"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."
Psychosocial Capacity Building
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 Capacity Building
STEP-UP's medical mission has been to improve maternal and child health in Aswa County.
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.
Over the past 4 years:
Ten skilled midwives, nurses and clinical officers have been trained to train others in Helping Babies Breathe and Bleeding After Birth
The Ugandan trainers have trained approximately 120 health care workers staffing the 26 health centres in Aswa County in Helping Babies Breathe and Bleeding After Birth
Additional trainings were provided in both curricula in 2019 to 40 newly hired staff
Plans for 2020:
Train 10 skilled midwives to train Pre-Eclampsia/Eclampsia and Essential care for Every Baby
The Ugandan midwife trainers will then train both curricula to 120 health care workers staffing 26 health centres
Facilitate ongoing practice in the skills of Helping Babies Breathe and Bleeding After Birth at each of the 26 health centres, eight weekly modules, one hour a week
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 write a check to "STEP-UP" and mail to Joshua Miller, 315 Lilly Hall, Northampton, MA 01063
STEP UP UGANDA TEAM BIOGRAPHIES
STEP UP U.S. TEAM BIOGRAPHIES
Father Remigio C. Obol, SUU board member
The spiritual leader of STEP-UP and SUU, Father Remigio C. Obol was the creator of STEP-UP in partnership with Dr. Joshua Miller. He is the parish priest of Assumption Parish in Awach in northern Uganda. He considers STEP-UP to be an important part of the parish program given its contribution to the improvement of health in the community. Because of the support of Archbishop Dr. John Baptist Odama, he visited the USA in 2006 where he met Professor Joshua and others, at which time the war was at its peak. After hearing Father describe the negative impact of the war on the health and education of the children, Joshua came with others to Gulu to evaluate ways in which they could be of help. That was the beginning of a program that has carried forth until now. It started with psychosocial support training and subsequently evolved to include medical capacity building. From 2006 through now there have been many instructional activities related to health, psychosocial support, and education, and “the impact of the activities is very great.” Service delivery of the health personnel and the concern demonstrated for their patients have improved. STEP-UP has also brought equipment to facilitate the work of the medical personnel in Aswa county. Father appeals to well-wishers who care about the health and education of the children of his region to help this program continue to succeed. He asks that people contribute to STEP-UP or personally join hands with STEP-UP and SUU. He feels that there are multiple ways to support health: stationery, books, money, equipment, medicines, “even tools for harvest.” He expresses faith in people, saying, “We are talking to the world, but not a faceless world.”
Joshua MILLER, Ph.D., MSW
Joshua MIller is a professor at Smith College School for Social Work. He focuses on antiracism, psychosocial capacity building in response to disasters and armed conflict, and helping people who are socio-politically targeted. He has responded to many disasters, including 9/11, Hurricane Katrina, the Asian Tsunami, and earthquakes in China and Haiti. He has written many articles and has published five books, including Psychosocial capacity building in response to disasters (2012, Columbia University Press) that describes the model of collaboration, capacity building and training of trainers used by STEP-UP. He is a co-founder of STEP-UP in Northern Uganda and is deeply committed to the work done for this project by his Ugandan and US colleagues.
Okello Patrick Onguti, SUU board member
Okello Patrick Onguti has been with STEP-UP since its beginning in 2010. He is happily married to Auma Mary Alai (Dr. Maria, also a board member of SUU) and enjoys their family in Gulu: their son, daughter and three nephews. He became involved after meeting Joshua Miller in 2006 and joining in the discussions with Father Remiggio. As someone who grew up in Father's parish, he saw the war and all its atrocities, and in fact had to leave school for three years before ultimately returning and completing his studies. His work as an agricultural extension officer requires him to interact with communities and gives him a unique understanding of their problems. He feels passionate about his people; the impact of the war on the people of his community has made him feel a great need to be a part of this project to help them. Several NGOs were in the region after the war, but they were only emergency responders. There was no attention to the lasting post-traumatic impact that has remained long after the NGOs moved out, that he continues to observe in his community during meetings, church services and everyday life. STEP-UP has remained here “and is here for the long run,” continuing their work with medical and psychosocial capacity building. He is proud to be a part of this journey; he can see the impact. “You cannot develop the world on your own.” As secretary of the board of STEP-UP Uganda he feels that we still have a lot to do to live up to our name and mission. We have had medical success but need to achieve more success in the psychosocial realm noting that people in good medical and psychological health are better able to be productive and take care of their families.
