“STEP-UP” (Sustain, Train, Educate, Promote-Uganda) is an ITD project working in Northern Uganda, an area which continues to suffer from the effects of a 20-year armed conflict. Our mission is to improve the health and psychosocial well-being of families in the region through collaborative medical and psychosocial capacity building. 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. US trained medical and social service personnel bring knowledge, skills and resources while local Ugandan practitioners and community leaders hold social, cultural, and indigenous knowledge and wisdom. Thus, the project is built on a foundation of collaboration based on shared respect, planning and decision making, leading to sustainable capacity building.
In the words of a member of the Ugandan branch of SUU, “we envision a world in which individuals, families, and communities have the health, psychosocial well-being, capacity and hope to build a society where people can experience education, good governance and pursue sustainable livelihoods. We appreciate how STEP-UP treats us with respect, values our skills and commitments, while sharing their valuable insights and knowledge. Together, we have already had an impact on improving maternal and child health and helping clan and religious leaders to work on confronting the long-standing trauma from the armed conflict that has not left our community.”
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.
Medical training has been primarily focused on maternal/child health:
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 Team 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 people living in remote villages. The emphasis was on the importance of their leadership role within their villages, even if they are not allowed to perform deliveries, utilizing that role to educate expectant families, encouraging them to seek care from skilled health professionals in the health centres, and knowing when a situation requires urgent, advanced care. The training was extended in 2020 and was updated with content from the curriculum provided to the skilled health workers. We would not have understood the importance of including these vital community members in our training program without the input from our Ugandan partners, reflecting the importance of collaboration.
STEP-UP medical team completed their 2020 trip on February 26, 2020, after having implemented training of Pre-Eclampsia/Eclampsia and Essential Care for Every Baby. Plans for large scale implementation were in place. In addition, widespread training of content appropriate to Village Health Team members and Traditional Birth Referral Assistants was planned. Shortly afterward the COVID-19 pandemic changed the world. Appropriately our plans for follow up training were halted. STEP-UP and our SUU partners quickly responded to the crisis and changed our emphasis. Throughout 2020 and 2021 STEP-UP has provided financial support for the following:
This training has been greatly appreciated and recognized by observers from the World Health Organization as a model that should be implemented throughout Uganda. The Gulu District Health Officer stated that the trainings were “very participative and quite interactive and informative to the participants” noting that “the community once engaged will own the efforts toward achieving and sustaining their own health.”
The government medical system in Gulu has reported a drop in infant mortality which they attribute to STEP-UP’s educational activities. We are in the process of developing a formal evaluation to better assess our impact, both of our training in Maternal/Child health and our more recent efforts in providing accurate information about COVID-19. 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.
Although the impact of the pandemic is decreasing in the United States, immunization availability in resource poor countries such as Uganda is clearly markedly lower and death rates from severe COVID in African are steeply higher. However, STEP-UP remains in constant communication with our Ugandan partners, and when considered safe, the midwife trainers are ready to resume the training plan implemented in 2020 and to continue to move forward to decrease infant and maternal mortality.
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)
Maria Torres, Ph.D., psychologist (2020)