Mukwege Foundation. The Treatment of Trauma – Women and their Families in DRC
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This
 document
 describes
 one
 of
 the
 necessary
 steps
 towards
 peace
 and
 stability
 in
 the
 DRC.
 ...

This
 document
 describes
 one
 of
 the
 necessary
 steps
 towards
 peace
 and
 stability
 in
 the
 DRC.

Because
 of
 the
 war
 in
 the
 DRC,
 with
 thousands
 and
 thousands
 of
 women
 of
 all
 ages,
 being
 raped
 in
 the
 most
 horrible
 way,
 we
 know
 that
 health
 care
 is
 not
 enough
 to
 rebuild
 the
 hope
 and
 the
 strength
 of
 the
 population.
 The
 affected
 women
 and
 their
 families
 need
 trauma
 therapy.
 Health
 care
 personnel,
 social
 workers,
 policemen,
 military
 as
 well
 as
 and
 other
 officials
 should
 be
 prepared
 for
 meeting
 and
 treating
 the
 affected
 families,
 without
 adding

to
 the 
stigma 
and 
trauma.



The
 project
 is
 initiated
 by
 Dr
 Mukwege,
 through
 the
 international
 network
 Yennenga

Progress
 (www.yennengaprogress.se).
 To
 be
 able
 to
 spread
 knowledge
 and
 the
 trauma

therapy
 method
 over
 a
 vast
 area
 of
 inaccessible
 land
 to
 a
 large
 number
 of
 affected
 people,
 an
 e‐learning
 tool
 will
 be
 produced
 in
 cooperation
 with
 MKFC.
 The
 psychological
 expertise
 is
 guaranteed
 by
 the
 Swedish
 CBT‐institute,
 in
 collaboration
 with
 the
 institute
 for
 crisis
 management 
at 
Uppsala 
University.


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Mukwege Foundation. The Treatment of Trauma – Women and their Families in DRC Document Transcript

  • 1. 





 


 


 


 


 


 


 


 


 Mukwege
Foundation
 
 The
Treatment
of
Trauma
 ‐
Women
and
their
Families
in
DRC
 


 


 

 
 

  • 2. Table
of
Contents
 Introduction ......................................................................................................................................3
 Project aim....................................................................................................................................3
 Methods and Techniques..................................................................................................................4
 Information and Communication Technology (ICT) ...................................................................5
 Project Activities ..........................................................................................................................5
 Treating Trauma Post-Traumatic Stress Disorder (PTSD) ..........................................................6
 Organisations Involved in the Project ..............................................................................................9
 The network Yennenga Progress..................................................................................................9
 Mukwege Foundation.................................................................................................................10
 MKFC Stockholm College.........................................................................................................11
 Svenska KBT Institutet (SKBTI) ...............................................................................................12
 Management of the Project ............................................................................................................12
 Project objective.........................................................................................................................12
 Sustainability Plan......................................................................................................................13
 Project Indicators........................................................................................................................13
 Risk factors.................................................................................................................................13
 Coordination...............................................................................................................................14
 Democracy and human rights in the project...............................................................................14
 The Democratic Republic of Congo – Background Information About the Social Situation........15
 Context .......................................................................................................................................15
 Democracy and human rights.....................................................................................................15
 Gender ........................................................................................................................................16
 Resources ...................................................................................................................................16
 Opportunities (e.g. education, employment)..............................................................................16
 
 
 
 
 
 
 

  • 3. Introduction

 


 


 “Right
 now
 there's
 a
 war
 taking
 place
 in
 the
 heart
 of
 Africa,
 in
 the
 Democratic
 Republic
 of
 Congo
 (DRC),
 and
 more
 people
 have
 died
 there
 than
 in
 Iraq,
 Afghanistan,
 and
 Darfur
 combined.

 
 You
probably
haven't
heard
much
about
it,
but
as
CNN's
Anderson
Cooper
first
reported
last
 January,
 it's
 the
 deadliest
 conflict
 since
 World
 War
 II.
 Within
 the
 last
 ten
 years,
 more
 than
 five
million
people
have
died
and
the
numbers
keep
rising.

 


 It
is,
in
fact,
a
war
against
women,
and
the
weapon
used
to
destroy
them,
their
families
and
 whole
communities,
is
rape.”[1]

 


 Quotas
from
60
minutes

 


 
 



 This
document
describes
one
of
the
necessary
steps
towards
peace
and
stability
in
the
DRC.
 Because
of
the
war
in
the
DRC,
with
thousands
and
thousands
of
women
of
all
ages,
being
 raped
in
the
most
horrible
way,
we
know
that
health
care
is
not
enough
to
rebuild
the
hope
 and
 the
 strength
 of
 the
 population.
 The
 affected
 women
 and
 their
 families
 need
 trauma
 therapy.
 Health
 care
 personnel,
 social
 workers,
 policemen,
 military
 as
 well
 as
 and
 other
 officials
should
be
prepared
for
meeting
and
treating
the
affected
families,
without
adding
 to
the
stigma
and
trauma.

 The
 project
 is
 initiated
 by
 Dr
 Mukwege,
 through
 the
 international
 network
 Yennenga
 Progress
 (www.yennengaprogress.se).
 To
 be
 able
 to
 spread
 knowledge
 and
 the
 trauma
 therapy
method
over
a
vast
area
of
inaccessible
land
to
a
large
number
of
affected
people,
 an
e‐learning
tool
will
be
produced
in
cooperation
with
MKFC.
The
psychological
expertise
is
 guaranteed
 by
 the
 Swedish
 CBT‐institute,
 in
 collaboration
 with
 the
 institute
 for
 crisis
 management
at
Uppsala
University.
 


 Project
aim

 The
DRC
has
met
important
difficulties
during
this
long
and
terrifying
war.
The
infrastructure
 and
 national
 institutions
 cannot
 meet
 the
 needs
 of
 the
 population.
 The
 civil
 society
 is
 therefore
crucial
for
the
development
of
the
country,
both
regarding
health,
education
and
 development
 work.
 Dr
 Mukwege
 and
 his
 crew
 have
 been
 working
 actively
 in
 the
 Kivu
 province
for
many
years.
They
are
well
known
and
have
a
reputation
among
the
population
 as
genuine
helpers
of
women
in
distress.
They
have
both
the
theoretical
knowledge
and
the
 experience
needed
to
carry
out
its
work.

 


 Because
 of
 the
 difficult
 political
 situation
 in
 the
 DRC,
 with
 thousands
 and
 thousands
 of
 women
of
all
ages
being
raped
in
the
most
horrible
way,
we
need
to
make
it
possible
to
give
 the
women
affected,
as
well
as
their
families,
psychological
treatment.
We
need
to
educate
 social
workers,
hospital
personnel
and
other
officials
on
the
subject
on
meeting
the
special
 needs
of
the
violated
women
and
their
families.
 



