Street Children "Denied" Proper Medical Care for Tuberculosis at Bwaila Hospital: Claim of Humiliation and Insults

Malawi: Alleged insults and rejection of street-connected children at Bwaila District Hospital are said to be forcing some of those children with tuberculosis to share TB drugs, writes Meclina Chirwa.

A visit to children living along the Lilongwe river banks revealed that some children who were diagnosed with tuberculosis did not take their medication and refused to return to the health facility, claiming that they were humiliated and insulted by the hospital's health workers because of their status.

Not his real name, this is Brian. A street-connected 16-year-old named Brian revealed that he was given a TB diagnosis in October 2022.

Only in October and November did Brian receive TB medications, according to his health passport, which he shared with us. Brian revealed that he shared these medications with his coworkers, who were also exhibiting TB symptoms.

Brian claims that children who are connected to the street are mistreated at Bwaila Hospital and are denied access to proper medical care because of their status.

He claims that the insults have prevented him from returning to the hospital to pick up his medication for the months of December and January.

"I was diagnosed with tuberculosis in October of last year. I only received drugs in October and November, but after the way I was treated, I doubt I'll return to Bwaila hospital. There is no regard for patients, especially for us street kids," he said.

Street children, like Brian, are part of a social group that uses public spaces, primarily in urban areas, as temporary or permanent living spaces.

These children are socially excluded, unable to meet basic needs such as food, and live in abject poverty.

But how does Brian get enough food to take his medication?

"With my condition, it's extremely difficult to survive on the streets. We are having difficulty obtaining food. Look at us, we're just beggars sleeping under the bridge, drinking contaminated water, and taking TB drugs," he said.

Brian has been off TB drugs for about three months, despite being fully aware of the risks of doing so.

"We know that defaulting on TB drugs is very dangerous, but the way we are treated, I don't think if it were someone, they could go back to the facility. I'm thinking about moving to another hospital to see if I can get help," he explained.

Chimwemwe is another street child who has accused health workers at Bwaila Hospital of ignoring street children who seek medical attention.

"I don't remember the last time I went to the hospital, not that I don't get sick but the attitude towards us is just unbearable. They have a negative perception of us because they believe we go there to cause destruction when, in fact, we only seek medical attention. This is most common at Bwaila Hospital. The majority of our friends are on TB treatment, while others are on ARVs, but getting drugs for them is extremely difficult," she explained.

These street-connected children are more vulnerable due to their living situations and social exclusion, which exposes them to drug and alcohol use, sleep deprivation, HIV infection, and limited access to healthcare, increasing their risk of developing TB and making TB control difficult in this population.

One of the organizations devoted to enhancing the welfare of these children with street connections is One Step Foundation.

Moses Mwalabu, the organization's executive director, talks about his interactions with the kids and the difficulties they have getting access to medical care.

He said: "It's very unfortunate that street-connected children cannot easily access medication at a public hospital like Bwaila. Imagine they share TB drugs among themselves, a very shameful development in a country that is doing everything it can to stop the spread of TB."

The Lilongwe District Health Office, on the other hand, has denied the accusations, claiming that the TB programme is well supported and that no one has been turned away when seeking medical assistance.

"The TB programme is the most well-supported programme in the facilities. "I believe the children are simply attempting to tarnish the hospital's image, or they have their own motive that we are unaware of," he said.

Professor Maureen Chirwa, a health rights activist, emphasises the importance of the country having proper guidelines for reaching out to all risk groups in the fight against tuberculosis. She was quick to point out, however, that the allegations are false.

"To be honest, I don't believe such malpractice could occur at Bwaila or any other facility. In any case, if they have ever experienced this, they should notify the hospital ombudsman," she said.

In the grand scheme of things, what is the National Tuberculosis and Leprosy Elimination Program doing to reach out to all groups of people, including street children?

Dr. James Mpunga, Programs Manager, stated, "As a programme we do not have specific interventions for street-connected children, but I should mention that our outage services the active case finding activities are also an opportunity for street kids to also access. We go to marketplaces, trading centres, and other places where these kids participate, and we expect that those services will be used by the street kids.”

Despite the country's tremendous progress in the fight against tuberculosis, the fight will be futile unless other groups, such as street-connected children, are reached.

Malawi has no specific data on street-connected children who have been diagnosed with tuberculosis (TB) or who are receiving TB treatment.