Mothers Finding Balance: Meet Sarah

Sarah’s Background

My name is Sarah. My primary work is being a consultant in the public health arena. My education includes a Master’s of Public Health and certification in counseling.

I am very passionate about community development, especially in the area of women and children issues and HIV. You will find me looking for solutions to problems in these areas, often in situations where the problems seem insurmountable. There are two areas I have been involved in recently. One of them is solved for the most part. The other is ongoing, and I am still looking for solutions.

I live in Uganda, married to a pastor. My work as a consultant helps us pay for our needs including housing, food, and schooling for the children. It is difficult. I do not always have work. 

Her Family

My husband is very hardworking, but life in ministry in the poverty-stricken northern part of Uganda is hard. Money is always a concern. We are not unique in this. Many in Uganda are struggling especially in 2020 with the pandemic resulting in lockdowns and the complete collapse of many micro-economies in the communities in Uganda. 

My husband and I have 6 children. Three were older when I married my husband, who was a widower. We are now also raising 2 of our grandchildren. So, at the moment, we have 4 children in our home.

My hardest mothering concern has always been worry about feeding, clothing, and educating the children. The Lord has been faithful. I have been amazed at how often work will appear just when it all seems hopeless. I thank God for all I have been able to accomplish. I still have a lot I would like to do, that I am passionate about.

Sarah’s Work

High Maternal Deaths

My work includes monitoring, research, and evaluation in communities. I helped to develop community insurance schemes in two communities in Eastern Uganda. When I arrived in the area, we noticed there were many maternal deaths. The official maternal mortality rate in Uganda is very high: 343 per 100,000 live births. This number could well be much higher since I’m not sure they have truly counted every case. 

Reason for High Death Rate

We did an evaluation of the mother’s age at the time of death, the cause of death, and the ages of any children left behind. After collecting other demographic characteristics of these deaths, we discovered that 90% were due to obstetric emergencies where the mother was not able to get the needed level of care, often because they could not afford it. Furthermore, our evaluation revealed that young women, particularly teenage girls, made up 75% of maternal deaths.

After conducting our initial investigation, we decided to delve deeper into the community by asking more questions. We found that many mothers were not receiving prenatal care and did not have a plan in case of an emergency. Consequently, due to the high cost of delivery, many were resorting to traditional birth attendants (TBAs). These women, who have no formal training but often command a high societal standing, have been outlawed in Uganda since 2010. This law has not stopped them. The TBAs are often preferred because of their proximity and lower cost.

During my interviews with several families, I discovered that many of the mothers were laboring for hours with traditional birth attendants (TBAs) who had false confidence in their abilities, often claiming they had not had a single death. However, on closer questioning, I discovered why the mothers were not dying while under the care of TBAs. Once the mother was in distress, they would be loaded onto a boda-boda (bicycle taxi) and taken to the nearest hospital or health center equipped to handle obstetric emergencies. Unfortunately, by the time they arrived, many of these mothers were dehydrated and delirious, and often died at the hospital away from the TBA’s care.

How to Solve the Issue

As a result of our findings, we held birth preparedness discussions to show the community and stakeholders what was happening and to brainstorm potential solutions. During these discussions, we stressed that with pregnancy, there were several months of time to prepare.

However, we quickly realized that the biggest problem was the lack of money to pay for healthcare services. Although healthcare in Uganda is supposed to be free, families are often required to pay. Those who cannot afford it often do not receive the necessary care. When we asked the families why the mothers were not going to hospitals or skilled birth attendants, they gave several reasons, but the main problem was the lack of funds.

Women & Money

Women in Uganda work so hard. They work long hours to cultivate large fields and then their husbands take the hard-earned money, leaving them with nothing. This pattern is unfortunately all too common, and efforts to involve men in discussions about the issue have been met with resistance. Women feel disposable, expressing the perceived sentiment that “He will bury you and replace you, so why spend the money?” Many women are part of “saving groups” in the communities, but it is difficult to save when your husband takes all the money. 

One solution: We decided upon community gardens. Each woman would plant, weed twice, and harvest in this garden. This money from the community gardens could not be claimed by the husbands, so women began to see their savings grow. 

Initially, this money was used for re-investment, household needs, and school for the children. Healthcare still did not get paid for. After discussion, specific savings for health were decided on, and negotiations began with health facilities. 

Saving for healthcare was difficult in the beginning. Over the course of 2 years, women began to have savings of 60,000 shillings ($17.00), some even up to 300,000 shillings ($85.00).  For families who live on less than $1.00 a day, this was amazing. Women were getting excited! 

