{UAH} IDDI AMIN NEVER TARGETED LANGIs/ACHOLIs, THEY TARGETED HIM {---Series two-Hundred and five}

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"the conflict is also bringing mental illness as a result of bad acts. For example you can sit only to be told that a relative of yours has been killed. This could be your child whom you love most. Then you can think too much and this leads to mental illness". Respondents also noted the effect on the mental health of people who may have been forced to commit the atrocities. A man from Amuru camp noted that "people were abducted and taken to the bush. They did a lot of dirty things and even killed so they came back when their brains were not OK".

This is a statement from an Acholi describing fellow Acholi, we need to worry about  their numbers and how they will fit into the rest of society after Museveni government leaves office and they become adults. If an Acholi states that the brains are not okay, you better understand that you are neglecting this violence at your very own peril.  Bayard Roberts^1*, Vicky Norah Odong², John Browne³, Kaducu Felix Ocaka⁴, Wenzel Geissler¹ and Egbert Sondorp¹ Wrote a thesis entitled An exploration of social determinants of health amongst internally displaced persons in northern Uganda. It was published by Conflict and Health.

Ugandans we need to discuss Acholi violence candidly.

Determinants of health

Traumatic events

Respondents noted the health effects of violent and traumatic events experienced during the war and displacement. The specific traumatic events mentioned commonly included abductions, killing, torture, atrocities and rape. Seventeen out of 21 respondents noted how these traumatic events caused "over thinking" (multiple thoughts, feeling that the mind isn't working properly, obsessive thinking). "Over thinking" appears to stand on the pathway from traumatic experiences and suffering to poor mental health and ultimately to severe mental disorders ("madness"). One man in Adak camp noted how:

"the conflict is also bringing mental illness as a result of bad acts. For example you can sit only to be told that a relative of yours has been killed. This could be your child whom you love most. Then you can think too much and this leads to mental illness".

Respondents also noted the effect on the mental health of people who may have been forced to commit the atrocities. A man from Amuru camp noted that "people were abducted and taken to the bush. They did a lot of dirty things and even killed so they came back when their brains were not OK".

Seven respondents linked the violence and killings in the war and resulting "over thinking" with traditional beliefs for the causes of poor health, particularly mental health. According to Acholi beliefs, the spirit (cen) of a killed person might return to disturb its killer, and respondents noted that killing people could result in "ghosts", "charms" and the "spirit of the dead" which bring on "madness". A 35 year old man in Ongako camp noted how "the blood [remo] of the people killed will lead to mental disorder of the person who killed. This has always been a belief in our culture".

Four respondents noted how "over thinking" from traumatic events reduced physical strength and energy. A woman in Omel Lapem camp noted how "the anger of losing all the children is breaking my energy all the more. I no longer have any energy of going to work". One respondent noted that "when I start thinking hard, it brings me body pain".

Respondents also commented on the importance of ending the violence, and how "if the war ends, the over thinking that causes madness and the bad killings that result into madness will not be there". However, this was tempered by concern over an enforced return process by the government without adequate security and protection. A woman in Anaka camp noted:

"They talk of taking people back home. If they take us without soldiers won't Kony [the LRA's leader] sweep all our children away?...When I know death is waiting, abductions is also waiting, there is war, I cannot have any happiness only sadness...I don't have any peace because there is still war".

Overcrowding

Almost all respondents commented on the overcrowded nature of the camps and this led to disease and poor physical health. Most frequently cited characteristics were "overcrowding", being "packed" and "packing together", "dirty water", "dirty places", and "dirtiness". These characteristics caused general "sickness", "cholera", and "measles". A man in Amuru camp noted how diarrhoea "can spread very quickly and it has killed very many because people are too packed". A woman from Te-Tugu Camp felt that:

"People should be taken back home so that there is fresh air because houses are spaced. People are too packed here. Somebody coughs from one corner, another from the other corner, and there is increased sickness".

Seven respondents expressed the problems of overcrowding with an emotional feeling of lacking freedom. One respondent noted how "the houses are very packed. You can't get freedom". Another respondent noted how "people should be allowed to return to their villages, be free and enjoy fresh air". A respondent from Ongako camp felt that "in the village there was no over thinking but now people are gathered together so this brings headache, over thinking and mental disorder".

Poverty

17 respondents commented on how the war and displacement to the camps had increased poverty and how this had affected their emotional and mental health. This was commonly expressed by participants in terms of lack of money or income, lack of housing, and ability to adequately provide for their children. A 50 year old man from Omel Lopem camp noted:

"Mental disorders can come as a result of too many thoughts about poverty. What you used to do and things you used to see and have are not there. If you think deeply about them, you can develop mental illness".

