable. A good place to start in South Africa would be Gauteng.
Noluthando Ndlovu, a public health researcher at the Health Systems Trust was a leading member of the research team. -The Conversation
-Karen Hofman: Professor and Program Director, PRICELESS SA ( Priority Cost Effective Lessons in Systems Stregthening South Africa), University of the Witwatersrand
-Safura Abdool Karim: Senior Project Manager, PRICELESS SA ( Priority Cost Effective Lessons in Systems Stregthening South Africa), University of the Witwatersrand
Danai Gurira: The Celluloid Warrior Fighting Against HIV
HIV/AIDS remains a global concern. International star and Zimbabwean playwright Danai Gurira is using her celebrity to battle for its elimination.
A superhero on the big screen and now a possible superhero in real life, actor and playwright, Danai Gurira, is making it her mission to join the fight against HIV/AIDS.
She is known for playing General Okoye in one of last year’s biggest films, Black Panther, which grossed over a billion dollars worldwide.
The famous Zimbabwean says the fight against the epidemic has been evident in her life ever since she was a little girl.
Recently appointed a United Nations Goodwill Ambassador, she chats to FORBES AFRICA about her work.
READ MORE | Danai Gurira: ‘Fully Feminine And Fully Fierce’
On December 3, 2018, a day after the Global Citizen Festival where Gurira made an appearance as a co-host to rapturous applause from an audience of 75,000 in Johannesburg, we meet her at an HIV clinic on the outskirts of the city in a township called Tembisa. It’s a trial clinic called Imbokodo for testing a combination of two experimental vaccines to prevent HIV.
At the clinic, Gurira meets with a group of women heading it, to discuss and learn how the trials work.
One of the women, dressed in a pink blouse, responsible for creating the trial vaccine, talks to Gurira about their work. Maria Grazia Pau is the Senior Director, Compound Development Team Leader, for the HIV vaccine programs at Janssen.
Pau has over 18 years of experience in the field of viral vectors.
“We have seen responses in the body systemically when we check the blood but also we have checked other studies, and we do see responses there,” she tells Gurira.
Everyone in the room pays attention.
“The composition is complex, we want to protect from many different types of HIV because there are so many traits everywhere,” Pau says.
“Right,” Gurira nods attentively.
“It is the answer to elimination,” Gurira says.
The group of women join in the conversation.
They may just be on a breakthrough to finding an HIV vaccine.
The study is being conducted by the HIV Vaccine Trials Network, Janssen Vaccines & Prevention B.V., part of the Janssen Pharmaceutical Companies of Johnson & Johnson, and all the participating study clinics.
These partners are working in collaboration with community stakeholders to ensure this research is acceptable to the local community and respectful of local cultures.
With 27 sites on the continent alone, they have clinics in countries including Zambia, Malawi and Mozambique.
Gurira has recently collaborated with them to help further their research and spread awareness about the disease.
Gurira was born in the United States (US) and later moved to Zimbabwe, when she was a young girl.
Growing up in Harare, she saw and heard a number of stories relating to HIV that touched her deeply.
The 1980s were a time when the disease had started spreading globally.
“I can’t really extricate my upbringing from understanding how this epidemic hit southern Africa and how it changed the tapestry of life,” she says.
The stigma around the disease and how women were treated were some of the issues that concerned her.
“Growing up, I witnessed how it was affecting, not only cultural dynamics, but also exacerbating issues around gender dynamics and various things that filled me with great passion,” she says.
“How women were dealing with a great amount of stigma in the family; if HIV was in the homestead, the involvement of even in-laws and how that was being interpreted – about faulting a woman. [As well as] blame imposed upon women and the loss of a spouse and how that would affect how a woman was treated post that time. So there were a lot of things affecting me as I grew up and as I watched these things happen.”
It was those personal experiences that shaped how she viewed HIV and the importance of eradicating it.
It was later that she moved back to the US and pursued a career in psychology and then a masters in Fine Arts.
How people perceived HIV there, was not what she expected.
“Coming to the US and seeing how the African was viewed as a statistic; I was seeing real people with real stories and experiences who were truly people who had aspirations and careers and had many things going for them that they were working towards.”
