Women to Women Group: Smear Campaign

                                                                                                                                             19/9/13

Two years ago Christine Adoch was struggling to find ways to help her community improve their livelihoods in Kyangwali. Since 2002 when Christine first arrived in the settlement camp, she has witnessed diseases which have ran rampant due to lack of hygiene and malpractices that tend to plague refugees when they settle in camp. Unfortunately because of the lack of education that many refugees have on hygienic practices, many of these problems persist even after they have been living in the camp for years. Even with all the programs that AAH has helped implement about the safe practices of water, sanitation, and hygiene, there are always some areas which AAH does not have enough people to help cover the issues and prevent disease.

Christine (far right) and her group
(minus two members)

The Women to Women Group, and similar ones like it, were established by AAH in 2010 to alleviate the lack of coverage to help educate people on these practices. The Idea was to have the refugees help educate other refugees; having a system like this one would increase the chances of educating the communities. If those refugees that they knew and lived with were the ones teaching the practices instead of the organizations, there would be a greater chance the refugees would be willing to learn because they would be more comfortable with someone who is in their exact situation. Also being close and interacting every day with those who they teach helps to monitor and control the progress of the hygiene practices AAH tries to implement.

Jiggers attacking feet

Two years ago when the Women to Women group was blooming, Christine was selected by her community and AAH to become the first Community Promoter in her area. Her job, along with the other twelve women (who were also selected by the community and AAH this year at the end of May) in this area’s group, help to teach their surrounding communal blocks the hygienic practices of smearing a house to prevent Jiggers (which are caused by dust). Jiggers are tiny flies that dig into skin (usually feet) and feed off of blood, they are commonly found around animals in areas of filth, usually pigs. Sever cases of jiggers can leave people unable to walk until the flies are removed by tweezers or being soaked and killed off in hydrogen peroxide. Though there are few cases that rarely get to that stage, even one jigger in your foot can cause a restless night sleep.

The process of smearing a house is a simple one that involves taking a mud and animal feces mixture to create a substance which holds moisture. This mixture is then smeared in the house to decreases dust in the household. To effectively decrease dust, the floor and the walls of the house must be smeared at least once a month, especially during the dry season. This process along with building a home with a base made of this mixture will drastically help prevent jiggers from hindering one’s life and their sleep.

Smearing a floor

 Christine and her group were first trained by AAH on this process of smearing homes before they were able to go out and educate others. Though the education and the process of smearing is easy, the difficulty in their job is making sure everyone in the communities continues to smear after they teach them. The way they educate their fellow refugees on this process is through demonstrations. Each month Christine and her group goes to a different block and helps smear four to five houses out of the twenty or so in the block in order to help teach the people in this community. This literal “Smear Campaign” is designed so the women can plan and promote the benefits of smearing in all of their surrounding communal blocks all year round. This type of campaign has already proven to be the most proficient in getting the word out and helping to preventing jiggers.

Ever since 2009 when this group of twelve women who arrived together by convoy with their families to come to Kyangwali, (aside from Christine) have already had their own experience with jiggers and other sanitary diseases, parasites’, and pests. Like the refugees they are helping to educate now, they too were ignorant of the practices to help prevent many of these sanitation issues, and many of them, if not all, have had complications with jiggers. In the Democratic Republic of Congo it is not uncommon to live with animals in the house, in fact it is a part of their culture to do so. However living with animals only raises the chance of having jiggers or other diseases in the house.  Ever since they had become apart of this group and learned these prevention methods, none of these ladies or their families have had any further problems with jiggers. Their success stories and their demonstrations have incited other to do the same thing in their homes. Ever since this group has been implemented the rate of jiggers has greatly decreased in the areas in which they have demonstrated.

Jiggers are not the only issue that these women have faced in this group. Being a part of this group, the first of its kind, and helping to teach others (they mainly teach other women) goes against many of the cultural norms that have been in place for generations. In the Congolese and most of the other African cultures the males are the ones who construct the houses and are even the ones to smear the homes. However once the men construct the homes for their families, they often neglect or are ignorant of the importance of continually smearing the houses.

Christine's village, the base around the houses is to
 prevent jiggers and other dust born diseases.

The women’s role in the household has always been along the same lines of bearing and raising the family while taking care of their needs. If one of the children got sick or had jiggers, it was the responsibly of the females in the household to take care of the illness, the males have no part in the healing process since this is the woman’s job. However if the women are part of the healing process shouldn't they be a part of the prevention process as well? That exact idea was the spark that ignited the idea for the Women to Women’s group. If women have to take care of the family then they need to be the ones to help prevent the disease, parasites, and pests. Fortunately for the women in these communities the men have accepted the women’s role in smearing as long as it does not interfere with their construction. Though the men in these communities accept only small roles for women, it is a great epoch for their future generations.

