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11.
Rape has been used in contemporary armed conflicts to inflict physical, psychological, cultural and social damage. In endeavoring to address the psychological damage of collective violence, some researchers and global health practitioners are turning toward post-conflict mental health promotion approaches that centrally feature resilience. Though previous findings from resilience and coping research are robust, few studies have actually investigated resilience among genocide-rape survivors in cultural context in non-Western settings. This paper presents ethnographic data gathered over 14 months (September 2005 to November 2006) in southern Rwanda on resilience among genocide-rape survivors who were members of two women's genocide survivor associations. Study methods included a content analysis of a stratified purposive sample of 44 semi-structured interviews, as well as participant-, and non-participant-observation. Resilience among genocide-rape survivors in this context was found to be shaped by the cultural-linguistic specific concepts of kwihangana (withstanding), kwongera kubaho (living again), and gukomeza ubuzima (continuing life/health), and comprised of multiple sociocultural processes that enabled ongoing social connection with like others in order to make meaning, establish normalcy, and endure suffering in daily life. The results of this research show that the process of resilience among genocide-rape survivors was the same regardless of whether genocide survivor association membership was organized around the identity of genocide-rape survivorship or the identity of widowhood. However, the genocide-rape survivors' association members were more involved with directing resilience specifically toward addressing problems associated with genocide-rape compared to the members of the genocide widows' association. The findings from this research suggest that ethnographic methods can be employed to support resilience-based post-conflict mental health promotion efforts through facilitating collective sexual violence survivors to safely socially connect around their shared experiences of rape, neutralizing social threats of stigma and marginalization. 相似文献
12.
《International journal of occupational and environmental health》2013,19(3):331-341
AbstractHistorical models postulate that genocide cannot occur without the ideology and decisions of its authoritarian perpetrators and the indifference of bystanders. These models do not address genocidal risks from ecocide. Study objectives were to assess 1) the role of Malthusian pressures in recent genocides, 2) the role of ecocide and ecologic abuse in creating these pressures, and 3) strategies for prevention and deterrence. Analysis of reports, demographic studies, and time trends in recent genocides and recent ecocidal events from ecologic abuse suggests that Malthusian pressures and zero-sum rivalries over water, arable land, or natural resources by themselves do not lead to genocide. Such pressures may have exacerbated the political and socioeconomic predictors in Rwanda and Darfur, but not in former Yugoslavia. However, collapse of socioeconomic and governmental infrastructures following genocide can leave behind massive sustained damage to carrying capacity and sustainability. Surviving victims, if they return to their environments, will remain at risk for persecution. Ecocide—the large-scale destruction, depletion, or contamination of natural ecosystems—can result in widespread damage to health, survival, fertility, reproduction, and sustenance, and forced flight. International early warning and effective response systems are needed to deter or prevent political decisions to carry out genocide. Such systems must include long-term measures to resolve zerosum conflicts over environmental resources and to prevent toxic risks to vulnerable populations and destruction of habitat by deliberate or wanton ecologic abuse, which itself should be redefined as a crime against humanity. 相似文献
13.
Pavlish C 《International nursing review》2007,54(1):28-34
BACKGROUND: Africa is the site of many refugee camps, and non-governmental agencies are often responsible for providing programmes and services to improve refugees' quality of life and health in temporary encampments. Rwanda hosts three refugee camps as a result of the 1994 genocide. AIM: This research examines meaningful life experiences as narrated by women and men Congolese refugees residing in a refugee camp in Rwanda. METHODS: Two in-depth interviews were conducted with 15 refugee men and 14 refugee women. Content in the research text was analysed separately by gender. FINDINGS: Women's experiences revealed themes of leaving the good life behind, worrying about their daughters, feeling ambivalent about marriage and lacking hope. Men's experiences revealed themes of leaving the good life behind, having no peace in the heart and fearing the future. CONCLUSIONS: Listening to refugee voices in narrated life experiences provides an opportunity for non-governmental organizations to create programmes and services that pertain closely to refugees' life experiences. 相似文献
14.
