Location: Kampala, Uganda
This week, our School of Public Health lessons revolved around the subject of mental health in Uganda. By far, the most interesting lecture we received was on the subject of post traumatic stress disorder in former Ugandan child solders. As we learned, the forces of Joseph Kony’s rebellion movement, the Lord’s Resistance Army (LRA), have brought utter chaos and destruction to the region of northern Uganda. Over a period of roughly two decades, the LRA acted with what seemed to be a complete disregard for human life in its effort to overcome the Ugandan military. As explained by Derluyn, Broekaert, Schuyten, and De Temmerman (2004), this conflict had a significant impact on the lives of all the inhabitants of northern Uganda: “Tens of thousands of people have been killed and mutilated, hundreds of thousands displaced, and farming activities and livestock have been totally disrupted” (p. 861).
Though few in northern Uganda were left untouched by the hands of the LRA, perhaps the most detrimentally effected were the child soldiers used to fuel Kony’s campaign of terror; with more than 20,000 youths abducted to date, children comprise roughly 90% of all LRA recruits (Derluyen et. al 861).
Although a great deal of stability has come to northern Uganda in recent years, the conflict lives on in the minds of these child soldiers. Subject to sexual exploitation and abuse and forced to engage in the rape and murder of their loved ones, those children abducted by the LRA are at a monumental risk of developing a multitude of psychiatric disorders (Okello, Onen, and Musisi 225-226). Among the most common and problematic of the psychiatric disorders developed by these youths is posttraumatic stress disorder (PTSD). Defined as “an emotional illness that usually develops as a result of a terribly frightening, life-threatening, or otherwise highly unsafe experience”, those living with PTSD may find it extremely difficult to adjust to life after war (Muhwezi slide 24). In general, PTSD symptoms are grouped into three categories: intrusive memories, avoidance and numbing, and increased anxiety or emotional arousal.
Intrusive memories, or “recurrent re-experiencing” of trauma, represent one of the most troublesome symptoms of PTSD (Muhwezi slide 25). Constantly burdened with the images and sounds of acts that they witnessed and committed during wartime, former Ugandan child soldiers often experience great struggles in their efforts to look toward a new, peaceful future. In a Lancet article entitled “Post-traumatic stress in former Ugandan child soldiers”, Ilse Derluyen and colleagues outline the true prevalence of the intrusive memories symptom in LRA abductees. Out of a total of 71 respondents who completed the impact of event scale-revised (IES-R)—a self-report scale for PTSD— the mean score for the intrusion symptom was found to be 18.2 out of a maximum score of 28 (Derluyen et. al 862). Given their additional findings on the events witnessed by many child soldiers during periods of conflict, this high occurrence of intrusion may come as no surprise; Out of a sample of 301 former child soldiers, 77% had seen someone being killed during their abduction, 6% saw a member of their immediate family being killed, 39% had to kill another person themselves, and 2% had to kill an immediate family member (Derluyen et. al 861). As many former Ugandan child soldiers have had their social support networks disrupted by the very events that caused their PTSD, policy makers in the Ugandan government and humanitarian organizations must continue with their efforts to support a healing process so that former LRA abductees may cope with their painful intrusive memories in a healthy fashion (Muhwezi slide 31).
Thought the symptoms of posttraumatic stress disorder are indeed serious, a great deal of hope exists for former Ugandan child soldiers living with PTSD. One of the most effective tools in overcoming this devastating mental ailment is psychotherapy; by speaking with former child soldiers about their experiences as members of the LRA, mental health professionals can provide them with an outlet for emotions and memories that would otherwise go unexpressed. Additionally, further efforts are necessary to combat the stigmatization of child soldiers in those communities that have been devastated by the LRA. Though it may be difficult for many individuals in northern Uganda to greet the very child soldiers who killed their loved ones with open arms, the Ugandan government and the international community must work to spread awareness that these children were indeed forced to comply with Joseph Kony’s agenda.
References:
Derluyn, I., Broekaert, E., Schuyten, G., & De Temmerman, E. (2004) Post-traumatic stress in former Ugandan child soldiers, Lancet; 363: 861–63
Muhwezi, Wilson W. "Traumatization [Post Traumatic Stress Disorder – PTSD]
in Uganda." Introduction to Public Health: Module 4. Makerere University, Kampala, Uganda. 27 May. 2010. Lecture.
Okello, J., Onen, T, S., & Musisi, S. (2007). Psychiatric disorders among war-abducted and non-abducted adolescents in Gulu district, Uganda: a comparative study. African Journal of Psychiatry. 10:225-231
Showing posts with label mental health. Show all posts
Showing posts with label mental health. Show all posts
Friday, May 28, 2010
Thursday, April 29, 2010
Week 4 - Good things come to those who wait
This week I had what I would call my first real run-in with "Uganda Time." I arranged to accompany a team from Butabika National Mental Referral Hospital on an outreach activity. I knew that I wouldn't be able to make it to Butabika in enough time to leave with the group to the outreach location, so I figured that I would meet them at the site. Centurio was gracious enough to accompany me so that I didn't get lost. We made it all the way to Old Park (a crazy-busy parking lot full of mutatus going all over Kampala) before figuring out that it would be easier for me to get picked up by the team half-way to the site.
So Centurio figured out how to get me to Ntinda, where the group from Butabika would meet me, and left me there to wait for their arrival. At this point, I called my contact from the outreach program, and it sounded like she said they were waiting for a driver. Now Butabika is on the far eastern side of Kampala, so I had a feeling that I would be waiting for awhile. Sure enough I stood in the sun in Ntinda for about an hour and a half before the Butabika truck pulled up and I jumped in the front seat. (They picked me up about two hours after the time that the outreach event was originally planned to begin.)