  • 4. The
 victims
 are
 spread
 over
 a
 big
 geographical
 area,
 which
 makes
 it
 necessary
 to
 extend
 these
 services
 beyond
 the
 established
 health
 care
 facilities
 in
 urban
 areas,
 e.g.
 the
 Panzi
 Hospital
in
Bukavu
where
Dr.
Mukweges
team
is
based.
 

 Dr
Mukwege
sees
an
urgent
need
for
an
expansive
treatment
and
competence
building.
We
 are
 therefore
 creating
 a
 project
 aiming
 at
 spreading
 trauma
 therapeutic
 knowledge
 to
 a
 large
number
of
people
in
a
short
period
of
time.

 


 This
will
be
done
in
a
series
of
steps:

 • Creating
 an
 e‐learning
 program
 with
 movies,
 voice
 and
 pictures,
 as
 well
 as
 written
 text.
(Learning
by
doing/seeing)
 • Training
 of
 10
 educators,
 who
 through
 an
 educational
 program
 will
 provide
 nurses
 and
 social
 workers
 at
 hospitals
 and
 clinics
 in
 the
 area
 with
 the
 tools
 and
 the
 knowledge
on
how
to
professionally
conduct
trauma
healing
for
affected
individuals,
 and
how
to
make
a
first
analysis
of
the
needs
of
the
survivor
of
rape.
(Each
educator
 will
need
a
portable
computer
or
smart
phone,
to
be
able
to
show
movies
and
use
 the
material.)

 • Creating
films
and
material
aimed
directly
at
the
women,
encouraging
them
to
take
 part
in
the
treatment
and
to
be
used
during
treatment.

 • Creating
 a
 manual
 for
 trauma
 therapy.
 The
 manual
 allows
 for
 staff
 with
 limited
 training
and
experience
on
trauma
healing
to
apply
the
method.
 • Conduct
research
on
trauma
therapy
and
gender
issues
in
conflict
situations.

 


 The
 psychiatrist
 at
 Mukwege
 Foundation
 is
 responsible
 for
 the
 coordination
 and
 the
 structure
of
education
of
all
persons
working
with
the
 survivors
of
rape
and
their
families.
 The
work
is
being
done
through
cooperation
between
Yennenga
Progress,
MKFC
and
SKBTI.

 




 During
 the
 first
 stage
 of
 the
 project,
 the
 pilot
 project,
 10
 educators
 (psychologists,
 social
 workers
 or
 other
 health
 workers)
 will
 be
 trained
 in
 the
 methods
 of
 trauma
 therapy
 and
 pedagogy,
to
be
able
to
become
educators.

 


 During
 the
 second
 stage,
 when
 the
 methods
 are
 tested
 and
 modified,
 500
 persons
 will
 be
 trained
to
be
able
to
conduct
trauma
therapy,
following
a
given
method.

 


 We
 are
 training
 both
 men
 and
 women.
 These
 will
 most
 probably
 treat
 men
 as
 well
 as
 women,
as
the
whole
family
is
affected,
not
only
the
raped
person
needs
therapy.

 


 The
 target
 group
 consists
 mostly
 of
 rural
 persons,
 living
 in
 the
 countryside,
 working
 with
 agriculture.
Their
economic
situation
is
difficult
and
fragile.
The
fact
of
being
raped
has
put
 the
women
and
their
families
in
an
even
more
difficult
social
situation.

 


 The
educators
will
also
train
official
personnel
such
as
health
care
workers
and
the
police
on
 how
to
work
with
the
affected
persons
without
adding
to
the
stigma
of
the
rape.

 


 
 
 Methods
and
Techniques
 

  • 5. Information
and
Communication
Technology
(ICT)


 Equal
 opportunities
 for
 knowledge
 building
 regardless
 of
 wealth,
 sex,
 religion
 or
 ethnicity
 are
possible
thanks
to
Information
and
Communication
Technology
(ICT).
Development
and
 the
opportunity
to
spread
the
formal
and
informal
learning
based
on
best
practice
are
linked
 to
 the
 local
 society
 with
 ICT.
 The
 cost‐effectiveness
 that
 this
 creates
 provides
 financial
 opportunities
for
new
reforms
and
sustainability
in
the
country.

 


 ICT
has
been
used
in
education
for
more
than
two
decades.
Advances
in
hardware,
software
 and
networks
have
further
enhanced
the
potential
of
ICT.
At
the
same
time
systematic
and
 strategic
factors
affecting
ICT
development
in
informal
education.
ICT
is
an
important
tool
to
 communicate
about
changes,
where
all
citizens
can
participate
and
make
their
voice
heard
 through
social
networks.

 


 Educations
 supported
 by
 ICT
 are
 crucial
 for
 making
 long‐term
 changes.
 A
 developed
 ICT
 community
as
Sweden
can
build
a
bridge
to
developing
communities
and
share
knowledge
 of
good
practices.

 


 • ICT
 creates
 opportunities
 for
 everyone
 to
 receive,
 create
 and
 disseminate
 information
in
local
environments

 • ICT
enables
people
to
increase
their
participation
in
learning
and
decision‐making

 • ICT
 for
 training
 tutors
 is
 cost
 effective
 and
 helps
 young
 people
 create
 jobs
 and
 teaches
 them
 how
 to
 apply
 entrepreneurial
 thinking
 to
 their
 future
 workplace.
 The
 result
is
a
more
robust
community.


 
 Project
Activities

 


 The
 therapist
 and
 the
 counsellors,
 their
 local
 contacts
 and
 understanding
 of
 the
 problems
 and
the
course
material
are
central
for
a
successful
implementation
of
the
project.

 


 Subject
 experts,
 e‐pedagogy
 experts
 and
 local
 experts
 from
 Sweden
 and
 the
 DRC
 are
 creating
the
educational
program
and
packaging
it
on
an
Learning
Management
System
with
 movies,
 voices,
 illustrations
 and
 pictures
 (on
 USBs)
 as
 well
 as
 written
 text
 with
 exercises
 based
on
active
learning
methods
as
for
example
role‐plays.

 
 All
 programme
 modules
 are
 digital
 and
 divided
 into
 units
 and
 facilitated
 in
 the
 LMS.
 The
 modules
can
be
distributed
to
laptop
computers,
mobile
devices
such
as
mobile
phones
or
 iPods,
USB
memory
sticks,
printed
to
paper
depending
on
ICT
infrastructure.

 
 Planning
 and
 local
 adjustments
 of
 the
 Program:
 The
 educational
 program
 is
 tested
 on
 patients
at
the
Panzi
Hospital
Centre
and
is
modified
based
on
local
needs.

