This story begins with my first journal entry, from June 15th,
and continues the update to this past Sunday August 18.
The First Hungry Girl
Today I saw what I have only seen
in pictures or read about and tried to imagine, “What would Severe Acute Malnutrition
look like?” I guess I never stopped to think, “Today might be the day I come
across someone dying in the village.” It was a typical day, I was stressed and
grumpy. Actually, before leaving for the field I vented to a colleague about my
disdain for some team members and was not proud of the words I chose to reflect
the individuals. It wasn’t my best moment of cool leadership, but it is me and
I have to be OK with my weaknesses, and quick to anger is one of them! It is
Saturday today and our team needs to work in order to keep up with the research
schedule. Having not slept well the night before because my driver and team
leader failed to check in with me that they had indeed returned safely to town
from the field (they were mobilizing the villages we visited today after we
already put in a full day in a village 2 hours away), I was ready to have a
stern meeting with the two and leave for the field. First I had to get my
things ready for the evenings party. Oh yes, it happens that there has been a
Murder Mystery Dinner that the ex=pats have been wanting to put on for quite
awhile now. I had volunteered months ago to host the thing, meaning I would
coordinate the foods and make sure everyone had a role, etc. So in the midst of
field week one, I held a planning meeting Thursday night and got all the
information out on Friday morning with the help of my co-host (Thank God for
Cormac stepping up at the meeting!!!) I woke up early Saturday to peel my 2
squash and 3 sweet potatoes, season them, get hummus ingredients, the game, my
candles, and other various party supplies ready to go. Plus all my field
things. By the time I was racing out the door I realized I was drenched in
sweat in not so awesome sweat patterns. Later my driver would say, its because
you are fat! Classy. Anyways, our field work was conducted in a village nearby
where a reported case of a death had just occurred due to malnutrition. People
were on edge. As the team was mobilizing in the manyatta, the driver and I were
asking the usual questions to the kids around the water pump, “how are things
in the village? Is everyone well?” and such. One of the young kids mentioned to
the driver that there was actually a woman who was severely malnourished and
wasn’t going to live much longer. He described her as having sunk in eyes and
her skin was tight to her skull. I made the decision to go ahead and visit this
woman as soon as all of the team had begun their interviews under the
supervision of the Field Research Manager. The driver and I then went to speak
with the LC1 (Local Chairman: responsible for community) to inquire about the
condition of this woman and to get a better understanding of the situation. He
explained that the woman, 21 years old (but looked much older/haggard!) lost
her mother and was an only child. She has some relatives but none want to claim
her. After losing her mother (1-2 years ago?) she went a bit “mad” and since
then hasn’t been the same. She had left the village for an unknown period of
time, wherein she was “with the enemies”, but had returned and the villagers
forgave her. When she returned her hut had toppled, so she constructed a shanty
with some sticks and plastic bags. He said she had fallen sick approx. 8 days
ago and that she wasn’t eating. He reported her condition to the Sub-County,
but it fell on deaf ears. He agreed that we should go and visit with the woman.
Her name is Santina and she
showed visible signs of acute malnutrition. She explained severe pains in lower
feet and legs, but showed no signs of puffiness/oedema. She hadn’t bathed in
quite some time and was barely audible when speaking. The LC1 pointed to the
buckets on top of her shanty and explained she was surviving off of the sludge
residue from the sorghum brew. Since she hasn’t had the strength to get firewood
to sell, she has not been able to buy her own food. She has some small garden,
but is unable to work in it due to her condition.
We asked the LCI how it came to
be she was in this state and he explained that nobody claimed her and there is
no food to share with her and at times she refuses to eat. We asked if we could
take her for treatment. A 20-minute discussion ensued about the pros/cons of
the health clinic in Kangole (closest proximity) vs. Matanye mission hospital
(a bit further, requiring transportation which the LC1 can not afford for
visits). The LC1 decided against Kangole health center because he knew it would
require the presence of an attendant to cook and care for Santina and nobody
was willing to do this. We chose Matanye hospital thinking that because they
have a full time kitchen staff we would not need an attendant in order for
Santina to be admitted.
