Undercover: On the street for four days with beggars

I stayed with street children to uncover what the eye does not see when you drive by on Kampala streets. Do these women own the children who beg? Who keeps the money? Or is there a bigger racket behind it all?

I HIT the streets at 5:00 am, Thursday August 2 to uncover the truth behind the children who beg on the streets of Kampala.

We always see women with many children, usually seated in one place and seemingly controlling a network of children who beg and hand over the harvest. But are they genuine beggars?

Are they incapable of earning their own living? Are all the children theirs? What kind of life do they lead? In short, are they pitiable or should they be rounded off?

MORNING MISSION

I reach my first destination, Uganda House, at 5:45am and position myself at one of the Pioneer bus stages. There are neither street children nor their ‘mothers’ begging on the streets yet. This is my chance to watch their arrival.

Time goes by; 6:45am, 7:45am, 8:45am, 9:45am, 10:45am and there is still no sign of street women or children. I move to the nearby Nandos for breakfast and I take a strategic location, but still no sign of the women.

THE BEGGING STRATEGIES

It is not until about 11:30am when I see a boy in a dirty blue T-shirt and black shorts, bare feet, begging alone. Ten minutes later, a girl in a dirty purple dress, also bare feet, appears.

The two have something in common: they have  money bags, hanging on their necks by a string and covered by the cloths they are wearing.

Each coin they receive is dropped in that bag. It is 12:10pm, four street women carrying babies on their backs and about fi ve others of about four to seven years arrive.

The women place their children, of two to three years, at a measurable distance from each other to beg, while seated.

Immediately the woman leaves, the child starts begging in a seemingly trained manner. With a titled pitiable head and sorry face, they extend a hand, expecting a sympathetic person to give.

Whoever receives something brings it victoriously to the ‘mother’, who sits at a strategic place to monitor them. The older ones follow passers- by, moving after them stubbornly for some distance, asking with a merciful face for some money.

They genuflect, display distress, signal hunger, sometimes thirst, call on ‘uncle’ or ‘aunt’, until a person yields. The older children keep all the money collected in their moneybag.

Occasionally, the ‘mothers’ move around, giving extra instructions and the children obey diligently. Sometimes, the mother is pointing out a potential ‘donor’ and other times she is not happy with the child’s act. Other times, the women sit under a small tree as they chat and laugh, but keeping a watchful eye on the children. 

DAY TWO

It is Friday August 3. This time, I arrive at 8:00am at the Electoral Commission, and I am not late. The women and children street beggars begin arriving at around 11:15am.

This time, children are first and they come one by one. Some come from the direction of the city centre, others from the side of Namuwongo while the rest are strolling in from the side of Garden City.

Unlike the ones I met yesterday, these seem to have masterde city roads because they cross unaided. The women, too, are begging. Dressed in a black and green checkered Karimojong skirt, with a dirty blue shirt, one of the women carries a baby on her back and uses it to generate sympathy. But the beggars here are not as lucky as those at Uganda House because this spot has a few pedestrians.

At about 3:30pm, a baby defecates by the roadside and the mother uses a piece of paper to remove the feaces, and ties the paper in a white polythene bag. She drops it by the roadside, where no one can step on it.

By 4:00pm, the traffic has increased and that is their harvest time, till 8:30pm, when they return home. Again, I follow stealthily, until Nalubwama Arcade on Ben Kiwanuka Street.

I find so many of the beggars already gathered here, chatting heartily, with happiness like one big family. I return very early the next day to start the day with them.

They say aunt, not mother

STILL AT UGANDA HOUSE ON DAY ONE  

Not many people give money. One girl, of about two years, who had not got anything for about two hours, suddenly receives a sh500 coin.

She runs, with a beaming smile to the woman under a tree to handover the money. “Aunt, aunt, kikumi kikumi,” she says as she approaches the woman. The child’s calling her aunt sends me thinking whether she is actually her mother.

The ‘aunt’ smiles, says nothing, but keeps the money and tells the child to hurry back to the station. At one time, the children started playing, but that did not last long because the ‘aunts’ sent them back to their station. The girl who had brought the sh500 coin boldly refuses, but is dragged back into duty.

