South Sudanese Women Carry Bulk of the Burden in Uganda Refugee Camps

This article originally appeared on the Women & Girls Hub of News Deeply, and you can find the original here. For important news about issues that affect women and girls in the developing world, you can sign up to the Women & Girls Hub email list. By Lorena Ríos

With their husbands fighting in the civil war or struggling to find work, the South Sudanese women staying in Uganda’s refugee camps often find themselves responsible for supporting their families on their own.

ADJUMANI, Uganda – When violence between government and opposition forces broke out in South Sudan’s capital, Juba, in July, Regina fled to Uganda with her husband and their seven children. After a month in the newly established Pagarinya refugee settlement in northern Uganda, her husband left. “My husband went back because there is no work in the camp,” says Regina, 37, sitting surrounded by her children on a Sunday morning in late September. Since his departure, she has not been able to communicate with him and has not received remittances. “I put my faith in God,” she said resolutely.

The recent clashes in Juba sparked an exodus of South Sudanese fleeing into neighboring countries such as Uganda, where three-quarters of the refugees have headed since July – more than 85 percent of them women and children. Poverty, lack of employment and education, and dependency on unreliable food aid only exacerbate the desperate conditions in many settlements. And often, women find themselves coping with these challenges on their own. With their husbands either staying behind in South Sudan to fight or struggling to find work in the refugee camps, many women have to take on the roles of breadwinner and head of the household on top of their traditional responsibilities.

“The majority of people in the settlement picking wood are women,” says Regina. “I go find firewood and sometimes my daughter comes as well.” For Regina, like many other women staying in Pagarinya, collecting wood is a four-hour task, as cutting trees is prohibited inside the settlement. A Ugandan shop overflowing with firewood and timber sits across from her plot, but Regina can’t afford to buy any. If she wants to cook for her family, she has to wake up at 5 a.m. to find firewood.

According to research by Molly Kellogg of the U.N. Women’s Peace and Security team in Uganda, the country’s limited resources for meeting the most basic protection services inside the settlements “compound the burden of violence South Sudanese women refugees bear.” Furthermore, U.N. Women found that in Kiryandongo refugee settlement, 68 percent of women refugees suffer from psychological trauma. “The breakdown of structures, forced displacement of people and separation of families have increased the prevalence of gender-based violence in the refugee settlements,” writes Kellogg in the report, which is not yet published.

Uganda’s progressive policy towards refugees grants them one 98 foot by 98 foot (30m by 30m) plot of land per household. However, this is not enough for women to feed their families and pay for school fees. To make enough to support their families, women often have to work in the fields around the settlements – making as little as 2,000 Ugandan shillings ($0.60) for a full day’s work – and sell a portion of their food rations.

In Ayilo refugee settlement, a few kilometers away from Pagariyna, a group of about 50 women gathers to talk about the trauma brought on by years of war and displacement. Even though most of them have been refugees since civil war broke out in South Sudan in 2013, none of them have yet reached self-reliance. “Our husbands don’t work, they stay at home,” says one of the women in the group. “Men are embarrassed to work in the fields since it is ‘women’s work.’”

The title of “refugee” is only for women, one of them says, to which the group quietly cheers, lamenting the precariousness of life in displacement and the challenges of carrying out their traditional roles as well as the added responsibility of ensuring the survival of their families.

With her husband fighting in South Sudan, Christine, 29, from Western Equatoria, relies on her children to help make ends meet. She has been living in Boroli refugee settlement in Adjumani district with her four children and five foster children since 2014. “My husband doesn’t get a salary,” she says. “He hasn’t earned anything in five months and we don’t have land to cultivate in the settlement.”

To pay for her children’s school fees, Christine sells food rations and works in the fields for about $3 a day. Her children help her pick groundnuts. And still, she can only afford school for one of her children at a time. At the moment, she’s sending her five-year-old son because he is the strongest, she says: “He doesn’t cry as much.”

Back in Pagariyna, Regina sits under the only tree in her plot and watches as people return to their plots after Sunday service. “I want to go to church, but I can’t,” she says. “I have to cook for the children.” Nearby, one of her children, a toddler, is chopping wood, letting the axe fall on a tree branch twice his size.

Reporting for this story was supported by the International Women’s Media Foundation as part of its Africa Great Lakes Initiative.