Leah Cantler, MSW, LICSW
Leah Cantler, MSW, LICSW is a graduate of the Smith College School for Social Work program. Her professional background includes a decade of working in the fields of immigration, education, community building and clinical therapy with immigrants and refugees both domestically and internationally. She currently works in the West Springfield Public Schools providing clinical support to students. She also has a private therapy practice for teens and young adults. She additionally provides clinical supervision to students in MSW programs and serves as an adjunct professor in several local universities teaching classes related to cross-cultural therapy and psychosocial capacity building.
Auma Mary Alai, M.D., SUU board member
Mary Auma Alai, MBchB, MMED, Diploma in Tropical Medicine and Hygiene, is known to STEP-UP and her fellow Ugandans as “Dr. Maria.” She has been on the board of SUU since the first US team trip in 2010. Trained in general internal medicine, she has specific experience in intensive care medicine and diabetes care. Her additional training in tropical medicine provided her with expertise in a wide spectrum of tropical diseases including tuberculosis, HIV infection/AIDS, and malaria. She was honored to travel to Washington DC in November 2014 to do a poster presentation at the annual conference of the American Society of Tropical Medicine and Hygiene, after which she spent time with the STEP-UP team in Massachusetts. Over the past six years her work has focused on clinical and humanitarian health programming in complex humanitarian emergencies in countries whose health systems have been devastated by conflict, such as South Sudan. When available, she assists the USA STEP-UP team with their training in northern Uganda; with teaching experience of medical students, interns and residents at Gulu University and at the University of Bar el Ghazal in South Sudan, her contribution to STEP-UP's work is highly valued. She stays involved with STEP-UP because she particularly values the positive impact that their activities have had on maternal and child health. She and her husband Okello Patrick have two children: Frederick (who is now himself completing medical school) and Karima.
Linda Cohen, M.D., pediatrics
Linda Cohen, M.D. has been a practicing pediatrician for more than 40 years. Coming from a public health/school health background, she has always been interested in the physical and emotional well being of children and their families, particularly those living in conflict and low resource areas. For many years she was a member of a medical and dental brigade working in Honduras. She is happy now to be working with STEP UP, training Ugandan midwives and health workers in safe deliveries and newborn care.
Okello Charles, SUU Coordinator
Okello Charles has been a part of the Step-Up team since 2016. He is married to Atimo Susan and they have three sons. Originally trained in the nursing field, he has been coordinating STEP-UP medical and psychosocial training activities on the ground, and has enjoyed learning the details of health care of mothers and babies. It has given him a unique opportunity to interface with the district leaders, medical practitioners, local leaders, and village health workers. When not performing his duties as the SUU coordinator, he volunteers as the chairperson of a farming cooperative focusing on production of grains, providing training and capacity building to farmers, and linking farmers to financial institutions. The goal is to increase productivity, financial status, nutrition and health of the household members of the community. His daily income comes primarily from running a mini-farm raising poultry and pork, and cultivating horticulture.
Matthew Kane, M.D., internal medicine
Matthew Kane, M.D. is a medical internist with a decades long passion for international medicine. He fell in love with Kenya during a semester abroad program in 1977. Completing medical school and residency, he and his wife, Ann Markes, M.D., then worked in a small rural hospital in Kenya in the 1980's. After raising their 3 children, they resumed their international work in Haiti on multiple occasions. Although rewarding, providing direct medical care never seemed to be sustainable. He feels that the work STEP-UP does in Uganda, partnering closely with our Ugandan colleagues, has been the most fulfilling work that he has done. Using the Trainer-of-Trainers model, it has been wonderful to see the Ugandan health providers have such passion for increasing their skills and the skills of their colleagues. The friendship and comradery that has developed among all of us keeps bringing him back to Uganda.
Komakech Denis, SUU Medical Coordinator
Komakech Denis is a clinical office currently stationed at Patiko Health Centre III. He is the father of four and the husband of Dr. Anena Joyce. During the height of the war he studied in Gulu, completed his studies and started working in various health centres and IDPs (Internally Displaced People camps). He gained valuable experience in his first placement with Lacore Hopsital, after which he worked with Medicine Sans Frontier, International Medical Corps and the local government health system. He is very passionate about being a health worker and finds benefit in aligning with outside organizations that address health care. He has been happy to be involved with STEP-UP, with its emphasis on maternal/child health. He wants to thank STEP up and SUU for entrusting him with a position that will involve him in directing the health care system to address the issues that are of high burden to his community. He pledges commitment to serve in his best capacity.