The ‘aunt’ then checks on all the older children, gathering the money they had so far collected. She puts it in her bag and resumes her sentry position. At about 4:30pm, something happens, that raises lots of questions. A woman, dressed in a red top and black jeans comes along, with soda in a plastic bottle and two disposable glasses.

These children are so happy to see her and gather around her, shouting ‘aunt, aunt’. They dance around her, jubilating. She distributes the soda to the three children and gives each of them Bogoya.

While the rest drink the soda happily, the young girl (of sh500) takes her soda to their ‘aunt’ who are seated under a tree. The women have a fi ve-litre yellow jerrycan in a green polythene bag, from which they have been drinking. They do not have cups, so they drink directly from it. They take her soda and give her the jerrycan to drink from.

It is 5:00pm. People are returning home and this, apparently, is their harvest time. Many give money and some food, even left-overs. It is mostly the pedestrians and people in taxis who give. Those in private cars close their car windows or look away when the children approach.

Time check is 7:30 pm. Women announce it is time to leave. They gather the children and leave with them. I follow from a distance up to Owino Market, till it becomes too dangerous for me to follow as they head towards Kisenyi.

717,970 Ugandans have kidney disease!!! How healthy is your kidney?

Kidneys are very important to our body as they control a variety of metabolic processes. Kidney has many other important functions to perform in the body which includes flush of the waste materials from the body and controlling blood pressure.

When the kidneys of a person are not functioning properly our body is more prone and more vulnerable and to numerous problems and diseases and some of them are potentially very serious and dangerous.

In Uganda, 717,970 people of 26.3 million were estimated to have kidney disease by the end of 2004, according to the US Census Bureau which has the latest statistics.

The prevalence (new and old cases) of kidney disease is 150 per million people in sub-Saharan Africa. It is estimated that by 2030, more than 70 percent of patients with end stage renal disease will be residents of developing countries, an article published in the New England Journal of Medicine of March 2006 states.

Kidney failure is when kidneys stop functioning properly. There are two types of kidney failure- acute and chronic. Acute renal failure (ARF) occurs when the kidneys suddenly stop filtering waste products from the blood. Chronic renal failure (CRF) develops slowly with very few symptoms in its early stages.

Dr. Kalyesubula says an adult should pass out one and half liters of urine daily. If the amount is less than half a liter, this is an indication that this person is suffering acute kidney injury.
In addition to filtering waste, kidneys keep the balance of salts in the body (electrolytes) to minimize swelling or dehydration. The kidneys ensure that the water balance in the body is right and metabolism is regulated rightly.

Studies show that kidneys release three vital hormones: erythropoietin (EPO), which stimulates the bone marrow to manufacture enough red blood cells; rennin, which regulates blood pressure; and calcitriol, the active form of Vitamin D, which helps maintain calcium for bones and for normal chemical balance in the body.   Kidneys sometimes break down, yet we desperately need them to perform all these very useful functions.

Expensive to treatment
Ugandans with kidney problems who cannot afford to pay 300,000 shillings per visit for a dialysis session three times a week.

Dialysis is a medical procedure in which a person’s body is cleaned of impurities and toxins, a task which his or her kidneys would perform if they were still functional.
This is done using a dialysis machine which acts like an artificial kidney and is used to help the patient get rid of human waste from the body.

Dialysis is an expensive process that costs the patient one million shillings at Mulago and over three million shillings in private clinics each week. The patient requires dialysis twice a day for four to five hours and at least thrice a week.
Currently 30 patients are undergoing dialysis at the renal unit making up between one and two percent of those who badly need the service.

Dr. Bateerana Byaruhanga, Mulago hospital Executive Director says the high fee charged on patients is due to the high costs of consumables used in the dialysis process.
The consumables include the catheter used to draw blood from the patient, the blood line tubes, the artificial kidney used for filtration, jerricans with acid concentrate and bicarbonate powder which form a dialyset that helps suck out the waste from the blood.

Kidney transplants at Mulago Hospital to start in 10 years

Mulago hospital is still facing a huge challenge in treating chronic Kidney failure due to the lack of financial and medical support.
 

