Sex education could have made all the difference

Suzan Adong massages the black rusty arm of her chair, leans back and chats away during the morning with her friends at the Reproductive Health Unit (RHU), a health-cum-training centre in Apac district.

Three minutes later, she’s back to business, making a pillow case on her sewing machine. Five minutes later, a nurse shouts out, disturbing her concentration.

“Adong, come and get the medicines to give to your baby,” she says in Langi, the local language spoken by the region’s inhabitants.

This instruction, its plain message aside, serves to remind her that she is no longer the ordinary school-going child she once was. The thought that she’s now a teenage mom trying to continue her education at an alternative school reoccupies her mind. Adong enrolled for a six months course in Tailoring and Design in August this year, having dropped out of school two years earlier because of getting pregnant. Apart from Tailoring, the centre also offers reproductive health and literacy skills and gives counseling, mostly to the youth.

Adong at the RHU clinic which has incorporated a tailoring school for teenage-mother school dropouts.

Outside Adong’s study room, happy little faces of children running around the school premises rush past us. Such moments make her realize what an appalling mistake she made engaging in sex at the age of 16.

Life changed for the now 19 year old, who once harbored the ambitions of becoming a nurse, when she exchanged her body for promised school fees money.

“While I was in Primary seven at Arocha primary school, I was occasionally sent back home for uncompleted payments of school fees. However, there was this man who promised to pay Shs 15,000 for me each term if I slept with him. I gave in,” the smooth skinned, milky eyed lass says, catching her breath as if her heart was about to spring out of her chest. 

This man and Adoch were just village friends but on the day he proposed to pay her school fees, he held her hand and they headed to his home. And as they say, the rest is history.

The banner of myths was still flying high in her young mind. Her colleagues always joked that girls cannot get pregnant the first time they have sex or that they couldn’t get pregnant if they had a bath immediately afterwards.

Oblivious of what her parents’ reaction would be, she kept the ‘promise’ and events of the evening a secret.

Two months later, she felt that something was going on inside her. She had skipped her monthly periods and was starting to feel sick. Gradually, the five kilometre journey to school from Baradong village became a cumbersome task.

Later, her mother’s suspicion of her first born child being pregnant was confirmed after Adoch felt weak and sick, and upon checking her, the doctor declared that she was pregnant.

“I was chased from home and I went to stay with my aunt and my lover disappeared on learning that I was pregnant. I stopped going to school and I can’t stop thinking of what I would have become if I had struggled on without giving in to this lie!” she coyly says, staring at the dusty cement floor.

Adoch’s advice now is for schools and parents to teach the children the dangers of early sexual activity which she didn’t know much about then.

COST ON EDUCATION

The 2012 State of Uganda Population report reveals that parenthood is a leading cause of school dropout among teenage girls. It notes that 30 per cent of teenage girls cite pregnancy or parenthood as a reason for dropping out of high school.

Moreover, less than one per cent of young teen mothers (those who have a baby before 18) attain a university degree by 30 and this trend negatively impacts on their children’s education.

“Children of teen mothers are more likely to drop out of high school than those of mothers who give birth at a later age. In fact, only about two-thirds of children born to teen mothers earn elementary education compared to 80 per cent of children of later child bearers,” reads the report.

A teenage mother in Apac district admires her baby.

RATIONALE FOR SEX EDUCATION

Lack of sex education in schools has been identified as a major contributory factor to the high rate of teenage pregnancy. Joyce Ampumuza, the project officer at DSW (Deutsche Stiftung Weltbevölkerung), a German NGO, says many young people are getting misleading information from their peers because parents consider discussion about sex a taboo.

A 2008 research by the Guttmacher Institute on youths aged 12 to 14 years in Uganda shows that only 33.8 per cent of females and 22 per cent of males have received sexuality education in schools. Guttmacher is an American organisation that seeks to advance sexual and reproductive health through research, policy analysis and public education. Currently, the ministry of Education messages to pupils and students is largely focusing on abstinence.

Ampumuza says life skills such as communications and coping skills and sexual reproductive health rights need to be incorporated in schools to help reduce the children’s ignorance. This includes teaching children about the emotional aspects of sexual relationships, sexually transmitted infections, HIV/Aids and the consequences of becoming sexually active.