As Mothers, Wives and Farmers, Women Feel the Strain of Climate Change

This article originally appeared on the Women & Girls Hub of News Deeply, and you can find the original here. For important news about issues that affect women and girls in the developing world, you can sign up to the Women & Girls Hub email list. By Sally Nyakanyanga

With Uganda suffering through climate change-related drought, flooding and unpredictable weather, women take on most of the work to keep their families fed. But lack of land rights means they reap few benefits.

LAGAJI VILLAGE, Uganda – In Nwoya district, families face a daily struggle to grow the crops they rely on for food and income. Extreme weather leaves the ground either too wet or too dry to grow anything. Drought and deforestation mean villagers – usually women – have to spend most of the day traveling long distances for water and firewood. And then there are the elephants.

“We have to grapple with elephants ravaging our crops, resulting in us being unable to fend for our families,” says Stella Ojara, a peasant farmer and mother of 10 who needs her crops to feed her family and the surplus to sell for school fees. A government conservation scheme in nearby Murchison Falls National Park has had success in increasing the area’s elephant population. But when the massive animals go in search of something to eat, they can devastate local crops, sinking Lagaji’s farmers deeper into poverty and hunger.

Even without rampaging wildlife, the effects of climate change – unseasonably high temperatures, perennial droughts, extreme and unpredictable weather – put enormous strain on farmers across Uganda. Making up more than half of the country’s farmers, women bear the brunt of the fight to survive from one planting season to the next. “When the rains come and we plant our crops, the rains vanish, leaving our crops to wilt and die due to inadequate rainfall,” says Jane Ochira, a farmer in the village of Lagaji.

But with limited land rights, few can reap the benefits of their work.

According to the Food and Agriculture Organization, the agricultural sector remains the backbone of Uganda’s economy, contributing over 70 percent of the country’s export earnings. Women constitute 56 percent of Ugandan farmers and make up more than 70 percent of agricultural production, nutrition and food security, at the household level, according to the Women of Uganda Network (WOUGNET). But while women do most of the farm work, they only own 16 percent of the arable land in the country.

Edidah Ampaire, coordinator for Uganda’s Policy Action for Climate Change Adaptation project, says that women’s rights and roles are severely restricted, particularly in rural areas, and that government policies don’t do enough to address the imbalance. “Gender inequality in agricultural practices demonstrates how men have an advantage over women,” he says. “Women from rural areas are highly dependent on land, yet they are less likely to own land.”

WOUGNET says making land available to women gives them the chance to sustain themselves and their households as climate change forces them to spend most of their time cultivating fields and collecting firewood and water, leaving little time to make an income.

But even women who own land can find themselves unable to grow enough to feed their families, let alone surplus to sell on. “The poor and rural communities, mainly women, are greatly affected by climate change as they depend on extracting resources from the land for their daily survival,” said Paul Mukwaya from Makerere University, speaking to the press last year. As farmers and family caregivers, women have to deal with a slew of consequences resulting from drought and flooding, not just food and water shortages, but also high incidences of malaria and other water-borne diseases. “Food has been rotting in the garden due to floods, and diseases like malaria have caused deaths in families,” says Lagaji farmer Jane Ochira.

Struggling to provide for their families, constantly on the search for food and water, and often battling illness or caring for sick family members, women also suffer from the impact that climate change has on their husbands. According to George Onen, the parish chief for Patira and Pabit in Nwoya district, many women in rural Uganda are subjected to domestic violence due to tensions at home over food shortages and mainly during harvest time. “Poverty and food shortages create fertile ground for conflicts and domestic violence in the home,” he says. “It’s saddening that some men during harvest time, instead of saving the money and preparing for the next farming season, will decide to waste the money on drinking and marrying more women.”

And when the situation becomes too dire to bear, women can find themselves completely alone in the struggle to keep their families fed. When a crop fails due to extreme weather conditions, men will often become “migrants,” leaving for the city to find work and sometimes not returning, according to Maria Mutagamba, minister of water and environment. “They abandon the family when the land is no longer productive to search for work in the city, leaving behind the women suffering with the children.”

This story was reported with the support of an African Great Lakes Fellowship from the International Women’s Media Foundation.