The referral hospital has 6 dialysis machines of which only 3 are in working condition. Dr. Eyoku Simon Peter a Renal physician at Mulago hospital says the machines are just enough to treat 30 patients.

Dr Eyoky reveals that the Mulago kidney unit has just two specialist doctors and five nurses serving ever increasing kidney patients.

A kidney transplant is an operation that places a healthy kidney in the patient’s body. The transplanted kidney takes over the work of the two kidneys that failed, and the patient no longer need dialysis.

He says offering kidney transplant operations remain the major challenge facing the treatment of kidney patients in Uganda.

What causes acute renal failure?

Acute renal failure has three main causes: a sudden, serious drop in blood flow to the kidneys. Heavy blood loss, an injury, or a bad infection called sepsis can reduce blood flow to the kidneys. Not enough fluid in the body (dehydration) also can harm the kidneys.

Damage from some medicines, poisons, or infections; most people don't have any kidney problems from taking medicines. But people who have serious, long-term health problems are more likely than other people to have a kidney problem from medicines. Examples of medicines that can sometimes harm the kidneys include: antibiotics, such as gentamicin and streptpmycin.

Pain medicines; such as aspirin, declofene and ibuprofen. Some blood pressure medicines, such as ACE inhibitors. The dyes used in some X-ray tests. A sudden blockage that stops urine from flowing out of the kidneys, kidney stones, a tumor, an injury, or an enlarged prostate gland can cause a blockage.

You have a greater chance of getting acute renal failure if: you are an older adult, you have a long-term health problem such as kidney or liver disease, diabetes, high blood pressure, heart failure or obesity.

You are already very ill and are in the hospital or intensive care (ICU). Heart or belly surgery or a bone marrow transplant can make you more likely to have kidney failure.

What are the symptoms?

Symptoms of acute renal failure may include: little or no urine when you urinate, swelling, especially in your legs and feet, not feeling like eating, nausea and vomiting, feeling confused, anxious and restless, or sleepy, pain in the back just below the rib cage. This is called flank pain.

Some people may not have any symptoms. And for people who are already quite ill, the problem that's causing the kidney failure may be causing other symptoms.

How is acute renal failure diagnosed?

Acute renal failure is most often diagnosed during a hospital stay for another cause. If you are already in the hospital, tests done for other problems may find your kidney failure.

If you are not in the hospital but have symptoms of kidney failure, your doctor will ask about your symptoms, what medicines you take, and what tests you have had. Your symptoms can help point to the cause of your kidney problem.

Feet care will give you relief and comfort

OUR feet are the most hardworking body part and most overlooked. The legs bear a heavy burden. But what do the feet get for their toil? A foot bath, monthly pedicure, or massage?

Many people give foot maintenance little thought. The feet are akin to plumbing, you never think about them until they complain.

Our feet have many points associated with different organs of our body; there are about 70,000 nerve endings on the foot. Therefore, foot massage is useful not only for legs but also for general well-being. It improves blood circulation, nourishes the skin, and reduces fatigue.

Unfortunately, massage is cautioned against in the case of varicose veins, skin disorders and foot edema. To boost the beneficial effects of massage even more, we can rub a nourishing cream into the skin so that it will become gentle and soft.

The foot is a reflexology zone associated with all of the internal organs. Foot Massage can enhance the protective functions of the body. The effects appear after the first massage session. The fact that foot massage is very sensual is not an invention of cult film directors, but actually true.

Five magical minutes of proper foot handling, and your partner will obtain a state of complete relaxation, with a sudden awareness of the meaning of life. As it says in Ayurveda, the ancient Indian medical treatise: "If a couple before going to bed will massage each other’s feet, it will not only bring health but also a mutual attraction."

According to Dr. Samuel Bandobera, a pharmacist at Modem Pharmacy in Ntinda, seven out of 10 people experience foot problems.

However, we think the pain and discomfort is normal. Foot pain, infections, bunions and corns often mask severe problems like diabetes, arthritis, gout, anaemia, or even heart problems.

Corns and callouses are caused by excessive pressure on the feet and inappropriate foot wear. This is common with women who wear high heels.
They place additional pressure on the toes and can cause problems with the feet and back.

