NORTHERN UGANDA
In
2014, I spent 4 months in the districts of Kitgum, Pader and Lamwo working on
an HIV project with the Food for the Hungry. My project was integrated within
the clinical discipline at the New Life Medical Centre that offers free HIV
treatment.
One
of my mandates was to help the staff strengthen service delivery at point of
care. The other, was to increase the reach of the HIV treatment program. This
facility has the most specialized HIV treatment in this region.
While
doing this work, I had not understood well, why male participation in HIV
treatment was a major challenge. In fact, the national HIV prevention strategy
recognizes that male participation is key to success of HIV treatment. One
would think that since the New Life Medical Centre provided a cost accessible
and free integrated HIV services, men would naturally flock into this facility
to seek treatment, and to bring their spouses for regular ante-natal visits and
treatment. The WHO recommends that women should at the least, attend four
ante-natal visits to seek qualified medical assessment.
What
I experienced during my stay, was that the Acholi man is constantly in retreat
from public spheres, and reneging their roles in society to women. The rural males
are deeply inserted in self-destructive activities such as being drunk
constantly, and aggressive non-productive activities leading to murders,
suicide, vagaries, and physical fights.
Further,
the Ugandan government policy is that healthcare facility should be within five
kilometers of reach by every community. To my surprise, men in these districts
avoid seeking HIV testing, counseling,or treatment, and are the least to adhere
to HIV treatment.
I
am bringing this background so that we can put in context, the recent
recommendation by the Lamwo County MP, Hon. Eng. Hillary Onek that Acholi
District councils should enact by-laws to ban alcohol and alcohol consumption
in this region.
During
my stay in Northern Uganda, I saw a pattern of post conflict maladjustment that
worried me excessively. I find that in the context of post conflict Acholi
region, banning alcohol using regional by-laws is merely band-aid that clumsily
attempts to resolve symptoms. Such approaches would justify an outsider’s view
that the Acholi rural males have decided, voluntarily to drink alcohol in this
excessive manner, whereas not.
In
my assessment, there is more to it. And, a vast number of foreign students who
have conducted research in this area in the past decades will agree that each
of the problems that manifest in post conflict Acholi, come with the same
intensity and are all intricately interlinked to perpetrate self-destruction.
Take for instance, myriad of studies associate gender-based or domestic
violence to alcoholism. While some associate the excessive consumption of
alcohol to the convenience of its availability in cheap sachets. Both high
alcohol consumption and gender-based violence are predisposing risk factors for
high HIV.
My
cursory professional assessment as a Public Health authority reveals that the
unattended to problem of Northern Uganda is mental illness and the lack of
primary healthcare services to detect, diagnose and treat it early. The post
conflict Acholi society is fraught with a huge burden of undiagnosed,
unattended to mental illness, which to me, is the primary driver of all the deviant
social manifestations.
Luckily,
Hon Onek is a deputy Premier and a Member of Parliament. He should know that
all social problems that are manifesting in post conflict Acholi now are
inherently rooted in the experiences of the two decades of conflict. The post
conflict Acholi is a place of broken systems and broken dreams. Enactment and
enforcement of band-aid interventions will not do much to alleviate the real
problems.
Here
are some proposed policy approaches to the matter; First, to treat alcohol
consumption not as an Acholi problem, but a national problem. Isn’t Uganda only
top of Luxembourg in the world list of alcoholics?
Second,
a national policy on primary healthcare services for mental health is needed in
the whole country. Ugandans as a whole need regular mental health treatment.
However, a specific focus on post conflict northern Uganda is utmost. Public
Health interventions that are cognizant, and taps into reviving cultural and
traditional structures are needed to focus on reduction of alcohol consumption,
enhancing domestic relationships, and boosting productivity on the land.
Mental
health management is the key determinant of Acholi survival right now. Lastly,
the Acholi men have switched roles with women. It is women now doing much of
the productive works, including bearing, raising and educating children; mothering
their husbands and in some instances, building houses and homes. Sadly, the typical
Acholi men have gone to the sachets. Enact policies that give the women more ownership
rights to property and land.
End.
