Motherhood in Conflict: Achola’s Story

“Women, in short, lack essential support for leading lives that are fully human. This lack of support is frequently caused by their being women.”
– Martha Nussbaum

Across the globe, mothers face difficulties in relation to their experiences of motherhood and well-being. Many of these are recognizable across countries and cultures.

Becoming and being a mother in the context of a conflict lasting over two decades, however, is different. For these women, their highly dangerous situation means daily care of her children becomes a matter of life and death. This was, and arguably still is, the case for many of the women in northern Uganda.

Before I went to volunteer in a women’s counselling centre in Uganda in 2018, I had prepared myself appropriately. Or so I thought. I watched documentaries on the government’s conflict with the Lord’s Resistance Army. I read loads of newspaper interviews, academic articles and NGO reports, and I spoke with professionals in the field.

All of my preparation, however, still came nowhere near to a full picture of what womanhood, and particularly motherhood, during and after war looks like.

Becoming a Mother in a Conflict Zone

During times of war, stories of motherhood – and female experience in general – have been excluded and unexplored. It is time this silence, often resulting from gender blindness, is broken.

To understand maternal well-being in a post-war context, we must realize what women had to deal with specific to their role as a mother.

The following story was told to me by Achola*. Achola is a 54 year old widow, with 8 children. I visited her home in rural Ngetta, close to the city of Lira in the northern part of Uganda. This region has been badly affected by the Lord’s Resistance Army insurgency, which had great consequences for all, and especially for pregnant women and mothers.

Pregnancy can be a challenging time for women anywhere in the world, and especially for women in impoverished regions.

The challenges Achola faced just became bigger and bigger after giving birth. Only two days post-birth, she had to run to a nearby mountain to find safety from the rebels. Her husband ran in a different direction and so she sat alone with their new-born baby.

“We were sleeping in the hut when the rebels came in 2002. I had a baby child and heard a gunshot. I came out and ran into the bush. The child was only two days old. We were hiding at a swamp and throughout it all the body was shaking.”

With no clean toilets, nothing to withhold the bleeding, no painkillers, no food, no emotional support, fear overtook Achola. At this point, she thought about killing her new-born baby.

“I felt like killing the baby I have so that I am left alone. Because I felt I was going to die, the rebel was going to kill me. There were no merits, that was just the sadness showing. I was full of sadness, and the feeling came from fear. Fear was the one thing making me think that … It was so painful, it was so painful in my heart.”

Like all the other families in the area, Achola had to run away from home every few nights for months in a row.

Hiding in the bush, however, came with great dangers and consequences – 5 tombs next to Achola’s hut are a painful and visual reminder of this.

“Those are the bodies of the children … I cannot recall when those children died. I gave birth to thirteen children, now there are eight … they could not even sit, they could not even crawl.

It happened as a result of running to the bush with these children, the mosquitos bit us in the bush and gave them malaria, then that child dies later on like that.”

Achola’s Way Forward

Achola suffered tremendous losses during the war. She tells me that she “cried and cried and cried for many years.” Today, however, she says: “I am feeling better and better slowly, it is not like in the past. I can laugh.

The community counselling centre, run by Ugandan psychologist and trauma specialist Sister Florence, has helped a lot: “I am now recovering from these problems and this pain … I am now getting energy and feeling better.”

Reconnecting with her body has helped Achola in overcoming some of her struggles. Besides the counselling centre, the church is a major source of social support for her. The word of God, according to Achola, is a form of counselling: “I am always counselled from there [church] by the word of God. When I’m in problem and I hear the word of God I always feel better.”

By sharing this story and trying to understand the complexity of post-conflict issues, we can move on from merely reading narratives of pain and loss.

Instead, we can focus on what helps women live more fulfilling lives after conflict – and how we can support them in their journey.

*Achola is a pseudonym. The image accompanying this article does not depict the woman who told this story.

Ola Abu Alghaib: an activist for women with disabilities

In November, we wrote about an amazing conference. It was born from the realization that women’s leadership needs to be a priority in the health ‘business’ landscape. Not only because women’s voices should be present at the ‘decision making table’, but also because a new narrative on leadership is needed for all the young women and girls out there.

Girls need female role models to look up to. They need role models who can inspire them to work towards their own goals and tell them that nothing is impossible. Role models who say: ‘you can, and should, fight like a girl in order to become whoever you want to be!’

Inspired by this feeling, Swedish Organization for Global Health wants to share the story of some of these role models. We hope you will feel inspired and relate to them. Maybe you’ll even decide that, yes, this is exactly what I would like to do too!

First up is Ola Abu Alghaib, the current Director of Global Influencing and Research at Leonard Cheshire – an organization supporting people with disability to achieve their goals and live life at their very best.

Photo credit: Ola Abu Alghaib

Ola embodies the real meaning of the word activist.

Her job is to fight for the rights of those who are generally underrepresented or even ignored by society – women and men who live with some form of disability. Her work tells you exactly what kind of person she is, but it doesn’t tell you for how long she has been an activist, or why she became one.