 
 A
 computer
 with
 Internet
 connection
 and
 printer
 is
 installed
 at
 the
 Panzi
 Hospital
 Centre
 together
 with
 one
 smart
 phone.
 The
 Panzi
 Hospital
 Centre
 works
 as
 a
 computer
 and
 communication
centre
in
the
project.
The
therapist
and
the
counsellors
at
the
Panzi
Hospital
 Centre
 will
 get
 training
 in
 basic
 computer
 and
 mobile
 phone
 skills
 including
 Internet
 skills,
 training
 in
 the
 Learning
 Management
 System
 (LMS),
 training
 on
 how
 to
 use
 the
 material,
 pedagogical
structure
of
the
training
programme
and
social
studies
of
meeting
traumatised
 people.

 

  • 6. Each
of
the
ten
councellors
is
using
an
Internet
connected
laptop
(GPRS,
mobile
broadband,
 satellite
 or
 dial
 up)
 computer
 and/or
 a
 smart
 phone
 when
 carrying
 out
 the
 course.
 This
 mobile
device
has
to
be
chargeable
by
solar
energy
since
there
is
no
electricity
in
many
of
 the
areas
where
the
counsellors
are
going
to
operate.

 
 The
counsellors
are
showing
and
use
the
material
on
the
mobile
devices.
The
mobile
devices
 are
 also
 used
 for
 two
 ways
 communicating
 with
 experts
 in
 Sweden
 and
 the
 DRC
 by
 voice,
 video
and
text.
Appropriate
materials
are
handed
out
on
site
as
paper
copies;
these
can
be
 checklists,
 manuals
 and
 guides
 for
 the
 treated
 patients
 for
 self
 help
 when
 the
 counsellors
 have
left.

 
 Counsellors
go
out
to
the
field
and
implement
the
project
to
the
target
groups,
continually
 communicating
 with
 therapists
 and
 experts
 on
 phone,
 e‐mail
 and
 video
 communication
 when
necessary
(through
Skype
or
mobile
phones).

 
 Evaluation
of
the
first
phase
of
the
project

 
 Final
report

 
 Forms
for
continuation
and
ownership
of
the
project

 


 


 
 Treating
Trauma
Post‐Traumatic
Stress
Disorder
(PTSD)
 
 
Who
is
affected?

 A
person
who
has
been
through
a
traumatic
event
in
which
both
1
and
2:

 
 A.

 1. The
person
experienced,
witnessed
or
was
confronted
with
an
event
involving
actual
 or
 threatened
 death
 or
 serious
 injury,
 or
 a
 threat
 to
 one's
 own
 or
 others'
 physical
 integrity.

 2. The
person's
response
involved
intense
fear,
helplessness
or
horror.

 
 B.
 The
traumatic
event
is
experienced
at
least
in
one
of
five
ways
(recurring
painful
memories
/
 thoughts,
 nightmares,
 a
 feeling
 that
 relive
 the
 event
 /
 flashbacks
 /
 hallucinations,
 intense
 psychological
 discomfort
 for
 internal
 /
 external
 signals
 reminiscent
 of
 the
 incident
 and
 physiological
responses
to
signals
that
symbolize
the
event
).

 
 C.
 The
individual
avoids
constant
stimuli
associated
with
trauma
or
presents
a
general
blunting
 of
 the
 ability
 to
 react
 emotionally
 as
 manifested
 by
 at
 least
 three
 of
 seven
 ways
 (active
 avoidance
of
thoughts,
feelings
or
conversations
associated
with
trauma,
active
avoidance
of
 activities,
 places
 or
 people
 that
 remind
 about
 the
 trauma,
 inability
 to
 recall
 an
 important
 aspect
of
the
event,
clearly
reduced
involvement
/
interest
in
important
activities,
feeling
of
 apathy
/
alienation
from
others,
constricted
affect,
and
feeling
that
no
future).


  • 7. 
 D.

 Persistence
 of
 signs
 of
 exaltation
 as
 manifested
 by
 at
 least
 two
 out
 of
 five
 ways
 (difficulty
 falling
asleep
or
restless
sleep,
irritability
/
anger,
difficulty
concentrating,
hypervigilance
and
 exaggerated
startle
response).
 

 E.
 Malfunction
duration
is
at
least
a
month
with
symptoms
in
B,
C
and
D.
 
 F.
 The
disturbance
causes
clinically
significant
distress
or
impairment
in
social,
occupational,
or
 other
important
areas
of
functioning.
 

 
 Prevalence

 Population
prevalence
of
PTSD
in
Sweden
is
about
5.6%
(2005).
In
other
countries
where
the
 population
is
exposed
to
persistent
violence
and
systematic
abuse,
the
estimated
prevalence
 is
obviously
much
higher,
but
often
missing
the
diagnosis
and
study
of
prevalence
in
these
 countries.
For
example,
prevalence
of
32.3%
among
6‐18‐year‐olds
in
Iraqi
Kurdistan
(2005)
 and
the
frequency
of
PTSD
in
78%
of
the
military
operation
in
Iraq
(2000)
with
a
follow‐up
 time
in
five
years.

 
 Point
prevalence
studies
conducted
in
the
United
States
and
Sweden
have
shown
that
the
 prevalence
of
PTSD
in
women
exposed
to
trauma
were
higher
(12,4‐17,8%)
among
female
 victims
 of
 assault,
 rape
 or
 other
 sexual
 abuse
 than
 those
 with
 non‐violent
 traumas
 where
 prevalence
 was
 3.4%.
 Another
 study
 found
 that
 violent
 trauma
 (threats
 with
 weapons,
 physical
assault
and
rape)
were
associated
with
32‐46%
risk
of
developing
PTSD
in
women.

 
 Risk
and
protective
factors

 Time,
factors:

 Before
 the
 trauma
 (vulnerability):
 Past
 mental
 illness,
 previous
 psychological
 trauma,
 hereditary,
burden
of
mental
illness,
sex,
social
status,
education
level,
mental
preparation.

 During
the
trauma:
the
severity,
duration
and
cognitive
factors
affecting
how
the
individual
 interprets
the
event,
eg
feelings
of
helplessness.

 After
the
trauma:
Equity
and
social
networking.

 
 
 Treatment

 The
 CBT
 model
 that
 has
 the
 strongest
 research
 support
 for
 the
 group
 of
 patients
 the
 treatment
will
be
aimed
at,
is
Foa
&
Rothbaums
emotional
processing
theory
(Treating
the
 trauma
of
rape:
Cognitive
behavioral
therapy
for
PTSD).

