Healing the Wounds of War: Victim Assistance in Post-conflict Burundi

by Cameron Macauley [CISR] - view pdf

Although violence in Burundi has subsided, the majority of the survivors still suffer from psychological trauma, including depression, poor self-esteem and anxiety. To manage these negative effects, the Centre d'Encadrement et de Développement des Anciens Combattants (Training Centre for Development of Ex-Combatants) initiated a peer-support program to help ex-combatants solve their challenges as a group. James Madison University’s Center for International Stabilization and Recovery and Action on Armed Violence worked with CEDAC on this peer-support program. The program is funded jointly by the Stavros Niarchos Foundation and AOAV.

Since its independence in 1962, Burundi has been plagued by periodic violence resulting from ethnic and political divisions, which reached a peak during the mass killings of 1993 and led to years of instability.1 Violence subsided with the 2008 peace accord, but many Burundians are left with permanent scars, long-term poverty and few social services.2 In a 2007 “satisfaction with life” study conducted with data from 178 nations, Burundi ranked last.3

Joseph Ntawanka shows CISR Trauma Rehabilitation Specialist Cameron Macauley and CEDAC Operations Coordinator Joël Nibigira the site of a mass grave in Kiganda, Burundi, where 32 people were buried after being shot by soldiers while drinking in a pub that Ntawanka owned. He was the only survivor.Joseph Ntawanka shows CISR Trauma Rehabilitation Specialist Cameron Macauley and CEDAC Operations Coordinator Joël Nibigira the site of a mass grave in Kiganda, Burundi, where 32 people were buried after being shot by soldiers while drinking in a pub that Ntawanka owned. He was the only survivor.
All photos courtesy of the author.

In recent years international aid agencies, including World Vision and HealthNet TPO, a Dutch aid agency affiliated with Medecins Sans Frontières-Holland (Doctors Without Borders), have implemented new programs to help Burundians learn how to recover from past traumas and assist one another.4 Psychosocial support promotes autonomy and empowerment among survivors who may have spent years as forced conscripts, refugees or political prisoners—situations in which they had no control over their lives. For these survivors, psychological recovery is facilitated by engaging in new activities designed to enhance self-esteem while generating income and interacting with others in a positive environment.5

CEDAC

An example of this approach is the program operated by the Centre d’Encadrement et de Développement des Anciens Combattants (Training Centre for Development of Ex- Combatants), a Burundian nongovernmental organization established in 2005. Its founder, Eric Niragira, is a former child soldier with first-hand knowledge of the helplessness many ex-combatants experience upon demobilization. “You’ve spent so many years being told what to do and when to do it that your own initiative disappears,” he says. “Once demobilized, you find yourself in a country with few opportunities for education or employment, and that feeling of powerlessness persists.”

Niragira himself struggled during the post-conflict years to learn English and find funding to start CEDAC.6 His goal was to unite ex-combatants to solve their problems as a group, so that they could support each other just as they had during the Burundian crisis—known in Burundi as la crise. This peer-support strategy is a central feature of many psychosocial support programs and is gaining wide acceptance as a cost-effective means of promoting recovery in post-conflict settings.7,8

A peer-support worker (right) talks to a survivor in a field not far from her home in Kiganda, Burundi.A peer-support worker (in white) talks to a survivor in a field not far from her home in Kiganda, Burundi.

CEDAC began by gathering female ex-combatants into groups where they could discuss concerns and experiences. Very often these discussions focused less on psychological trauma and more on practical concerns such as poor housing, illiteracy, unemployment and illness. Advice and information from peers suggest sensible options for solving problems, and problem-solving builds self-esteem. Moreover, helping others is fulfilling. These peer-support groups counteracted the humiliation and helplessness that people experienced during the war.

Niragira also wanted to provide assistance for ex-combatants who were so depressed and withdrawn that they would not attend group meetings. He sought to train survivors so that they could offer not only friendship but individual counseling as well. He also wanted to include survivors with disabilities in his program. In 2010, CEDAC formed a partnership with the Center for International Stabilization and Recovery at James Madison University.

Peer Support Programs

Starting in 2011, CISR trained peer-support workers and other CEDAC staff so they could in turn conduct their own trainings.9 One of the obstacles CISR faced was how to instruct peer-support workers who could not read or write. Literacy in Burundi is around 77 percent for the 15- to 24-year-old age group; however, it is significantly less for those over 24 and for persons with disabilities.10 This means that many survivors in their thirties and forties cannot read or write, especially those living in rural communities. CEDAC did not want to exclude peer-support worker candidates who are not literate; therefore, CISR developed a curriculum that did not rely on reading and writing. Exercises and presentations had to be entirely verbal while recognizing that the participants were adults with significant life experience.

CISR Trauma Rehabilitation Specialist Cameron Macauley rests for a moment with CEDAC Operations Coordinator Joël Nibigira on their way to visit peer-support workers in Bugarama, Burundi. A group of children want to see the muzungu (anyone who is not African) up close.CISR Trauma Rehabilitation Specialist Cameron Macauley rests for a moment with
CEDAC Operations Coordinator Joël Nibigira on their way to visit peer-support workers in Bugarama, Burundi. A group of children want to see the muzungu (anyone who is not African) up close.

The training of peer-support workers was only the first step. In order to implement a full-scale psychosocial support program, CEDAC also created an administrative structure to ensure the provision of quality services. Peer-support workers needed supervisors to whom they could refer survivors who had complex issues to resolve. Supervisors had to be familiar with other agencies and institutions that assist survivors in need of health care, education, employment and legal issues. All of this required a reliable system of communication and transportation.

