Setting up mental health provision by building local capacity: the case of Nakivale : epidemiological and treatment outcomes
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Zusammenfassung
It is an indisputable fact that organized violence has steadily increased world wide in the decades following the World Wars 1 and 11. Over 100 wars are fought worldwide during any given year. Forced migration accompanies conflict, as people are displaced from their areas of origin by the different conflicts. While the over 34 million people who are in some way displaced clearly have physical, medical, nutritional, social and other pressing needs, it is becoming clear that often, their mental health needs are often just as urgent. Among the most common mental health challenges faced by survivors of organised violence are disorders of extreme stress. Much work has been done to quantify the prevalence of Post Traumatic Stress Disorder among diaspora refugee populations relocated to safety in western high-income countries. Little information is available however, about the prevalence of various mental disorders among refugees that relocate to a second low-income country neighbour to the conflict regions. This study set out to investigate the health and mental health status of Rwandese and Somali refugees relocated to a refugee camp in neighbouring Uganda in East Africa. Of special interest were the prevalence of PTSD and depression, as well as the predictors thereof across and within the two cultural groups. It is the moral responsibility of the able to provide interventions to effectively address mental health disorders in such populations, in this case Post Traumatic Stress Disorder. It is quite clear what interventions are effective in the treatment of Post Traumatic Stress Disorder. However, many such interventions have not been tested in low-income countries, nor have they been disseminated for use by trained lay people at lower cost and higher availability. This study aimed to assess the efficacy of Narrative Exposure Therapy as compared to Trauma Counselling and a waiting list control, and as carried out by trained lay refugee therapists. Lastly, this study investigated the efficacy of Narrative Exposure Therapy as applied to children, who constitute over 43% of the population of concern.
Zusammenfassung in einer weiteren Sprache
Nach den Weltkriegen I und II hat organisierte Gewalt weltweit zugenommen. Jährlich finden mehr als 100 Kriege und Auseinandersetzungen statt. Eine Folge von Konflikten ist auch, daß die Betroffenen in bezug von ihre Heimat entwurzelt werden. Mehr als 34 Millionen Menschen weltweit sind von ihrer Heimat entwurzelt worden aufgrund von Krieg. Es wird zunehmend deutlich, daß ihre psychischen Bedürfnisse genauso dringend zu beachten sind wie gesundheitliche, soziale und andere Bedürfnisse. Zu den Störungen, die als Folge belastender Erfahrungen auftreten können, gehören die Posttraumatische Belastungs-Störung (PTBS) und Depression. Viele Forscher konzentrieren sich auf Flüchtlinge, die in industrialisierte Länder immigriert sind. Weniger Befunde liegen für Opfer vor, die im Heimatland geblieben sind, beispielsweise in Afrika. Diese vorliegende Studie hatte zum Ziel, die physische und psychische Gesundheit bei Flüchlingen aus Rwanda und Somalia zu erfassen. Ein besonderes Augenmerk lag auf der Prävalenz von Posttraumatischer Belastungs-Störung und Depression. Unter ethischen Gesichtspunkten genügt es nicht, das Ausmaß psychischen Leidens zu erfassen, ohne darauf aufbauende Lösungsansätze zu entwickeln, wie beispieleweise Psychotherapie. Ohne Zweifel existieren wirkungsvolle Behandlungen für PTBS, jedoch ist das Behandlungsangebot in nichtindustrialisierten Länder in der Regel nicht ausreichend. Daher beschäftigt sich diese Studie zusätzlich mit der therapeutischen Ausbildung von Laien vor Ort, so daß diese sowohl Diagnostik als auch Therapie von PTBS und Depression beherrschen. Dieses Ausbildungskonzept ermöglicht Nachhaltigkeit, indem lokale Therapeuten die Verantwortung zur Behandlung der Betroffenen übernehmen. Solche Hilfe zur Selbsthilfe ist langfristig hilfreich und führt dazu, daß wertvolle Fähigkeiten in der Gesellschaft verankert werden. Fast die Hälfte (43%) der vertriebenen Bevölkerung besteht aus unter 18jährigen Kindern. Im Rahmen der vorliegenden Untersuchung wurde auch die besondere psychische Verletzlichkeit dieser Kinder festgestellt und infolgedessen eine Psychotherapie zur Behandlung von Kindern mit Narrativer Expositionstherapie durchgeführt.
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ONYUT, Patience Lamaro, 2005. Setting up mental health provision by building local capacity: the case of Nakivale : epidemiological and treatment outcomes [Dissertation]. Konstanz: University of KonstanzBibTex
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