The outreach experience was definitely worth the wait, though. I went with the outreach director, two psychiatric nurses, and a psychiatric clinical officer to a health center in the northern part of Kampala. The health center was located within a school complex that was associated with an orphanage. When we pulled up, there was a small room full of people waiting to meet with the clinical officer. While the outreach director went to resettle a rehabilitated patient in his home, I sat in as the clinical officer interviewed patients briefly and updated their prescriptions.
Once again, I was alarmed by the amount of access I had to the patients' personal information. The clinical officer conducted the meetings in Luganda, but often he turned to me and explained what was happening in English. Through his comments and those of the health center nurse, I learned that many of the patients who came to the outreach event suffered from epilepsy.
Before coming to Uganda, I knew that epilepsy was often treated as psychiatric illness, even though it is treated more strictly as a neurological disorder in the United States. Thus, it struck me as odd that epilepsy would be categorized as a psychiatric issue. I learned, however, that epilepsy in Uganda affects many children, and psychiatric complications often accompany seizures. Because of these psychiatric complications, epilepsy is treated with other mental illnesses. There was also a mention of the tie between epilepsy and malaria, which is something I would like to investigate a little bit more.
The story of a young girl attending the outreach event for the first time provided the most striking example of psychiatric complications related to epilepsy. The health center nurse and adoptive mother of this child described how this girl would hallucinate during her epileptic episodes. As a result, the child would try to run away, jump from high places, and become violent. The mother thought that her daughter was possessed or cursed. When the girl was not having an episode, she was very calm and well-mannered. Luckily, someone convinced the mother to bring her child to an outreach event, and the young girl received medication for her condition for the very first time during my visit.
Overall, I learned a great deal about different conditions that affect people in Uganda and the way that illnesses are categorized differently depending on the manifestations of symptoms. As a result of my visit, I am thinking about working with the outreach team from Butabika or another group on a presentation that would raise awareness about epilepsy. Without an understanding of epilepsy, patients and their caregivers may be confused and not seek medical support as early as they could. Furthermore, stigma is often attached to anyone who suffers from a mental illness, and this need not be the case with sensitization.
I'm sure that Butabika and the health center do a great deal to educate the public about epilepsy and other conditions. Because we were running late on the day that I accompanied the outreach team, I was not able to view the presentation that the group normally gives in the community before personally meeting with patients. I look forward to learning more about the outreach program and epilepsy in Uganda in the coming weeks. My experience with the outreach team was certainly worth the two-hour wait in the sun.
Location: Kampala, Uganda
So Centurio figured out how to get me to Ntinda, where the group from Butabika would meet me, and left me there to wait for their arrival. At this point, I called my contact from the outreach program, and it sounded like she said they were waiting for a driver. Now Butabika is on the far eastern side of Kampala, so I had a feeling that I would be waiting for awhile. Sure enough I stood in the sun in Ntinda for about an hour and a half before the Butabika truck pulled up and I jumped in the front seat. (They picked me up about two hours after the time that the outreach event was originally planned to begin.)
The outreach experience was definitely worth the wait, though. I went with the outreach director, two psychiatric nurses, and a psychiatric clinical officer to a health center in the northern part of Kampala. The health center was located within a school complex that was associated with an orphanage. When we pulled up, there was a small room full of people waiting to meet with the clinical officer. While the outreach director went to resettle a rehabilitated patient in his home, I sat in as the clinical officer interviewed patients briefly and updated their prescriptions.
Once again, I was alarmed by the amount of access I had to the patients' personal information. The clinical officer conducted the meetings in Luganda, but often he turned to me and explained what was happening in English. Through his comments and those of the health center nurse, I learned that many of the patients who came to the outreach event suffered from epilepsy.
Before coming to Uganda, I knew that epilepsy was often treated as psychiatric illness, even though it is treated more strictly as a neurological disorder in the United States. Thus, it struck me as odd that epilepsy would be categorized as a psychiatric issue. I learned, however, that epilepsy in Uganda affects many children, and psychiatric complications often accompany seizures. Because of these psychiatric complications, epilepsy is treated with other mental illnesses. There was also a mention of the tie between epilepsy and malaria, which is something I would like to investigate a little bit more.
The story of a young girl attending the outreach event for the first time provided the most striking example of psychiatric complications related to epilepsy. The health center nurse and adoptive mother of this child described how this girl would hallucinate during her epileptic episodes. As a result, the child would try to run away, jump from high places, and become violent. The mother thought that her daughter was possessed or cursed. When the girl was not having an episode, she was very calm and well-mannered. Luckily, someone convinced the mother to bring her child to an outreach event, and the young girl received medication for her condition for the very first time during my visit.
Overall, I learned a great deal about different conditions that affect people in Uganda and the way that illnesses are categorized differently depending on the manifestations of symptoms. As a result of my visit, I am thinking about working with the outreach team from Butabika or another group on a presentation that would raise awareness about epilepsy. Without an understanding of epilepsy, patients and their caregivers may be confused and not seek medical support as early as they could. Furthermore, stigma is often attached to anyone who suffers from a mental illness, and this need not be the case with sensitization.
I'm sure that Butabika and the health center do a great deal to educate the public about epilepsy and other conditions. Because we were running late on the day that I accompanied the outreach team, I was not able to view the presentation that the group normally gives in the community before personally meeting with patients. I look forward to learning more about the outreach program and epilepsy in Uganda in the coming weeks. My experience with the outreach team was certainly worth the two-hour wait in the sun.
Location: Kampala, Uganda
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