She adds that this should be done to dispel myths like those Adong had.

Her views are supported by the United Nations Population Fund (UNFPA) country representative, Esperance Fundira who believes that information empowers young people with informative decision making choices.  

“When girls are educated and healthy, they are more likely to marry later, delay childbearing and gain productive or employable skills. We must therefore enforce existing laws and policies to ensure that no girl below 18 is allowed to get married,” Fundira argues.

One success story is that of Atar primary school in Apac that has a project dubbed ‘family initiative’ where teachers and parents organize monthly counseling sessions for the pupils.

Francis Lagmuht, a teacher at the school, says the initiative has registered success this year as no dropouts due to early pregnancy have been recorded compared to four cases last year. 

Girls clad in T-shirts with messages that are aimed at encouraging them to keep in school.

Elsewhere, the Netherlands, where sex education begins at preschool and is integrated into all levels and subjects of schooling, boasts of having one of the lowest teen birth rates in the world at 5.3 per 1,000 women aged 15 to 19 (2011 UNAIDS report).

DOUBLE MINISTRY EFFORT

The ministry of Health has partnered with the ministry of Education to draft a policy on school health with a special focus on re-enrolling adolescent ‘mother’ dropouts back into school.

 “We intend to work with the Education Ministry to ensure that we identify girls who have dropped out of school because of early pregnancy to re-enrol so that they are empowered with knowledge and life skills,” the acting head for Reproductive Health Services, in the ministry of Health, Dr Collins Tusingwiire says.

In the ongoing efforts between the two ministries, the state minister for Primary Health Care, Sarah Opendi, says there is a review of the lower school curriculum to incorporate adolescent-friendly health information in schools.

There is also support of parent peer programmes for adolescent and reproductive health and training of peer educators to provide this information in schools.

Uganda loses 1500 women to unsafe abortions annually

The president of the Association of Gynaecologists and Obstetrician of Uganda (AOGU), Dr Charles Kiggundu has revealed that over 1500 women especially the youth die annually due to complications of unsafe abortion. Unsafe abortion refers to the termination of pregnancy in an environment that does not observe acceptable standards done by unskilled providers.

In Uganda, of the two million pregnancies that occur annually there are 400,000 unsafe abortions majority of which are self induced using methods such as smoking cow dung, drinking laundry detergent, bleach or gasoline, insertion of a catheter, clothes hanger, stick and cassava into the vagina and taking oral hormonal drugs.

 “Out of every 100preganant women, 20 will get abortions and eight of these will need emergency post abortion care but might not access it because of the stigma society and health workers attach to abortion,” Dr Kiggundu said during a lawyers meeting on the use of a human rights approach to unpack the legal and policy framework on abortion on Monday.

He added that 90,000 of these women develop complications such as haemorrhage that need emergency obstetric care and this is available in only 15 per cent of the health facilities. 

A lady at Hoima Hospital being led to theatre for surgery after developing fistula

Unsafe abortion accounts for 26 percent of Uganda’s maternal mortality burden which is currently at 438 deaths per 100,000 live births. Among the factors fuelling the high rates of the unsafe abortion in Uganda are the restrictive and unaddressed misconceptions about laws concerning abortion.

Unpacking the abortion laws;

According to Moses Mulumba, the Executive Director of the Centre for Health, Human Rights and Development (CEHURD), abortion is permitted in Uganda under some circumstances but the relevant laws and policies are unclear and are often interpreted inconsistently, making it difficult for both women and the medical community to understand their options.

Currently, the Penal Code Act is the substantive law on abortion and under its Sections 140 to 142; it is an offense for a person to procure the miscarriage of woman or to attempt to procure the miscarriage of a woman. Under Section 143, it is also an offense for a woman to procure her own miscarriage.

“Because abortion is an offence under this law, it is being carried out secretively in un safe dark places, using unsafe instruments so that the giver and receiver of the service is not penalized. This has worsened the situation,” the acting assistant commissioner for reproductive health services in the health ministry, Dr Collins Tusingwire, said. 