A study by Harvard University suggests that high heels may cause knee problems. If you must wear high heels, take along a pair of flat shoes so that while at your desk, you can always slip the high heels off.

Also be sure to buy shoes that give your toes room.Snug, tight-fitting shoes cause corns.

Buy shoes that breathe- like those made of canvas and leather. Plastic and vinyl cause feet to sweat, which creates a breeding ground for bacteria and fungi.

Rebecca Namatovu, a beautician, advises that everyone needs to own a pair of flat shoes with thick-cushioned soles that support the arch and have rounded tips.

Replace worn out shoes as soon as possible and try not to wear the same shoes daily.

Some remedies for your feet

 
Soak your feet in a basin of warm water mixed with lemon juice, a few neem leaves and mineral salt for about 10 minutes. Neem has antiseptic qualities.

You can place pebbles and roll your feet back and forth giving slight pressure as it gives a massaging effect.
Scrub using a pumice stone to remove the dead skin. Wash your feet, then pat them dry and massage with a moisturising cream or foot cream.

Wash your feet well and apply vaseline at night and slip on a pair of cotton socks. In a few weeks, your feet will become soft.

He beat me to near-death, then fled

Pauline Adong lies in agony in the female ward of Pentecostal Assemblies Hospital in Lira.

Her skeletal frame is covered by threadbare, dirty, old linen. The fresh wound on her backside is dressed with plaster and cotton.

 

At her bedside, there is no juice or even a bottle of water for the patient. Her eight-month-old son, only dressed in a shirt, smiles at his mother, oblivious of her pain.

 

Adong holds back tears as she gathers strength to raise her head to talk to her visitors.

 

“My husband was never violent. For the four years we had been together, he had never even slapped me. Maybe when he did this to me, he was just looking for a way out of our marriage. I have always been an obedient and submissive wife. 

 

“So I think when he realised that he had no excuse to get rid of me, he decided to beat me so brutally,” says Adong, amid tears.

 

Among’s misery began in 2004, when her first husband was killed by the Lord’s Resistance Army rebels. In 2007, she was remarried to her brother-in-law, Jimmy Engola, under the cultural practice of widow inheritance.

 

With four children from her previous marriage, she bore her fifth child, a boy, during her four-year marriage to Engola. But Adong’s new marriage was never a bed of roses. Her husband is a drunkard.

 

The fateful day

 

The events that led to her admission in hospital began on September 8, at her home in Akuriluba village, Acan Pii Akalo parish. Her husband returned home at around 3:00pm. As usual, he was drunk. Adong welcomed Engola and served him tea.

 

Shortly after, she asked him to permit her to sell the family’s only goat, because she needed money to clear school fees for her daughter. Engola seemed to grant her request. But no sooner had she untethered the goat from the backyard, than Engola stood up in fury. 

 

Engola is a big man. So with his well-built physique, he snatched the goat from Adong, held it by its legs and used it to flog her continually.

 

The physical assault was directed at Adong’s backside. 

 

The pain was so unbearable that she passed out. She has no recollection of how long the assault lasted and what prompted Engola to stop, but when she regained her consciousness, she realised that she had sustained deep wounds on her backside. 

 

Engola had fled as soon as Adong collapsed and has never returned home. He is wanted by the Police to answer assault charges, but no one knows his whereabouts.

 

Among regained consciousness three days later and was taken to Lira  Hospital, where she was admitted for a month and discharged. 

 

Still too weak, she returned to her marital home with no one to take care of her, except her 10-year old son. 

 

Rescued

 

Adong’s wounds had become septic due to lack of care. One day, the Kole district chairperson, Peter Ocen Akalo and Caesar Alajo, a district councillor, heard about her plight and came to her rescue. They took her back to the hospital, where she is presently receiving treatment. She was operated on and is recuperating. 

 

Adong describes her husband as a philanderer. Despite this, she says, she wanted to be with him for the rest of her life.

“I tried to do everything the exact way he wanted,” Adong narrates from her hospital bed. 

 

Her aunt, Florence Acen, is taking care of her at the hospital. Adong’s three children also stay with her at the hospital. 