Her life is the expression of leadership. Ola was born north of Nablus, West Bank, in Palestine. Like every child, she had many dreams and goals for her life.

When she was just 14 years old she underwent surgery, but a mistake during the operation resulted in Ola losing the ability to walk or move her right hand. Ola says, “this was obviously very shocking, but it didn’t change who I was and what I wanted to achieve in life”.

However, she soon realized that people around her started to see her differently. Many thought she could not live a ‘normal’ life, that she was broken, and that the only option she had left was to survive. Ola proved those people wrong. She was, and continues to be, a very determined and ambitious woman.

She is not just writing her own story but is also influencing the lives of others on her way.

After completing her first degree, Ola came across the German Organization for the Disabled, who decided to invest in this smart woman. Through them, she started to work in a rehabilitation center that supported people with disabilities. In the following 8 years at the center, she was aware that she was the only woman working there.

She felt that women with disabilities were not being given the opportunities they deserve, and knew was time for NGOs to act and involve more people. However, the issue seemed to fall on deaf ears. Her response?

Ola founded Stars of Hope. Their mission is to abolish disability and gender discrimination, while empowering women with disabilities to achieve their goals.

From that first step into advocacy, Ola has done so much work to bring the voices of women with disabilities into decision making rooms, such as the UN disability committee.

“Access to services continues to be a challenge for women,” she says. Influencing policy is fundamental to changing that.”

Ola has often underlined her belief that women with disabilities are generally forgotten by the feminist movement. She says this happens because disability-related issues make things even more complicated for women’s rights advocacy, but also because women with disabilities don’t ask to sit at the table. She says:

(1) We need to understand what disability means for a woman
(2) We must make sure disability receives as much attention as any other issue
(3) Women with disabilities need to demand their seat at the table

When I asked what leadership means to her, Ola told me: “Leadership is the privilege that comes with it”. If you are a leader, you should use that position to make your own contribution to improve things for others.

If you are a girl or a woman who feels, “I can’t be a leader,” and if you are suffering because of the way society defines you, Ola has this piece of advice: “The world is changing so take the lead and be determined, starting in your household.”

Feeling inspired by Ola’s story? Are you a woman with disabilities and want to become a leader in global health? Check out the following links that could give you some ideas about where to start, but remember – everything always starts from within, from you.

Ashoka Fellowship
Google Europe Students with Disability Scholarship
Wellcome Trust fellowships/scholarships

Put Aside Your Stethoscope & Listen to Women’s Pain

It was sudden, debilitating pain that would come out of the blue. It just kept getting worse. Eventually, I ended up in hospital.

The emergency room doctor sent me home with no leads on the cause of my pain. He told me to follow up with my primary care physician, and so I made an appointment.

As I sat in my lovely exam gown waiting, my mind went to dark places about what this pain could possibly be. “I really hope the doctor will have some thoughts on this,” I thought. “I hope he’ll be able to reassure me somehow.”

He didn’t. Instead, he asked me two questions and mumbled something while scribbling on his prescription pad. He shoved the paper in my face and told me to pick it up at the pharmacy.

Before I had time to decipher the handwriting, he was gone. Securing the back of my gown with one hand, I jumped off the exam table and chased him down the hallway.

I don’t embarrass easily, so I didn’t care that I was running around in a paper-thin gown while other patients gave me the side eye.

“I’m not done, I have questions” I said. Visibly annoyed, he followed me back into the exam room.

I hopped back onto the table while still holding my gown closed, impressed with my own acrobatic abilities. But I was even more impressed with my boldness. Where had it come from?

I was taught that doctors are powerful and mighty. They shouldn’t be questioned, only readily and blindly trusted.

Yet, here I was, demanding he take the time to answer my questions.

“What are the side effects?” I asked.
He smirked.
“There are very few. This is a very common medication for stomach upset.”
“Stomach upset? I’m having sharp pains. And they’re not going away.”
“You’ll be fine. Just take the medication as prescribed.”
“But what do you think is causing it?”
“Take the medicine and if it doesn’t work, call us.”
“Do you need to do any tests?”

“Tests?” he said. “We don’t need to do any tests. It’s probably just gas.”

This was useless. I’ve made plenty of excuses for doctors like him before: he’s busy, he’s stressed, maybe it’s the nature of the job.

The truth was, he just didn’t care.

At home, I began to read the little pamphlet inside the box of medication. Did it really state that caution should be taken with Asian patients due to higher risk of side effects?

But…I’m Asian?

I made an appointment with a new doctor. A woman. By now, the pain was worse and more frequent. I had done some research on my symptoms and was starting to think it it lined up with some form of dietary sensitivity. There was a pretty clear pattern and I’d been taking detailed notes.

The doctor was an older woman with a commanding presence. “She’ll listen,” I thought. “She’s a woman.”

