· PROMOCiÓN DE lA SAlUD Y PREVENCiÓN DE lA

In order to get insight in older people’s ow n perceptions o f vulnerability, group discussions w ere held in various compositions: men and women separately, w idow s (mean age 74 years), very old people (mean age 80 years) and HAI’s homevisitors. The concept o f vulnerability is quite abstract and hard to explain to illiterate people. Therefore the Rwandan word “himibereko” w as used which means well-being in its broadest sense (comprising social, economic, psychological and health aspects). The ranking methodology was followed and discussions were confined to the refugee situation.

According to older people themselves, main problem s o f the less well-to-do w ere: 1. Physical impairment.

2. No purchasing pow er, income, tools and utensils.

3. No people to provide assistance and moral support, social isolation.

Men and wom en came up with similar determ inants o f well-being, although it seemed that men tend to mention income generating capacity or purchasing power first and emphasise economic independence, w hereas w om en mentioned more o ften having productive household members or others around to provide support (annex 6 .2 shows men's and w om en's definitions o f well-being). Similarly, homevisitors also identified those without jobs o r physical working ability as the most vulnerable. They classified the least well-to-do elderly as:

1. Widows and widowers.

2. The physically impaired and disabled.

3. Those w ho live alone, have no children living nearby, have care giving responsibilities (e.g. for young children, old spouse).

Older people mentioned that they had insufficient clothing and blankets to rem ain warm. HA1 identified in participatory exercises in all camps in Karagwe that insufficient or

inappropriate clothing also affected their dignity. Further boredom was observed as a problem, particularly for those people who were unable to w ork further from home (due to physical impairment or n o access to (nearby) land). In Rwanda women in such situations used to engage in m a t and basket making, but here raw materials were not available in nearby surroundings.

In Ngara district, UNHCR conducted interviews when the second influx o f refugees w as moving between transit ce n tre s from the border to the camps. Refugees themselves mentioned older people and children as th e most vulnerable among them. They gave reasons such as exhaustion, undem utrition, health, suffering from rain and cold, separation from family m em bers and lack o f information (pers.com. UNHCR Ngara).

For widows and very old p eo p le working ability w as the main criterion to identify vulnerable groups and they identified business men, those with jobs and wage labourers as the better-off. With m inor differences in ranking order, the following vulnerable groups were mentioned: old widows/widowers, old people living alone or without younger adults or who care fo r young children, young widows/widowers with young children, the disabled and m entally disturbed, destitute w om en5 and young orphans living without adults. As both g ro u p s found they suffer m ost, they put themselves on to p o f their respective lists. They s ta te d that old people w ho are looked after by their children are still worse off than in R w anda. Their explanation w as that in Rwanda, children used to cultivate their parent's la n d , sharing the produce, and did not neglect their parents because they would inherit th e ir land. However, as refugees, children have nothing to inherit from parents who have lost their property.

All widows lived with grandchildren and mentioned they gave priority to the children if food was insufficient. They sta te d that daughters generally help their parents m ore than sons. They were very concerned about old people w ho were neglected by mature children and feel a burden. O n e o f them illustrated this w ith her personal situation: “I live next door to my son and w e share a ration card. His wife always argues with me and is impolite. Now I behave like a child because I’m treated like a child; 1 just keep quiet. My daughter in law blames me fo r doing nothing, she says I just sit and eat. Things have

changed nowadays. Elderly people are treated like children and children behave as superiors.” The others agreed that there w as always something to do at home in Rwanda, even for weak people. N ow they feel bored and are ashamed to ask assistance.

The very old group also mentioned that daughters w ere m ore helpful to their parents: “Even if a daughter becomes delinquent, she never forgets her parents” . Particularly men seemed to be annoyed that they were expected to w ork according to their ability: “In Rwanda we w ould stay at hom e and ju st eat and sleep. Old people in Rwanda can benefit from what they have built up in the past. They get income from their plantations and there are people around to take care o f them .”

Witchcraft was also a discussion topic and was know n in the camp. According to the widows anybody can be suspected o f magical pow ers and if there is witchcraft in the house men and women are equally vulnerable. The group o f older people how ever said that women are m ore often bewitched. It occurs that people in conflict, for example two wives o f the sam e husband, are accused o f witchcraft. I f the traditional doctor diagnoses witchcraft and cannot cure it, the patient is often chased away or murdered.

Food and health was also discussed w ith older homevisitors. They characterised the diet as inferior to th e Rwandan diet in term s o f quantity and quality. Fresh maize used to be eaten roasted as a snack (the dried grain was kept as seed o r chicken feed), however in the camp maize was eaten cooked as whole grain o r as stiff or thin porridge. The distribution o f beans was sometimes substituted by peas o r lentils. H ow ever peas were thought to cause diarrhoea if eaten daily. Lentils w ere initially disliked and most Rwandans did not know how to prepare them. In summary, food was less tasty and palatable and relatively m ore food w as lost due to inappropriate storage.

The relation between ill health and food was explained as follows. In the case o f ill health, the stom ach cannot “grind" the food, which causes diarrhoea and nausea. Undigested food appears in the faeces as the intestines fail to “select what food to absorb” . Therefore ill people prefer to eat liquid food such as thin porridge and soup. Children and old people are less able to digest whole grain and therefore suffer much from abdominal discomfort.