Spending so much time with pregnant woman here in the settlement and being so close to life and death on a daily bases has caused me to do a great deal of thinking, specifically about the differences between delivery in a country such as Uganda and the U.S; the differences not only in the delivery itself but also in the preparation leading up to the birth. Back home, we have the power and the knowledge to be in charge of our bodies (in most cases) from pre-conception to post-delivery. We can plan whether or not to become pregnant and after our urine dipsticks display a '+', we have nine months to fully prepare for the coming child. We order parenting 'how to' books, attend parenting classes and workshops, practice prenatal Yoga, consult with our friends who have gone before us, outfit the baby's room and line up friends who can deliver meals. Once the delivery gets closer we go to work in our search for the perfect midwife and if we are lucky, a doula as well. We visit birthing centers and hospitals and start choosing how and where we will bring new life into the world. Through every step of the process we are receiving routine antenatal care, which includes ultrasounds to tell us whether all is well inside the womb. In Africa, and many other areas of the world, women are never consulted about the decision of whether to get pregnant. Theirs is a life of subservience and reproductive surrender. There are no books for them to read or classes to attend on how to be a good parent, there is no one telling them what they should or shouldn't eat as the baby begins to grow inside their wombs. As their gestation period winds to an end, there are no ultrasounds, no fancy birthing suites and no pain medications. They do what their ancestors have been doing for millenia before them. They squat on a dirt or concrete floor and bring new life into the world. Their bodies know what to do and for many, both baby and mom come out of the experience healthy. The problem however, is that for the majority of women, this is not their story. According to the WHO, almost 800 women die from pregnancy or childbirth-related complications around the world every day, with 99% of maternal deaths occurring in developing countries (primarily Africa and areas of Asia and the Middle East). http://www.who.int/mediacentre/factsheets/fs348/en/
Read MoreMedical Teams International
My first paracentesis, for starters.... /
At six years of age he was unable to walk and appeared to be perhaps 3 years old, his head being completely disproportionate to the rest of his body which had stopped growing early into his development.
Read MoreWhat is Nakivale? /
In 2008, UNHCR (United Nations High Commissioner for Refugees) made the decision to resettle 40,000 refugees in the Nakivale settlement in NW Uganda, after fighting escalated in the North Kivu district of the Democratic Republic of the Congo (DRC). Both the Nakivale and Oruchinga settlements were first established in 1959 by UNHCR, thus some families have been living on the settlement for over 50 years! UNHCR has now handed over all of the medical care to Medical Teams International which currently employees and trains all of the national staff in the 6 health centers spread across the settlement.
The settlements host refugees from 8 neighboring countries: DRC, Somalia, Rwanda, Burundi, South Sudan, Ethiopia, Eritrea and Kenya. Although Nakivale is a refugee settlement, Nationals are free to live on the land and take advantage of the services offered, such as schooling and healthcare. Although the concept seemed strange to me at first, I now understand that this policy ensures fair and equal treatment for both refugees and nationals, especially considering that many Ugandans were living on the settlement land far before UNHCR decided to take it over. The settlement is divided into 21 zones and has 76 registered villages. In order to avoid tribal conflict, each zone is populated by a different ethnic group. The settlement encompasses 71 square miles and is now home to over 76,000 refugees.
On arrival, the refugees are first taken to a reception center where they are registered as asylum seekers until they go through the refugee eligibility committee. Once given a status as a refugee they are given a small plot of land and are provided with a ration card so that they can receive food from the World Food Program. They also receive basic supplies such as a plastic sheet, cooking pot, jerry can and a few small tools for land cultivation (Uganda has very welcoming policies for refugees. Most countries are not so generous).
Refugees lingering outside the Resettlement Office
Somali women waiting for refugee status updates to be posted on the UNHCR Notice Board
The settlement is actually quite beautiful. It begins with fields of banana plantations and ends in a dry savannah-esqe valley that is littered with towering anthills, Acacia trees and cows with tusks that could easily impale a person. The rust red road, which descends deep into the settlement, offers breathtaking views of Lake Nakivale. Supposedly the lake is home to a family of crocodiles, however rumor has it that their numbers have dwindled, along with the exotic snakes and local monkey population as the numbers of Congolese refugees have continued to increase. The joke goes,
“Meat is meat if you are Congolese.”
A few iPhone and 'through the car window shots'