 
 This
 is
 based
 on
 the
 conclusion
 that
 people
 who
 develop
 chronic
 PTSD
 have
 a
 memory
 structure
 of
 trauma
 involving
 disproportionately
 strong
 responses
 (such
 as
 fear,
 physiological
responses
and
avoidance)
in
confrontation
with
stimuli
reminiscent
of
trauma.
 Three
 main
 elements
 are
 included
 in
 treatment:
 exposure
 in
 terms
 of
 performance
 re‐
  • 8. experiencing,
 and
 often
 on‐site
 visits
 for
 trauma,
 cognitive
 restructuring
 to
 change
 the
 problematic
assessment
of
the
patient,
and
stress
control
training
(including
relaxation).

 
 Important
principles
in
the
treatment

 Treatment
 aims
 to
 change
 factors
 the
 suppression
 of
 ideas,
 selective
 attention
 to
 threat,
 safety
behaviors,
avoidance
of
reminders
of
the
trauma,
physical
tension
/
difficulty
sleeping
 and
brooding
about
the
trauma.
V
 In
 PTSD
 in
 general
 and
 for
 PTSD
 as
 a
 result
 of
 rape
 or
 sexual
 assault
 in
 particular,
 it
 is
 extremely
important
that
the
therapist
has
a
very
accepting
and
validating
attitude
towards
 the
patient
to
show
that
he
or
her
accept,
understands
and
is
able
to
hear
everything
that
 the
patient
will
tell
about
the
trauma.

 It
 is
 particularly
 important
 to
 strengthen
 the
 patient
 for
 what
 he
 or
 she
 did
 during
 the
 trauma,
 in
 order
 to
 reduce
 their
 problematic
 assessments
 about
 what
 they
 should
 have
 done
differently,
to
prevent
what
happened.

 Reactions
of
shame
and
guilt
are
often
reinforced
by
negative
responses
from
other
people
 trying
to
give
the
victim
some
of
the
blame
for
what
happened.

 Treatment
step
by
step

 1. Behavior
 Analysis
 for
 gathering
 information
 about
 what
 happened.
 Note
 the
 importance
 of
 the
 therapist's
 approach
 to
 increase
 the
 likelihood
 that
 the
 patient
 should
 dare
 to
 tell
 what
 happened.
 Major
 emphasis
 should
 be
 placed
 on
 the
 identification
 and
 mapping
 of
 dysfunctional
 assumptions
 and
 negative
 thoughts
 about
oneself,
evasions,
and
safety
behaviors.

 2. Measuring
 the
 prevalence
 of
 PTSD‐related
 symptoms
 and
 psychopathology
 using
 self‐rating
scales
and
clinical
interview.

 3. Rational
 for
 the
 treatment,
 as
 for
 all
 exposure
 treatment,
 it
 is
 important
 to
 emphasize
 that
 nothing
 will
 happen
 against
 the
 patient's
 will.
 The
 exposure,
 ie
 the
 imaginary
 reliving
 force,
 will
 occur
 gradually
 and
 completely
 in
 agreement
 with
 the
 patient.
 It
 should
 prepare
 the
 patient
 for
 that
 the
 presence
 of
 strong
 emotions
 are
 normal.
Great
importance
should
also
be
given
to
explaining
what
anxiety
is
and
that
 strong
anxiety
reactions
subside
and
are
completely
harmless.

 4. Psychoeducation
about
trauma,
normal
acute
reactions
arising
and
development
of
 more
 chronic
 PTSD,
 in
 order
 to
 help
 the
 patient
 understand,
 accept
 and
 normalize
 their
reactions
and
behaviours.

 5. Exposure
Treatment
in
the
form
of
performance‐rate
/
imaginary
exposure
with
the
 goal
that
the
patient
should
be
able
to
have
thoughts
about
the
trauma,
to
talk
about
 it
and
be
aware
of
trigger
stimuli
without
experiencing
intense
fear
and
anxiety.
The
 treatment
involves
to
gradually
move
closer
to
the
memory
of
the
trauma
by
talking
 about
 it
 and
 provide
 increasingly
 specific
 questions.
 The
 purpose
 of
 this
 is
 to
 reconstruct
 the
 incident
 /
 make
 it
 less
 fragmented
 and
 linking
 the
 most
 traumatic
 moment
(eg,
"I
thought
they
would
kill
me")
with
the
actual
outcome
(
"I
survived,
 after
 all,
 and
 sitting
 here
 today").
 This
 exposure
 also
 increases
 the
 possibility
 of

  • 9. access
the
patients
problematic
assessments
of
trauma
which
is
processed
in
phase
 cognitive
restructuring.


 6. Cognitive
restructuring
with
the
goal
of
the
patient
to
identify,
challenge
and
modify
 negative
 thoughts
 and
 assumptions
 that
 perpetuate
 PTSD‐symptoms.
 When
 the
 specific
 negative
 thoughts
 have
 been
 identified,
 the
 patient
 can
 summarized
 them
 into
 dysfunctional
 assumptions,
 such
 that
 other
 people
 in
 general
 are
 evil
 and
 untrustworthy,
 that
 they
 themselves
 can
 not
 handle
 difficult
 situations
 in
 an
 adequate
manner,
etc.
 
 7. Stress
Control
Training.

 Organisations
Involved
in
the
Project
 
 The
network
Yennenga
Progress

 Yennenga
 Progress,
 High
 Professionals
 Development
 Club,
 is
 an
 organization
 based
 on
 a
 worldwide
 network
 of
 members
 with
 a
 high
 knowledge
 and
 experience.
 By
 sharing
 their
 connections,
networks,
methods
and
perspectives,
they
can
provide
consulting
and
support
 for
project
development
and
fundraising.
Using
an
expression
from
the
business
world,
we
 give
Yennenga
Progress
the
subtitle
High
Professionals
Development
Club.
 
 With
the
desire
to
further
develop
the
high
level
of
competence
and
expertise
that
we
have
 encountered
around
the
world,
and
after
having
done
development
cooperation
work
with
 several
 organizations
 in
 Burkina
 Faso
 in
 West
 Africa,
 Yennenga
 Progress
 was
 created
 in
 Sweden.
 Yennenga
 Progress
 will
 enable
 for
 the
 resources
 in
 the
 newtork
 to
 be
 used
 in
 a
 creative
 way
 and
 facilitate
 the
 administration
 of
 the
 network,
 as
 well
 as
 the
 projects
 that
 Yennenga
Progress
manage.
Another
priority
is
to
document
and
share
the
experience
that
 the
network
is
gaining
in
the
process
of
development
cooperation
work.
 
 The
projects
Yennenga
Progress
works
with
are
initiated
by
our
members.
This
guarantees
 that
 the
 real
 issues
 are
 addressed
 and
 avoids
 a
 top‐down
 approach.
 It
 gives
 us,
 as
 an
 organisation/network,
a
close
relation
to
all
activities
undertaken;
it
guarantees
equality
in
 the
 work
 method
 (avoids
 donor/receiver
 imbalance)
 and
 it
 helps
 people
 grow
 through
 networking,
exchange
of
experience
and
new
friendships.
 
