One more. . .

I just walked this morning to the ARC office from the guesthouse (where I'm staying now) so I can get some work done, use the internet.   As I walked along the dirt roads I passed many Ugandan and Sudanese men working in their shops and those waiting on their motorcycle taxis.  I forget that I look different but am quickly reminded by the stares as I walk pass.  The attention makes me uncomfortable and somewhat unsafe as I wonder what they think of me being there.  Just as I was passing a large group of men on motorcycles staring I heard, "When I see a white woman, I see the image of God."  Made me smile and laugh a bit

Interesting things this week. . .

 We finished this week with some fun.  We had one implant insertion on Thursday that one of the postnatal (postpartum) nurses did with me and I talked two officers through two IUD insertions on Friday.  So much fun!!  Here, they use the Jadelle and Sinorod which are 2-rod implants so I even got to put one rod in and then he did the other.  We were so grateful to Marie Stopes and the nurse midwife who took care of us there. 

We came back to Hotel Intra-Africa to take the postcourse test and to hand out certificates.  I was soooo proud. . . the pretest average for the test was 57% and the average on Friday was 84%!!!!  They had prayed on Monday for God to open their minds and fill them with knowledge and they were heard.

 After passing out certificates, the class gave Pamela and I gifts. . . a mat for Pamela to do her meditation and traditional Bari cups to hang milk and drink tea for me (I'm holding them in the picture). 

I'm so excited for them to go on and continue learning family planning and to start counseling patients.  One of our participants is a nurse midwife who speaks on Miraya Radio in Juba several times a week.  She beautifully placed one of the IUDs on Friday and was sooo happy, she can't wait to talk about the importance of family planning on the radio and how easy IUD insertions are!!

After a long week of training, Pamela and I celebrated last night by going to dinner at Lula, an Ethiopian restaurant.  We have enjoyed trying different places together and the conversation is always interesting with Pamela.  Whether it is about her family in Kenya, being a midwife in Nairobi at Kenyatta Teaching Hospital (120 deliveries a day!!!!) or just talking about life.  Last night we enjoyed a glass of wine and relaxed while another thunderstorm hit Juba.  Lula is a large hut with pretty wooden tables and open sides so we experienced some gentle spray from the storm while we had dinner.  Lula has nice music playing and also has two flat screens to watch football or rugby.  Last night they showed some of the swimming championships in Shanghai so I asked Pamela if she swam.  She said, "Well I learned to swim with hippos so I don't think I can swim in a pool."  What??  In Kenya her father would place her on a hippo and when the water got deep she would slide off and would learn to swim.  Incredible. . . I also learned at dinner last night that one of our participants comes from Abeyi royalty (one of the Sudanese regions you may have read about--where all the oil is).  Her father is a King there and he has 40 wives!!!!  She is one of around 200 children!!!  Pamela thinks he had some help from friends creating that many children--I think so too.

I hear interesting things here all the time--stories, but also just phrases.  Even though everyone speaks English here, its amazing how different communication can be from the same language.  Today, Pamela and I had lunch at a Sudanese place eating kisra (a type of Sudanese flatbread), ungali (Kenyan cooked dough), vegetables and soup.  It was all delicious and Pamela wanted me to try some more of her vegetable dish.  I told her I was getting full and she told me, "my dear, today is not the day you will grow fat."  I stopped at the Somali market across the street this afternoon to get a soda and saw my new Somali friends there.  I'm wearing a long black cotton dress and the father who works the register told me, "You look very nice today with that dress.  You are white and the dress is black so it makes you look very shiny."  I find my heart smiling today.

Week 2: Family Planning Training

I love my job!

With their new Managing Contraception books

Thank you Dr. Hatcher!!

 Day one of family planning training was long but SOOO enjoyable.  Pamela and I are doing a comprehensive competency-based family planning training in five days to 13 providers (nurses, midwives, medical officers) who work throughout Juba in the teaching hospital and two health centers.  Four participants only speak Arabic so it was an adjustment to slow down lectures to await translations.  Fortunately, the language barrier did not stop questions!!!

Again, our training started on the Nile at the Intra-Africa hotel.  Day one was filled with lectures and discussions as we reviewed all family planning methods available in South Sudan, medical eligibility criteria and common myths to dispel in the community.

I think my two favorite moments of the day were:
1.  When I explained continuous use of combined pills and how women can avoid their periods.  Mama Rose (older women in S Sudan are addressed Mama) said to me, "Please wait, this must be translated right now, this message is too sweet!!"  They started clapping!
2.  Starting and ending the day with a prayer in Arabic.  In a country where God is everywhere, spoken everywhere, all the time, they understand how important contraception is to women and families and how it saves lives.  It was really moving to end the day like that, all understanding the importance of what they will be doing, God's will.