The Women to Women groups in Kyangwali are not only a group of educators and preventers, but they are also pioneers. These trail blazers are brave enough to start fighting the old cultural norms and break down the social stigmas of their people, all while helping to educate and protect their families and neighbors. This inspiring group of women preform a very important duty in this settlement camp, but the most inspiring quality about all of these women is that they do not want to stop here. They wish to go one step further and learn farming, tailoring, and other trades from AAH so they can have more to teach to their community and prosper all together. 

Safe Motherhood Meeting

                                                                                                                   16/9/13

In rural parts of Africa child birth is still a major killer among mothers and new born babies. For generations in the unspoiled lands of Africa, children have been conceived the same way which is natural and without help from anyone medically trained. Often, mothers give birth to their children in the comfort of their homes but under unfavorable conditions, (stress, laborious tasks they used to do, and unsanitary surroundings). Due to the lack of knowledge in these rural communities complications often arise. That major lack of knowledge in these developing parts of the world create a large majority of the problems that mother’s face, (unaware of status of HIV, not breast feeding after birth, and having too many children). These problems too often lead to the death of mother or child, and sometimes even both. Neither mother nor child should ever die from childbirth.

In 1987 AAH realized that far too many mothers and children were dying due to complications arising in child birth and that the lack of knowledge that the refugees had in the camps was the root of the problem. AAH’s mission is better health and better livelihood, this is why the Safe Motherhood Program was founded in 1987 to help educate the general population of the settlement camps. This program, which is a branch of the Health Department began holding open meetings for the communities to come and attend. The meetings teach the safe practices that the mothers, families, and communities should use when a mother in their community is expecting.

AAH representatives hold the meeting
at the local Youth Center 

All issues are discussed when these meetings are in session to help break down some of the social stigmas that have been built up in these communities over generations. Everything from Planned Parenthood to HIV testing and even myths such as child birth being a disease are discussed in the meeting so everyone can learn and take this knowledge back to their communities. During the meetings all who attend are encouraged to ask any questions on the processes or what they might be able to do in order to help. So far this year Kyangwali has already lost six mothers and even more children all from childbirth, unfortunately all the mothers died after their fifth pregnancy. This preventable number of deaths is closely related to the education these women in the communities are not receiving.

 The main goal of these meetings are to keep the people informed of how they can have a safe pregnancy. The paramount issue that the Health Department pushes is by first conceiving the baby in the health centers and not at home. Women who are expecting are encouraged to visit the health centers at least four times throughout the pregnancy to check up on the status in order to test the health of the mother and fetus.

The four visits are for:

1.      Make sure the woman is pregnant

2.      Go for tests, HIV, malaria, and then receives results and provisions to protect her from diseases and parasites

3.      Check on status of pregnancy and see if the child can be delivered here in Kyangwali or if it must be delivered in Hoima (the nearest city an hour and a half away on dirt roads)

4.      Same as # 3

The earlier the better, women often delay to visit health centers and wait till the last minute when complications could arise. So the earlier a pregnant woman goes to the health center the easier the pregnancy will be. Once the expecting mother’s delays and waits until the later stages of labor then simple tasks like getting to the health centers in order to have a safe delivery become a problem. Though Kyangwali does have some ambulances, they are often being used for other emergencies. When they are able to come for the expecting mother when she is in her later stages, issues such as getting to the village and then getting back to the health center become difficult and very painful for the mothers. Families and mothers often delay so much that when the ambulance arrives the mother has already delivered. However the responsibility should not be on the mother alone to make sure the pregnancy is as safe as possible.

Sister Joan talks to the those who attend the meeting
about safe practices of childbirth

The Congolese refugees have a strong sense of community. Those at the meeting voice their concerns on child birthing deaths, they want these children to live because if not then a part of your country’s future dies, your culture’s future dies, and it’s a waste. Community participation in these villages in the camp is a huge point that AAH tries to drive into those who attend the meeting. If AAH can reach out and teach the communities on these processes then there will be less of a chance that the expecting mothers of that community will fail to perform these visits. Providing the families and communities with responsibility over the expecting mother will help encourage the mother to go and visit the health centers throughout her pregnancy.

Aside from failing to visit the health centers to assist in mothers pregnancies there are also other major issues that many refugees tend to ignore in the settlement camps. HIV is a massive problem all over the world, according to the WHO there are 35 million people living with HIV (two-thirds of which reside in Sub-Saharan Africa) and around 2.5 million people who become newly infected each year. Out of those 35 million who are living with it, 1.7 million die each year from HIV ⁽¹⁾. AAH talks with those at the meeting of the dangers of not being tested and not knowing of the individual’s status. This is one of the most dangerous issues for women and especially for expecting mothers.

For mothers who are unaware of their HIV status often stop breastfeeding or never start it in fear that they may transmit the infection to their newborn. This method would leave life-long issues which hurts the child almost as much as transmitting the infection to them. If the parents got tested and were aware of their HIV status then AAH could provide the necessary drugs so mothers would not have to believe that they must stop nurturing their newborns in order to keep them safe.