 By
connecting
members
of
the
network
with
a
variety
of
professional
skills,
we
develop
new
 ways
of
creating
more
efficient
methods
for
project
implementation.
Lessons
learned
in
one
 project
 specializing
 in
 a
 certain
 type
 of
 development
 cooperation
 can
 be
 transmitted
 to
 other
 projects
 linked
 to
 the
 network.
 Thus
 the
 quality
 of
 the
 process
 and
 methods
 are
 increased.
To
learn
more
about
the
Yennenga
Progress
network
and
our
projects,
please
visit
 www.yennengaprogress.se
 
 

  • 10. Mukwege
Foundation
 One
 of
 the
 Yennenga
 Progress
 network’s
 prominent
 members
 is
 Dr
 Mukwege.
 Dr.
 Denis
 Mukwege
is
the
director
of
the
Panzi
Hospital
in
eastern
DR
Congo.
He
is
the
chief
surgeon,
 and
 has
 become
 one
 of
 the
 world's
 leading
 experts
 on
 how
 to
 repair
 the
 internal
 physical
 damage
caused
by
the
gang
rapes
used
as
a
strategic
weapon
of
war.

 


 For
 his
 important
 work
 and
 enormous
 courage,
 he
 has
 received
 numerous
 prizes
 and
 awards.
 To
 mention
 some,
 Dr
 Mukwege
 last
 year
 received
 The
 Olof
 Palme
 Prize,
 he
 was
 awarded
African
of
the
Year,
by
Daily
Trust,
and
he
received
the
UN
Human
Rights
prize.

 


 Mukwege
Foundation
is
an
organisation
created
by
Dr
Mukwege
and
the
people
around
him
 to
 meet
 the
 needs
 of
 the
 population,
 effected
 by
 the
 horrible
 fact
 of
 rape
 as
 a
 war
 mass
 destruction
 weapon.
 Dr
 Mukwege
 is
 working
 hard
 at
 the
 Panzi
 Hospital
 to
 heal
 the
 raped
 women
 by
 giving
 the
 medical
 aid
 and
 performing
 the
 necessary
 surgical
 nterventions.
 The
 work
is
not
over
when
the
physical
problems
are
met.
It
is
a
long
process
of
psychological
 healing
as
well
as
social
reintegration.

 


 The
main
goals
of
the
organization,
Mukwege
Foundation,
is
to
put
in
place
the
professional
 team
needed
to
organize
and
administrate
the
long
term
projects,
taking
action
to
give
the
 tools
 needed
 for
 the
 women
 and
 their
 families
 to
 take
 control
 over
 their
 own
 lives,
 and
 giving
the
women
and
their
families
the
support
needed
to
reunite
and
build
a
new
future
 together.

Organize
lobbying
and
legal
actions
to
prevent
further
violence.

 


 Mukwege
Foundation
is
well
aware
that
the
very
unstable
political
situation
in
DRC,
makes
it
 hard
 to
 count
 on
 the
 government
 to
 meet
 the
 needs
 of
 the
 population.
 Civil
 society
 has
 a
 crucial
role
to
play
for
the
development
of
the
country.

 


 There
 is
 a
 close
 collaboration
 both
 with
 national
 and
 international
 aid
 organizations,
 to
 complement
each
other
to
meet
the
needs
of
the
population.

 


 This
is
one
of
the
reasons
why
Mukwege
Foundation
has
been
created.
Dr
Mukwege
is
a
well
 known
 actor
 on
 the
 humanitarian
 field.
 Many
 organizations
 address
 him
 to
 support
 his
 important
 work.
 This
 poses
 a
 grand
 demand
 on
 administration
 and
 coordination.
 The
 mission
of
Dr
Mukwege
is
to
take
care
of
his
patients,
and
he
is
well
aware
of
the
needs
they
 have
 when
 they
 are
 physically
 ready
 to
 leave
 the
 hospital.
 There
 is
 a
 lack
 of
 professional
 personnel
 around
 Dr
 Mukwege,
 to
 take
 care
 of
 the
 important
 questions
 that
 must
 be
 run
 parallel:
social
support,
psychological
help,
and
legal
support,
as
well
as
peace
building
and
 conflict
prevention.




 


 The
 need
 for
 de‐traumatisation
 services
 of
 this
 kind
 is
 also
 highly
 expressed
 by
 the
 population,
 men
 as
 well
 as
 women
 (source:
 ACT
 Forum
 Evaluation
 on
 Psychosocial
 Needs
 and
 Resources
 in
 North
 Kivu,
 February
 2009).
 The
 population
 notices
 that
 many
 people
 affected
 by
 the
 war,
 e.g.
 in
 the
 form
 of
 rapes,
 has
 changed
 their
 behaviour
 and
 become
 more
depressed
or
withdrawn
and
are
not
able
to
attend
to
their
normal
chores.
People
in
 the
 Kivu
 provinces
 put
 much
 faith
 in
 tangible
 medical
 treatment,
 such
 as
 medicines
 and
 vaccines.
With
positive
examples
of
activities
by
organizations
in
the
provinces
and
evidence
 of
persons
being
healed
through
psychological
treatment,
more
faith
is
put
in
such
methods.
 There
 is
 a
 great
 demand
 for
 distraction
 and
 access
 to
 entertainment
 or
 events,
 such
 as
 sports
or
cultural
events,
which
break
the
routine
and
thus
increase
the
general
well‐being

  • 11. of
entire
communities.
Mukwege
Foundation
providing
healing
on
a
psychological
and
social
 level,
the
populations
will
be
aided
to
live
out
their
full
potential
and
allow
all
members
of
 society
to
be
valuable
and
contribute
to
the
development
of
their
communities.

 


 
Mukwege
Foundation
as
a
member
of
the
Yennenga
Progress
network:
 
 Through
the
membership
of
Dr
Mukwege,
the
Yennenga
Progress
network
can
benefit
from
 the
knowledge
and
experience
of
Mukwege
Foundation
and
in
return
offer:
(1)
the
exchange
 and
support
from
the
members
of
Yennenga
Progress,
active
in
the
touched
fields
of
need
 (Trauma
 Therapy
 and
 psychology)
 to
 the
 staff
 of
 the
 Mukwege
 Foundation,
 (2)
 financial
 support
 for
 capacity
 building,
 and
 support
 to
 the
 development
 projects
 initiated
 by
 Mukwege
Foundation.