For now, this is their temporary home, until their mother is discharged. Akalo and Alajo, are footing the hospital bills.

 

Expert Opinion

 

According to the Family Protection Unit of Kole Central Police Station, at least 100 serious cases of physical violence were recorded between January and June this year. Most of the gender-based violence cases in communities go unreported and are not reflected in the crime records.

 

This is according to an analysis by a non-governmental organisation, Issis-Women’s International Cross-Cultural Exchange (WICCE), which has completed a study on sexual and gender-based violence in Lango region.

 

“Most of the assault cases reported to the Police are against women. Men are also assaulted, but do not report because of stigma from fellow men and the society. Most women who report these cases do not follow them up because they fear reprisals at home,” says Ruth Ojambo Ochieng, the executive director of Issis-WICCE.

 

Ojambo recommends that communities collectively engage in an effort to denounce norms and ways that promote violence against women.

 

“Communities need to drop patriarchal ways that position women as subjects to men. This should be a collective movement that respects the bodily integrity of women. This will eventually help reduce violence,” she says.

 

Catherine Awor, the acting coordinator of Women Peace Initiatives Uganda, says Gender-Based Violence(GBV) has reduced over the years. However, sexual and GBV remain a challenge in Lango sub-region and has taken a trend of domestic violence, often leading to death.

 

Alex Oremu, the Lira district chairperson, says the Peace Recovery and Development Programme has failed to address the psycho-social needs of the communities.

 

“People cannot fully participate when their mental wellbeing is not catered for,” Oremu said, adding that the cultural practices and norms that still position women as the weaker gender has also been a big problem. 

 

“The clan system needs to be engaged, so that they are part of the process of identifying ways of reducing this violence,” says Oremu.

After the Baby, Can I Have My Lean Body Back?

With the blessing of a baby comes the unspoken threat of never getting one's body shape back. While some women have devised means to salvage what will be left of their bodies, others have perfected the art of looking much better than before.

Pregnancy does things to a woman's body, most of them irreversible. One of the most difficult things for mothers is getting rid of the extra weight after childbirth.
For some, it can take between two months to a year, while others just add more weight with each successive baby and their size changes forever.

Teri Washitu, 22, a first-time mother, got back her ideal body shape within three months of giving birth.

"For any young woman, the thought of carrying a baby for nine months and the life of motherhood can be both exciting and scary. Worst of all, the fear of gaining weight and getting out of shape gets the better of you.

I, however, vowed to enjoy every minute of my motherhood from the moment the doctor gave me the great news. Weight gain during pregnancy is normal, so I was told by my midwife during the first antenatal visit. I was assured that with proper diet and exercise I would be able to gain just the ideal pregnancy weight and keep fit.

You just never realise how much weight you are gaining until you have given birth. I was shocked after my caesarean section birth to learn that I had gained over 19kg during pregnancy.
Getting back into shape after birth can be very challenging, most especially, when you have had a caesarean section birth. Unlike normal birth, I was advised not to exercise or tie my stomach until I was declared healed by my gynaecologist.

With a 4kg baby boy, my stomach was virtually a balloon and deep down, I knew getting back into shape was not going to be a walk in the park. But for someone whose flat tummy was once the envy of many, I was determined to get back into shape.

Exclusive breastfeeding has certainly helped me lose weight. Ironically, I am required to eat more calories (about 2,500 a day) to maintain my energy levels as well as provide a good flow of milk.
I also observed a proper diet by eating foods rich in protein and calcium, plenty of fresh fruits and vegetables.

This has helped to fasten and ease my digestion. I also started taking two litres of warm water daily in between meals. This has done magic to my stomach without having to tie it.
I was advised to avoid sugary or salted snacks and caffeinated drinks. I did exercises daily and my body shape returned to normal and within three months after birth.
My husband, Gilbert Tizihwayo, was very supportive, always reminding me to exercise and accompanying me to the fitness lessons.

Challenges

There are times when I suffered discomfort from the exercises. I was advised to listen to my body and to take note of that because the exercises exhausted me. So I was limited to pelvic tilts, lifts, side bends and long slow walks in the morning and evenings.