A teenage mother in Apac district looks adorably at her suckling infant. The rate of unsafe abortion is highest among the country's youths

In 1995, the Constitution introduced improvements to the law on abortion in article 22 (2) which provides that “no person has the right to terminate the life of an unborn child except as may be authorized by law.”

“The Constitution envisages that a law may be enacted authorizing the termination of the life of an unborn child in the circumstances which should be specified in that law. However, since 1995 there is no law that has been enacted to give effect to article 22(2) of the Constitution,” Denis Kibirige, a senior state attorney said.

This disclarity, according to Dr Kiggundu has limited women’s access to safe surgical and medical abortion procedures such as dilation and curettage.

Moreover, policies on abortion remain unknown.

In the meantime however, Uganda is using the 2006 National Policy Guidelines and Service Standards for Sexual and Reproductive Health Rights for skilled medical personnel to carry out an abortion.

According to these guidelines, pregnancy termination is permissible in cases of foetal anomaly, rape and incest or if the woman has HIV. The challenge however, is that these guidelines are not clearly detailed in legislation.  

Kibirige argued that Sections 141 to 143, 212 of the Penal Code could be amended to remove the general criminalization on procuring a miscarriage in order to realize safe medical abortions.

He also proposed that a new law may be promoted and introduced in Parliament to specifically address the circumstances under which the life of an unborn child may be terminated in accordance with article 22(2) of the Constitution

From witchdoctor’s altar to freedom

Harrowing tale of little angels that survived child sacrifice

“Let us pray…humble yourselves and close your eyes… Dear God…” 10-year-old Canaan Nankunda breaks into the cheerful play of his peers, drawing them into a circle.

This fabric of family and friendship is knit with the golden thread of prayer, because it is this that has mended their broken hearts, lives and families. 

Some of the children at KCM in prayer

Welcome to Kyampisi Child Care ministries, located in Kisaasi and Mukono, a safe haven for children that have been grabbed from the jaws of death through child sacrifice.

After prayer, the children break into harmonious praise to God – after all, it is by God’s mercy that they are still alive.

These children have experienced trauma beyond my ability to comprehend; like the story of five-year-old Hope.

She was found lying in a sack in a cattle yard where it was discovered that the tip of her tongue and her big toe had been cut off, and some teeth snapped out. This has impaired her speech greatly.

Peter Ssewakiryanga, a director at Kyampisi Child care ministries (an organisation working to end child sacrifice in Uganda) recounts Hope’s journey to freedom:

A daughter of impoverished parents, she vanished without a trace in June 2009. One and half years later, a lady named Agnes was walking to church with a young boy.

The boy came across a sack lying in a cattle yard – he ran up to Agnes and told her there was a strange noise coming from the bag. Agnes described it as a pig snorting, kind of.

They opened the bag to find a little girl bound by ropes and barely alive. Agnes carried her to the nearest medical clinic and they told her the child was dead but she did not believe them. In disbelief, she hurried off to the next health centre but was told the same thing.  But her belief insisted otherwise; the child she was holding was not dead. 

It was only at the third clinic that they realised Hope was alive, but barely. She was transferred to Mulago Hospital where she received a number of blood transfusions and treatment for over two months. Agnes stayed by her side and gave her the name ‘Hope’. Hope was what everyone was holding on to for this precious little life.

Agnes went to the local council to tell the story of how Hope was found. They referred her to the police and announcements were made over the radio about the little girl. Hope’s parents came forward and identified the little girl as their daughter who was kidnapped more than a year earlier. Hope’s parents left and soon after, a man arrived.

He had heard the announcements over the radio for Hope, who had been found.

He introduced himself to Agnes as someone who was looking out for Hope’s best interests. He said he wanted to help Agnes care for Hope, but asked Agnes for the child’s hair and nails.

When Hope was first discovered she had long, unkempt hair and long curled nails which Agnes had trimmed. Knowing this was an unusual question, Agnes said, “I gave those to the doctor and he disposed of them.”

A vibrant looking Hope at KCM

Without another word, he left. A child's hair and nails are used in witchcraft. Even after Hope’s narrow escape, the radio adverts had interested witchdoctors too, who wanted more from her.

