Mental health of health professionals and their perspectives on mental health services in a conflict-affected setting: a qualitative study in health centres in the Gaza Strip during the COVID-19 pandemic

OBJECTIVES

To explore how primary care health professionals perceive their own mental health in a conflict-affected setting during and beyond the COVID-19 pandemic and to explore their perspectives on mental health services.

METHODS

The Gaza Strip faces a chronic humanitarian crisis and is suffering from the consequences of the COVID-19 pandemic; United Nations Relief and Works Agency (UNRWA) health centres were used to recruit participants for this study. Semistructured interviews were conducted with 29 health professionals in UNRWA health centres who were sampled using maximum variation sampling. Transcripts were translated, double checked and analysed via thematic analysis.

RESULTS

From the analysis, a thematic map was developed showing how health professionals perceive their mental health impacts. This included difficulties due to the COVID-19 pandemic, as well as the socioeconomic processes stemming from the on-going conflict.Another thematic map was developed showing the perceived strengths and challenges of the health services. The strengths included positive impact of the services to the service users and health professionals. In terms of challenges, health professionals identified socioeconomic processes and aspects of remote service provision during COVID-19.

CONCLUSIONS

Based on the findings, we suggest that an improved signposting mechanism should be developed to address many of the challenges that emergencies bring about; in particular, this could support the health professionals' mental health, as well as improve the response to patients' socioeconomic challenges. We further suggest recommendations for improving mental health services when delivered remotely to increase their resiliency during various emergencies.

Local experience of using traditional medicine in northern Rwanda: a qualitative study

BACKGROUND

The popular use of traditional medicine in low-income settings has previously been attributed to poverty, lack of education, and insufficient accessibility to conventional health service. However, in many countries, including in Rwanda, the use of traditional medicine is still popular despite the good accessibility and availability of conventional health services. This study aims to explore why traditional medicine is popularly used in Rwanda where it has achieved universal health coverage.

METHODS

The qualitative study, which included in-depth interviews and participant observations, investigated the experience of using traditional medicine as well as the perceived needs and reasons for its use in the Musanze district of northern Rwanda. We recruited 21 participants (15 community members and 6 traditional healers) for in-depth interviews. Thematic analysis was conducted to generate common themes and coding schemes.

RESULTS

Our findings suggest that the characteristics of traditional medicine are responding to community members' health, social and financial needs which are insufficiently met by the current conventional health services. Participants used traditional medicine particularly to deal with culture-specific illness - uburozi. To treat uburozi appropriately, referrals from hospitals to traditional healers took place spontaneously.

CONCLUSIONS

In Rwanda, conventional health services universally cover diseases that are diagnosed by the standard of conventional medicine. However, this universal health coverage may not sufficiently respond patients' social and financial needs arising from the health needs. Given this, integrating traditional medicine into national health systems, with adequate regulatory framework for quality control, would be beneficial to meet patients' needs.

Sociality and temporality in local experiences of distress and healing: Ethnographic research in northern Rwanda

Prior studies have traced sociality and temporality as significant features of African healing. However, association between the two has not been explicitly investigated. This paper explores how sociality and temporality are associated in local experiences of distress and healing among northern Rwandans. The ethnographic research, including in-depth interviews, focus-group discussions and participant observation, was conducted in 2015-2016, with 43 participants from the Musanze district who have suffered from not only the genocide but also post-genocide massacres. Findings identified common local idioms of distress: ibikomere (wounded feelings), ihungabana (mental disturbances), ihahamuka (trauma), and kurwara mu mutwe (illness of the head, severe mental illness). One stage of distress was perceived to develop into another, slightly more serious than the previous. Social isolation played a significant role in the development as it activated 'remembering' and 'thinking too much' about the past and worsened symptoms. Subsequently, healing was experienced through social reconnection and a shift of time orientation from the past to the future; the healing experience traced a process of leaving the past behind, moving forwards and creating a future through community involvement. The experiences of distress and healing in this population were explained by two axes, i.e. sociality (isolation - reconnection) and temporality (past - future), which are associated with each other. Given the sociality-temporality association in African post-war healing, the study highlights that assistant programmes that facilitate social practice and future creation can be therapeutic and be an alternative for people who cannot benefit from talking-based and trauma-focused approaches.

Linking coping strategies to locally-perceived aetiologies of mental distress in northern Rwanda

INTRODUCTION

How and why people in a particular setting turn to a specific coping strategy for their distress is pivotal for strengthening mental healthcare and this needs to be understood from a local point of view. Prior research in northern Rwanda documented common local concepts of distress for the population that cannot receive assistance despite severe adversities; however, the locally-perceived causes, manifestation and coping strategies and their associations are still unclear.

METHODS

The qualitative study in the Musanze district, northern Rwanda, was informed by Interpretative Phenomenological Analysis. In-depth interviews were conducted with people with lived experience and those in close contact with people with lived experience of distress. Ethnographic observation was conducted and the analyses were complimented by an earlier ethnography in the same village.

RESULTS

Study participants (n=15) included community members with lived experience of mental distress and/or those with close friends or family with lived experience. The perceived manifestations of the mental distresses were diverse and the causal attributions shifted from more social, concrete and explainable (eg, loss) towards magical, more abstract and unexplainable (eg, poisoning). Finally, participants sought coping strategies in accordance with their causal attribution in ways that made sense to them.

CONCLUSION

The coping strategies were chosen according to the perceived aetiology of the symptoms and they were perceived to be effective for their distress. Local coping strategies that match people's help-seeking patterns should therefore be supported in policy and programmes. In Rwanda this requires a mutual training of medical professionals and traditional healers and establishing co-treatment within two parallel systems. This also requires the support for programmes and initiatives that strengthen positive interactions and change in circumstances.