I think losing weight can be affected by emotions. I had a positive attitude and deep down I knew I would make it. This was simplified with the emotional support and patience from my husband.
The Cost
I used a physical instructor only once during pregnancy. I paid sh40,000 for a whole day's lesson on fitness and exercise during and after the birth. I was given exercise leaflets, but I also have a book on getting back into shape after pregnancy, which I followed.
I advise new mothers to keep their dream of getting back in shape. It is not easy, but eventually you get there. It has been 18 weeks since I had my baby and I am perfectly fit in all my outfits.

What the doctor says
Dr. Emmanuel Netuwa, a gynaecologist in private practice in Mbale, says getting back in shape is not something one should rush. If it has taken about 40 weeks for one to gain the pregnancy weight, it may take a similar length of time to lose it.

However, he says, the best way to get back in shape after giving birth is through exercising, the exercises though should be regulated. "You should not overdo it because it might stretch your body and cause complications," he says.

"There is no specified time that you should start exercising, but do what you can handle, even if it is only 10 to 15 minutes at a time. If you exercise too hard, too soon after giving birth, your vaginal bleeding may get heavier. This is a signal to slow down," says Dr. Netuwa.

He notes that you can start with some gentle exercises, including pelvic floor exercises and lower tummy muscles (not sit-ups) almost straightaway. Strengthening your pelvic floor will help you guard against urine leaks while you are exercising.

He also states that if you had a normal delivery you can wrap the belly with a cloth wrapper or use a corset. Any cloth will do, as long as it is long and able to wrap around the waist. Some women who have had a natural birth start to do this right after delivery.
"You can put it on for as long as you want. You can even wear it when you are out and about," he adds.
However, a mother who has delivered through a c-section is not advised to tie the stomach, because it can disrupt the healing of the wound and might lead to major health complications.
"A mother who has had a c-section birth should consult her gynecologist on when to start exercising and how often she can do it."

Raped Every day for nine months

Raped every day for nine months

Gang raped by seven men.

 My name is Mado Nzigire, 33years old, from Bukavu district from Democratic Republic of Congo, one evening I was busy preparing supper for my family when armed men stormed my compound. They collected all my family members together, and then they started raping me one by one until the seventh rebel got his turn. Can you imagine I was raped in the presence of my children and mother in law, and when my husband tried to stop them, he was killed instantly? I passed out and only to wake up in the middle of nowhere surrounded by bush. The rebels had taken me to be their wife. They fought amongst themselves for me, and in the end the leader decided to have me. I would cook food for them, clean around and sometimes fetch water at gun point. To make it worse I was raped every day for nine months by the rebel leader. My private parts got torn and now I cannot manage to hold waste. Fortunately one day I was allowed to fetch water from the well on my own and there was an exchanged of bullets between the government and the rebel, so I used that opportunity to escape. I went to the hospital where I was treated. Now I work as a porter by carrying people’s lugage and sometimes work as house help. I have to look after my family and mother in law. Life is not easy because I have recto-vaginal fistula, a very dangerous health problem with repeated pelvic infections and the memories of those horrible days still linger in my mind.

Fortune to rape a virgin

My name is Yoles Kambele, 31 years from Bundibugyo. I was abducted by Allied Democratic Forces rebels at the age of 13 and I was still a virgin the rebels tattooed all virgins in the bush whom they believed it was a source of fortune to have sex with them. I was gang raped by 9 men, one I tried to refuse to have sex with the men then I was heavily beaten bushed in a trunk of a tree I still feel some of scares.  Unfortunately I became pregnant I was operated by using the razor blade and a knife during labor, and I was healed by going in cold water every early morning and giving me herbs. But today I have heard complications during every delivery. This person who operated me, I could not establish whether he was a medical personnel qualified or not because everybody claimed to be expert especially when it came to crisis and there was need to help somebody. 

Forced to eat flesh fresh.