Agnes reported this incident to the police and described the man who had visited the hospital. Police identified him as a neighbour to Hope’s parents.

Police identified him as a witchdoctor and the one responsible for Hope’s kidnap and torture for the past one-and-a-half years.

Currently, Hope is receiving psychological, spiritual and physical healing at Kyampisi Childcare ministries.

When I looked at her seated in her wheelchair, I saw a light inside her. Her laugh could encourage anyone to laugh along with her.

Children in death’s pot 

Children like these left on their own are easy pray to kidnappers

The harrowing practice of child sacrifice begins when an individual consults a witchdoctor or ‘traditional healer’, who will then require a child.

Depending on the gravity of the issue that brought the ‘client’ to the witchdoctor, the witchdoctor may demand for a certain body part of the child to sacrifice to the witch’s gods.

Any part of a child becomes a currency; a barter tool for the gods to allegedly grant business success, prosperity, wealth or health. 

“Hundreds of children are kidnapped usually by a neighbour and brutally mutilated in this completely selfish and heartless act. A maimed child may be left to bleed and die, while others are kept alive for continued acts of witchcraft,” Ssewakiryanga says.

He adds that the most sought-after body parts are the ears, genitals, heart, liver, tongue, nails, blood and oesophagus. 

Canaan Nankunda, a former P1 pupil at Kamera Community primary school in Luweero is lucky to have escaped this hellish sacrifice in October 2010.

As he narrates the tales of his past, emotions well up so much so that he cannot bear the pain of it. The sound of silence echoes…until finally the tears roll down his dark skin.

Nankunda and his eight-year-old sister Sylvia Suubi had been herding cattle when they fell into the mutilators’ claws. When Nankunda left to fetch water for the cattle, Suubi’s activity was interrupted by a man who wanted her to follow him. She, however, insisted that she had to wait for Nankunda who returned 25 minutes later.

“Without warning, he grabbed us both, tied our shirts together and led us to a shrine. He told us to lie down and he begun strangling me but I fought him until I lost consciousness,” he now says is a low monotone.

On regaining consciousness, he noticed he was bleeding from the back. He suffered a deep stab wound on his neck and Suubi was by then dead.

He made an alarm and dashed out of the shrine causing the witchdoctor to scamper for safety. Nevertheless, he was arrested three days later.

 

One of the children who were burnt in a shrine is recovering at KCM

Hope at KCM

Nankunda says he is slowly recovering from the trauma of being held hostage in a shrine and seeing his sister killed.

George Mukisa had his genitals completely removed and was rescued close to death after he had been mutilated and then discarded. Ssewakiryanga says that by the time Mukisa was rescued, he had lost so much blood and required extensive treatment to reconstruct his genital area.

“After failed attempts to reconstruct his genitals in Uganda, he remained unable to control his bladder and a sufferer of continued urinary tract infections,” he recalls.

However, through the outreach of KCM, he was able to receive reconstructive surgery in Brisbane, Australia. He can now control his bladder and is attending school at Kyampisi Childcare Centre in Mukono.

KCM -Uganda chapter was registered in 2009 with a focus on reaching out to the community in order to impact positive change for victims of child sacrifice and their families in terms of social awareness, economic and spiritual development. 

Some of the KCM staff

The centre has worked with more than 100 affected families and is working towards increasing awareness on child sacrifice

“We started a school, Kyampisi childcare centre that has enrolled at least 200 children and its mission is to give vulnerable children spiritual, physical, emotional springboards to better their lives,” Ssewakiryanga says.

He says many of the children they rescue are raised in families that believe in witchcraft. In fact, Kyampisi is a renowned hill for witchdoctors.

However, boys such as Mukisa now face a future of infertility because of the castration. Moreover, police does not promptly follow up cases of child sacrifice and sometimes, court claims to have lost the files and guilty witchdoctors walk free, only to snare another unsuspecting child and wipe out its innocence.

As I bade them farewell, the little ones threw their palms wide into the air and waved goodbye, some saying ‘God bless you’ and others saying, ‘aunt weeraba (see you).’

They may be too young to lose sleep over their future for now, but with the sun beaming down from the clear skies on their small bodies, they seem quite content with their ‘now’.