Isis-WICCE trains south Sudanese health workers in post-conflict trauma management.

Since its independence in 1956, Sudan has been a battleground for two armed conflicts (1955-1972) and 1983-2005 after which a Comprehensive Peace Agreement (CPA) was signed on 9th January 2005. The conflicts were characterized by terrifying levels of brutality that left a many civilians dead, killed in brutal massacres.

Survivors of armed conflict suffer a wide ray of psychological trauma and reproductive health complications arising from the several sexual and gender based violations inflicted upon them, torture, loss of family members, loss of property, resulting into post traumatic stress disorder.
It is against this background that Isis-WICCE with the support of the Dutch Fund for Gender Equality (MDG3) thought to address such problems through training of health workers in Management of Medical and Psychological Effects of Armed Conflict Trauma.

The training that ran from October 11 to 20, 2010 in ¬Juba brought together 36 primary health workers from six counties in Central Equatoria State ( Morobo, Kajo-Keji, Terekekka, Layinya, Yei and Juba). The purpose of this training was to build the capacity of community based health workers in identification and management of physical, reproductive and psychological health complications and to highlight the importance of healing reproductive and psychological health problems of war survivors in improving participation in reconstruction processes.

This training was the first of its kind in Southern Sudan as confirmed by John JimLong, the Executive Director of Toto Chan Centre for Child Trauma in his welcome remarks. Jim Long applauded Isis-WICCE for giving attention and funds to the needs and problems affecting women in post conflict S. Sudan. In 2005, Isis-WICCE in collaboration with Toto Chan Centre for Child Trauma conducted an in-depth research study in Central Equatoria State as a first step to know the war effects of armed conflict on women’s lives.

The research identified among others two critical needs; high levels of illiteracy and sexual and reproductive health complication among women needs. And as a result, in 2009, Isis-WICCE carried out training for 53 women in S.Sudan in leadership and peace building and many have now taken up political leadership.

In addressing the problems of sexual and reproductive heath complications, Isis-WICCE felt it important to train health workers as a way of building their capacity to be able to manage and treat such health complications.

In his remarks, the Director General Primary Health Care, Ministry of Health, Central equatorial state, Dr Hassam Gamal, said that this training is very important because it will enlighten health workers on effects of armed conflict on both minds and bodies and enable them train others and heal those who are suffering psychologically as a result of armed conflict.

He said that the Ministry of Health will continue support efforts to address the issues of capacity building for health workers in Southern Sudan.

The health workers were trained in: understanding of the human reproductive systems, sexual and gender based violence; human rights approach to health care; women’s rights; mental health; torture, grief, depression and suicide; management of surgical consequences of armed conflict; HIV and AIDS in post conflict.

The training helped to bring out cultural values that are attached to the female and the male gender. For example in some communities in Southern Sudan when a baby boy is born, there are celebrations in the family and the father will buy soap, jerry and other materials for the baby and the mother because the boy will remain in the family, expand and keep the identity of the clan. On the other hand, when a baby girl is born, the parents will not be happy and the father will fake a journey and run away from home.

During the naming ceremony, the baby boy is presented with an arrow and a bow a sign that he will defend his family, clan and nation and the girl is presented with a hoe and a bloom meaning that all she has to is house work.
In other circumstances, baby girls are favoured because they are seen as source of wealth for the family since they are auctioned at marriage and the highest bidder who pays many cows marries her. This implies that the woman has to endure all the abuse and violence in her marriage.

The training was an eye opener to many health workers on the issues of human rights, women’s rights, sexual and reproductive rights as well as mental health as many expressed lack of knowledge on such issues.
Some of the health workers shared touching experiences.
“I have now realised that throughout my marriage, I have always been raped by my husband.” said a female health worker from Terekekka County.

Others called for the training to be expanded to other community workers.
“This is the first workshop we have had about mental health, trauma, stress and anger. It should include other officers such as the Police and Army Officers,” said a health worker from Kajo Keji County.

Another trainee said the training was in itself helping them heal.“This training is reminding us of the past and open our hearts and forgive each other. Now that we are entering the referendum, it will help us to know what we want,” said James Remo, a healthy worker at Juba Teaching Hospital.

The training also gave the health workers an opportunity to open up and share their own traumatic experiences.
“I was abducted at 4 by soldiers along with 6 other women as we worked in the field. All the women were raped and killed. I pleaded and was spared but had my breasts pierced with sharp metals. I was beaten severely and left for the dead. Other SPLA army men picked me from the bush and brought me to Juba hospital after 4 days of not drinking or eating anything. I did not think at that time that I would ever live to tell the story,” a participant from Kajo Keji County narrated her ordeal.

Another participant Mary Palma Muja said: “I witnessed an elderly woman have her hands tied at the back and petrol poured over her and lit. This traumatised me very much because I think she was an innocent old woman”

Another participant narrated, “ Kony rebels attacked our village. They burned the entire village. They made us cary very heavy loads into the bush. If you refused they beat you until you died. We walked with the luggage as we were being beaten. It was shocking to see people I know being clubbed to death.
Further more, health workers said their challenges were heavy work load and lack of skills and facilities to handle many cases in their health units.

A health worker from Mangala Payam, Juba County said: “ I am alone at the health centre. I am the cleaner, I am the storekeeper and I am treating patients there is no single nurse. People even call me at night and they will follow you up to your home.”

In Terekka the whole county has only 4 Clinical Officers. The few officers who are available do not want to be in the villages because of the conditions there.
Juba Teaching Hospital has only one psychiatrist to handle all the mental illness and in most cases patients of mental health are tied and thrown in jail.

The health workers expressed the need for government to recruit specialised and skilled medical personnel and set up health facilities where they are non existent as well as improving the already existing ones. The health workers also urged government to include mental health in the Primary Health Care Package.

A the end of the training participants drew up plans of actions which included; conduct health education on reproductive health and HIV and AIDS and mental health, offer counselling, conduct training for other health workers; counselling services on going; carry out sensitization on health issues through community radios; carry out advocacy to support to people who are in of health services such as the women, children and the elderly.

In order to contribute to improved health service delivery in Southern Sudan, Isis-WICCE donated assorted medical supplies which included Artery Forcepts, Cuscos Vaginal Spectrum, dissecting Forcepts,Weghting Scales, Kidney Dishes, Surgical Gloves among others to Lobonok and Pager Primary Health Care Units in Juba County.