The team was briefed and agreed
to our course of action. We dropped the team in the next village and proceeded
with Santina, LC1, one FIC enumerator, and driver to Matanye hospital. It was
the weekend so it was triage only in the emergency ward. There was one
nurse-student on duty to do intake and then the doctor was called to come in.
Her stats were taken, blood pressure was OK and so was Blood Sugar (most likely
b/c of alcohol in system). Her temperature was 39.7C/103.46F. When I asked the
nurse attendant for a cool rag for her forehead she told me we needed to bring
that ourselves. She also said we would need a basin, soap, bowl, and cup. I
sent the driver to bring these immediately. They began a drip of fluids with
supplements and an injection to bring the fever down. The nurse attendant was
stunned at the state of the woman’s feet and kept insisting we clean them. Once
the basin arrived I began to wash her feet (seemed completely non-priority!)
Later the nurse-student finished the washing and we found severe damage from
chiggers.
The doctor arrived and I gave her
medical history to best of my knowledge. The doctor said that they would admit
her, but we would need an attendant. Of course this was the very problem in the
beginning!! So I was really thinking I was doomed at this point, I have a woman
I am responsible for who is hooked up to an IV drip, coming in and out of
consciousness and is on a 48 hour liquid diet, who can not stay unless there is
an attendant. The LC1 understood the severity of the situation, but gave me a
look that said it all—pretty much, “Hey lady, saw this coming a mile-away, I
gave up long ago.” Refusing to give up I sent the LC1 back to the village to
plead with the community.
Meanwhile the doctor explained
the treatment: She would be given milk with added nutrients from their
emergency feeding room (for babies/children). Once she stabilized she would
undergo the tests on Monday to see if HIV/TB etc are present. She explained
that they can sometimes cook the food ONLY when it is after the “nutritional
screening” which takes place on Mondays. But they cook the food we bring (it
was very unclear). She said we would need to provide the food for the patient
and attendant for a week. She advised us to buy things for porridge, small
dried fish, etc. I found myself racing through town with my enumerator buying
the following: posho, sugar, rice, beans (for attendant only), salt, cooking
oil, fish, a spoon, a pot, charcoal, and a stove. We also bought a new set of
clothes. All of this was done with the hope an attendant would arrive from the
village. I even offered to pay someone in town to care for her, but they refused.
Nobody likes a hospital.
Eventually a young girl
volunteered from the village to be the attendant. She is no relation. Her
father nearly refused because he wanted the muzungu to pay her. Another factor
for everyone’s refusal is that it is a key time to be in the field. People are
unwilling to give up critical cultivation time. When the driver brought her
back to the hospital I briefed her on what a hospital was like. She was never
in one before, of course, and was visibly scared. She had a lot of instructions
re: the diet and care, and I worried about how she would cope when I left.”
Santina stayed in the hospital
for 3 weeks. Her attendant left as soon as the food was finished but Santina
remained under the care at the staff –after one week she was able to get
herself to the restroom and kitchen for food. All of her tests came back
negative for TB/HIV, etc. Phenomenal. She was sent home with Plumpy Nut bars
and told to return for another health check up. When the driver brought her
back to the community, she immediately began yelling at them, “How could you
let me die? If you were my family you wouldn’t leave me to die! You just want
me to die like my mother! I am not sharing anything with you (i.e. her hospital
bed sheet)” The driver tried to calm her down, and the community, exasperated,
just returned her hostility with more of their own barbs. One problem down,
another boiling.
I left for vacation the next
morning and had no chance to follow-up. Of course, I had alerted the
appropriate NGOs who are working in the community to please monitor her over
the coming months.