My name is Amina 25 years old. I was abducted by Allied Democratic Forces rebels when they attacked my village in Ndughuthu Sub County in Bundibugyo. I was abducted together with my sister and cousin. We walked for a very long period of time, when my sister could not take it anymore; she complained and begged that we get some rest. The rebel leader commanded his men to cut her body into pieces and this was then mixed with goat meat. I was forced to eat my sister’s flesh; I was the first to be given the piece of her flesh to eat, I had to eat it or else I would lose my life. Sometime later my cousin could not take it anymore, she was also killed and then her private parts were cut off and they forced me to eat them too fresh. I was threatened, that in case I refused I would be the next on the row, I simply ate.  It was too devastating, up to now I cannot forget the trauma I went through. Those were the worst days of my life, seeing my family lose their lives and at the same time being forced to eat their flesh fresh. I managed to escape and returned home. Even though I have got counseling from women in Isis WICCE, the memories are still fresh in my mind.

Those are some of the testimonies given by women from war affected areas from different parts of the world, in the ongoing Isis-WICCE leadership training for peace and security taking at Esella country hotel in Najjera for a period of two weeks.

Africa is a witness to severe civil and political conflict. These conflicts among other political, economic and social problems have led to increased instances of complex forms of Violence Against Women (VAW) including Sexual and Gender Based Violence (SGBV).

Sexual violence against women shatters victims’ relationships with their families and society.

Violence and abuse in armed and post conflict settings is rooted in gender inequalities, power dynamics, oppression and lack of privilege for women. The humiliation that women go through results in loss of pride, loss of voice and self-worth, indignity, fear, depression, trauma and bitterness.

Koffi Annan, (1999) notes that violence against women is the most shameful human rights violation and it is perhaps the most pervasive. It knows no boundaries of geography, culture or wealth. As long as it continues, we cannot claim to be making real progress towards equality, development and peace. Yet further still, patriarchy and masculinities are used to intimidate those trying t address indignity and injustices.

Consequently women are forced to be silent, their presence is stigmatized and their rights as a productive economic force collapse.

Despite the recent adoption of the UN resolution 1820 (2008) which calls for the cessation of war related sexual violence against civilians in conflict zones, Africa continues to see some of the worst cases of war related sexual violence including the mass sexual abuse of entire rural communities particularly in the Great Lakes region. In addition to calling for a complete halt to this abuse, there is a need for the systematic study of the reproductive, surgical and psychological effects of war related sexual violence in the African socio-cultural setting.

Long term health consequences of war related sexual violence include reproductive health problems, surgical problems and psychological health problems in the survivors. Reproductive health problems have been reported to include: pain in both external and internal genitalia; menstrual disturbances; urination and defecation problems; sexual problems such as sexual dysfunction; rectal and vaginal fistulae and traumatic genital injury; urinary tract infections; STDs including pelvic inflammatory disease, HIV/AIDS; disturbance of reproduction including infertility; and precancerous and/or cancerous cervical tumours. Destruction of breast tissue may result in necrosis of the papillae so that a mother cannot breastfeed her infant, which is often the only available source of nutrition for babies in situations of war.

Psychological torture

According to the international Health and Human Right research article about War related sexual violence and it's medical and psychological consequences as seen in Kitgum, Northern Uganda has suffered chronic warfare for the last 20 years, with a conflict waged between the central government army (the Uganda Peoples Defence Forces; UPDF) and a vicious rebel group, the Lord's Resistance Army. This conflict has led to the mass traumatisation of the population including the abuse of human rights, and the forced displacement of over 2 million people (80% of the population in the region) into internally displaced persons camps.

Since 2006, the Sudan sponsored peace talks between the Uganda government and the Lord's Resistance Army have brought relative peace to the region with people gradually returning to their homes; as a result both government and the international community have begun focusing on the rehabilitation and resettlement of the war survivors. However often such rehabilitation and resettlement programs fail to address the mental health and reproductive health needs of war survivors; when these needs are addressed it is done in a very superficial manner.

Mental illness the ignored catastrophe in Africa

Mental illness in Uganda has not received the same attention as HIV/Aids or malaria, but is just as serious. A consultant psychiatrist, Sarah Nalule at Butabika hospital, Uganda's national referral mental hospital, said that 35% of Ugandans, about 11.5 million people, suffer from some form of mental illness, with depression being one of the most common. But barely half of these people seek medical attention from health centers in a country where people only associate mental illness with advanced and possessed psychosis.

