Emotional problems of children in Uganda lead to medicalisation

19 May 2009

Grace Akello-Ayebare studied at Makarere University in Kampala, the capital of Uganda. She then carried out doctoral research on children growing up in Gulu in North Uganda. Civil war had been raging for more than twenty years between the Ugandan army and the rebels of the Lord's resistance army. Many children have lost their parents as a result of violence or HIV/aids and have had to take on responsibility for the other children in the family. Treatment Akello spoke with children aged between 9 and 16 who were head of a family and she investigated how they obtained care or treatment for their problems in an environment of continuous warfare. She wanted to know what they did to try to recover, both from infections and from emotional distress.

Medical and emotional problems
The children appeared to suffer from medical conditions, particularly infectious diseases. They talked about shivering, fever and headaches, generally diagnosed as malaria, and about diarrhoea, cholera, coughing and flu, scabies, eye infections and wounds.

Akello also found a range of complaints indicative of emotional distress caused by the dreadful living conditions, the extreme poverty, fear of abduction, loss of close family relatives and coping with sexual and war violence.

Somatisation
The children were discouraged from talking about their emotional problems. Although they suffer from depressed moods and 'evil spirits', the children's emotional problems often manifest themselves in somatic complaints, such as headaches, stomach aches or sleeplessness. A 'benefit' of somatisation is that physical complaints are more readily accepted by the environment and there is also a treatment for such complaints in the form of medication. Some children hide their pain, many use sleeping pills or a herbal medicine to help them sleep, such as the Atika plant (genus Labiate).

Children have to buy medicines
Herbal remedies and pharmaceuticals can easily be acquired in North Uganda, including medicines that are provided against an official prescription, such as antibiotics and malaria treatments. The government-funded health centres in theory provide free pharmaceutical medications to sick people, but they often have no medicines available. The children are often advised to buy the medicines themselves from private sales outlets (private clinics and pharmacies, which differ very little from one another).

Purchasing power
The children's ability to obtain medicines depends on their purchasing power. They are exposed to such risks as incorrect usage and over-consumption of medication, as well as addiction. The use of pharmaceuticals is very extensive, particularly antibiotics, anti-fever agents such as paracetamol, quinine to combat malaria and psychopharmaceuticals such as valium.

Prevention is impossible
The situation in which the children live makes it practically impossible for them to avoid infections by means of preventive measures. They are therefore forcef to opt for a short-term solution. Although these can have a beneficial effect on the children's wellbeing and can alleviate the symptoms of emotional suffering, Akello is critical of the focus on medicalisation since this can lead to pharmaceuticalisation of emotional suffering. True healing is out of the question. However, an ‘unintended cure’ (an unexpected curative effect) can take place: the fact that children can do something about their problems does give them some relief.

Grace Akello-Ayebare, Wartime children’s suffering and quests for therapy in northern Uganda
PhD defence: Wednesday 20 May
Faculty: Medicine
Supervisor: Prof. J.M. Richters
Source: Universiteit Leiden