CRITERIOS ÉTICOS

Chldren used a wde range of pharmaceutcals and herbal remedes n the management of malara. In partcular, chldren mentoned usng chloroqune, Panadol, Hedex, Acton, Fansdar, and qunne. In some nstances lace, laburi, and neem tree leaves were also used n the treatment of malara. Pharmaceutcals were readly accessble over the counter without prior consultation with professional healthcare workers. Such findings have mplcatons for emergency ad nterventon and prorty settng n healthcare.

Although chldren readly accessed pharmaceutcals, ncludng prescrpton only medcnes, over the counter from clncs, drug shops, health centres, and market vendors, t appears that pharmaceutcals may not actually be magc bullets for allevatng chldren’s sufferng. Symptom based management of malara epsodes mght lead to the abuse of

46 _{Somatc symptoms are emotonal aches whch chldren presented as body aches, whle psychosomatc symptoms are physcal} and/or emotonal problems whch cause genune physcal sufferng.

medcnes, for nstance by buyng varous medcnes to treat one symptom; one chld purchased Panadol and Hedex for pan relef, both of whch are analgescs and therefore made of the same actve ngredents. Subsequently, t appears that chldren often used more pharmaceutcals than necessary.

The market orentedness of healthcare, where even pharmaceutcals are a commodty, renforces self-medcaton and over use of pharmaceutcals. A wde range of advertsements for pharmaceutcals – statng whch ones provde effectve relef, fast cure, and other appealng qualtes – whch appear n prnt and n audo and vsual meda, were a common phenomenon n Gulu at the tme of ths study. These advertsements were vtal n dssemnatng knowledge about pharmaceutcals and nformng people on how to manage common symptoms themselves. It was therefore only the amount of money whch an ndvdual had that determned the qualty and quantty of pharmaceutcals accessed. The prolferaton of pharmaceutcal companes, and the subsequent unregulated mport of such pharmaceutcal commodtes to Uganda facltated easy access to varous types of medcaton, ncludng those whch are prescrpton only, over the counter and for a fee. Moreover, wth the adopton of structural adjustment polces snce the 1980s and subsequent prvatsaton of healthcare and lberalsaton of the markets, Uganda has wtnessed an ncrease n mports of pharmaceutcals of varyng qualtes, whch explans the presence of, for nstance, Hedex, Panadol, Acton, and Panex, to menton only a few examples for headache relef.

In the management of self-dagnosed malara, t appears that chldren were pragmatsts n allevatng ther sufferng. In ther quests for therapy, chldren not only engaged in practices to find a cure, but they also went beyond acceptable rationalities and norms n ther own lfe world n these attempts. For nstance, chldren frequently dscouraged the mxng of pharmaceutcals and herbal remedes for llnesses. In ther own narratves they dsclosured such practces, for example havng mxed or used chloroqune wth kor muyeme, lace, and laburi for an epsode of self-dagnosed malara. Further, chldren ndcated tryng out other pharmaceutcals, to see f they offered a soluton to ther symptoms, f the prevous one was not effectve. In general however, chldren had trust n the healng propertes of pharmaceutcals.

Conclusion

Malara was a common llness experenced by dsplaced chldren of prmary school age. Chldren self-dagnosed malara and subsequently managed t wth both pharmaceutcals and herbal remedes. The fact that dsplaced chldren readly dscussed ther experences wth clncally- and self-dagnosed malara ponts to ts acuteness, severty, and hgh prevalence. The latter demonstrates that malara s a prorty and an mmedate healthcare need. In analyses of emprcal data I have propostoned that chldren ranked malara as a severe llness whch commonly affected them, and also that the hgh prevalence of malara could account for the substantal use of antmalarals. The hgh count of antmalarals used wthn a one month recall suggests not only that chldren were pragmatsts n ther quests for therapy (or opted for short term curatve approaches n the management of malara), but also that the hgh prevalence of self-dagnosed (and even clncally-dagnosed) malara might reflect a neglect or mis-diagnosis of other febrile llnesses. Ths hghlghts the need for blood smears in order to confirm whether the prevalence of malara s n fact as hgh as the number of self- and clncally-dagnosed cases ndeed suggest. Further, a hgh count of pharmaceutcal and herbal medcne use could suggest the pharmaceuticalisation and herbalisation of complex forms of sufferng n stuatons of armed conflict.

Based on empirical evidence which signifies a high prevalence of malara, and the contemporary emphases on curatve approaches ncludng the ntroducton of artemsnn combination therapies as a first line drug, I propose that there is instead a need to address wder soco-economc and poltcal nequaltes n the management of malara. I suggest that effectve strateges n preventon and control n areas of hgh transmsson, ncludng northern Uganda, need to go beyond curatve approaches to encompass preventve approaches. However, gven the dre context n whch chldren who partcpated n ths study lved, I propose that t s approprate for them to engage n short term curatve approaches n management of malara. I propose the latter whle recognsng that the effectve approach n malara control les n preventve measures whch wartme chldren could not practce because of poverty, lack, poor lvng condtons and dsplacement from ther lvelhood.

Chapter Six Diarrhoea Introduction

Ths chapter’s objectve s to analyse chldren’s experences and medcne use for epsodes of darrhoea. Chldren frequently dscussed ther experences wth cado (darrhoeal dseases), cado remo (bloody darrhoea), cado pii pii (darrhoea wth watery stools), dysentery, and cholera, whch they treated wth pharmaceutcals and herbal remedes. Cholera epdemcs n northern Uganda durng the two phases of research are presented and analysed n ths chapter as a severe form of darrhoea.

In ths chapter emprcal data s organsed followng these themes: prevalence, medcne use, dsease aetologes, and epdemcs of darrhoeal dseases. Analyses of data wll focus upon questons concernng the prevalence of darrhoeal dseases, ncludng cholera epdemcs, and ts dfferental prevalence wthn Gulu dstrct (n affectng manly resource poor communtes); contemporary areas of emphass n the control of epdemcs of darrhoeal diseases; and the conflict between children’s perspectives about their own darrhoea epsodes compared to others’. I wll also explore how control of the cholera epdemc n Gulu dstrct at the tme of ths study presented varous challenges.

6. Findings

6.1. Quantitative data: Prevalence and medicine use for episodes of diarrhoea