When I returned last week for
field work I paid her a visit. She looks so much healthier-rounder cheeks and
some weight on her legs/collarbone. Sadly, she had returned to wearing her old
clothes (I had purchased her a new outfit when she was hospitalized—nothing
fancy of course, practical, clean and new). She hadn’t bathed in a long time
and her feet were again caked in mud. She made eye contact briefly with me and
then just mumbled short quick responses. She thanked me for the health care and
told me that she sold the stove we bought her for her time in hospital. She had
used the money for posho (local carbohydrate/starch) but the kids nearby stole
it. When reporting this to the LC1 he just laughed. We asked to see her shoes
and her old health statement. She went inside her shack—which she was guarding
with her life—and pulled out 2 soaking wet sandals caked in mud. It was then we
realized, this shack leaks and even if she wanted to stay clean, the poor thing
couldn’t. Relations were still strained in the community, which became
abundantly clear by the spectators milling around and laughing at her replies.
I noticed the doctor had ordered her to return for a follow-up treatment. I
explained this to her and the LC1 and gave him 25,000UGX ($13) for treatment
costs. He promised me he would take her the following day.
Things just weren’t sitting
right. I knew it was wrong for me to just abandon her with this mess. I had
intervened when taking the step to save her, and now it was up to me to at
least TRY to advocate on her behalf for better relations in the community and
the construction of a proper shelter. The LC1 and community just kept repeating
that she was mental, and it seemed that by repeating this so much, that over
time they had actually come to believe it as the truth. However, whenever I
dealt with her what she said was 100% reasonable. And don’t get me wrong, she
wasn’t putting a show on for me, I saw her lash out at the community! She
wasn’t afraid to go after them in front of me! Also, the doctor really felt
that there was no problem in terms of her mental capacities. She by no means
has been easy to deal with, so I can’t fault the community (especially her
relatives!) because I am not in her shoes, but I do know that sometimes all
someone needs is a push in the right direction. Anyone who lives with someone
who is difficult in their family knows how tiresome it can be to be a constant
person of love and support, especially when they may be hurtful. I was hopeful
that the situation just needed some reconciling and encouragement to mend the
hurt of the past, fueling all of her anger, and begin new.
I asked the LC1 and Santina to
prepare for a reconciliation meeting on Sunday.
Little did I know I was going to
work Saturday 7:30AM (no lie!) to 10:00pm at night, non-stop. Sunday morning
came pretty dang quick!
I had the good fortune of asking
two Stepping Stones facilitators (one of our implementing partner
organizations) who are trained in conflict resolution and peace building to
assist me. They were briefed in advance and were aware of the situation. They
were 100% volunteering their time and energy, and it was absolutely one of the
best things I have ever witnessed. These two, one male and one female, reminded
me that anger comes from hurt, and hurt comes from either/or the failure of
having a need met or from having a fear of something. In order to have Santina
come to peace, they explained, they first needed to dig deeper. There were
signs that pointed to key factors that had to be addressed: Where are her
relatives, and why aren’t they claiming her? Why didn’t she feel comfortable
enough to go with the LC1 to get her health check-up? When did she become
“mad”? They quickly convinced me
that we should first start with a talk with Santina in a quiet, removed
location, away from everyone. Meanwhile, two of their recently trained Peer
Educators would be working with the rest of the community going over some role
plays borrowed from the adapted Stepping Stones manual that directly relate to
the very issue of Santina. This allowed the community members the necessary
time for self-awareness and reflection before entering a large community meeting.
During our 2 hour discussion
under the tree with Santina, we came to realize that she does have relatives in
the community, but they don’t claim her and they have wished her dead, beaten
her, and she worries at times they even want to sell her (i.e. in marriage for
cattle). They use her deceased mother’s card for aid and don’t give her any.
They have yelled at her to turn to prostitution. The whole thing is horrible.
She was completely shut down and trusts no one.
Alas, a moment came in the deep
and very emotionally raw conversation, where tears began to stream down her
face. One of the facilitators looked at me and said, “We did it Emily. She has
let it sink in and touch her.” And it was true.
After some time for things to
settle, we motioned to the other tree that we were ready for a sit down with
the relatives. As the trainers told me, if the relatives in the village don’t
take up the cause, nobody else will see the value in it.