Additional STEP-UP members
Ashley Brant, M.D., obstetrician/gynecologist
Ashley Brant, M.D. is an obstetrician-gynecologists and family planning specialist at the Cleveland Clinic in Ohio. She completed her residency at Baystate Medical Center in Massachusetts where she became involved with Step-Up in 2015. She has worked closely with the medical team to coordinate training on postpartum hemorrhage, family planning, and miscarriage management. Her professional passions include expanding access to comprehensive family planning services, contraception, and reproductive healthcare. She enjoys spending her free time with her husband, their two young children, and their dog.
Apiyo Susan, Master Midwife
Apiyo Susan has been a midwife since 2011. She is on staff at Pabwo Health Centre III, located in a distant rural area. She attended her first STEP-UP training in Helping Babies Breathe in 2013. She became proficient and was later chosen to be a trainer of other skilled health providers in Northern Uganda in Helping Babies Breathe, Essential Care for Every Baby and Bleeding After Birth. She is excited to have recently become an official part of the STEP-UP Uganda structure. She is the busy mother of her twin 4 year olds, Hope and Happy. Currently advancing her midwifery degree, her long-term vision is to obtain a Bachelor's degree and become an instructor in a midwifery school.
Ann Markes, M.D., internal medicine/pediatrics
Like her husband, Matthew Kane, Dr. Ann Markes' first contact with global health was at the age of 19 while participating in a semester abroad in Kenya. This was followed by two other trips to Kenya with Matthew, three months as medical students, and a year (1985-86) working at Tumutumu Hospital in Karatina. After raising three children and working in primary care, she started to participate in global health again, including several trips to Haiti and participation with Interplast in China and Vietnam. However, it is the work in Uganda that keeps calling her back. The resilience of the Acholi people after suffering for so long during the war, the commitment of the health workers in northern Uganda to their people, the health workers' enthusiasm for training, and their hard work to continue to pass that training on are sources of great inspiration to her. She looks forward to continued trips to Gulu, strengthening the partnership with the STEP-UP Uganda team, and expansion of the work that is being done together.
Akello Monica, Master Midwife
Akello Monica is an enrolled midwife, and mother of two children. She studied in Kalongo Midwifery School, attaining her certificate in 2010. She initially started working as a midwife, then joined AIDS relief, after which she joined the government system in 2012 as a midwife. She took part in Helping Babies Breath training in 2013 at Awach Health Centre IV and was soon mentored to train trainees. She has trained other health workers in Helping Babies Breathe, Essential Care for Every Baby and Helping Mothers Survive/Bleeding After Birth. She loves working with STEP-UP and STEP-UP Uganda, loves her job as a midwife, and loves seeing healthy babies and healthy mothers. Currently advancing her education to attain a diploma in midwifery, the knowledge and skills she has developed as a trainer for STEP-UP made her proficient enough to train her fellow diploma students on newborn resuscitation and saving mother's lives.
Davina Miller, LICSW
Davina Miller has been a clinical social worker for 36 years. She was previously the director of counseling at Mt. Holyoke College and is now in private practice. She helps people with a range of psychosocial problems, including trauma, eating disorders and relationship challenges. Davina has volunteered for STEP-UP twice and is in charge of securing second-hand computers for use by Ugandan medical personnel.
Olanya Jackeline Grace, Master Midwife
Olanya Jackeline Grace has been a midwife for 22 years. She initially worked at Lacore Hospital for 3 years after which she joined the government system. She likes her work and likes seeing babies born healthy and alive, to healthy mothers. She has been happy with the work that STEP-UP has done in Aswa, noting that they have built her capacity and she in turn has built the capacity of others. She hopes to soon see the impact of the work. She prays that STEP-UP continues to help a “desperate community” with limited resources. She is the mother of four children ages 15 (twins!)-21.
Past STEP-UP Participants
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)
New participants in 2020
Megan Carmel, M.D., obstetrician/gynecologist
Janet Namono, LICSW
Maria Torres, Ph.D., psychologist
Vicki Weld, LICSW
Planned participants 2021
Shani Ofrat, Ph.D., psychologist
Alexander Roseman, M.D., internal medicine/pediatrics
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