Building A Bridge with Umunthu: Supporting Equal Treatment of LGBTI Patients in Malawi

“To quote Mother Theresa, ‘We are all angels with only one wing — we can only fly embracing each other.’ This represents the concept of Umunthu, an African philosophy that connects to many other spiritual teachings across the world,” Rodger Phiri explained as he stood in front of a room of 30 healthcare workers. 

The workers were gathered to spend three days with ArtGlo, exploring issues of stigmatization, marginalization, discrimination, and social exclusion in healthcare settings. The workshop uses the concept of Umunthu — “I am because we are” — to lay the groundwork for social change and to emphasize equality of treatment across different social groups. This African philosophy emphasizes the “consciousness of our interdependence and our interconnectedness,” explains Rodger, who is the program officer for the Umunthu Program for ArtGlo. 

Umunthu workshops bring together a variety of healthcare workers, from doctors to nurses to surgeons. To help set the stage for the next few days, the workshops start off with games and songs that break the ice among the participants, allowing everyone to get to know each other and lessening the social barriers and hierarchies that exist between different healthcare positions. Through activities like drawing, they explore their own understanding of the Umunthu philosophy. Drama activities encourage participants to reflect on their personal experiences of stigma and discrimination, and the connection between the absence of Umunthu and the experience of discrimination. 

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From there, Rodger and his colleagues ask the participants to identify the groups that they feel are experiencing the most discrimination in the healthcare setting. The workers list off groups of patients, the most common of which include people who are economically disadvantaged, sex workers, people with disabilities, and lesbian, gay, bisexual, transgender, and intersex (LGBTI) individuals. Rodger then works with the participants to explore the experience of the last group further, guiding a conversation around the treatment of LGBTI patients, how the healthcare workers feel about treating these patients, and the kinds of barriers these individuals face when trying to access care. 

The conversation that ensues is often a sensitive one that can become very emotional and deeply personal. For many Malawians, religion plays a very central role in life. It is a guiding light for people’s choices in the home and in the workplace. During the workshop conversation, the participants share their feelings about accepting and treating patients who identify as LGBTI, and how they often feel that this is a betrayal of their faith. They express their thinking that working with LGBTI people implies that they are supporting a behavior that goes against the teachings of the Bible. 

“Whenever I met people from the LGBTI community at the hospital in need of medical attention, I read them Bible verses and later refer them to pastors for repentance and deliverance,” said one healthcare worker in a recent workshop. 

This participant, together with many of his fellow healthcare workers, would only treat LGBTI patients if they agreed to be counseled first, with the goal of convincing them to identify as heterosexual.

The Umunthu workshop provides a safe space for all the healthcare workers to have this conversation, and to speak openly and honestly about their fears and concerns in regards to treating LGBTI patients. But once the dialogue gets going, Rodger begins to use the Umunthu concept to connect to the core values of Christianity and other faiths, emphasizing the oneness and interconnectedness of humanity, the golden rule, and the concept of loving thy neighbor.  

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As this particular workshop progressed, the healthcare worker who previously said he couldn’t treat LGBTI patients due to religious beliefs came to realize that it is through the same religion that he is directed to treat others equally. He referred to the Bible, saying that Christ commanded us to do unto others as we would love them to do unto us.

“As a God-fearing nation we should not choose whom to treat because we are all equal in God’s eyes. This workshop enlightened me that it is not wrong to treat them because of my religious beliefs,” he explained.

Another healthworker explained her thinking prior to the workshop experience: "I knew about the minority communities, the gays, lesbians, sex workers; I was well aware that they were a part of our communities, but I never once supported their work or their lifestyle. They were not people to me, they were not to be treated as such for being the way they are or choosing that line of work. I would purposely seat them at the end of the line or separately when they came in for treatment or health services at my workplace because I felt that they were not important enough to be treated first or be prioritized."

However, attending the workshop brought about a new perspective for her: "I came to realize that my mindset and attitude toward these communities was wrong, it was dehumanizing which is wrong. The workshop enlightened me on the fact that all these people were indeed people just like myself, they were also a creation of God just as myself," the healthworker said. "I was reminded that as a healthworker, it is my duty to serve everyone regardless of their work, sex orientation, and other things that I may have thought separated them from me."

Through this connection between Umunthu and religious teachings, a bridge is built, supporting the healthcare workers as they begin to see their LGBTI patients in a new light—as individuals who deserve equal treatment, especially from those who have taken an oath to provide care to their fellow man and woman.

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The workshops also explore how discrimination in hospitals and clinics builds fear among LGBTI patients and prevents them from seeking and adhering to HIV, STI, and other communicable disease prevention and treatment programs. After the healthcare workers participate in the workshops and start to apply these new approaches to their LGBTI patient care, they often report an increase in health-seeking behavior from LGBTI and other vulnerable patient populations. This indicates the potential positive impact that these workshops are beginning to have in communities of care.  

On the final day of the workshops, community leaders join the healthcare workers to make Community Action Plans that lay the groundwork for addressing discrimination. In addition, each participant makes a personal pledge to support equal care for minority groups. ArtGlo follows up on these plans and pledges, helping the participants keep their commitments and move their communities toward a stronger healthcare environment.