 


 Projects
and
needs
are
addressed
by
Dr
Mukwege
and
his
crew
in
Bukavu.
At
the
Yennenga
 Progress
level,
contacts
are
taken
with
member
experts
in
the
field
requested,
to
discuss
and
 exchange
on
possible
solutions
to
the
problem,
and
to
connect
with
people,
enterprises
or
 organizations
 that
 may
 correspond
 to
 the
 expressed
 need.
 The
 decisions
 are
 taken
 by
 Dr
 Mukwege
and
his
crew
in
Bukavu,
as
only
they
are
the
true
experts
on
their
own
context.

 


 


 
 Here,
the
two
member
organizations
in
the
network
involved
in
this
project
are
presented:
 


 MKFC
Stockholm
College


 The
 Multicultural
 Popular
 Education
 Centre
 (MKFC)
 Stockholm
 College
 is
 based
 in
 Sweden
 with
a
branch
in
Finland.
Its
origins
are
in
the
inclusive
Nordic
education
system.
Education
 in
 the
 Nordic
 countries
 is
 free
 and
 includes
 all
 age
 groups
 and
 education
 levels.
 MKFC
 belongs
 to
 a
 popular
 adult
 education
 movement
 originating
 in
 the
 grassroots
 movements
 and
 supported
 by
 state
 funds.
 This
 Nordic
 education
 tradition
 has
 supported
 MKFC
 in
 designing
 a
 roadmap
 to
 creating
 inclusive,
 sustainable
 development
 and
 economic
 growth
 driven
by
education.

 


 MKFC
 moved
 all
 of
 its
 courses
 online
 in
 2001.
 MKFC
 Stockholm
 College
 uses
 “End‐To‐End
 eLearning”
for
its
global
ICT4D
mission.
This
means
that
the
whole
learning
process
is
online,
 from
course
content
and
student
support
to
feedback.
Our
passion
is
to
support
and
offer
 sustainable
life
skills
to
citizens.
For
us
education
is
a
central
means
to
this
end.
Flexibility
is
 one
of
the
basic
characteristics
of
eLearning.
It
can
be
adjusted
to
local
requests
and
to
new
 demands
the
workers
in
authentic
environment
need
answers
to.
Therefore,
eLearning
is
an
 indispensable
 part
 of
 this
 mission:
 it
 needs
 to
 be
 part
 of
 both
 educational
 policy
 and
 practice.

 


 MKFC
 Stockholm
 College
 supports
 inclusive
 learning
 and
 believes
 that
 in
 a
 knowledge
 society
education
must
support
people’s
capacity
to
change
and
innovate.
At
the
core
of
our
 education
 programmes
 are
 the
 Millennium
 Development
 Goals
 (MDGs),
 we
 support
 grassroots
 movements
 for
 sustainable
 changes.
 Participants,
 that
 is,
 students,
 tutors
 and
 members
of
local
communities,
are
the
Change
Makers.
They
realize,
build
up
and
innovate
 in
line
with
the
Nobel
Prize
winner
Amartya
Sen’s
Capability
Approach.
Today
we
work
with
 eLearning
 and
 sustainable
 development
 in
 Eritrea,
 Somalia,
 Pakistan,
 Ghana,
 Tanzania,
 Zambia,
Kenya,
Sweden
and
Finland.


  • 12. 


 MKFC
 Stockholm
 College
 teachers
 use
 Information
 and
 Communication
 Technology
 for
 Development
(ICT4D).
The
goals
for
our
eLearning
ICT4D
strategy
are:

 • No
more
isolation

 • Equal
education
standard
for
all

 • Learning
in
an
authentic
environment

 • Health
awareness
on
the
grassroots
level

 • Decrease
the
costs
for
education

 
 MKFC’s
role
in
this
project
is
to
package
the
courses
to
fit
the
eLearning
approach
connected
 with
local
implementation
and
technical
and
pedagogical
support
during
the
project.
 


 


 Svenska
KBT
Institutet
(SKBTI)

 The
 private
 company
 “The
 Swedish
 CBT
 Institute”
 was
 founded
 1999.
 The
 company
 gives
 specialist
treatment
to
people
suffering
from
psychological
and
related
problems.
Treatment
 is
 given
 by
 therapists
 working
 with
 the
 psychological
 method
 Cognitive
 Behavior
 Terapy
 (CBT).
CBT
consists
of
a
wide
range
of
methods
and
interventions,
mainly
based
on
learning
 theory.
 It
 is
 an
 evidence
 based
 method
 that
 today
 is
 State
 of
 the
 Art
 regarding
 treating
 different
psychological
problems.

 


 All
therapists
have
long
term
experience
of
working
within
a
wide
spectrum
of
psychological
 areas
 and
 also
 within
 the
 educational
 field.
 Of
 special
 interest
 for
 this
 project
 is
 the
 company´s
 experience
 from
 treating
 PTSD
 and
 to
 give
 interventions
 for
 crisis.
 Two
 of
 the
 therapists
 has
 also
 conducted
 studies
 and
 implemented
 manual
 based
 treatments
 administered
by
computer
or
internet
(Information
and
Communication
Technology
(ICT).

 Svenska
KBT
Institutet
takes
part
in
this
project
by:

 


 Supporting
the
project
direct
by
taking
a
active
role
in
management,

 


 Providing
 the
 most
 suitable
 guidelines
 for
 treating
 PTSD,
 through
 cooperation
 with
 specialists
and
scientist
in
the
field,

 


 SKBTI
 will
 together
 with
 MKFC
 ensure
 that
 the
 guidelines
 are
 being
 transformed
 into
 a
 helpful
e‐learning
method
to
treat
PTSD
for
the
target
groups,
and
give
methodological
and
 implementation
support
to
the
staff
and
administrators
of
this
project.

 
 
 Management
of
the
Project
 
 Project
objective

 The
 Mukwege
 Foundation
 is
 an
 established
 and
 well
 functioning
 structure.
 The
 successful
 recruitment
of
an
expert
psychologist
is
done,
having
the
professional
skills
needed
and
the
 capacity
of
meeting
the
women
and
families
affected,
conducting
trauma
therapy,
educating
 educators
 as
 well
 as
 policemen,
 military,
 and
 health
 personnel.

 The
 Foundation
 will
 also
 conduct
research
in
the
area
of
gender
based
violence.


  • 13. 


 Meetings,
 exchange
 of
 ideas,
 and
 professional
 support
 on
 project
 management
 and
 organizational
 development,
 has
 resulted
 in
 clear
 structures,
 infrastructure
 and
 working
 methods,
to
facilitate
the
goal
of
improvement
of
the
life
situation
in
the
Kivu
Province
of
 DRC,
diminishing
the
stigma
of
the
rapes
and
violence.

 


 The
international
network
of
Yennenga
Progress,
is
able
to
support
the
psychologist
and
the
 team
at
the
Mukwege
Foundation
as
well
as
contribute
to
debriefing,
and
make
use
of
the
 experience
of
the
Mukwege
Foundation
psychologist
to
open
doors
internationally,
for
the
 positive
change.

