Uganda has become one of the largest refugee hosting countries in the world. At the height of the crisis, more than 3,000-7,000 people from South Sudan would arrive every day in the search for refuge. Currently, the settlement receives about 2,000 people on average but the numbers can rise anytime again. Imvepi refugee settlement hosts more than 110,000 refugees; almost three times the number of locals in the subcounty of Odupi. Of the 1.2 million refugees in Uganda, 900,000 are South Sudanese and 86% are women and children who are in real danger of sexual and physical violence, with many reporting incidents of violence on their brutal journey. CARE established five centers in Imvepi where refugee women and girls can seek assistance and sexual violence survivors can be provided with psychosocial support and health services.
Mary Maturu, working in one of CARE’s women centres, gives insight into what it’s like to be a midwife in one of the world’s largest refugee settlements.
My day starts early in the morning. After I get ready myself, I prepare food for my son. He is three years old and my sister takes care of him when I am at work. I quickly go over my notes I prepared the previous evening of things I am going to speak about with the women I meet for the day. The topics can range from reproductive health, gender-based violence over to anti-natal care. After breakfast, I start walking to the women centre in Imvepi camp. It’s about a 30-minute walk from home.
I arrive at the women centre in Imvepi to organize and map out the day. I usually discuss these plans with one of CARE’s community volunteers, Faiza, who works with me. Having fled from South Sudan herself, Faiza has a great outreach to the refugee communities here and often suggests topics we could cover. I get my consultation desk ready, where I screen and diagnose patients and refer serious medical cases to health clinics. I also advise pregnant mothers on ante-natal care and check for any pre-natal complications. Our centre is very close to the main reception centre in Imvepi, where new arrivals wait for their initial registration. We often go over to identify pregnant refugees who need maternal health services. Usually when we enter the tents where new female arrivals temporarily stay, it doesn’t take very long to find several pregnant women. We start speaking and informing them about accessing health services for themselves and their unborn babies. I often use my health education booklet to teach women on the stages of their pregnancies, common medical complications they could be experiencing, why it’s important to get antenatal care and how they can access antenatal services. Before long, I am often surrounded by 20-30 breastfeeding and pregnant mothers.
For many women, the centre is too far away from their homes. Imvepi is vast – it covers an area of some 150 square kilometres. So I usually head out to the communities for home visits. We cover different topics on different days. A few weeks ago we touched on the topic of family planning. Most of the women who arrived in Imvepi are deeply traumatized as they lost family members and try to replace them by new children. They did not like to hear about family planning at all but we highlighted the importance of it, especially since we have seen quite a number of unwanted pregnancies in the settlement. Other times, we talked about maternal health to severely malnourished mothers or those who are HIV positive. Topics such as sexual and gender-based violence are also of high relevance, sadly. It is a reoccurring problem in many families. I mostly hear of cases where food shortages lead to physical violence. Many families decide to sell the food rations they receive from aid agencies, ending up with little to no food left for themselves and extreme tensions at home. Some men also exchange food for alcohol, further fueling violence at home. I screen such women to see if they are in need of immediate help or referrals.
It’s time for me to go back to the women centre. Between morning and early afternoon, I try and see as many women as possible at their homes. Sometimes I end up speaking to them much longer and skip lunch to answer all questions. Many women tell me it is better to teach them how to fish rather than give them food assistance. This is what we try to do at the women center as well. We educate and train them so they can start something themselves, such as small-scale farming or other small businesses, and become independent again.
I spend the rest of the afternoon in the centre to see more women who come to seek assistance. Some of the mothers come to see me because they are unable to build up their tents by themselves. CARE has helped more than 2,500 vulnerable refugees to build their new homes in Imvepi. Usually in a day I see around 80-100 people, many of them are pregnant mothers. I make sure to highlight the importance of hospital deliveries, as most of them have never seen a doctor before. But it is challenging. The refugee mothers often live very far away from a health clinic and have no means to get there. The hospitals themselves are also overwhelmed. They lack equipment and space; often patients are forced to share the limited hospital supplies available.
By 5 pm I usually wrap up for the day and start walking home before it gets dark. The walk gives me time to reflect and revisit some of the things people have told me. Some of the stories are heartbreaking, especially those of unaccompanied children who are left alone with no supervision or care. I pick my son up at my sister’s place and give him a hug while being thankful for what I have. We have dinner and I bring him to sleep before I start preparing for the next day.
I get ready for bed to get some sleep before starting my daily routine starts all over again tomorrow. I feel blessed because I have a job in which I can contribute to making people’s lives better. I like speaking to those who need help and share their stories. I have always wanted to become a midwife and although there is always more to do than I can manage in Imvepi, I know that I make a difference in the lives of hundreds of mothers here.
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