At the time, antiretroviral (ARV) therapy had not yet been introduced and there was no way to manage it.
“It was such a death sentence at the time,” she says.
“And to come to the US to find that what we were dealing with in southern Africa was statistical, that also gave a great amount of need to bridge that very unfortunate disconnect between the actual human experience of it and the value of people who were being affected by this… and how they were being viewed.”
While there, she connected with some of her friends who did field work around the issue while she was more focused on her advocacy in the field of arts.
She married her advocacy for HIV with her passion for the arts.
Gurira began writing plays in an effort to use her strengths as an actor, and tell stories about issues she felt strongly about.
She co-wrote and co-starred in In the Continuum, a play about HIV/AIDS from the perspective of a married Zimbabwean woman.
With this play, her aim was to break away from the “statistical component of how the African is viewed often”.
In December 2011, In the Continuum commemorated World AIDS Day.
Little did she know that was the beginning of her activism against HIV/AIDS.
The ‘golden age’ of HIV science
The same year, a woman in South Africa by the name of Dr Glenda Gray, was elected into the US Institute of Medicine, National Academies, as a foreign associate for her research on preventing HIV-infected mothers from passing the virus to their newborns.
She is a National Research Foundation A-rated scientist, CEO and President of the South African Medical Research Council (SAMRC).
She is a qualified paediatrician and clinician and co-founder of the internationally recognized Perinatal HIV Research Unit in Soweto, South Africa.
5 Things You Should Do The Night Before A Job Interview
Preparation is key for having a successful a job interview. What you do the night before a job interview has an impact on your interview. What can you do to make sure this impact is a positive one?
1.Get a good night’s sleep.
Getting a good night’s sleep is the most important thing you can do before an interview. When you’re well rested, you’re more alert and focused, and you won’t have to resort to caffeine or sugar to stay awake. Being sleep deprived can also increase feelings of stress or anxiety, neither of which is helpful going into a job interview.
Of course, it can be hard to sleep because you’re anxious about the interview. If you find yourself having trouble getting to sleep, try a relaxation exercise like meditation or yoga. Whatever you do, take your mind off of the interview – overthinking it is most likely what’s keeping you awake.
2.Review your resume and cover letter.
Review your resume and cover letter, as well as any answers to questions you might have filled out on the job application. Focus on key statistics you’ve listed, major accomplishments, and relevant skills. This is especially important if you’re applying to multiple positions and sending out different versions of your resume and cover letter.
By reviewing your documents, they’ll be fresh in your mind and you’ll be able to answer any questions relating to them quickly. This shows the hiring manager that you are confident, both in your abilities and in the interview itself. If you have to think too hard about a question relating to your resume or cover letter, it could signal to the hiring manager that you weren’t truthful on your application and raise a red flag.
3.Prepare a list of questions to ask.
Asking questions is one the most critical things you must do in a job interview, so it’s important to prepare some questions in advance. By having a few questions already prepared, you won’t draw a blank when the hiring manager asks you. Great questions to ask inquire about the company culture, job responsibilities, or what a typical day looks like. Review the job description to see if there’s anything from there that you’d like clarified. This will often be covered during the interview, but if not, you’ll be ready to ask about it.
4.Plan out your route.
Plan out your route and how long it will take you to get to the interview location. If you’re driving, consider traffic conditions and weather that could cause delays. If you’re taking public transportation, check to make sure that the subway or buses are running on schedule and nothing has changed due to planned work. If you’re doing a video interview, plan out your location, and check your video and microphone to make sure they work.
Always leave yourself a minimum of 30 extra minutes, regardless of how you’re getting to the interview. If you’re early, you can find a nearby cafe or just sit in your car and relax. Nothing is worse than stressing about being late, except for actually being late. Avoid both of those things by leaving much earlier than you think you need to. For a video interview, get yourself set up 15 minutes early.
5.Plan what you’re going to wear.
Deciding what you’re going to wear in advance takes one less thing off of your mind in the morning and allows you to focus your energy on more important things. Make sure your clothes are free of wrinkles, stains, and pet hair. You can also pack your bag the night before, so that all you have to do is grab it and go in the morning.
By starting your interview preparations the night before, you’ll be able to focus fully on the interview itself during the day and put 100% of your energy into it.
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