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 minister 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.
1 Comment
This is interesting piece of information. Komakech touched on Mental Illness as a major concern in northern Uganda, which is very true.
But before you start treating mental illness, you need to assess the cause of mental illness.
Now we need to ask question as to why there is huge cases of mental illness in northern Uganda. By getting the causes, that is when we can get possible treatment.
I did not see any causes of mental Illness listed in this article.