January 2014 - December 2015
“We are returning people to productive lives… Men, women and children…People we thought were lost forever.”
Peter C. Alderman Foundation
Uganda is located in Eastern Africa, bordering Kenya, Rwanda, Tanzania and the Democratic Republic of Congo. It declared its independence from the British in 1962 and since then, it endured a 35-year-long civil war. From 1987 to 2008, the Lord’s Resistance Army (LRA) waged war against the Uganda People’s Defense Force and civilians. As a result, practically all of Uganda’s northern population has directly experienced mass violence. In addition, 1.8 million civilians have been forced to live as internally displaced persons (IDPs) in squalid camps.
Uganda’s population suffers from deep emotional, psychological and social wounds. In this context, there is a worrying prevalence of both depression and post-traumatic stress disorder (PTSD) symptoms. Population surveys in the north of the country indicate an incidence of 54%-75% of PTSD and 44.5%-67% of depression. Women, girls and a small number of men, have suffered from sexual violence and thousands of children were abducted during the war and forced to commit atrocities against their families and friends.
Patients in need of psychiatric help, whether mild or severe, must travel long distances over bad roads to seek care. Mental health in Uganda currently faces many obstacles, including finances, stigma, family resistance and the tendency of the mentally ill to retreat to their homes and huts.
As in many low-income African countries, psychiatric help is relegated to major urban centers, leaving most of the country badly neglected. Uganda has only 1.83 beds in mental hospitals, 1.4 beds in community-based psychiatric units and 0.42 beds in forensic facilities per 100,000 people.
The Peter C. Alderman Foundation (PCAF) has established public-private partnerships with the Ugandan government to make mental health care accessible to its traumatized population. For this purpose, four mental health clinics have been set up on the grounds of government district hospitals in Gulu, Arua, Kitgum and Soroti, in northern Uganda.
The mental health community outreach project is carried out from these clinics and takes mental health services to communities that have limited access to care.
The most innovative aspect of the program is that it links hard-to-reach areas with high quality, hospital-based psychiatric and psychosocial care.
While PCAF has developed and ambitious and comprehensive program, this project specifically aims at two of its aspects: (i) the expansion and improvement of the community outreach program to new and existing patients and (ii) the development and implementation of specialized group therapy sessions in the communities.
The outreaches rely on the assistance of trusted community mobilizers who help us identify, contact and treat patients. They also help us to provide psycho-education to the community.
The group therapy initiative is an integral part of our outreach effort, with supportive groups formed around specific identified vulnerabilities, such as former child soldiers, people living with HIV, women who have suffered domestic violence, and the elderly.
Peter C. Alderman Foundation
Ministry of Health in Uganda
Our outreach activities include:
We also recruit and train mobilizers from within the target communities. Community mobilizers are trained to screen patients for possible mental health issues. One of their most important tasks is to provide their communities with basic awareness and education regarding mental health.
The four PCAF clinics in northern Uganda have engaged thousands of individuals with the outreach visits and provided treatment and follow-up to hundreds of patients in need.
During January-March 2014, PCAF staff completed 49 outreach visits and social workers made 110 home and school visits. The outreaches provided 9,672 community members with health education about the psychological effects of war: 1,256 individuals were screened for services, 465 new patients were recruited and 1,626 existing patient cases received follow-up treatment.
In the last quarter, 18 different groups have been formed for women, men and people living with HIV/AIDS. Patients have reported improvement in function, and group therapy engagement has increased at several sites.
Community Mobilizer Training
PCAF Soroti has already completed a mental health training for its mobilizers. PCAF Arua, Gulu and Kitgum will be conducting trainings for community mobilizers in the coming weeks.
The overall objectives of the trainings are to: (1) define terminology such as psychological trauma, war trauma, drugs of abuse, domestic and sexual violence; (2) describe methods of war torture; (3) provide information and psycho-education on common mental health problems in war and post-war situations; (4) teach basic counseling skills to be used when screening patients; and (5) show trainees how to administer PCAF assessment and follow-up forms.
To increase the effectiveness of the community mobilizers who are employed to assist in recruiting patients, each clinic will develop its own training curriculum. From these, a training model will be designed and implemented at all PCAF clinics in the future.
Status of Outreach Program
Social workers are continuing home visits to existing patients for follow-up treatment and support. They also visit schools and refugee settlements. Patients who have defaulted from their scheduled visits and group therapy sessions are being called and reminded. Regular psycho-education sessions on various topics are held during the outreaches.
In general, our outreach services have greatly increased awareness in all of the target communities, multiplying the number of patients recovering and their adherence to treatment.
Status of Group Therapy
Staff has reported positive feedback from the community on the impact of group support activities, particularly from village leaders. Our group therapy sessions have yielded promising results, especially in reducing symptom loads.
In Soroti, attendance and recovery time were improved by offering sessions every two weeks. In Kitgum, the team has held a total of 13 group sessions at three different locations, while our Gulu team has conducted three group therapy sessions for women and one for people living with HIV/AIDS. In Arua, 2 more groups for school-age children are scheduled to begin in April.
Group therapy sessions are also improving personal hygiene and increasing both the knowledge and presence of the psychotrauma services available.