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Malawi Report Reveals Questionable Uterus Removals in Public Hospitals

FILE - Some women in Malawi have had their uteruses involuntarily removed soon after giving birth in procedures that have come under scrutiny. Pictured here are mothers attending a clinic with their children the at Likuni clinic in the capital Lilongwe.

In Malawi, a report by the office of the public protector, or Ombudsman, has shown that poor conditions in public hospitals are resulting in many expectant mothers having their uteruses removed during child birth. The report faulted the Ministry of Health for failing to provide sufficient staff for Obstetrics and Gynecology departments. But health authorities say efforts are being made to address the matter.

The report, Woes of the Womb, released last week, says more than 100 expectant mothers received care in the country’s referral hospitals and had their uteruses removed during a six-month period last year.

“Between January and July 2018, 160 uteruses were removed in the Central hospitals only. There are some patients who we picked up because they could substantiate their cases. We will refer them to legal aid actual claim for compensation,” said Martha Chizuma, the country’s ombudswoman.

The 37-page report follows a news article published by the privately-owned weekly Malawi News in 2018 and later a documentary aired by local radio station Zodiak Radio, in which women who had their uteruses removed at Queen Elizabeth Central Hospital recounted their ordeal.

Victims' stories

An alleged victim said, “When I arrived here I was told to go for a caesarian section operation because nurses said the baby inside my womb had difficulties breathing. But a day after delivery, I was referred to another operation where they removed my uterus because they said it had gone bad.”

Other women recounted similar experiences.

A second alleged victim said “I came here on the 14th and the baby was born on the 15th through an operation. But when I returned home I came back because I was feeling dizzy. Once there, they told me that my uterus was full of puss and that they had to remove it.”

The Ombudwoman report says that it is largely because of the government's failure "to provide sufficient staff to cater for the needs for Obstetrics and Gynecology Departments in all health facilities that there are instances of compromised quality service delivery in the country."

“Most of the time they find themselves in situations where they are simply attending to [an] emergency. So you just go the hospital, you are ok, you just waiting for delivery. But until you become an emergency yourself, that’s when you get an assistance,” said Chizuma the ombudswoman.

The report recommends health workers who are negligent in their work face disciplinary action, a view that health rights campaigners support.

Awaiting government response

George Jobe, the executive director for Malawi Heath Equity Network, said “Our expectation is those in authority will act on the report. Punishment should be done. But not only that, it should be timely because justice delayed is almost justice denied.”

Andrew Likaka, director of quality management of digital health for the Malawi Ministry of Health, said the report's findings are of great concern to the government. But he added disciplinary action does not happen overnight.

“When we are talking about discipline in [the] health sector, it has to be noted that there are so many agencies that are responsible for discipline, and discipline is also taken on fairness principals. It has something to do with normal disciplinary issues; we have authorities at any level of health care that address those disciplinary [issues].”

The country’s medical regulatory body, the Medical Council of Malawi, says it has so far confirmed 20 cases of women who had their uterus removed, and has warned it will bar all medical workers implicated in cases of malpractice.