"A Poor Person Struggles": Working Together in Northern Uganda
The crisis in Darfur, Sudan, has rightly captured the world's attention. But another emergency is taking place in Uganda, Sudan's southern neighbor, where a forgotten war has been raging for more than two decades. In camps like Tetugu, in northern Uganda, CARE's work with women is helping to ensure the health and livelihoods of families displaced by conflict.
This 47-year-old mother of six arrived in Tetugu camp three years ago. "When I came from my home, I had nothing," Anna says. Like millions of others in northern Uganda, Anna and her family fled their home because of fighting between government troops and the Lord's Resistance Army (LRA). It's a battle that had been raging for nearly 20 years, and the toll of the feud is heaviest on families of poor, rural farmers — families like Anna's. With land their greatest asset, being forced off it leaves these families with scarce opportunities to feed themselves or earn enough cash to buy items such as clothing, soap or school supplies.
Anna certainly felt the burden of meeting her family's needs when she arrived in Tetugu. She was not alone. "When families were displaced by the war, we realized women could not rebuild all by ourselves. We needed to work together to earn some money," says Anna.
Anna helped form and now chairs a 40-member group called Lacan Kwitte, "A Poor Person Struggles." When CARE began working in Tetugu, we sought the support of groups like Anna's; we believed these women had the most to gain from projects to increase food production, and they had clearly demonstrated an interest in working together to improve life for their families. CARE worked with several women's associations in Tetugu to distribute seeds and tools, and cows for plowing fields more efficiently. The women also got training in small-scale savings and loan management and general leadership skills.
Angela Anywar, chairwoman of another association that has worked with CARE, says, "The groups and training have really helped and caused a change. Women are able to pay for school fees, medical services, clothing and buy needed household items. We'll continue these activities when we go back to our home communities."
The issue of medical services is a critical one in camps like Tetugu. Crowded conditions and poor water quality and sanitation can lead to malaria, diarrhea, respiratory infections and even cholera. Fully staffed and stocked hospitals are often tens of kilometers away, and the military restricts transit after dark. So, any situation that requires medical attention at night — even a woman going into labor — must be handled within the camp.
CARE has responded to these circumstances in two ways: Improving the quality of government health services available in the camp itself and training camp residents to manage and monitor their health in absence of professional health care providers. The latter is truly the first line of defense.
Rose knows women's bodies by touch, which is a good thing since LRA rebels stole her stethoscope when they ransacked her village. CARE has helped re-equip TBAs with not only gloves, scissors, plastic sheeting and gauze, but also refresher training. Rose has now added some additional topics to her pre- and postnatal counseling sessions.
"Since CARE gave me training, I talk to women about family planning and domestic violence. When a woman gives birth, I tell her she doesn't have to have a baby every year. I tell her she can go to the camp clinic and choose the family planning method she wants." For cases of abuse, Rose encourages the woman to engage camp and local leaders in helping to solve the problem and stop the violence.
For more formal medical attention, residents of Tetugu have a three-room health center, which CARE helped them build in 2002. But CARE project manager William Oloya explains that building a health center was just a first step — to save lives, we needed to build skills.
"CARE's project was designed to respond to the situation created when health workers were displaced by the war and camps didn't have health facilities," says William. "One of the first things was to redeploy health workers by giving them incentives to stay in the camps. In camps where there were no health facilities, CARE built new structures — a total of 16.
"We came in with tailor-made courses for the health workers so they could respond quickly to the emergency," William recalls. "One strategy was to strengthen the capacity for disease surveillance. We did this by training health workers and also community resource persons — camp residents — who could help us detect diseases and report them to the nearest health unit, which would mount an appropriate response."
These community resource persons and TBAs like Rose Ajok are key to identifying and addressing potential outbreaks or complications before they become deadly. The camp health centers are small facilities with no medical doctors or maternity wards. CARE trained the district health team to provide supervision and mentoring to the staff in the facilities within the camps so they can provide the best care possible with limited resources.
William reflects on women like Anna Okot and Angela Anywar — women who work in their fields to feed their families and then go home to cook, care for the children, collect water, clean house, care for animals and possibly manage some small enterprise on the side. They masterfully juggle these tremendous responsibilities, but one shock to the system, one unexpected illness, could bring the whole thing crashing down. That's why CARE's efforts to help people guard their health and treat illness promptly are so important.
"If you go to most of these health units, it's the women who are the main caretakers of the sick, be it children, be it adult men," William says. "Yet, the women are the main bread earners in the camps — it's the woman who does most of the cultivation, most of the processing of food, cooking and other household support. So if a woman also spends a lot of time in a hospital, you can imagine how the family back at home is going to be. Probably a girl is going to have to drop out of school to look after other family members. That's the reality of a typical household here. If someone is sick, then it affects the children in school, the ability of this family to produce food and sustain itself."
|