Today, day 2 we focused on IUDs and implants.  The CopperT and Jadelle (a 2-rod implant) are the two devices available here AND THEY'RE FREE (a Juba Choice project, to all my FP friends)!!  We spent the morning at the hotel reviewing the methods, watching insertion videos and discussing aseptic technique. 

 After lunch, we moved our training to Marie Stopes clinic in Juba who is graciously letting us work with their clients this week to become competent in CopperT and Jadelle insertions.  Marie Stopes is a private international clinic focused on RH.  They see 8-10 clients a day and according to their director, the IUD and implant are the most popular methods women are using!!!!  She says that women just can't be bothered with taking a pill everyday.

 This afternoon I trained half the group in IUD insertion technique with hand models and how to "tent" the skin with the implant model. 

Madam Zoe

 Meanwhile, Pamela taught the other half of the group how to perform bimanual exams and place a speculum to visualize the cervix using the lovely Madam Zoe model. 

Powerful messages on t-shirts are very common here!!

One of our providers has tribal markings on both hands which you can see in this picture.  We spent a large amount of time yesterday discussing different tribal customs and how they affect family planning and reproductive health.  The most common tribes in South Sudan are those of the president Salva Kiir (Dinka) and the vice-president (Nuer), but there are over 60 indigenous tribes in the whole country!  Some examples providers gave us:  Some tribes practice polygamy and those generally do not support sexual activity for two years after childbirth (the husband will "visit with other wives").  Others believe sex immediately after childbirth brings good health to the new baby.  Most people in South Sudan believe that the husband should choose the contraceptive method.  Luckily the trainers from last week and the providers we are training this week believe in empowering the female patients and encouraging partner support for contraceptive acceptability and continuation. 

We have a lot of work to do this week but hopefully we'll see many clients this week.  I'm thrilled to see them sooo excited to learn about family planning and train for the important role of patient advocate and family planning provider (I'm slightly biased!!!)

Will keep you updated!!!  Tara xoxo

Exciting day!!

So I've really been working on adjusting myself to what is, and not try to adjust everything to my wants and desires, taking my luck as it comes and fitting myself to it.  I would be miserable here if I wasn't practicing resiliency and flexibility.  For instance, most mornings I wake up and the generator is down, so I've gotten used to showering in the dark with cold water and getting ready using my headlamp--its pretty funny!!  I have my routine down now though!
I obviously realized life would be different here and I wouldn't be able to do all the things I'm used to at home.  BUT Today, I was given such a gift--I found a new running buddy!!  Nelson, one of the logistics officers here at ARC mentioned the UN compound has some dirt roads which are safe to run on, so we went this morning.  He wants to get back into it, so he said he'll drive me and we can go a couple times a week!!  Oh, the little things in life that make me happy.  I'm so grateful here not to be distracted so I can appreciate these things!! 
Unfortunately I can't take pictures at the UN compound but the sites kept me entertained during the run, especially since my iPod was dead this morning (couldn't charge it without power!).  Lots of trucks moving around with UN workers, military.  A few animals here and there, a vulture and a bull just hanging out along the run.  I could see the mountains in the distance.  Soft dirt to run on is always nice instead of concrete.  I always love running in other cities and other countries--its always an interesting experience.  Now, I just have to find someone to play soccer with . . . maybe when I get to Wau next week!
Hope everyone's having a great weekend.  I got to skype with my parents, my sister Jackie and Martina and Liam yesterday which was such a treat.  Today, I hope to catch up with Danielle, who's doing her first triathlon today!! So looking forward to hearing about that!
Love Tara xoxo

Juba Training Week One

Intra-Africa Hotel

 This week Pamela and I completed a five-day Training of Trainers (TOT).  We worked with 11 ARC health officers mostly with nursing backgrounds from 6 different ARC sites in South Sudan (Juba, Wau, Kapoeta, Nimule, Kajokeji and Malakal).  The goal is for them to roll-out their own training of Home Health Promotors (Community Health Educators) in the next month to improve family planning in the community.
Intra-Africa was a very nice hotel where the trainees stayed during the week.  It is right on the Nile River which was nice to see but meant LOTS of mosquito bites for me. 

 The ARC staff was really wonderful.  Young, energetic, smart and really motivated to do hard work in RH implementation.  Most had a lot of experience already with patients and counseling so we focused on how to teach, give presentations and be organized for their training sessions.