Seven respondents noted how their mental health was affected because the impoverishment meant they could no longer meet the needs of their children. A woman from Bobi camp said:

"Life in the camp is very difficult. What we can eat that can be enough for me and my children is not there. I cannot buy clothes for the children. It touches me so much in my brain and wants to develop mental illness in me".

The effect of poverty on the ability to care for children and payment of school fees was noted. A respondent from Amuru camp noted that "there is an old man who got mad. He tried to pay his son at school in vain due to lack of money...The old man got mad due to poverty and he could see his child not going to school".

Respondents viewed the lack of access to "lands" and "gardens" and having "nowhere to dig" as the main cause of impoverishment. This in turn affected mental health. A man in Bobi camp commented:

"Given this kind of life, over thinking about how you should live can also result to madness. There is nothing you can do to bring money to your land. You keep planning for what you cannot get. This can finally lead to madness".

A man from Opit camp noted that "I feel thoughts have filled my head. I have nowhere to dig. The money I used to get from home is all lost. I am now a poor man". The cyclical effect of poor health on ability to work was noted by respondents. One respondent in Anaka camp noted that "we are really over thinking. This affects my work".

Seven respondents commented on impoverishment affecting their physical energy and strength, causing weakness and bodily pain. A respondent noted how "here there is no means of getting money, food and nowhere to dig. The strength I had those days is no longer there". Three respondents noted the lack of money to travel to obtain medicines and access medical care. The combined effects of displacement, poverty and loss of vitality were noted by respondents. A 45 year old woman in Omel Lapem camp described how "I have now moved in two different camps, even if you were hard working you will get weak. I don't have any energy now".

Respondents again noted the importance of being allowed to return home for improving their health. A woman in Adak camp also felt:

"If this war ends, mental cases will be reduced and there will be general improvement on health. Because you go back home, you will stay there and resume your work as you used to do. This will reduce on madness because right now poverty can also lead to madness".

The war and displacement meant people could no longer access their lands and so had lost their source of food and income, and were reliant on food aid. Over half of respondents noted how the lack of food was causing physical health problems, particularly in terms of "energy" and "strength". One respondent from Ongako camp commented how "my energy has gone down because there is nothing I can eat to give me energy to do work... We shall never have strength to do work and we shall remain weak". Food insecurity was also linked with poor mental health by seven respondents. A 47 year old woman in Ongako camp noted the effect of impoverishment, lack of access to land and food upon her health:

"I feel sick all the time with pain. I cannot get food. That's how it is in the camp. There is no means of getting money, food and nowhere to dig. The strength I had those days is no longer there".

Changes in social norms

The effect of war, displacement, impoverishment and living conditions in the camps also led respondents to comment on the changes in social and cultural norms and standards, and how this was affecting their well-being. Respondents noted that living in the camps had increased activities such as "prostitution", "adultery", "defilement", and "thieving", particularly amongst young people and children. This caused "unhappiness" and "anger" amongst the respondents. One respondent noted how "we even share bedrooms with the children which bring shame". A 50 year old man from Omel Lopem camp noted that:

"Today you train your child, and the child of the neighbour comes and spoils it all. Formerly people lived on various different hill sides with different cultures and different teaching".

Five respondents noted alcohol consumption as contributing to poor mental health. Excessive drinking was viewed by some respondents as on the pathway between "over-thinking" and "madness". One respondent noted that "if you fail to control deep thinking and you resort to drunkenness, it can lead to mental illness".

Response strategies

The response strategies used by IDPs to support their health needs are described below.

Biopsychosocial health services and traditional local practices

Nineteen of the respondents noted the use of biopsychosocial (biomedical and psychosocial) health services for their health needs. These services included health centres, hospitals, and health workers. Twelve respondents mentioned biopsychosocial services as sources of support for emotional or mental health problems, and three of these noted the value of community-based counsellors as a source of support before seeking help at the hospital.

Respondents also noted the use of traditional local practices as a response for physical and particularly mental health needs. These included the use of traditional healers, rituals, and traditional medicines. Five respondents noted the use of traditional healers, often in combination with biopsychosocial health services, for emotional or mental health needs. A man in Ongako camp noted that "I take the victim [of mental illness] to the hospital. If the hospital fails I will follow our culture and go to the witch doctor to find out the root cause of the problem". Respondents also noted the use of religion alongside traditional practices and biopsychosocial health services. A woman in Anaka camp preferred to "pray first...and then go to the witchdoctors to find out what has brought the madness. You can then finally try counsellors or health workers". A man from Pabbo camp felt that if someone is suffering from physical sickness, "you can go to a witch doctor. and also be saved in a born again church and God will help you if he so wish. You can also take the person to hospital and the treatment can reduce it.