Fanello CI Karema C van Doren W Van Overmeir C Ngamije D D'Alessandro U 《Transactions of the Royal Society of Tropical Medicine and Hygiene》2007,101(4):344-350
Coartem is a fixed-dose combination of artemether-lumefantrine that, given in six doses, provides effective treatment for children with uncomplicated Plasmodium falciparum infection in areas with highly endemic and multidrug-resistant malaria. In Rwanda since 2001, amodiaquine+sulfadoxine-pyrimethamine (AQ+SP) has been the first-line treatment, but resistance to this combination has rapidly emerged and spread. Coartem was considered as a possible alternative, and a randomised, open-label, clinical trial to test its safety, tolerability and efficacy was carried out in 2004-2005. Five hundred children aged 12-59 months with uncomplicated P. falciparum malaria were randomly allocated to AQ+SP or Coartem. Patients were followed up until day 28 after treatment. Adverse events and clinical and parasitological outcomes were recorded. Adequate clinical and parasitological response (ACPR) was significantly higher in children treated with Coartem than in those treated with AQ+SP: the PCR-adjusted 28-day ACPR was 96.68% for Coartem and 79.35% for AQ+SP. Both treatments rapidly cleared parasitaemia and fever, although parasite clearance was significantly faster in children treated with Coartem. Mean packed cell volume increased in all patients, with no significant differences between treatments. Coartem proved to be more efficacious than AQ+SP, with a good safety and tolerability profile. 相似文献
15.
Vincent Kalumire Cubaka Michael Schriver Peter Vedsted Gregory Makoul Per Kallestrup 《Patient education and counseling》2018,101(9):1601-1610
Objective
To identify, adapt and validate a measure for providers’ communication and interpersonal skills in Rwanda.Methods
After selection, translation and piloting of the measure, structural validity, test-retest reliability, and differential item functioning were assessed.Results
Identification and adaptation: The 14-item Communication Assessment Tool (CAT) was selected and adapted.Validity and reliability testing
Content validation found all items highly relevant in the local context except two, which were retained upon understanding the reasoning applied by patients. Eleven providers and 291 patients were involved in the field-testing. Confirmatory factor analysis showed a good fit for the original one factor model. Test-retest reliability assessment revealed a mean quadratic weighted Kappa?=?0.81 (range: 0.69–0.89, N?=?57). The average proportion of excellent scores was 15.7% (SD: 24.7, range: 9.9–21.8%, N?=?180). Differential item functioning was not observed except for item 1, which focuses on greetings, for age groups (p?=?0.02, N?=?180).Conclusion
The Kinyarwanda version of CAT (K-CAT) is a reliable and valid patient-reported measure of providers’ communication and interpersonal skills. K-CAT was validated on nurses and its use on other types of providers may require further validation.Practice implication
K-CAT is expected to be a valuable feedback tool for providers in practice and in training. 相似文献16.
The factor structure of posttraumatic stress disorder (PTSD) symptoms in Euro-American populations has been extensively studied, but confirmatory factor analytic studies from non-Western societies are lacking. Alternative models of DSM-IV symptoms were tested among Rwandan adults (N = 465) who experienced trauma during the 1994 genocide. A cluster random survey was conducted with interviews held in Rwandan households. PTSD was assessed with the Posttraumatic Stress Disorder Checklist-Civilian version. Competing models were the DSM-IV, emotional numbing, dysphoria, aroused intrusion, and dysphoric arousal models. Results showed that the emotional numbing, dysphoria, and dysphoric arousal models had almost identical, good fit indices and fit the data significantly better than the other models. The emotional numbing and dysphoric arousal models also exhibited good construct validity. Results suggest that the latent structure of PTSD symptoms in Rwanda are comparable to that found in Euro-American samples, thereby lending further support to the cross-cultural validity of the construct. 相似文献
17.