Our conference room

IntraAfrica restaurant on the Nile

Pamela

Areas surrounding the hotel

 It was wonderful to co-train with Pamela.  She has so much experience training midwives, nurses, and health officers in Emergency OB care, postabortion care and family planning.  Here are some pictures of her in action . . .

 The group was very diverse coming from all over South Sudan.  Every day we had tea breaks in the morning and afternoon as well as a lunch break.  I tried to sit with different people everyday to hear what life is like back home and what it was like growing up here.  Many did nursing school in Uganda during the war, but a few from the Malakal area stayed behind. 

Our tallest student, around 6'8"!! He says his brother is a bit taller too

 The trainees practiced giving us presentations during the week and really did a nice job.  Pamela and I were very happy with their progress

 On the last day, Gina the country director for ARC and Derebe, the senior health program coordinator, came to hand out certificates to the trainees.  They came up with great Action Plans today in order to reach the ARC/UNFPA goal of training 270 HHPs by December.  I think they can do it!

Next week, Pamela and I will move on to training midwives and MDs in family planning theory and delivery.  We will be both in the same conference room giving presentations and then moving on to a nearby Marie Stopes clinic which provides family planning care.  We hope to expose them to enough patients to be competent in IUD and implant insertions so they can bring their new skills back to Juba teaching hospital to start delivering those services safely.  Its been quite a week. . . we're looking forward to recharging this weekend so we have enough energy for next week.  Plans for the weekend. . . going to the market so Pamela can teach me how to cook some Kenyan food, finding a football game, resting up and preparing slides for next week!  Hope you're all well.  Sorry to disappoint some but not posting sooner, but the days are LONG!! Rest assured I am very safe, comfortable and enjoying myself.  I can't believe I've been gone two weeks already!  Much love, Tara

The group with Pamela

ARC

Drive from airport

 Finally arriving in Juba was so exciting after so many months of planning and anticipation!  One of the ARC drivers picked me up from the airport in one of the trucks (with a HUGE antenna on the front) and took me to the office where Pamela and I got right to work!

"A Toast to a New Nation"

Pride is radiating everywhere from street billboards to people's faces and big smiles.  I keep congratulating those I meet and its great to see their happiness and hear about the celebrations from last week.  I'm so sad I missed it!

"Celebrating Freedom"

  Driving around Juba is really interesting.  There is such a mix of old and new.  The city is quickly developing from unpaved, uneven roads with one room huts and one room steel contructed boxes to paved roads and cement two- to three- story buildings. 

ARC office building

 The ARC compound includes a building with several offices, a security building and a portable building with two bedrooms.

Office I share with Pamela

Logistics/Security office

ARC mascot

Portable building, each one bedroom

My lovely room!!  Yes, that's an air conditioner up there!!

Some Background on why I'm here!!
ARC (American Refugee Committee) International has been providing services to refugees and internally displaced persons in crisis-affected settings for decades.  They started working in South Sudan in 2004 and while based in Juba have opened several offices throughout the country. Programs in primary and reproductive healthcare, gender-based violence prevention, STI/HIV prevention and treatment as well as water sanitation aim to provide sustainable services that communities can continue on their own.  
South Sudan is greatly in need of these services especially those in RH (reproductive health).  The average woman delivers 6-7 children and only 10% of women deliver with a trained attendant present (and that's usually at home).  Unattended births leads to a large number of complications and maternal deaths.  South Sudan has the world's highest maternal mortality--1 in 7 women is at risk of death during pregnancy.  By improving RH access and delivery, the goal of the Ministry of Health is to decrease maternal and child morbidity and mortality.  With only 30 trained OB/Gyns and 100 midwives in a country of almost 9 million people, the largest problem is human resources and disseminating information properly. 
RAISE (Reproductive Health Access, Information and Services in Emergencies) is a program that was started in Kenya with the help of Pamela Ochieng, a midwife and now RH coordinator for ARC.  Using the RAISE curriculum, ARC has been commissioned by UNFPA to train home health promotors with a goal of training 270 HHPs by December and to also train MDs, midwives and medical officers in family planning.  So this week, Pamela and I will be doing TOT (training of trainers) in Juba.  We will be training 11 ARC officers from different offices across South Sudan to train HHPs in their communities.  Each ARC officer will be responsible for training 20-50 HHPs to provide RH care to women in their communities and hopefully Pamela will reach her goal!
The following week we will be training MDs and midwives in family planning services, counseling and delivery.   
OK, that's enough, but you all know I get pretty excited about my job!!  More to come later this week. . .