Barriers and facilitators to physical and mental health help-seeking among Congolese male refugee survivors of conflict-related sexual violence living in Kampala

Kansiime, Peninah (2017-12)

Thesis (M.Phil)--Stellenbosch University, 2018.

Thesis

ENGLISH SUMMARY: Background. Armed conflicts place ordinary people at risk of injury, displacement, sexual violence, and hunger among other challenges. The United Nations High Commissioner for Refugees (UNHCR) states that conflicts result in people fleeing their countries, and consequently, a significant increase in the number of people affected, such as the over half a million found in Uganda. The DRC has one of the largest population of refugees in the Great Lakes Region, with Uganda hosting about 195 746 refugees from the country. A salient feature of the conflict in DRC is the widespread sexual violence inflicted on males and females of all ages. Male victims of rape often fall through the cracks especially regarding the delivery of services as most focus on female survivors. Few studies on conflict-related sexual violence (CRSV) in general have been conducted among male refugee survivors in urban post-conflict settings. Specifically, very few studies have been conducted to investigate barriers and facilitators among male survivors who are seeking help from physical and mental health services. This study explored barriers and facilitators encountered by male refugee survivors of CRSV seeking physical and mental health assistance, and elicited suggestions for overcoming the identified barriers. Methods. Sixteen participants were recruited in total, and of these, ten were male refugee survivors of CRSV from DRC, aged between 18 and 47 years, living in Kampala, Uganda. The rest of the participants were six service providers including: medical practitioners, psychologists and counsellors. 4 were male and 2 female, aged between 25 and 58 years, working in Kampala, Uganda. The study adopted a qualitative research design using semi-structured in-depth interviews. The study was mainly conducted at the premises of the head office of the Refugee Law Project (RLP), an organisation providing support to refugees. Qualitative research computer software, NVivo 11 for Windows, was used to analyse the data, with the aid of the framework approach, which ensured a systematic analysis of the data. Results. Regarding barriers to accessing treatment, themes that emerged from the analysis included socio-cultural and political barriers, poor health and infrastructural systems, poverty and lack of livelihood, physical effects of CRSV, fear of marital disharmony and breakup, and self-sufficiency. Facilitators to accessing treatment described by the respondents included social support, symptom severity, professionalism among service providers, availability of free tailored services; and information, education and communication. To overcome the barriers, participants suggested strategies such as increasing information and communication, providing education and training, providing required infrastructure, developing and implementing gender inclusive policies and models, increasing research and addressing basic food and employment needs. In order to attain a broad understanding of the issues raised, the Ecological Systems Theory by Bronfenbrenner was used in the discussion. Conclusion. Overall, findings of the study show that male survivors of CRSV are faced with several barriers in seeking physical and mental health assistance. A multidisciplinary and multisectoral approach is important to address the issues raised. In addition, participants recommended that government should effect change in several legal and health policies to recognise that sexual violence against men is an issue of genuine concern.

AFRIKAANS OPSOMMING: Agtergrond. Gewapende konflik hou onder andere die gevaar van beserings, verplasing, seksuele geweld en honger vir gewone mense in. Volgens die Verenigde Nasies se Hoë Kommissaris vir Vlugtelinge, lei konflik daartoe dat mense uit hul lande vlug en dat die aantal mense wat daardeur geraak word gevolglik aanmerklik toeneem, waarvan die meer as half miljoen vlugtelinge in Uganda ʼn voorbeeld is. Die Demokratiese Republiek Kongo (DRK) het een van die grootste bevolkings vlugtelinge in die Groot Mere-streek, en daar is bykans 195 746 vlugtelinge van dié land in Uganda. ʼn Hooftrek van die konflik in die DRK is die wydverspreide seksuele konflik wat deur mans en vroue van alle ouderdomme ervaar word. Manslagoffers van verkragting word dikwels oorgesien, veral wat dienslewering betref, aangesien die meeste dienste op vroue-oorlewendes gefokus is. Min studies oor konflikverwante seksuele geweld (KSG) in die algemeen is onder mansvlugtelinge in stedelike nákonflikomgewings uitgevoer. Baie min studies is spesifiek gedoen om ondersoek in te stel na hindernisse en fasiliteerders onder mansoorlewendes wat hulp by fisiese en geestelike gesondheidsdienste vra. Hierdie studie het hindernisse en fasiliteerders ondersoek soos wat dit ervaar is deur mansvlugtelingoorlewendes van KSG wat fisiese en geestelike gesondheidshulp versoek het, en maak voorstelle oor hoe die geïdentifiseerde hindernisse oorkom kan word. Metodes. Sestien deelnemers is altesaam gewerf, en hiervan was tien mansvlugtelingoorlewendes van KSG uit die DRK, tussen die ouderdom 18 en 47 jaar, wat in Kampala, Uganda, woon. Die res van die deelnemers was ses diensverskaffers, insluitende mediese praktisyns, sielkundiges en beraders. Vier was mans en twee was vroue, tussen die ouderdom 25 en 58 jaar, wat in Kampala, Uganda, werk. Die studie het ʼn kwalitatiewe navorsingsontwerp gevolg met semigestruktureerde diepte-onderhoude. Die studie is hoofsaaklik by die perseel van die hoofkantoor van die Refugee Law Project, ʼn organisasie wat hulp aan vlugtelinge bied, uitgevoer. Rekenaarprogrammatuur vir kwalitatiewe navorsing, NVivo 11 for Windows, is gebruik om die data te ontleed, met behulp van die raamwerkbenadering, wat ʼn stelselmatige ontleding van die data verseker het. Resultate. Ten opsigte van hindernisse tot toegang tot behandeling, het temas wat uit die ontleding na vore gekom het sosio-kulturele en politieke hindernisse, swak gesondheid- en infrastruktuurstelsels, armoede en gebrek aan lewensonderhoud, fisiese gevolge van KSG, vrees vir onenigheid in die huwelik en egskeiding, en selfonderhoudendheid ingesluit. Fasiliteerders tot toegang tot behandeling wat deur die deelnemers beskryf is, het sosiale ondersteuning; erns van simptome; professionalisme onder diensverskaffers; beskikbaarheid van gratis pasgemaakte dienste; en inligting, opvoeding en kommunikasie ingesluit. Om die hindernisse te oorkom, het die deelnemers strategieë soos toename in inligting en kommunikasie, verskaffing van opvoeding en opleiding, verskaffing van die nodige infrastruktuur, ontwikkeling en implementering van geslagsinklusiewe beleide en modelle, toename in navorsing en voldoening in basiese voedsel- en werkbehoeftes voorgestel. Om ʼn breë begrip van die kwessies te verkry, is Bronfenbrenner se ekologiese stelselteorie in die bespreking gebruik. Gevolgtrekking. Die algemene bevindinge van die studie toon dat mansoorlewendes van KSG voor verskeie hindernisse te staan kom ten opsigte van toegang tot fisiese en geestelike gesondheidshulp. ʼn Multidissiplinêre en multisektorbenadering is belangrik om hierdie kwessies aan te pak. Hierbenewens het deelnemers aanbeveel dat die regering verandering in verskeie regs- en gesondheidsbeleide aanbring om erkenning daaraan te gee dat seksuele geweld teen mans ʼn kommerwekkende kwessie is.

Please refer to this item in SUNScholar by using the following persistent URL: http://hdl.handle.net/10019.1/102722
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