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Uva-DARE (Digital Academic Repository) UvA-DARE (Digital Academic Repository) Wartime children's suffering and quests for therapy in northern Uganda Akello, G. Publication date 2010 Document Version Final published version Link to publication Citation for published version (APA): Akello, G. (2010). Wartime children's suffering and quests for therapy in northern Uganda. (African Studies Collection; No. 25). African Studies Centre. http://hdl.handle.net/1887/15604 General rights It is not permitted to download or to forward/distribute the text or part of it without the consent of the author(s) and/or copyright holder(s), other than for strictly personal, individual use, unless the work is under an open content license (like Creative Commons). Disclaimer/Complaints regulations If you believe that digital publication of certain material infringes any of your rights or (privacy) interests, please let the Library know, stating your reasons. In case of a legitimate complaint, the Library will make the material inaccessible and/or remove it from the website. Please Ask the Library: https://uba.uva.nl/en/contact, or a letter to: Library of the University of Amsterdam, Secretariat, Singel 425, 1012 WP Amsterdam, The Netherlands. You will be contacted as soon as possible. UvA-DARE is a service provided by the library of the University of Amsterdam (https://dare.uva.nl) Download date:01 Oct 2021 Wartime children’s suffering and quests for therapy in northern Uganda African Studies Centre African Studies Collection, vol. 25 Wartime children’s suffering and quests for therapy in northern Uganda Grace Akello Published by: African Studies Centre P.O. Box 9555 2300 RB Leiden The Netherlands [email protected] www.ascleiden.nl Cover design: Heike Slingerland Cover illustration: Detail of drawing by one of the studied children Printed by Ipskamp Drukkers, Enschede ISSN: 1876-018X ISBN: 978-90-5448-095-2 © Grace Akello, 2010 Contents Tables and boxes ix Maps, illustrations and photographs x Abbreviations xi Acknowledgements xii Prologue xiv PART I RESEARCH PROBLEM, THEORETICAL APPROACH AND RESEARCH METHODS 1 1 CONTEXT AND FOCUS OF THE STUDY 3 The war in northern Uganda 4 Conflicting roles played by the state in its attempts to pacify northern Uganda 6 Uncertainty about the end of hostilities 10 Enormous state expenditures in defence budgets 12 Wartime people’s vulnerability and exposure to health dangers 16 Focus of the study 18 2 METHODOLOGY 21 Theoretical approach 21 Research methods 32 Ethical considerations 41 My personal involvement in the study 42 PART II MICRO-LEVEL SETTING IN WHICH WARTIME CHILDREN LIVED 45 3 SOCIAL LIVES OF PRIMARY SCHOOL AGE CHILDREN IN GULU MUNICIPALITY 47 Night commuters’ shelters 48 Displaced primary schools 52 Churches 59 Wartime children in informal settings 61 Conclusion 69 v PART III CHILDREN’S SUFFERING AND QUESTS FOR THERAPY 73 4 SURVEY DATA FROM ASSESSMENT OF COMMON ILLNESS EXPERIENCES AND QUESTS FOR THERAPY 75 General characteristics of respondents 75 Prevalence of children’s illness experiences 76 How children knew they were ill 79 Medicines used in the management of common health complaints 80 Herbal medicines used by children 85 5 MALARIA 87 Quantitative data: Prevalence of and medicine use for episodes of malaria from children’s perspectives 88 Qualitative data: Prevalence, symptoms, severity and management of malaria 89 Discussion of results: Prevalence and management of malaria 94 Conclusion 98 6 DIARRHOEA 100 Quantitative data: Prevalence and medicine use for episodes of diarrhoea 100 Qualitative data: Prevalence, symptoms, severity and prevention of diarrhoeal diseases 102 Intermittent episodes of cholera: Children’s perspectives concerning a severe form of diarrhoea 107 Discussion: Prevalence and management of diarrhoea 110 Conclusion 115 7 RESPIRATORY TRACT INFECTIONS 116 Quantitative data: Prevalence and treatment of acute respiratory infections 117 Qualitative data: Prevalence, symptoms and management of respiratory tract infections 118 Discussion: Prevalence and management of ARIs 126 Wider socio-economic conditions linked to increased prevalence of tuberculosis 129 Conclusion 130 8 SCABIES 131 Quantitative data: Prevalence and management of scabies 132 Qualitative data: Prevalence, symptoms and management of scabies 133 Discussion: Prevalence and management of scabies 137 Conclusion 140 vi 9 EYE INFECTIONS 141 Quantitative data: Prevalence and management of eye infections 141 Qualitative data: Prevalence, symptoms and management of eye infections from children’s perspectives 142 Discussion: Prevalence and management of eye infections 144 Conclusion 146 10 WOUNDS, INJURIES AND EPILEPSY 148 Quantitative findings: Prevalence and management 148 Qualitative findings: Prevalence, severity and quests for