Reducing Maternal Mortality

Once their savings grew, many women stopped going to the TBAs. The Sub-county leadership got involved and attached the threat of imprisonment to any TBA who was found to have assisted at a birth. The law was an advocacy strategy and lead to some TBAs getting skilled training. Just this change has helped significantly decrease maternal mortality.

Formalizing a Health-Saving Scheme

The next problem: How to formalize this health-saving scheme so it works when it needs to. This problem was solved by working with Save for Health Uganda (SHU). SHU is a vibrant, Non-Governmental Organization (NGO) that has a strategy in place for community insurance schemes. SHU taught us how to formalize the schemes for basic illnesses like Malaria, acute vomiting, diarrhea, respiratory illnesses, and infections. These common illnesses would be covered at great savings for communities. 

How it works: First, you invite the organization into a community, and they help set up. Because they can only take on a specific number of communities every year, they also show communities how to mobilize and invest. Micro Finance Associations and Banks are used for money collection. They take care of payouts to health facilities after confirming with community leaders and also checking that any co-pays were paid. This is just one of many ways that SHU can help communities.

One other challenge was making arrangements for care with health facilities. It was immediately clear we could not use government facilities. These are supposed to give free service. They do not, but you also cannot make any formal payment plan. All the arrangements were made with Private Not for Profit (PNFP) and Private for Profit (PFP) organizations. In many communities, well-managed and well-run organizations are under the umbrella of the Catholic Church. There are some others but many are not as well regulated.

The Government of Uganda has been trying to pass a universal health insurance plan for about 12 years now. I am not sure why it is being delayed. In 2018, the Minister of Finance announced that by 2019, everyone would be required to be in a health insurance scheme, public or private. This did not happen. In the meantime, communities are mobilizing. They have given up waiting on the government.

Sarah’s Work

Counseling for Children

My second area of concern is child counseling, especially for children coming out of abusive situations including neglect, physical abuse, and sexual defilement. My current passion project is in need of support. 

I have been involved with about 40 children who were rescued from chronic sexual abuse, almost all as a result of incest. Following their rescue, I have provided them with a safe haven for 6-12 months, during which time they live with me and receive emotional and physical rehabilitation. They live with me, and I spend time counseling and feeding them back to health. 

Within the time they are with me, they get better. You often cannot see their wounds externally or emotionally. But, I have discovered almost all of them have some type of learning disability. I do not know what it is. All I know at the moment is that their only hope to get out of the cycle of disenfranchisement and poverty is through education and learning a trade. 

The cycle of extreme poverty and dependence needs to be broken so that exploitation can stop. Something happens to the brain in these children; they are unable to learn. Several of these children are now sponsored to go to good schools, but they are not learning. I have scoured the research and cannot find any studies that have linked chronic sexual abuse to a learning disorder. And yet, I am seeing it.

How YOU can help Sarah!

I need funding to carry out two areas of research:

1) Is there a cause/effect relationship here? Is it the chronic sexual abuse that is causing the inability to learn when emotionally the children seem OK after rehabilitation? Is there another factor? I have found studies about childhood trauma affecting health across a lifetime, but nothing in this specific area.

2) If a child has suffered years of sexual abuse (age 4 is the earliest age I have documented) and has a learning disability, what is the best way to teach them? What kind of learning environment would they benefit from?

In order to help these children, we need a longitudinal study, a place of respite, specialized teachers and an environment in which they can thrive. I want them to thrive. I want these children to get out of this cycle and be economically stable. I am currently researching funding options and may have an update in 1-2 years.

Apio (not her real name) was with me for 3 years and left a few months ago. She is a third-generation defilement case. Her grandmother was sexually abused as a child. Her mother was also abused and gave birth to Apio at age 14. Apio herself was abused from the age of 4, first by a step-brother, and then by a step-dad. 

Many mothers and grandmothers are completely disempowered to report abuse, often because they fear the perpetrator going to jail will result in further poverty as their livelihood vanishes. Apio’s stepfather did go to jail, earning the wrath of her mother. She is now a strong girl. She is in a good school, but she has a lot of difficulty learning.

My husband and I want to retire on a farm with a big enough home to rehabilitate girls like Apio. Our goal for them is to create the best learning environment as well as opportunities to be economically independent. This is what will stop the cycle of extreme poverty and disenfranchisement which is the cauldron in which sexual victimization and abuse occur.

Thank you for your time & consideration!
Sarah
Community Advocate, Counselor, & Public Health Consultant.

Note from Doc Tibbs:
Because of the Covid-19 pandemic, I interviewed Sarah using video communication. Her passion is palpable. I am determined to be a resource for her in this endeavor. She is a mother (and now a grandmother) who has taken in very broken children and loved them back to health. If you are able to partner with her financially, please contact me! She is working on the details of her research plan and looking for partners.