Instead, she dismissed everything I shared and everything I asked. She attributed the skin breakouts around my elbows to a type of spider bite.

“So you think it’s a coincidence that I have these breakouts every time I eat bread?” I asked. She actually rolled her eyes. Finally, she agreed to test for celiac disease, saying it was nearly impossible that I had it.

The test was negative. I started to feel like a hypochondriac. Was I making these symptoms up?

I reminded myself that dismissal of symptoms are a reality of health care for women, and that I’d have to fight to be listened to.

In my appointment with a third doctor, she shook my hand warmly. But she scrunched up her eyebrows as I explained my symptoms and gluten theory. “Here it comes,” I thought. “She’s going to tell me I’m imagining this.”

The doctor scooted closer to me and said, “You know, there is a test for celiac disease but not gluten sensitivity. It sounds possible that your body is reacting negatively.” She paused, and then said, “My goodness, it must’ve been frustrating dealing with this.”

My mouth dropped open. She went on to share next steps and review possible treatment options. She even asked me about my thoughts on my symptoms. I walked out feeling informed and validated.

Listening is one of the most healing forms of medicine.

To know we’re not alone is a powerful form of treatment. Hear us. Believe us. Put aside your stethoscopes for a moment and listen with your hearts.

Mental Health Treatment & Gender Equality in Uganda

Conflict, poverty and instances of social injustice can provide the context within which a person develops mental health issues. And yet, while studying to become a creative/psychomotor therapist, I learned very little about this.

I didn’t question it at the time, because mental health is a personal issue, right? My time in a counselling centre in Uganda last summer showed me that the answer to this question is, in fact, a clear no.

I volunteered as a psychomotor therapist in the Bishop Asili Counselling, Rehabilitation and Community Centre in Ngetta, northern Uganda. The local population living here suffered badly during the Lord’s Resistance Army insurgency.

More than a decade after the end of the war, I came to Uganda with a stack of books on trauma and post-traumatic stress, ready to do creative therapeutic interventions that might help women cope with their war-time experiences.

Very quickly, it became clear to me that the conditions these women lived in asked for something different. Something more.

Sister Florence, an Ugandan psychologist who founded and runs the counselling centre, reminded me that next to their history of war, “there are so many [other] sources of trauma, so many, so many, so many”.

Women in Ngetta face many challenges. The patriarchal context leaves women with few, to zero, rights.

They have no right to land or any kind of ownership, and the moment a woman marries, her new husband acquires rights over her sexuality and reproductive ability.

Ellen, one of the women I worked with in the counselling centre, described the patriarchal culture: “I was now in the hands of my husband and I was now under authority of my husband. I need to respect him and do everything he tells me.”

Her words reflect the complex power dynamics and hegemonic masculinity that undermine women’s social status and power. On top of this, many women struggle to feed their families every day, while often their husbands drink away the little money there is. Other women have lived through (often multiple) more recent traumatic events, such as emotional and physical abuse by a husband or brother.

It made me wonder how much help my therapeutic interventions focused on (individual) war-trauma could be.

Recognizing the unequal social position of women, I needed to have a clear feminist ideology underlying my therapy. This meant focusing on women’s social position and equality.

Our sessions were related to resilience, visibility and communication, grounding techniques, personal boundaries, and more. Work related to the strive for equality for women was essential. However, paying attention to – and ultimately challenging – violent and unjust structures is not often included in mental health interventions in the Global South.

The importance of women’s mental health for general health is widely recognized. Mental health in international contexts is slowly becoming more of an acknowledged topic within the field of international development. This is really good news, especially considering the fact that only a small minority of the 450 million people suffering from mental or behavioural disorders worldwide receive treatment.

In 2013, the World Health Organization published their Mental Health Action Plan: 2013-2020. It is an ambitious action plan that understands ‘the essential role of mental health in achieving health for all people’. Global Mental Health (GMH) is thus an emergent topic in which more and more people are currently working. However, with this renewed focus on mental health, many critiques have emerged, some of them accusing GMH of being a colonial practice.

GMH is accused of globally enforcing biomedical systems, which are characteristic of the Global North’s approach to health. The biomedical framework locates illness, including mental illness, within a person. Though psychological and social principles are sometimes taken into account, biological variables are the most central.

Issues of social injustice and structural violence (such as poverty, conflict, sexism, racism) are not taken into account, despite their significant impact on women’s mental health.

Very important work is being done in the field of GMH. Organizations like SOS Children’s Villages or Action for Child Trauma International are great examples of a rights-based approach to trauma.

We must be careful to avoid new forms of imperialism in which the Global North enforces its biomedical approach to health on all cultures. We should work towards locally-informed care which approaches mental health not as an individual issue, but as something to be addressed on personal, community, national and global levels.

Mental health should be seen as a social issue.

This would allow us to challenge discriminating structures, both globally and nationally, while also focusing on community and personal struggles.

In order to achieve mental health for all, there is an essential role for work towards an equal world, and this work is should be integrated in the field of Global Mental Health.