“STEP-UP” stands for “Sustain, Train, Educate and Promote in Uganda”. STEP-UP is an ITD project which offers medical and psycho-social capacity building in Northern Uganda, an area which continues to suffer from the effects of a 20-year armed conflict. Volunteer U.S. health and social work professionals work in partnership with Ugandan colleagues at our sister NGO, called SUU (STEP-UP UGANDA), to offer training and consultation to professionals and community members. The project is predicated on the belief that medical and psychosocial well-being are inextricably related to the process of peace and reconciliation.
In the words of a member of the Ugandan branch of SUU, “we envision a world in which individuals, families, and communities have the capacity and hope to build conditions that promote total health, education, good governance and livelihood. The activities of SUU are therefore meant to address health needs, good living standards, timely delivery of services, promotion of democracy, good governance and open opportunities for the young to build a strong nurturing working society in the whole Acholi sub-region.”
The combination of a brutal 20-year armed conflict that left 95% of the population living in Internally Displaced Person’s (IDP) Camps, and other factors – ethnic marginalization and isolation of the Acholi tribe in Uganda, poverty, increasing difficulty farming due to climate change, the lack of a comprehensive and effective peace and reconciliation process – has led to unresolved collective and individual trauma. During the armed conflict, when people were living in IDP camps, many cultural traditions were neglected and not passed down to younger generations, social cohesion was frayed, and the clan leadership structure of extended families was placed under severe stress. Consequently, there are high rates of conflict within and between clans, domestic conflict and violence, suicide, alcohol and drug use.
STEP-UP’s psychosocial capacity building work focuses on training medical providers, catechists, tribal and religious elders, community organizers and administrators, women’s leaders, police officers and others to recognize the many ways that collective trauma is manifested and to help people to develop the skills to prevent further social fragmentation and to intervene with individuals and families who are suffering. Cultural practices are centralized and Ugandan and US team members collaboratively plan strategies, interventions and training programs. Internationally recognized and validated psychosocial programs that respond to war and conflict are adapted by the Ugandan and US volunteers so that they are culturally and socially meaningful and appropriate. In an area where talk therapy and counseling are not normative, there is an emphasis on narratives, story-telling, problem solving skills, instilling hope, and the use of music, and dance as culturally meaningful healing strategies. There is also a focus on strengthening families. A training of trainers model is utilized so that those who are trained can in turn train others.
Our medical work in northern Uganda has evolved over the years. At its inception in 2010 we offered direct patient care and didactic sessions on topics requested by our Ugandan partners. We now are committed to a more sustainable train-the-trainer model. We utilize well developed programs from the American Academy of Pediatrics, WHO, JPIEGO (from Johns Hopkins), complete with program guides, participant and provider booklets, flip charts, posters, and exquisitely developed models of babies to be resuscitated and pregnant bellies to be delivered and monitored. These allow for excellent educational simulations.
Our current model is to provide training of these well developed programs (examples include Helping Babies Breathe, Essential Care for Every Baby and Bleeding After Birth) to midwives, clinical officers and skilled nurses who staff the local health centers in Aswa County. We then work together with our Ugandan medical colleagues to prepare them to train other health personnel, the goal being that anyone who may attend a delivery, care for a pregnant mother, or care for a newborn baby, have these essential skills.
In 2021, we hope to roll out training in a similar pattern in Threatened Premature Labour and Essential Care of the Small Baby.
We have distributed to all 26 health centres equipment to ventilate newborns , blood pressure cuffs, educational materials, thermometers and other supplies to promote safe deliveries and newborn care.
In 2017, upon the recommendation of Komakech Denis, a clinical officer within the government health system and medical coordinator of STEP-UP Uganda, we started a training program for over 200 village health workers and Traditional Birth Referral Agents (former Traditional Birth Assistants), noting that often they are the first, and at times the only, health care sought by some of the population. The emphasis was on the importance of their role within the community, even if they are not allowed to perform deliveries, utilizing that role to educate expectant families and encourage them to seek care from skilled health professionals in the health centres. We think this is very unique program.
We are in the process of developing a formal evaluation to better assess our impact. However the government medical system in Gulu has reported a drop in infant mortality which they attribute to STEP-UP’s educational activities. It has been requested that we facilitate similar interventions in neighboring Omora County, something that STEP-UP would like to make happen if substantial additional financial support became available.
To make donations, you may donate through our GoFundMe button (at right) or write a check to “STEP-UP” and mail to:
Joshua Miller, Ph.D., Smith College School for Social Work, Lilly Hall, Northampton, MA 01063
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Pamela Cavanaugh, P.T. (2016)
Sallie Lake-Deans, LICSW (2019)
Jane Fields, M.D. (2016)
Eileen Giardina, R.N. (2010)
Sandy Kobylarz, P.T. (2016)
David LaLima (2010, 2012)
Heather Summerby, R.N. (2012)
Megan Carmel, M.D., obstetrician/gynecologist
Janet Namono, LICSW
Maria Torres, Ph.D., psychologist
Vicki Weld, LICSW
Shani Ofrat, Ph.D., psychologist
Alexander Roseman, M.D., internal medicine/pediatrics