The meeting stresses on couple testing for HIV, this is a major issue to test to know if someone is safe. If AAH can prevent the child from getting HIV it is one less person they need to worry about for drugs. This year alone the HIV prevalence is 6.2% and increasing, more and more refugees are getting infected daily whether it is from lack of knowledge or malicious cases such as rapes. Out of the ever growing 20,000+ population of Kyangwali, there are thousands of people in the settlement camp that are unaware of their status; not knowing tends to cause a great deal of problems.

AAH hands out condoms in efforts to promote
Planned Parenthood

Having too many kids is also another major issue in the settlement camp, which is why Planned Parenthood is another critical program which AAH teaches in these meetings. When parents have too many children than they can bare they are unknowingly driving themselves into poverty. Taking care of the needs, health, and school supplies of one or two children can add up to a lot of money for the parents. When the parents start having more than two children then complications arise for the whole family, its becomes a worse life for everyone, parent and child a like. AAH tries to show at the meeting that having fewer children will help their financial situation and also the health of their entire family. Being aware of Planned Parenthood and having fewer children will help the parents focus more on the health, safety, and supplies for the children they already have.

AAH tries to promote the individual’s culture as much as possible, they do not want refugees to lose themselves and who they are just because they are in the settlement camp. When the refugees and their children start dying due to the lack of knowledge or the unwillingness to help themselves, a part of their culture does die, their future dies. Things will never change until people are ready to learn, they need to learn the proper and safer ways of doing things. HIV testing, Planned Parenthood, and safer practices of pregnancy are all major issues that need to be addressed to the refugees of Kyangwali. Helping those who attend the meetings change will help their communities change as well. Hopefully in time these small changes can add up to big decreases in the amount of deaths of mothers and children.   

⁽¹⁾        World Health Organization, “HIV/ AIDS” 30^th June 2013, http://www.who.int/features/qa/71/en/

Children of Kyangwali

Personal Stories: Nepo & Amani                                                                                                11/9/2013

Nepo Nteziyaremye

Nepo Nteziyaremye (27) and Amani Jean Damas (30) have both grown up in Kyangwali spending more than half their lives, seventeen years each in the refugee settlement camp. Independent of the other, both of their families made their decisions to seek refuge from the conflict in the Democratic Republic of Congo and leave their homes to find safety. To Nepo and Amani the DRC is not a place they knew as home, though it is where they were born, there is not a connection like there is with Kyangwali. Both men have created lives and families here, building their own homes, getting married with wives they met in Kyangwali, and raising two children each. Growing up in the camp, making new friends, and building their lives here, it has always seemed to them that Kyangwali has been their home.  

Coming to Kyangwali and being raised here from an early age gave them the opportunity to see how much this settlement camp helped their families. The generosity that they experienced from AAH and the organizations in Kyangwali compelled them to give back their own communities and help however they can. From early on in 2009 Nepo was a club leader in his local club which helped the youth in his community with schooling and activities; Amani had been trained as a peer educator from school ever since 2007. AAH got word and had sought out each of these men to help with programs due to their exemplary conduct and devotion to help their communities.

The Youth Center where Nepo and Amani
help out

Nepo and Amani now help out in a variety of projects ranging from assisting AAH field workers when they are meeting or teaching different communities to working in the Youth Center as mentors, teaching and helping out the younger refugee population. Nepo and Amani are both trained in a variety of  languages that are spoken here in Kyangwali which makes each of them incredibly valuable when meeting other refugees. Often newly arrived refugees or even veteran ones at the camp often do not listen or speak to AAH field workers because of the lack of comfortably and familiarity with the staff. Having these two men who are refugees themselves to work and translate for AAH bridges that gap between field workers and refugees, making the community more comfortable with programs and meetings. Nepo and Amani help in many of the programs, especially in the health sector to help convey the message and help teach others about health issues refugees should be aware of here in Kyangwali.

Amani Jean Damas

Aside from being translators they also help with home teachings, going around to different villages and blocks and also teaching to those who do not wish to come out to meetings, such as women and children. Nepo and Amani reach out to these communities and try to break down social stigmas about viruses and diseases (HIV/ AIDS) and provide support for those who have health issues and are infected. The community may not see benefits of the programs or these two going around from village to village. But what these two men teach is prevention, which is arguably the most important part that every sector of AAH tries to work on with the refugees.

 

Being a vital part of AAH has helped both of these men fulfill many of their needs to help out their communities. But being a part of these programs and working to help teach refugees have also helped their families learn and prosper. Learning of all of these health issues and becoming the voices of AAH has helped them teach their loved ones and keep them safe from many of these issues. Both of their families have become exemplary in their communities, becoming the model refugees and showing everyone how to live in the refugee camp and how use safe health practices for prevention.