How Nurses and Cheap Morphine Made Uganda a Model for Palliative Care

This article originally appeared on the Women & Girls Hub of News Deeply, and you can find the original here. For important news about issues that affect women and girls in the developing world, you can sign up to the Women & Girls Hub email list. By Grainne Harrington

Uganda’s underfunded health system struggles to effectively treat the country’s growing number of cancer patients. But for the terminally ill, a small hospice organization has come up with a homemade pain relief treatment that has revolutionized end-of-life care.

KAMPALA, Uganda – Roselight Katusabe sets off for work in the morning with her usual tools: patient notes and a pen, some gauze dressings, and a suitcase full of morphine. Katusabe is a palliative care nurse at Hospice Africa Uganda (HAU), an NGO based in Kampala, which focuses on home care. The bottles of morphine she brings to her patients have revolutionized the way terminally ill people spend their final days in Uganda. And it all began at a kitchen sink in the hospice, where for 17 years healthcare workers made up the solution for thousands of patients.

“It’s easier to make than a cup of coffee,” says Dr. Anne Merriman, the British founder of HAU. Merriman, a palliative care specialist and former missionary doctor, developed her own formula for affordable oral morphine while working in Singapore, and brought it to Uganda in 1993. At the time, the most commonly used analgesic for severe pain was codeine. Commercial injectable morphine was expensive and only available in hospitals on an “as needed” basis, which Merriman says left patients in pain. To make HAU’s cheaper, oral solution, “all you need is accurate scales to weigh the [morphine] powder, then all you do is add distilled water, a preservative … and then we add a dye to show the strength,” says Merriman.

These days, the formula hasn’t changed, but the kitchen sink has been replaced by a modern laboratory. Since 2011, the hospice, in partnership with the Ugandan government, has been manufacturing its morphine solution for the entire country, free of charge.

In Uganda, where the underfunded health system struggles to provide even basic care, morphine is the key to pain relief and a better end of life for thousands of cancer patients. HAU’s homemade approach makes the drug affordable: While other countries buy injections and tablets from pharmaceutical companies, a 10-day supply of oral solution costs just $2.

And by pioneering a system that allows nurses to administer morphine, Uganda has led the way in palliative care for cancer patients in low-income countries.

On this day’s rounds, Katusabe is delivering a bottle of Merriman’s formula to Agatha, a 38-year-old battling stage-four breast cancer, at her home in a slum in Kawempe, northern Kampala. The nurse takes out a brown bottle and a dosing syringe, shows the patient how much she should take and gently answers her questions. When asked what difference the hospice has made to her life, Agatha pauses. She cannot express it in words, she says.

The palliative care Agatha is receiving is unique in this region. Uganda was the first country in the world to let specially trained and registered nurses administer morphine, a job previously reserved for doctors. This development, too, was largely due to Merriman and her NGO. When HAU was founded, the country was going through one of the worst AIDS epidemics in the world, and widespread immunodeficiency led to a rise in many types of cancer. The minister of health at the time immediately agreed to Merriman’s plan to introduce her cheap morphine solution, but doctors were far more reticent, fearing it would lead to addiction and overdose.

“The doctors said we were bringing in euthanasia,” says Merriman. “Many of those senior doctors would not let any of their patients have morphine. They said, ‘They’re going to be addicted.’”

As cancer rates continued to rise, Merriman realized her morphine wouldn’t get to the people who needed it unless the number of prescribers increased. Nurses were already allowed to administer another opioid drug, pethidine, to women in labor. In 1998, HAU began to lobby the Ministry of Health to widen the legislation so that nurses could also prescribe morphine. The change eventually went through in 2004. Uganda has an average of one doctor per 20,000 people but almost twice as many nurses, so allowing nurses to administer the homemade morphine solution has made affordable pain relief accessible from the capital right down to village level.

Merriman credits the Ugandan government’s progressive policymaking for bringing about radical changes in the way people with terminal illness are treated in the country. In the Economist’s 2015 Quality of Death Index, Uganda ranked 35th out of 80 countries, and was one of only two African countries in the top 50, along with South Africa.

But while it has made strides in quality of death for cancer patients, Uganda’s healthcare system still struggles to provide effective treatment that could improve their quality of life. Katusabe’s patient was diagnosed when her illness was at stage two. In many countries, this is early enough to hope for a good outcome, but Agatha first turned to a traditional healer for help – she didn’t seek medical treatment until her cancer was advanced.