 
 Sustainability
Plan

 The
 material
 will
 be
 available
 after
 the
 project
 and
 the
 counsellors
 participating
 in
 the
 project
are
able
to
educate
and
tutor
new
counsellors
with
help
of
the
acquired
knowledge
 from
the
project,
old
and
new
contacts
and
with
the
help
from
the
Hospital
centre.

 


 By
using
the
method
of
e‐learning,
counsellors
can
bring
new
courses
and
educations
to
the
 rural
areas
and
such
as
vocational
trainings,
community
action
projects,
microcredit,
teacher
 training,
 entrepreneurship
 etc.,
 helping
 entire
 communities
 achieve
 sustainable
 development.
This
can
also
be
applied
to
the
treated
women
and
families
who
can’t
return
 home.
By
studying
at
a
computer
centre
connected
to
the
hospital,
these
persons
can
get
an
 education
without
attending
a
school,
and
work
at
the
same
time.

 
 
Project
Indicators

 • A
skilled
psychologist
is
employed
in
Bukavu.

 • The
experts
from
the
Yennenga
Progress
Network
are
connected
to
and
collaborate
 with
the
expert
of
the
Mukwege
Foundation
crew.
 • Creation
 of
 educational
 therapy
 material
 and
 capacity
 building
 through
 the
 educational
program.
 • Research
on
trauma
therapy
methods.
 • A
 stable
 structure
 is
 in
 place,
 supporting
 the
 target
 group
 of
 effected
 women
 and
 their
families,
with
the
expected
results,
i.e.
healing
of
individuals
and
communities.


 • 
Structures
and
working
methods
will
be
documented.

 
 Risk
factors
 Wherever
money
is
involved,
there
is
a
risk
of
corruption.
The
choice
of
personnel
is
of
great
 importance
when
it
comes
to
preventing
corruption.
The
network
of
Dr
Mukwege’s
through
 his
 long
 and
 engaging
 career,
 his
 collaboration
 with
 various
 organizations
 in
 the
 field,
 and
 through
 his
 network
 of
 Yennenga
 Progress,
 Dr
 Mukwege
 and
 his
 activities
 are
 well
 know.
 The
 international
 attention
 and
 reputation
 that
 his
 job
 has
 attracted
 to
 the
 activities
 guarantee
 seriousness
 and
 credibility
 in
 the
 activites.
 A
 decent
 salary
 paid
 monthly
 is
 another
way
to
minimize
the
risk
of
corruption.
Clear
structures
and
control
systems
in
the
 daily
work
are
a
must
for
all
human
beings.
Social
responsibility
and
social
networks
are
also
 a
 corruption
 minimiser.

 An
 important
 method
 of
 Dr
 Mukwege’s,
 is
 to
 make
 sure
 that
 all
 involved
 personnel
 have
 the
 same
 goal
 and
 the
 same
 vision.
 This
 creates
 strong
 and
 dedicated
teams.



 



  • 14. The
 political
 situation
 may
 become
 worse.
 However,
 the
 difficult
 political
 situation
 is
 the
 very
reason
of
this
project.
Dr
Mukwege
and
his
crew
are
deeply
devoted
to
their
work,
and
 are
already
working
in
a
very
difficult
situation.
The
unstable
political
situation
of
the
DRC
 which
 leads
 to
 extreme
 violence,
 was
 the
 very
 reason
 for
 Dr
 Mukwege
 to
 leave
 his
 comfortable
life
in
France
to
contribute
with
his
“share”
of
knowledge
and
competence
for
 the
development
of
the
population.
The
commitment
to
helping
the
population
gain
a
better
 life
in
the
war
context
is
strong.

 














 Coordination
 There
 is
 a
 wide
 range
 of
 international
 aid
 organizations
 in
 the
 Kivu
 Provinces.
 Among
 only
 the
 Swedish
 organizations
 present
 at
 the
 Panzi
 Hospital,
 there
 is
 close
 collaboration
 with
 Läkarmissionen,
PMU
InterLife,
and
Kvinna
till
Kvinna.
There
are
some
common
projects
and
 some
projects
taking
different
parts
of
the
actions
needed
to
support
the
population,
such
 as
day
care
for
children,
nutrition,
education
etc.

 


 Other
 organizations
 providing
 medical,
 legal
 and
 psychosocial
 assistance
 to
 survivors
 of
 gender‐based
violence
are,
among
others,
MSF,
HEAL
Africa,
ICRC,
Mercy
Corps,
LWF,
NCA
 and
Dynamique
des
Femmes
Juristes.
A
big
number
of
local
organizations
are
working
in
this
 field,
 as
 well
 as
 so
 called
 “maisons
 d’écoute”
 providing
 a
 safe
 haven
 and
 counseling
 to
 women
exposed
to
gender
based
violence.
Among
the
UN
family,
UNICEF,
UNFPA,
UNHCR
 and
 MONUC
 all
 are
 concerned
 with
 work
 in
 this
 field
 of
 operation.
 The
 problem
 of
 rape
 linked
 to
 the
 conflict
 being
 so
 widespread
 and
 touching
 large
 and
 inaccessible
 areas,
 the
 organizations
providing
assistance
are
numerous
and
coordination
is
sometimes
a
problem.
 In
order
to
carry
out
efficient
work
and
avoid
duplication,
Mukwege
Foundation
participates
 in
cluster
meetings
and
other
coordination
opportunities.

 
 Democracy
and
human
rights
in
the
project

 Mukwege
 Foundation
 gives
 hope
 to
 the
 women
 affected
 and
 their
 families:
 hope
 of
 being
 able
to
make
decisions
for
their
own
lives
and
to
build
a
future.
This
is
the
seed
to
peace.
 Peace
must
be
built
on
people
with
self‐confidence
knowing
they
can
make
a
change.

 


 Dr
Mukwege
is
a
well
known
person
both
nationally
and
internationally.
His
presence
in
the
 conflict
area
therefore
creates
a
force
of
security,
as
it
is
known
that
the
eyes
of
the
world
 are
in
the
direction
of
what
is
happening
around
him.

 
 By
helping
women
to
regain
their
self‐esteem
and
social
status,
the
overall
well
being
of
the
 communities
 is
 increased.
 Women
 will
 be
 able
 to
 be
 active
 actors
 in
 society
 and
 influence
 future
 generations
 positively.
 When
 women
 are
 re‐integrated
 in
 their
 habitual
 context,
 family
 support
 systems
 function
 well.
 The
 financial
 situation
 for
 the
 women
 and
 their
 children
 is
 improved,
 thus
 avoiding
 malnutrition
 and
 exploitative
 working
 conditions,
 and
 allowing
parents
to
invest
in
children’s
school
material.
By
combating
the
stigma
attached
to
 raped
 women
 through
 sensitization
 of
 various
 levels
 of
 society,
 women
 will
 be
 allowed
 to
 take
a
more
active
part
in
decision
making.

