Linking Health and Peace Building
by Mary Okumu

I was assigned to come up with improved health policies and service delivery for women and children in rural and peri-urban populations, in very remote parts of the country. I was also responsible for training health workers to manage rural health services. After two years of my hands-on work in the field, I tried to work out what was wrong with the situation. "Why?" was the question that was recurring in my mind. Why were women and children regularly dying in such large numbers? Why did that appear to be acceptable and "normal"? I knew that women's poor health in Africa was inextricably linked to their marginalization.

Needless to say, each question only raised more questions. I did discover that there were many more concerned women, at both the village and the institutional levels, than I had thought. This gave me the motivation to do more than simply ask questions. I wrote a circular to the head of the organization I was working for - the African Medical Research Foundation (AMREF) - briefing people on my views about maternal and child health status in Kenya. I gave a factual account of what I had seen, what I thought the problems were, and what I thought ought to be done. I also indicated that I had consulted people who felt the same way as I did. Most of those I had consulted were highly respected, both inside the organization and outside the organization. I had also spoken with ordinary women and men in the rural communities, and knew that they did not want their children or mothers dying from illnesses.

Because it had not been written by a "health professional," my circular generated considerable tension, and although the Director General gave it some thought, he was under a lot of pressure from his fellow doctors to reject my suggestions. We needed consultations, but many of these professionals did not want them. Eventually I succeeded in having the organization integrate its health services. The organization, which for twelve years had recruited only "health" personnel, recruited social/medical anthropologists, economists, and other categories of social scientists. I became one of two trainers responsible for training health workers to incorporate the social dimensions of health into their work, and to discuss these with patients at all times.

As a result many desirable changes were effected in favor of the disadvantaged, including nomadic populations and people in peri-urban slums who lacked basic amenities. Little did I or any of my colleagues know that what we were doing in the health sector program was called mediation, linking, empowerment, and advocacy. These techniques could and in fact later did become models of effecting grassroots and institutional community empowerment and action. This would later be adapted to other areas of human relations and community development, as in conflict transformation and peace building work! This is how I came to peace building.

Lira, Northern Uganda - A Mother's Milk
AMREF worked in Eastern Africa. It found its work stifled by civil wars, especially in the Horn of Africa (Ethiopia, Uganda, Somalia, Sudan, and Eritrea) and the Great Lakes region (Rwanda, the former Zaire-now the Democratic Republic of Congo, and Burundi). The various bloody civil wars in Uganda literally brought health services in Uganda to a halt, and AMREF was called upon to rehabilitate health facilities.

I was sent to Lira District in northern Uganda in 1987 to undertake a needs assessment, following the 1984-86 war. Because of the prolonged war in the north, women and children - the only people left - suffered starvation. Infants of three or four months had never tasted their mothers' milk, because their mothers were severely malnourished. The women lived only on an occasional food handout, the distribution of which was restricted by rebels.

When I undertook this assignment, I was lactating. I had left my seven-month-old baby at home in Nairobi. One day, both out of dismay at what I saw and to prevent breast engorgement, I was looking for a safe place to express my milk. As I did so, a woman came close to see what I was doing. She asked me not to throw out the milk, but to feed her infant. After a long hesitation, I obliged. Soon enough, nine more women brought to me ten infants to breast-feed, none of whom had ever tasted milk. I breast-fed these infants for the next ten days. This was also how I came to meet the women. Earlier in our assessment, we had only been able to undertake an assessment of the district's physical conditions. We could not find people to talk to. The villages had been abandoned, left bare. There was not a soul, not even chickens or goats. The people - mostly women and children - had run away because of intensified rebel raids and attacks. The men had either gone to war or had been killed. Now, more than two hundred women with similarly famished and dying babies came forward and met us.

My breast-feeding event in the Lira district changed my life forever. It was a rude introduction to the atrocities - the pain, the dispossession, the denigration, and the disfigurement - that one human being can inflict on another. To me, Lira became the epitome of human disaster. The tragedy, impact, and aftermath of the Uganda war became both my awakening and my point of reference and turning point. It became the proverbial thread that, at a very personal level, has linked the core of my being to the work of women's empowerment and equal participation in their own and their families' lives. This background has brought me to working closely with issues of human rights, sustainable development, and conflict transformation, which are intrinsically linked to peace building.

The needs assessment report that my colleague and I wrote consisted of accounts of the slow and painful deaths of the children and their mothers. It included accounts of physical and cultural destruction. The report ended with strong and passionate appeals and recommendations for urgent action in response to the insecurity and the enormous need for humanitarian assistance to northern Uganda. Naturally, my colleague wanted the story about breast-feeding the ten infants obliterated from the "technical" report. According to him, the breast-feeding story "nonsense" was a subjective, emotional, temporary, and unsustainable move. Not only was it not objective, he said, but it "diluted" the report. By this time, I had become better at managing gender-based tensions/conflicts. I had learned that the tensions, propagated by male ignorance, chauvinism, and short-sightedness, were often generated out of fear. I presented the story scientifically, adding tables of statistics with a footnote to the effect that had it not been for my breast-feeding, the infants would have died as had many others.

I took courage in knowing deep in my heart that the women had spoken, and what they had said was real, honest, urgent. It taught me that there are ways of knowing, feeling, listening, hearing, and responding that are perhaps much better than those we usually use. I started to "listen with the ears of my heart," sharing in and with other people's concerns, empathizing. I was driven to act quickly, but thoroughly, weighing up the impact and outcomes of all the potential responses. I have also learned that to be trusted, I have to trust.