Karema C Fanello CI van Overmeir C van Geertruyden JP van Doren W Ngamije D D'Alessandro U 《Transactions of the Royal Society of Tropical Medicine and Hygiene》2006,100(12):1105-1111
In Rwanda, amodiaquine+sulfadoxine/pyrimethamine (AQ+SP) is the current first-line treatment for malaria, introduced in 2001 as an interim strategy before the future deployment of an artemisinin-based combination treatment (ACT). Dihydroartemisinin/piperaquine (DHA-PQP) is a new co-formulated and well tolerated ACT increasingly used in Southeast Asia where it has proved to be highly effective against Plasmodium falciparum malaria. We tested the efficacy, safety and tolerability of DHA-PQP in children with uncomplicated P. falciparum malaria. A randomised, open trial was carried out in 2003-2004. Seven hundred and sixty-two children aged 12-59 months with uncomplicated P. falciparum malaria were randomly allocated to one of the following treatments: amodiaquine+artesunate; AQ+SP; or DHA-PQP. Patients were followed-up until Day 28 after treatment. Adverse events and clinical and parasitological outcomes were recorded. Children treated with DHA-PQP or AQ+AS had a significantly higher cure rate compared with those treated with amodiaquine+sulfadoxine/pyrimethamine (95.2% and 92.0% vs. 84.7%, respectively). Parasite clearance was significantly faster in children treated with DHA-PQP and AQ+AS compared with those treated with amodiaquine+sulfadoxine/pyrimethamine. The frequency of adverse events was significantly lower in patients treated with DHA-PQP than in those treated with combinations containing amodiaquine. A 3-day treatment with DHA-PQP proved to be efficacious with a good safety and tolerability profile and could be a good candidate for the next first-line treatment. 相似文献
18.
Bompangue Nkoko D Giraudoux P Plisnier PD Tinda AM Piarroux M Sudre B Horion S Tamfum JJ Ilunga BK Piarroux R 《Emerging infectious diseases》2011,17(11):2026-2034
Cholera outbreaks have occurred in Burundi, Rwanda, Democratic Republic of Congo, Tanzania, Uganda, and Kenya almost every year since 1977-1978, when the disease emerged in these countries. We used a multiscale, geographic information system-based approach to assess the link between cholera outbreaks, climate, and environmental variables. We performed time-series analyses and field investigations in the main affected areas. Results showed that cholera greatly increased during El Nino warm events (abnormally warm El Ninos) but decreased or remained stable between these events. Most epidemics occurred in a few hotspots in lakeside areas, where the weekly incidence of cholera varied by season, rainfall, fluctuations of plankton, and fishing activities. During lull periods, persistence of cholera was explained by outbreak dynamics, which suggested a metapopulation pattern, and by endemic foci around the lakes. These links between cholera outbreaks, climate, and lake environments need additional, multidisciplinary study. 相似文献
19.
Palacios G Lowenstine LJ Cranfield MR Gilardi KV Spelman L Lukasik-Braum M Kinani JF Mudakikwa A Nyirakaragire E Bussetti AV Savji N Hutchison S Egholm M Lipkin WI 《Emerging infectious diseases》2011,17(4):711-713
The genetic relatedness of mountain gorillas and humans has led to concerns about interspecies transmission of infectious agents. Human-to-gorilla transmission may explain human metapneumovirus in 2 wild mountain gorillas that died during a respiratory disease outbreak in Rwanda in 2009. Surveillance is needed to ensure survival of these critically endangered animals. 相似文献
20.
Can performance‐based financing help reaching the poor with maternal and child health services? The experience of rural Rwanda
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Laurence Lannes Bruno Meessen Agnes Soucat Paulin Basinga 《The International journal of health planning and management》2016,31(3):309-348
More than 20 countries in Africa are scaling up performance‐based financing (PBF), but its impact on equity in access to health services remains to be documented. This paper draws on evidence from Rwanda to examine the capacity of PBF to ensure equal access to key health interventions especially in rural areas where most of the poor live. Specifically, it focuses on maternal and child health services, distinguishing two wealth groups, and uses data from a rigorous impact evaluation. Difference‐in‐difference technique is used, and different model specifications are tested: control for unobserved heterogeneity and common random error using linear probability model, seemingly unrelated regression equations, and clustering and fixed effects. Results suggest that in Rwanda, PBF improved efficiency rather than equity for most health services. We find that PBF achieved efficiency gains by improving access to health services for those easier to reach, generally the relatively more affluent. It turns out to be less effective in reaching the poorest. Our results illustrate the advantages of rigorous randomized impact evaluation data as results published earlier using a nationally representative survey (Demographic and Health Survey) were not able to capture the pro‐rich nature of the PBF scheme in Rwanda. Our paper advocates for building mechanisms targeting the vulnerable groups in PBF strategies. It also highlights the need to understand the impact of PBF together with the specific development of health insurance coverage and the organization of the health system. 相似文献