Maslow

Since coming to South Sudan, I have been doing a lot of thinking about Maslow's hierarchy of needs. I assume most people who read this might not be familiar with Maslow's hierarchy of needs. Honestly, I am not sure why it is one of those things that has always stuck with me from school but it has. So, I have a picture of it above for reference. The idea of the pyramid is the bottom level is the basis on which life is founded (meaning our basic needs) and then from there each level of the pyramid builds on the other when the needs of the one below is met. So, the foundation or the bottom of the pyramid should be met so that the other levels can be achieved. That being said, when someone is easily able to meet the bottom parts of the pyramid, they are more easily able to move through the upper levels, and it can be more fluid in nature.

The basic levels are as follows: Physiological, safety, love and belonging, esteem, and then Self-actualization. Physiological includes things such as good air to breath, safe drinking water, shelter from the elements, food to eat, and clothing to protect and cover the body. This is just the very basic elements of survival. Then the next level is security needs which are things like personal safety, employment, security, access to resources, and healthcare access. From there the 3rd level includes friendship, levels of intimacy, family and a sense of belonging. The 4th level includes respect, rank and status, and recognition. The final level, the one that is hardest for people to reach, is self-actualization where the person becomes the most that they can possibly be.

In the US I find it easy to go between these different levels and to reach to the top of the pyramid. I have easy access to food, a home, a bed, clothing, a job, relative safety, friends and family. I have pretty good self-esteem and respect, and I am able to chase after my ambitions and dreams. In the US I think we find excuses often to be in the lower levels of the pyramid at times. Now I am not saying this is everyone in hard situations, but I think people pick things incorrectly at times that sometimes have them chasing the bottom levels of the pyramid. Others are in a position where things like medical debt and certain other situations make it very, very challenging to climb above the bottom two levels of the pyramid.

One example of people choosing to be a lower level of the pyramid are those that go to college and choose a career where they are unable to earn a decent living. I use this example because I was that person when I got my first degree. I wasn't able to live the life I wanted to with that degree, so I went back to college and got another career where I am better able to meet more needs and thrive better. This is not to belittle people for their choices but to reflect that in the US we have an abundance of options that are not available in many other areas of the developing world. I love that I am a nurse and I love what I do, but that being said, I chose to go back to college and get that degree partially because I knew I would be able to find a job and have options to earn a bigger pay. I certainly did not do nursing because it was an easy career.

Here in South Sudan, I am concerned mainly with the bottom 2-3. Most people here are only trying to fulfill the bottom level most days. The other levels are hard to reach for them. Safe drinking water is hard to find in many places. Here in Yambio the different NGOs have created boreholes so that people are able to pump safe drinking, cooking, and bathing water. Some areas of the country have large water tankers who bring water to them, such as in the capital city of Juba. But farther out, especially in the hard-to-reach areas and deep in the bush people drink water from streams, and rivers, and other unsafe bodies of water. All of this causes disease.

Many people in South Sudan struggle to have adequate food. This year is potentially going to be a year with the worst levels of poverty and lack of food for the entire country. That means many people will not have access to food and many children will be malnourished. Part of that is due to the fact that global warming is drastically impacting the climate here and the ability to cultivate crops (I will write more about this in the future). Even in areas where crops grow food can be hard to access for many reasons. Clothing here is often not new, but used clothing. People have only a few sets of clothing and are unable to afford more so continued washing of clothes is necessary. People cannot replace clothes that rip or are stained as easily because it would be too costly.

Access to healthcare and reproductive services is very limited. People have a dozen children or more due to both cultural norms and to the fact that they do not have access to reproductive education or birth control. Reproduction is a very challenging topic to discuss here because the entire topic is many layered and very much culturally sensitive, so I won't write more on that now. But even the access to safe places to deliver a baby and access to medical care during the pregnancy is very limited. So here in South Sudan people are struggling to even meet the needs at the very base of this pyramid.

Those that are able to meet the bottom level of the pyramid may advance to the second level. They may be able to find a job, though here finding jobs is very challenging. Once someone secures a job, they may be able to afford a house that has a security gate and fence around it. They might be able to shop at the market or in the stands, instead of relying on their own gardens for much of their food. From there maybe they can buy more land or even things like a smart phone or better clothing, or a second bed so the entire family does not share one bed. This is just the second level of the pyramid.

From there people may worry about love and friendship. Friendship is probably an easier thing to get here, though finding good friends and many is challenging. Because of the extreme levels of poverty some people turn to stealing to get their needs met which would make friendships challenging. Love is a lot harder to find here, owing to cultural obligations. Many people do not marry for love. Polygamy is also common here as well. Family connections are stronger here than elsewhere, so that is something good here. But with the tribalism that exists, those that come from other regions or tribes in the country may struggle to feel connection or make friends if they move outside their own villages, which many have to due to waring and poverty and employment.

The last 2 levels of the pyramid are hardest still for people here to reach. Yes, elsewhere they are hard to achieve, but in the context of South Sudan I think very few truly get to the 4th level of the pyramid and I think the 5th level is virtually impossible for most people. There is so much that people are unable to achieve and so many that can barely make it from the bottom level of the pyramid that reaching the top of the pyramid doesn't ever happen.

It is heartbreaking to see people struggling so much. A whole country where the basic physiological and safety needs are not met for most people is devastating to see. I don't think words or photos or stories ever fully do this matter justice. I cannot explain to someone who has not experienced and been in the community firsthand what it is really like. I truly never knew or understood until I was here.

Even for me, living here in South Sudan, my ability to access things is harder. I know I will have food, but sometimes getting food is a bit more challenging. Or finding drinking water or running water takes a little more time and consideration than it would in the Western World. My personal safety and security is always a consideration. Because I am a Westerner the community overall makes sure that I am more secure and more protected than those that are from here, but oddly that can be a double-edged sword. My safety needs are more often met, but building friendships and making connections is harder because I am also confined inside those safety measures. So, you meet the more basic needs first and worry about the other needs later.

Certainly, I am very fortunate though. Comparatively I have much less to worry about. I am living a much easier life than my colleagues and those in the community. I wish I could help them all out, but the realistic part is that I cannot. However, as a mental health provider, we discuss where people's priorities and needs are and what part of Maslow’s Hierarchy the person is struggling with, and therefore where we need to focus attention. Of course, I do not use the literal pyramid in discussions, but it guides my work. It guides lives and work everywhere, even if we do not know it. But for me, it is one of those things I often think about and consider during my time here in South Sudan.