therapy 150 Discussion: Quests for therapy in the context of uncertainty 157 Conclusion 161 11 COMPLAINTS SYMPTOMATIC OF EMOTIONAL DISTRESS 162 Quantitative data: Common forms of complaints possibly symptomatic of emotional problems and quests for therapy 163 Qualitative data: Emotional distress and quests for therapy x164 Discussion: Chronicity of emotional distress 175 Conclusion 178 PART IV REFLECTIONS AND CONCLUDING REMARKS 181 12 SILENCING DISTRESSED CHILDREN IN THE CONTEXT OF WAR: AN ANALYSIS OF ITS CAUSES AND HEALTH CONSEQUENCES 183 Children’s suffering and critique of public expressions of emotional distress 184 Silencing children taking care of sick close kin and suffering effects of sexual violence 187 Indigenous and religious healers’ perspectives on expressions of emotional suffering 191 Discussion 193 Conclusion 197 13 AN EVALUATION OF HEALTHCARE SERVICES’ PROVISION IN RELATION TO CHILDREN’S PERSPECTIVES 199 State and humanitarian agencies’ service provision 200 An effort to bridge the gap between NGO activities and children’s needs 204 Evaluating the impact of state and NGO provision of healthcare services 211 Conclusion 214 vii 14 CONCLUDING REMARKS 216 Commonness of infectious diseases 216 Children’s focus on curative approaches in the management of infectious illnesses and emotional distress 217 Policy and intervention agencies’ approaches in healthcare 223 Epistemological issues 225 Reflections on theoretical and methodological approaches 229 Appendices 235 References 239 viii Tables and boxes Tables 4.1 Study sample characteristics 75 4.2 Illness experiences or health complaints 76 4.3 Coding of illness experiences (or health complaints) 78 4.4 Illnesses as ultimately coded 78 4.5 Symptoms of illnesses 79 4.6 Medicines commonly used by children 80 4.7 Coding of medicines used by children 82 4.8 Medicines used by children as ultimately coded 82 4.9 Sources of medicines used by children 84 4.10 Herbal medicines used by children 85 5.1 Prevalence of malaria 88 5.2 Medicines used in the management of malaria 88 6.1 Prevalence of diarrhoea(s) 101 6.2 Medicines used in the treatment of diarrhoea 101 6.3 Herbal medicines used in the treatment of diarrhoea 101 7.1 Prevalence of acute respiratory infections 117 7.2 Medicines used in the treatment of acute respiratory infections 117 7.3 Herbal medicines used for cough 118 8.1 Prevalence of scabies 132 8.2 Medicines used in the treatment of scabies 132 8.3 Herbal medicines used in the treatment of scabies 133 9.1 Prevalence of eye infections 142 9.2 Medicines used in the management of eye infections 142 10.1 Prevalence of wounds, injuries, epilepsy and snakebites 149 10.2 Medicines used in the management of wounds, injuries, epilepsy and snakebites 150 11.1 Prevalence of complaints possibly symptomatic of emotional distress 163 11.2 Medicines used in the management of complaints possibly symptomatic of emotional distress 164 Boxes 3.1 Description of Noah’s Ark 50 3.2 Structure of a displaced primary school 54 ix Maps, illustrations and photographs Maps 1 Map of Uganda showing districts of Gulu, Kitgum and Pader xvi 2 Gulu District with its ‘protected’ villages 70 Illustrations 1 LRA activities in abducting children 71 2 UPDF activities in ‘protecting’ children in displaced persons camps 71 3 Common illnesses experienced in a one-month recall 180 4 Common medicines used in a one-month recall 180 Photographs 1 A ‘protected’ village in 2006 72 2 The plant atika (Labiate species) 179 x Abbreviations ADF Allied Democratic Forces AMREF Africa Medical Research Foundation AVSI The International Service Volunteers’ Association CMR Crude Mortality Rate CSOPNU Civil Society Organisation for Peace in Northern Uganda DDHS District Directorate of Health Services DHO District Health Officer HIV/AIDS Human Immuno-deficiency Syndrome/Acquired Immuno- deficiency Syndrome ICRC International Committee of the Red Cross IOM International Organisation for Migration IDP(s) Internally Displaced Person(s) GRRH Gulu Regional Referral Hospital GUSCO Gulu Support the Children’s Organisation HURIFO Human Rights Focus JCCMC Joint Country Coordination and Monitoring Committee LRA Lord’s Resistance Army MOH Ministry of Health MSF Médicins sans Frontières [Medicines without borders] NGO(s) Non-Governmental Organisation(s) NRA National Resistance Army NRC Norwegian Refugee Council NURP Northern Uganda Rehabilitation Programme NUSAF Northern Uganda Social Action Fund RDC Resident District Commissioner SCiU(G) Save the Children in Uganda UN United Nations UNICEF United Nations Children’s Fund UNOCHA United Nations Office for the Coordination of Humanitarian Affairs UPDA Uganda Peoples’ Defence Army UPDF Uganda People’s Defence Force WFP World Food Programme WHO World Health Organisation WVCFAC World Vision Centre
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