Across five health centers in rural Jangamo District, patients faced an impossible situation: facilities either lacked functioning toilets entirely or had toilets so unsanitary they were unusable. This forced people to relieve themselves outdoors, creating profound embarrassment that drove some patients - particularly those with chronic illness - away from essential care.
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Through a series of advocacy meetings, the team secured a commitment from District Health Director Carlos Simango to address the crisis. Within months, new public toilets were constructed at Jangamo, Ravene, and Mutamba Health Centers - benefiting thousands of patients across the district.
Manuel reflected: "Today, everybody is comfortable. After seeing this issue resolved, I felt relieved - not just for myself, but because the benefit reached the whole community. Speaking up was good for a lot of people."
Manuel's experience sparked a transformation. In the months that followed, he became a passionate advocate for patient rights, joining the village health committee and sharing his story before 150 attendees at a national health forum in the capital.
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A 36-year-old patient named Manuel described his ordeal: "I went for an appointment because I wasn't feeling well. While waiting in line, I started experiencing severe stomach pains. I searched desperately for a bathroom, but when I found the patient toilet and looked inside, it was so filthy I couldn't enter. I had no choice but to run behind a tree for relief—in full view of other patients and staff. It wasn't a hidden thing. A lot of people were watching me in this situation, and I couldn't escape from it. All that embarrassment was very humiliating to me."
Manuel’s experience reflects a broader crisis affecting HIV and TB patients, whose medications often cause diarrhea. Namati's health advocate, Geraldo explains: "Patients think 'Let the diarrhea pass and then I'll go to the hospital,' or they simply skip appointments altogether. They'd rather stay home than face public humiliation at a place meant to heal them."
Rather than accepting the humiliation, Manuel chose to speak up: "I raised my concern with the health advocate at a community meeting. We went to the health center with some members of the village health committee to speak with the person in charge. He claimed to have no funds and referred us to the district health office, who also said they lacked funding but would seek support from local partners."