They were very defensive, told us
we were just listening to her lies and that she was mental. Her old stubborn
uncle yelled over the rest that we should just take her, cure her, and return
her. Immediately the trainers jumped into action, letting Santina speak (or
rather, shout) her responses. Then, when the relatives refused to take it
seriously, they told them that it seems she is speaking the truth and she is
very reasonable. After some time, and all of the accusations were called out,
the trainers said it was time to bring in the community. Their presence would
add another driving force into our desired momentum for reconciliation.
The community came over from the
tree. The trainers explained that we came here today as friends of Santina’s.
That she sounds reasonable and is very hurt. That much of her hurt and anger
stems from the actions taken by her relatives and community members. We
appealed to them to treat her as a human being, as a daughter to the men and
women. We said that she wants to be a member of their community. We asked them
to please admit they have treated her disrespectfully and ask for forgiveness.
At which point, everyone turned their hands out to Santina, asking her for her
forgiveness. I have never seen anything like it. Santina was clearly shocked, I
was sitting right next to her. Can you imagine? Here is a girl who thinks
everyone hates her—and now they are gathered around her apologizing? Santina
said yes. Then, the trainer said, Santina, it’s your turn. Now, one should note
here that earlier Santina kept saying that she didn’t know how to handle
herself in big group meetings. That she never attended and was fearful. But,
without a moment of hesitation, Santina leapt up and began apologizing to
everyone- swinging her arms with her message, and facing everyone in the
community, concluding with an apology and request for their forgiveness. I was
dumbfounded, amazed, speechless.
 |
| Santina asking for forgiveness, Mary Lilly (trainer) beaming with happiness |
 |
| The men |
 |
| The women |
They agreed and burst into
applause and shouting her name with joy.
The Peer Educators then led the
community in the following exercises, beautifully weaving the main themes of
the day into one clear message: forgive and move on with acceptance and love
for Santina.
 |
| Peer Educator explains the "Goat Scenario" |
 |
| Peer Educator Gemma gets goat#1 ready |
 |
| Goat #2 is readied, tied to the same rope |
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| Can't reach the grass |
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| Nor here |
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| Struggling |
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| Convene for a planning meeting :-) |
Next, the community played Tug of War. 5 men on one side, 5 on the other side. Of
course, the men won, bringing the whole women’s side tumbling down. Human
reaction is of course to cheer and laugh a bit. Once things settled, the women,
returned to their seats brushing their dusted knees. The Peer Educators asked
how the two teams felt. Then there was a discussion about how the men felt
victorious and proud, and the women were hurt and annoyed. They used this
example as a depiction for abuse of power and how one has to be responsible
with the power they may yield over others. Of course, they then brought this
full circle to the issue of Santina and how the community has taken advantage
of her. Even what they may consider slight, like laughter, is extremely hurtful
to her.
Once they understood, the Peer Educators tied the ends of the rope forming a circle. They placed it on the ground and explained that what we now have here is an end to the competing sides and disadvantaged parties. Instead, we have agreed today to put aside the past and move together into the future as one. They all joined hands on the rope and lifted it up. Santina was beaming.
After that, spontaneous singing and dancing broke out, and I could hardly believe it when Santina jumped into the circle leaping up and down in the traditional dance.
Before leaving, we urged the community to show good faith in their promises and commitment to Santina by building for her a proper hut she can call her own. They agreed.
Time will tell.
But as we pulled away, with her uncles/relatives and other men (who wanted a lift to town to go drinking) in the back of the car, the driver and trainers whispered to me, “Emily, they are saying that they couldn’t believe she was holding so much inside, and that she was speaking the truth. The uncle is admitting he is wrong and he can’t believe she was capable of making those accusations.”
I smiled thinking, well, this HAS to be a win.
Couldn’t be more proud to work with such an exceptional team piloting such a unique mediation approach in Karamoja. They expertly handled a situation as if they had had years of training as counselors. Every moment of our staged intervention was fragile and could have seriously destroyed everything for this woman. And yet they courageously guided me, her, and the community through discussions and exercises which at least for a moment, let her smile, dream, and feel valued.
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