REPORT Author: Reference: Subject:
Staff Coordinator - IPPB
Date:
24-11-2014
AMDJ-un.AIDorg. Implementing Programs Promotion Breastfeeding
Author: Staff Coordinator - IPPB Date: 24-11-2014 Reference: AMDJ-un.AIDorg. Subject: Implementing Programs Promotion Breastfeeding Program staff, stationed at the Refugee Camp on the banks of Lake Tanganyika - being the largest camp in the region – requested assistance in relation to the implementing programs for Breastfeeding. The refugees, majority being women – witnesses of the atrocities of the current conflicts – have fled the neighbouring country, the Democratic Republic of the Congo. The accounts of these women describe most harrowing circumstances under which they decided to leave their villages; watching loved-ones captured, beaten and murdered, in some cases being subjected to torture, and rape. Survival of these ordeals seemed a sheer miracle, but now they find themselves drained, having to come to terms with their losses and facing an uncertain future. On arrival I noticed a number of young women, aged 16 upward, lying outside the tents, holding babies and young children hanging in sling. There was very little activity amongst the new arrivals, and some senior officers of the staff expressed concern for what seems to be a general lethargic attitude amongst them. After the first briefing session with all staff concerned I set up a brief survey for them to consider: 1.
Identify the group of women that show signs of lethargy for over two weeks,
2.
Identify the same who neglect the needs of their young ones,
3.
Identify the same who can’t be bothered to eat or drink,
4.
Identify those who seem too tired to get up and leave their tent,
5. Identify those who show non-typical behaviour or a significant lack of connection to their surroundings. Staff was asked to put a timeline on the events; commencement of these signals - whether they could indicate these effects also affected women – who had arrived earlier and had been successfully integrated in the Breastfeeding Program. This latter information could indicate if a significant downward spiral (cohort) was present, and the general sense of lethargy was spreading amongst the group. I urged the staff to come forward if any attempted suicide[1] had occurred, or instances that involved infants, as a prodrome to a mother planning to take her own life, after killing her child/ren.
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REPORT This was not just a straight forward situation of Maternal Depression, and various elements like bereavement, stress, violence and hormonal changes point toward a very serious and dangerously confusing diagnosis. The burden of Depression is reflected in the case history of Tahina in Darfur. Tahina delivered a baby boy during her escape from her home region Zalingei. The infant’s age was an assumption, as Tahina’s tongue had been cut out, and she was illiterate. Medical examination proved that Tahina was victim to multiple sexual assaults; it was assumed that the baby was conceived during one of these. Having found shelter in the camp Tahina tried to cut her wrists, whilst covering the baby with own body in the attempt to smother him. We managed to safe both lives; putting aside shame or embarrassment would prevent similar risks. The result of the survey proved the following; during the last three months increase of percentage of young mothers was considerable, congruent with violent militia raids. Not only did they fear for physical infectious diseases [2] like Aids, but they feared for how their children would regard them, as some of them had been forced to watch while they were being raped. News from their home country triggered signs of Depression in women who had been living in the refugee camp longer. Although they had been settling in quite well; acceptance of their situation and well integrated in the Breastfeed program, this new wave of bad news - together with the diminishing hope of repatriation -rekindled despair, anxiety and caused what should be recognised as Maternal Depression in its broadest form. Adequate measures must be taken before these symptoms “infect”[3] others – emotions, state of mind, stress and anxiety; all are part of Major Depression Syndrome and can be treated. The negative effects on the children are well known and can be reversed and, in some cases, prevented. Intervention includes enhancing the process of Breastfeeding implementing program, so that the mother-infant interaction can be improved by educating the mothers, ensure better cognitive development and growth, reduce risk of diarrhoea, and introduce hygiene and immunisation programs. Medical checks for those mothers who fear that they have contracted AIDS must be initiated, together with additional support for those who need it. Additional Recommendations:
Author: Staff Coordinator - IPPB Date: 29-11-2014 Reference: AMDJ-un.AIDorg. - Advisory Note From an Etic Perspective, research methods that can analyse the cause and consequences, applying the international criteria as compared with the DSM, ICD or CIDI. However, I would not concur with the comparison of a disease in the way Ethic methodology likes to approach this specific situation, as it would be wholly unrealistic to even try and compare the situation in the camp to any situation arising in a developed, comparably prosperous and stable environment like the Western industrialised countries. From the outcome of the survey mentioned in my report, I would much rather see the solutions in breaking this downward spiral by applying the Emic approach and see how a practical solution in intensifying the Breastfeeding Programme is fully incorporated.
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[email protected] • HP : +31-640750484
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REPORT The staff has furthermore identified where the major risks for persistent depression will occur, and have been very alert, intensifying their pro-active intervention in making sure that the youngest mothers are being monitored quite sharply – this does confirm the method in pinpointing the actual context in which we can regard how Maternal Depression can be identified and putting a name to the beast[1], so to speak. Various studies and research have shown what the consequences are when children are in the daily care of a mother who suffers from Maternal Depression; underweight and stunted growth, diminished immune systems, additional risks of digestive problems, such as diarrhoea, as well as diminished cognitive development and emotional development[2]. Treatment and prevention is now assigned to older staff members, who are regarded with great respect as they are more experienced and enjoy a greater esteem. They have been put in charge of the more serious cases, are trained on the spot to act as counsellors. Group therapy[3] has been organised to draw these women out of their mental isolation; results are increasingly positive. The therapy encourages women to talk about their experiences and ordeals, which helps them to come to terms with their past – sharing their grief helps putting their sadness and loss into perspective, and makes them aware that they are not alone - it also alleviates the overpowering sense of guilt, that tends to draw them into a social isolation. Additional care must be provided where hygiene matters are concerned and the younger staff can be in charge of showing all the residents how to simply prevent infections generally. By intensifying the general monitoring system where the weight of the infants are being recorded – showing the mothers the immediate benefits of breastfeeding, and applying the theories of what they learned in the hygiene sessions – the overall welfare of mother and child can be increased. Most importantly, the interaction between mother and infant will dramatically improve and safe and constitutional bonding is established. These protective measures can break the downward spiral the most urgent and severe cases showing signs of Maternal Depression and can also avoid spreading the general trend of negativism, as discussed in terms of the infectiousness of negative emotions in such a vulnerable group, such as this one.
Phone: +31 15-2126718• E-mail:
[email protected] • HP : +31-640750484
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