According to Tina Ntulo, Africa director of Basic Needs, Mental health organization, not much money has been invested in fully functioning mental health units in district hospitals. It has been undermined by planners and decision makers with just meager budget allocations.

‘Whilst there is newly constructed mental health infrastructure in Hoima district, there is no infrastructure for mental health at all in Masindi and Sembabule districts and only a very small unit in Masaka district and this is the same with the Eastern region,” she added.

Ntulo stressed the point that there are only thirteen practicing psychiatrists in the country. Twelve of them are practicing in Butabika hospital in the capital, Kampala. This means that it is virtually impossible for people living in rural areas to easily access a psychiatrist and get the help they need unless they travel long distances, which can be very expensive.

Some drugs are only allowed to be dispensed at major Health Centers. If there is demand for such drugs at lower levels, these patients should be referred to bigger hospitals for better management. However, the distances and access to these major hospitals coupled with the poverty that mentally ill people face makes referral difficult.

What is mental health?
Mental health is how we think, feel and act as we cope with life. It also helps determine how we handle stress, relate to others and make choices. Like physical health, mental health is important at every stage of life, says

Dr. Sheila Ndyanabangi, principal medical officer at the Ministry of Health said that mental illness is an illness that affects or is manifested in a person's brain. It may impact on the way a person thinks, behaves, and interacts with other people.

“The term "mental illness" actually encompasses numerous psychiatric disorders, and just like illnesses that affect other parts of the body, they can vary in severity. Many people suffering from mental illness may not look as though they are ill or that something is wrong, while others may appear to be confused, agitated, or withdrawn,” she added.

Warning signs of Mental Illness
A person with one or more of the following symptoms should be evaluated by a psychiatrist or other physician immediately: Marked personality change, inability to cope with problems and daily activities, strange ideas and excessive anxiety, prolonged depression, change in eating or sleeping patterns, extreme highs and lows, abuse of alcohol or drugs, excessive anger, hostility, or violent behavior, suicidal tendencies

Post Traumatic Stress Disorder (PTSD), the most common mental ailment in war affected areas like the northern Uganda; it is a result of events that cause horror. These include war, accidents, loss of loved ones and sexual abuse like rape.

Dr. Seggane Musisi, a lecturer of psychiatry at the Faculty of Medicine, Makerere University says that mental illnesses are common but many times, the patients do not get treatment. Disorders which include depression and irrational fear should not be ignored. Fortunately, they are often treatable. Prescriptions and therapy can improve the life of most people with mental illnesses.

He also noted that more than a third of the individuals surveyed (67%) had signs of depression. A person who is depressed feels irritable, persistently sad, unnecessarily tired, anxious, guilty, lack of sleep and worthless.

“One also loses interest in pleasurable activities like sex or may fail to concentrate on tasks and usually has problems remembering details. One’s appetite may also rise or decline,” he added.

Link between mental health and poverty

Uganda has come a long way in its recognition and treatment of mental health problems, but stigma and a misunderstanding about conditions remain unsolved.
Lukwago Godfrey, a Programme Officer at Mental Health Uganda says that in Uganda there is a close association between mental illness and chronic poverty. Although statistics on mental health are scanty, there is an increase in cases of mental disorder.

“Many people in rural areas turn to traditional healers or faith healers to cure their illnesses. Whilst these healers are successful in treating some mental illnesses by using counseling methods in their treatments, often their methods are inappropriate and ineffective,” he added.

He stressed that there is a massive dearth in trained staff, which is why Mental Health Organisations rely a lot on local volunteers from within the communities we work in to help us reach out to people with mental health problems.

Lack of adequate treatment

Lukwago also stressed that effective treatment is a vital first step in giving mentally ill people the chance at a new life. Through effective treatment we show that mentally ill people can return to a normal state and this is an essential part removing the stigma from family and community that mentally ill people face.

“The most important thing that mentally ill people need is care that they can access in their communities however the little health care available is often found in psychiatric hospitals in cities. That means that people who live in very remote rural areas have to travel long journeys to get treatment. The transport is not free and many people cannot afford it,” Lukwago added.