The Uganda Cancer Institute says that 75 to 80 percent of cancer patients are diagnosed at stage three or four, when surgery and other curative therapies are far less effective. Part of this is due to a lack of awareness, despite a considerable outreach effort on the part of the Ugandan government and other organizations. Financial constraints also play a big part. Hospitals frequently run out of necessary drugs, Katusabe says.

And even when treatment is available, it’s often too expensive for most Ugandans. According to HAU, a four-week course of chemotherapy can cost from $900 to $1,000. Because of this, Katusabe says patients who know they can’t afford treatment will simply accept a cancer diagnosis as a death sentence.

In April, Uganda’s only radiotherapy machine broke down after years of disrepair. Replacing it will take over a year. In the meantime, patients who can afford it have been told to go to neighboring Kenya for treatment.

After leaving Agatha, Katusabe visits two cervical cancer patients who are going for treatment in Nairobi with HAU funding. The women are cheerful and hopeful that radiotherapy will help. But for many other cancer patients in Uganda, Katusabe and her plastic bottles of morphine are the best relief they can hope for.

How the death of two Ugandan mothers is helping entrench the right to health care

Every day, an average of 16 women in Uganda die avoidable deaths during childbirth. And while neighboring Rwanda has decreased similar incidents, Uganda continues to struggle even as it promises free health services to citizens. Resources, salaries and staff training are in short supply, and even without user fees for health services patients are expected to pay out-of-pocket for some services--and are denied or delayed when they can't. It's a recipe that has led to many of the preventable deaths--deaths of infants and mothers that could have been avoided with prompt maternal care. The tragic deaths of two expectant mothers, Sylvia Nalubowa and Jennifer Anguko, are spurring calls for the Ugandan government to take responsibility--and to change the system to ensure meaningful rights to health care for all.

Respecting women's rights as well as the country's constitution and international agreements, the Centre for health, Human Rights and Development argues, includes the right to necessary maternal care.

Click through to follow the progress of this case through Ugandan courts.

venturesafrica.com - When Sylvia Nalubowa went into labour in Uganda’s Mityana district in August 2009, she was taken to a local health centre where she expected to have a normal birth, supervised by a midwife.

After she had delivered her first baby the midwife realised there was a twin on the way. The midwife recommended that Nalubowa be taken to the district hospital where a doctor could handle the second delivery.

But when she arrived at the Mityana District Hospital in Central Uganda, the nurses asked for her maternity kit. This is commonly known as a “mama kit” and contains a plastic sheet, razor blades, cotton wool or gauze pad, soap, gloves, cord ties, and a child health card. All mothers delivering babies in Ugandan hospitals and clinics are expected to bring their own “mama kits” when they go into labour.

But Nalubowa had used her “mama kit” at the first health facility when delivering her first child. The nurses would hear none of her excuses and demanded money to purchase the kit before they could attend to her.

Read more here.

Uganda's anti-child trafficking campaign goes to schools

This story from The Christian Science Monitor, via the Thomson Reuters Foundation, follows a group of volunteers who hope to use reading and raising awareness to help provide opportunities to children and fight the demand for child trafficking. Child prostitution, which can affect girls as well as boys, is often best fought by educating the children--and their communities. Read more below and click through for the full story. csmonitor.com - KAMPALA, Uganda — In a remote corner of Uganda a team of American volunteers are distributing books to children. But this is no ordinary literacy drive; their aim is to protect children at risk of being trafficked into prostitution, forced labor, and even for use in sacrifices.

Their work is part of a project by the Interior Ministry's anti-human-trafficking task force to reach out to poor communities vulnerable to child trafficking by promoting literacy.

Children in Uganda are trafficked and forced to work in cattle herding, stone quarrying, and brick making. Girls and boys are lured from poor families in rural areas to the city and exploited in prostitution, or abducted to fight in rebel ranks, said Agnes Igoye, deputy national coordinator of the task force.

Another abuse plaguing Uganda is the trafficking of children for sacrifice in rituals some Ugandans think bring wealth and power. Children are also trafficked abroad for adoption, domestic work, or sexual exploitation.

The distribution of books, supported by the U.S.-based charity Books for Africa, is a strategy of "prevention is better than cure," she said.

Read the rest here.