Religion

Nine respondents noted the importance of Christian faith in consoling them and providing support, with specific activities including attending church, prayer and reading the bible. A woman in Amuru camp noted:

"I have a lot of anger but the reason I give up taking my life is when I go to the church and the bible consoles me. Then I give up as everything is worldly. We don't deal with hospital. We only depend on prayer".

However, a woman from Acet camp rejected religion, stating that "I have given up religion. It doesn't help me. After all, my children are all dead".

Family and friends

Ten of the respondents noted the value of seeking emotional support from family or friends. An 18 year old woman from Pawel camp noted:

"You go to friends and tell them and they advise you against thinking too much because it can result to sickness. I tell my husband that my brain is not working well or that I have pain which is giving me thoughts".

Three respondents noted the support provided simply by having company, rather than discussing specific painful issues. A 24 year old woman noted that "when I'm thinking too much I go to my friends and have other stories. I have never told anybody about the problem of over thinking that I have now". A woman in Amuru camp noted that "if you are over thinking and you try to involve somebody, the person may instead worsen it".

Isolating

Three respondents felt that not mixing with other people or "isolating" was their preferred response to emotional or mental health problems. These were all older women. A 45 year old woman from Te-Tugu Camp said "I isolate because of over thinking when I feel pain in my heart". A 60 year old woman from Acet camp noted that "when I have much thought, I isolate myself and sit in my house and sleep...I handle it alone".

Discussion

Research on social determinants of overall health amongst forcibly displaced populations is at a nascent stage, particularly for IDPs. This study provides new evidence on social determinants of overall health of IDPs using evidence from northern Uganda. Work looking at specific mental health outcomes of conflict-affected populations has highlighted the influence of political, environmental, economic, and socio-cultural determinants and the underlying pervasive influence of conflict and displacement on these determinants [33-36]. The findings from this study in Uganda will now be discussed within these broader classifications of determinants, drawing on relevant literature on IDPs in northern Uganda and other forcibly displaced populations in low-income settings.

Political determinants

IDPs are often subject to prolonged exposure to politically-induced collective violence as they often experience much greater insecurity than refugees. Much of the collective violence in northern Uganda has taken place against IDPs living in the camps [5,26]. The respondents were thus living in situations in which mental and physical distress was caused not only by past experiences but also the fear of continuing and future violence. This study provides new evidence on how IDPs in northern Uganda describe the effect of this violence on their mental health. Over three quarters of respondents discussed the effect of collective violence and traumatic events on "over thinking" which could lead to "madness". In the Acholi socio-cultural context "over thinking" can refer to the way in which stressful circumstances cause constant worrying, multiple or obsessive thoughts, difficulty in identifying a clear solution, and a feeling that the mind isn't working properly and is "stuck". The term relates to Acholi terms such as par and two tam which incorporate stress and depression-like symptoms and have been described in detail elsewhere [37]. Studies with other displaced populations have also noted use of the term "over thinking" as a description of poor mental health. Astier Almedom notes how Eritrean IDPs spoke of too much thinking [14]. Elizabeth Marie Coker noted in her study of Sudanese refugees in Cairo how respondents referred to "thinking too much" on their current conditions and past events which in turn "fuelled" their physical illness [38]. "Over thinking" was also referred to by study respondents as an outcome relating to other determinants, particularly economic determinants, and this is discussed further below.

"Madness" was attributed by some study respondents to the "spirits" and "ghosts" (cen) of people killed. The strong belief in cen is consistent with beliefs of other Luo-speaking peoples [39], but Harlacher et al note how in the context and aftermath of the war in northern Uganda, the vengeful ghosts of those who had died a violent death has become the most widespread interpretation of mental illness amongst those who committed violent acts or event witnessed such acts [40].

The study also provides new information on how the "over thinking" from political violence in northern Uganda has also affected IDPs physical health in terms of "energy", "strength" and "body pain". The connection between trauma and physical suffering was also observed in a study by Tina Sideris of Mozambican women refugees in which respondents reported how the traumatic effects of war and displacement caused physical deterioration, bodily distress, and loss of vitality [41].

 

Stay in the forum for Series two hundred and six on the way   ------>

EM

On the 49^th Parallel          

                 Thé Mulindwas Communication Group
"With Yoweri Museveni, Ssabassajja and Dr. Kiiza Besigye, Uganda is in anarchy"
                    Kuungana Mulindwa Mawasiliano Kikundi
"Pamoja na Yoweri Museveni, Ssabassajja na Dk. Kiiza Besigye, Uganda ni katika machafuko"