Additionally, a program of this kind needs monitoring and evaluation to learn what works and what does not. This depends on data collection by literate peer-support workers who record information about survivors for their supervisors to analyze, including periodic mental health assessments to determine if survivors are benefiting from peer support.

In late 2011 another partner entered the picture: Action on Armed Violence, a London-based NGO formerly known as Landmine Action. Its work in Burundi began with an interest in controlling the large numbers of handguns, rifles and grenades that remained in the hands of citizens following the conflict.11 These weapons contribute to violent crime and political instability.

AOAV identified psychological trauma as one of many motivations that lead to acts of violence and felt that CEDAC’s peer-support program could help mitigate anger, bitterness and the desire for revenge—commonly felt by people experiencing unresolved traumatic stress. AOAV decided to conduct a baseline population survey to examine mental health indicators as well as socioeconomic conditions in the communities where CEDAC works. AOAV also stepped in to provide mobile phones for all of CEDAC’s peer-support workers and bicycles for supervisors, therein providing the communication and transportation necessary to facilitate the program.

“I have been lonely and sad since I lost my arm during the violence that devastated my community. A woman with one arm is nobody—people act as if she doesn’t exist. But my peer-support worker cares about me, wants me to feel better. She has made me think about myself differently. When I talk to her, I feel as if my life has meaning once again.” ~ Languide Nsabiyumva

The results are impressive. Although quantitative data is still being compiled, interviews with 16 randomly selected survivors showed that participants have enthusiastically positive opinions of the services received.

For peer-support workers, work days are long and strenuous as many homes are remote and accessible only on foot. Yet, the rewards of helping others make every step worthwhile. “Even when I’m not working, I think about the people that I’m trying to help,” said Candide Nsabiyumva. “Knowing that I can make a difference in their lives is an inspiration for me.”

CEDAC collected monitoring and evaluation data on hundreds of survivors that will be analyzed during the next few months and used to improve program activities in 2013. “Each day brings new refinements to this program,” says Eric Niragira. “We look forward to expanding into new communities and eventually helping the entire nation. We are assisting each other to recover from Burundi’s violent past.” globe

 

Biography

Cameron MacauleyCameron Macauley, MPH, joined CISR in August 2010 as its peer support and trauma rehabilitation specialist. He holds a Master of Public Health as well as degrees in anthropology and psychology, and became a physician assistant in 1983. He has worked in a refugee camp on the Thai-Cambodian border, at a district hospital in Sumatra, as a Peace Corps volunteer in Guinea- Bissau, in Mozambique where he taught trauma surgery for landmine injuries, in an immunization program in Angola and in a malaria-control program in Brazil. Between 2005 and 2010, he taught mental health courses for Survivor Corps in Bosnia and Herzegovina, Colombia, El Salvador, Ethiopia, Jordan and Vietnam.


Contact Information

Cameron Macauley, MPH
Peer Support and Trauma
Rehabilitation Specialist
Center for International Stabilization and Recovery
James Madison University
MSC 4902
Harrisonburg, VA 22807 / USA
Tel: +1 540 568 4941
Email: macaulcx@jmu.edu
Website: http://cisr.jmu.edu

Endnotes

  1. Watt, N., Burundi: The Biography of a Small African Country. Columbia University Press, 2008.
  2. “Burundi: Country Brief.” The World Bank. http://www.worldbank.org/en/country/burundi. White, A. (2007).
  3. “A Global Projection of Subjective Well-being: A Challenge to Positive Psychology?” Psychtalk 56: 17-20. http://data360.org/pdf/20071219073602.A%20Global%20Projection%20of%20Subjective%20Well-being.pdf. Accessed 13 September 2012.
  4. “Background Note: Burundi.” U.S. Department of State: Diplomacy in Action. http://www.state.gov/
    r/pa/ei/bgn/2821.htm
    . February 2012.
  5. Ventevogel, P, Ndayisaba, H. and van de Put, W. “Psychosocial Assistance and Decentralised Mental Health Care in Post Conflict Burundi 2000-2008.” Intervention 9, no. 3 (2011): 315-331.
  6. “Eric Biography.” CEDAC. http://www.freewebs.com/cedac/biographyoftheauthor.htm. Accessed 13 September 2012.
  7. Rubenstein, L. and Kohli, A. “Mental Health Services During and After Armed Conflict: The State of Knowledge and Practice.” Peace Brief, 28 September 2010. United States Institute of Peace. http://www.usip.org/publications/mental-health-services-during-and-after-armed-conflict-the-state-knowledge-and-practice. Accessed 13 September 2012.
  8. Macauley, C. “Peer Support and Trauma Recovery,” The Journal of ERW and Mine Action, Issue 15.1 (Spring 2011): 14–17. http://www.jmu.edu/cisr/journal/15.1/feature/macauley/macauley.shtml. Accessed 13 September 2012.
  9. Macauley, C., M. Onyango, Niragira, E. “Peer-support Training for Nonliterate and Semiliterate Female Ex-combatants: Experience in Burundi.” The Journal of ERW and Mine Action, Issue 16.1 (Spring 2012). http://www.jmu.edu/cisr/journal/16.2/notes/Macauley/macauley.shtml. Accessed 13 September 2012.
  10. “Literacy rate, youth total (% of people ages 15–24.)” The World Bank. http://data.worldbank.org/indicator/SE.ADT.1524.LT.ZS. Accessed 13 September 2012.
  11. “International & local partners on the ground.” Action on Armed Violence. http://www.aoav.org.uk/about-us/our-partners/international-and-local-partners-on-the-ground. Accessed 13 September 2012.

 

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