Malawian couple face 14-year jail sentence

Arrest of a same-sex couple in the African state spotlights endemic persecution

As the gay rights cause makes headway in Latin America, with same-sex marriage becoming legal in Uruguay, Brazil, Argentina and Mexico, a story from Africa has illustrated that this is not the case across the globe.

Tiwonge Chimbalanga, 29, and Steven Monjeza, 26, were arrested at their home in Malawi two days after they were married in a symbolic ceremony last weekend. They were accused of "unnatural practices between males" and gross indecency, and will face up to 14 years in prison if found guilty. Today they were denied bail, amid reports of beatings in prison.

It has remained unclear why they chose to make such a public statement -- homosexuality is illegal in the Southern African state. But the case has shone a spotlight on the terrible social and state persecution that gay people face in Africa.

Sadly, it is not a unique story. In Senegal last year, 25 men were arrested at a party and charged with committing indecent acts. In Uganda in 2008, several gay rights activists were arrested. There are countless more stories that do not cause sufficient international outcry to reach our ears.

But while other continents take steps towards acknowledging the human rights of homosexuals, there is a worrying tide of increasingly conservative legislation actually growing across Africa. Gay sex is illegal in 37 African countries, with Burundi the latest addition, criminalising it in 2009. Uganda's parliament is debating legislation that would introduce the death penalty for homosexuality, a policy already in place in Sudan and some northern states of Nigeria.

South Africa is the only country on the continent that legally protects gay rights.

Pearson Mtata, professor of sociology at the University of Malawi, discussed the case of Chimbalanga and Monjeza on national radio, saying:

This has given us a wake-up call but also a new chapter in terms of how we deepen the discussion or the debate on the gay citizens in Malawi.

This seems optimistic, given that the magistrate said he was denying the men bail for their own protection: "The public out there is angry with them." Reports described a hostile crowd outside the court, taunting the couple.

But a glimmer of hope is the burgeoning gay rights movement, gathering force across Africa -- a handful of activists were there outside the court, too. Let's hope they have the strength to keep up the fight.


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Samira Shackle is a freelance journalist, who tweets @samirashackle. She was formerly a staff writer for the New Statesman.

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Want to know how you really behave as a doctor? Watch yourself on video

There is nothing quite like watching oneself at work to spur development – and videos can help us understand patients, too.

One of the most useful tools I have as a GP trainer is my video camera. Periodically, and always with patients’ permission, I place it in the corner of my registrar’s room. We then look through their consultations together during a tutorial.

There is nothing quite like watching oneself at work to spur development. One of my trainees – a lovely guy called Nick – was appalled to find that he wheeled his chair closer and closer to the patient as he narrowed down the diagnosis with a series of questions. It was entirely unconscious, but somewhat intimidating, and he never repeated it once he’d seen the recording. Whether it’s spending half the consultation staring at the computer screen, or slipping into baffling technospeak, or parroting “OK” after every comment a patient makes, we all have unhelpful mannerisms of which we are blithely unaware.

Videos are a great way of understanding how patients communicate, too. Another registrar, Anthony, had spent several years as a rheumatologist before switching to general practice, so when consulted by Yvette he felt on familiar ground. She began by saying she thought she had carpal tunnel syndrome. Anthony confirmed the diagnosis with some clinical tests, then went on to establish the impact it was having on Yvette’s life. Her sleep was disturbed every night, and she was no longer able to pick up and carry her young children. Her desperation for a swift cure came across loud and clear.

The consultation then ran into difficulty. There are three things that can help CTS: wrist splints, steroid injections and surgery to release the nerve. Splints are usually the preferred first option because they carry no risk of complications, and are inexpensive to the NHS. We watched as Anthony tried to explain this. Yvette kept raising objections, and even though Anthony did his best to address her concerns, it was clear she remained unconvinced.

The problem for Anthony, as for many doctors, is that much medical training still reflects an era when patients relied heavily on professionals for health information. Today, most will have consulted with Dr Google before presenting to their GP. Sometimes this will have stoked unfounded fears – pretty much any symptom just might be an indication of cancer – and our task then is to put things in proper context. But frequently, as with Yvette, patients have not only worked out what is wrong, they also have firm ideas what to do about it.

We played the video through again, and I highlighted the numerous subtle cues that Yvette had offered. Like many patients, she was reticent about stating outright what she wanted, but the information was there in what she did and didn’t say, and in how she responded to Anthony’s suggestions. By the time we’d finished analysing their exchanges, Anthony could see that Yvette had already decided against splints as being too cumbersome and taking too long to work. For her, a steroid injection was the quickest and surest way to obtain relief.

Competing considerations must be weighed in any “shared” decision between a doctor and patient. Autonomy – the ability for a patient to determine their own care – is of prime importance, but it isn’t unrestricted. The balance between doing good and doing harm, of which doctors sometimes have a far clearer appreciation, has to be factored in. Then there are questions of equity and fairness: within a finite NHS budget, doctors have a duty to prioritise the most cost-effective treatments. For the NHS and for Yvette, going straight for surgery wouldn’t have been right – nor did she want it – but a steroid injection is both low-cost and low-risk, and Anthony could see he’d missed the chance to maximise her autonomy.

The lessons he learned from the video had a powerful impact on him, and from that day on he became much more adept at achieving truly shared decisions with his patients.

This article first appeared in the 01 October 2015 issue of the New Statesman, The Tory tide