Promoting public health among displaced people

by Mwakamubaya Nasekwa.

Tearfund has several partners based in Nyankunde, Democratic Republic of Congo. Staff were forced to leave Nyankunde when tensions between the Hema and Lendu communities led to a massacre of around 1,000 people at Nyankunde.

‘Leaving Nyankunde was like a bad dream,’ says Mwaka. ‘It was very difficult to look on, powerless, as the looters destroyed the houses and carried everything away. The future looked grim – we did not know where we were going, how we would live, what our children’s fate would be… so many questions which needed answering. We had invested a large part of our lives in this community, now destroyed in a single day. We were all traumatised and despairing.’

Survivors fled into the forests or to other centres nearby. Over 65,000 displaced people are now in the area, mostly in three centres, Oicha, Beni and Eringeti.

Many of the displaced staff are health promoters. With the support of Tearfund UK, the PPSSP (Programme for the Promotion of Primary Health Care in Rural Areas) programme started and quickly became popular. Its aim was to promote public health, a need few consider during an emergency. PPSSP wanted to reduce sickness and death due to diarrhoea and infectious diseases among both displaced people and the local population. In a situation where the most urgent needs were food, drinking water, accommodation, non-food items and medical care, what practical help could such a programme bring?

The programme quickly gained the trust of its target group because:

• Most staff are also displaced people – they really understand the problems.
• The health promoters have learned the value of listening to the community and staying among them.
• The displaced people actively participate in identifying their needs and in seeking possible solutions.

The major health concerns encountered in the refugee camps include:

• poor general hygiene
• very poor use of latrines
• lack of rubbish dumps
• poor drainage of waste water
• flies and mosquitoes everywhere.

Strategies 

The programme has three main strategies:

Health education Awareness-raising by the promoters has led to the creation of a health and hygiene committee run by the displaced people themselves. The committee’s role is to plan activities to maintain the cleanliness of the camps and avoid the spread of diarrhoeal diseases.

Displaced people have been very satisfied with the programme, commenting, ‘Without this programme, many of us would have died, especially the children.’

Distribution of practical items Items such as mosquito nets, soap, clothing and water containers are distributed to support the health messages given. These are given to the most vulnerable people first, which includes families with young children, pregnant women, widows, orphans and people with disabilities.

Trauma counselling Counselling is one of the programme’s major activities. It is our duty to take care of the whole person (body, soul and spirit). The displaced people here are victims of war and its consequences. In a word, the whole population is traumatised.

The women and girls are usually the most traumatised, because they have either been raped or made widows or orphans by the violence. We organised workshops for the training of trainers on trauma counselling. During the group work, some real cases have been discussed.

These workshops have been an opportunity for reconciliation between the two ethnic groups in conflict. The promoters show the compassion and love of Christ to the displaced people. Since they been displaced and are suffering themselves, they find they can better serve those who are suffering.

Mwakamubaya Nasekwa is Programme Co-ordinator of the PPSSP. He can be contacted at PPSSP, Beni, PO Box 21285, Nairobi, Kenya. E-mail: [email protected]   

Case study of trauma

While fleeing from their home, a family becomes separated. A father travels alone with his daughter for two months. He sleeps with her and she becomes pregnant. Out of shame, the girl decides to have an abortion. The father is troubled and goes to a counsellor. The mother goes to another counsellor, saying: ‘I can’t stand living with my husband and daughter.’

If you were in this situation, consider how you might feel – first as the husband, then as the daughter and then as the mother. How could you help this family through this trauma?