 


 

  • 15. The
Democratic
Republic
of
Congo
–
Background
Information
About
 the
Social
Situation
 
 Context

 The
 Kivu
 Province
 is
 deeply
 affected
 by
 the
 political
 problems
 of
 DRC
 and
 of
 Rwanda.
 The
 UNHCR
has
estimated
that
over
857
000
people
in
North
Kivu
were
displaced
2008.
Rape
as
 a
mass
destruction
weapon
is
one
of
the
horrors
the
population
is
facing.



 


 The
 war
 and
 its
 consequences
 are
 the
 most
 important
 difficulties
 in
 the
 project
 area.
 The
 insecurity
problem
is
vast.
The
choice
of
target
group
derives
from
the
fact
that
Dr
Mukwege
 and
 his
 colleagues
 at
 the
 Panzi
 Hospital
 feel
 very
 strongly
 for
 their
 patients.
 Every
 time
 a
 patient
leaves
the
hospital,
after
healing,
they
fear
the
fact
that
she
might
soon
come
back
 after
 having
 been
 raped
 again.
 As
 we
 are
 working
 against
 rape
 as
 a
 mass
 destruction
 weapon,
both
conflict
and
HIV/AIDS
are
areas
of
great
importance.
It
is
mostly
the
women
 being
raped
and
infected
by
HIV,
and
they
are
then
likely
to
spread
it
to
their
husbands,
if
 they
 are
 accepted
 by
 their
 husbands
 and
 if
 they
 are
 physically
 able
 to
 have
 sexual
 intercourse
after
the
violence
they
have
faced.

 


 The
 nationwide
 HIV
 prevalence
 is
 approximately
 1.3%
 (source:
 HIV
 in
 Humanitarian
 Situations).
 However,
 the
 war
 in
 the
 provinces
 of
 North
 and
 South
 Kivu
 has
 seriously
 aggravated
the
situation
due
to
the
many
displacements
and
poverty
and
rape
as
a
weapon
 of
war.
Infidelity
in
couples
is
also
a
contributing
factor.
Access
to
anti‐retroviral
therapy
is
 poor,
very
costly
and
staff
trained
to
administer
it
is
scarce.
Medical
facilities
are
not
always
 easily
 accessible
 due
 to
 displacements
 of
 the
 population
 and
 because
 services
 are
 mostly
 concentrated
to
urban
centres.
Voluntary
testing
facilities
exist
but
are
not
sufficient.

 


 The
 consequences
 on
 men,
 women,
 boys
 and
 girls
 is
 that
 they
 become
 weakened
 due
 to
 recurrent
 diseases
 and
 find
 it
 harder
 to
 participate
 in
 work
 and
 social
 life.
 Families
 are
 affected
 as
 family
 members
 die
 from
 AIDS.
 Many
 misconceptions
 exist
 regarding
 the
 pandemic
and
persons
living
with
HIV/AIDS
are
often
stigmatized
and
excluded
from
social
 life.

 
 

Democracy
and
human
rights
 The
 Congolese
 state
 fails
 in
 many
 of
 its
 undertakings
 towards
 its
 citizens.
 The
 access
 to
 medical
services,
clean
water,
educational
opportunities
etc.
are
failing.
The
state
is
unable
 to
protect
its
population,
and
the
corruption
being
widespread,
decisions
by
legal
authorities
 are
 not
 guaranteed
 to
 be
 fair.
 People
 working
 for
 the
 state,
 such
 as
 military
 personnel,
 teachers
and
other
civil
servants
testify
that
their
salaries
are
late
and
sometimes
missing.
 We
face
a
war
situation,
with
massive
violations
of
human
rights.

 
 Every
town
has
its
own
administrative
structure.
The
board
is
composed
almost
entirely
of
 men.
There
is
usually
only
a
female
representative
for
the
women’s
committee
(one
of
many
 sub‐committees
on
the
board).
The
board
members
explain
the
low
attendance
of
women
 with
that
women
are
welcome
to
take
up
positions
but
“are
not
interested
in
politics”
and
 that
 they
 are
 busy
 doing
 house
 chores.
 People
 with
 low
 financial
 status
 are
 not
 much
 respected
or
trusted
to
be
representatives
on
the
board.

 





  • 16. Gender

 Women
and
men
are
impacted
differently
by
the
difficulties.
Women
of
all
ages
are
by
far
 the
most
targeted
by
rape
and
the
psychological
trauma
that
comes
with
that.
The
men
are
 targeted
deeply
psychologically
as
not
able
to
protect
their
wives
and
families.
They
are
also
 often
killed
if
they
try
to
stop
the
violence.
Rape
is
very
efficient
when
it
comes
to
breaking
 down
the
society.

 


 The
entire
society
is
impacted
as
rape
is
a
threat
touching
all
levels
of
every‐day
survival.
The
 fear
of
falling
victim
to
rape
creates
anxiety,
which
affects
entire
families,
and
hinders
the
 population
 from
 accessing
 their
 fields
 and
 do
 agricultural
 activities,
 resulting
 in
 poverty.
 Persons
 who
 travel
 by
 road
 are
 vulnerable
 as
 ambushes
 against
 commercial
 vehicles
 sometimes
include
forcing
all
passengers
to
have
sex
with
each
other,
thus
targeting
men
as
 well
as
women.
The
practice
of
rebels
forcing
family
members
to
have
intercourse
impacts
 men
as
well
as
women.
However,
women
of
all
ages,
due
to
their
physically
and
culturally
 weak
status,
are
targeted
in
the
large
majority
of
rape
cases.
Rape
is
very
efficient
when
it
 comes
to
breaking
down
the
society.
Women,
bearers
of
culture
and
the
ones
fostering
and
 encouraging
 the
 children,
 are
 being
 demoralised.
 The
 social
 effects
 on
 raped
 women
 are
 fatal,
as
many
are
being
excluded
from
their
family
unity
by
their
husbands,
who
fear
they
 are
bearers
of
HIV
and
act
on
social
pressure
to
not
accept
that
his
woman
has
been
sexually
 active
with
another
man.
The
excluded
women
often
face
financial
difficulties,
being
outside
 of
the
social
support
system,
which
affects
the
women
as
well
as
their
children.

 


 Resources

 For
persons
relying
on
agriculture
or
animal
farming
for
their
subsistence,
the
situation
has
 grown
almost
insupportable.
The
fighting
groups
being
poor
and
hungry,
have
to
loot
farms
 in
order
to
eat.
This
renders
the
yields
of
agriculture
very
poor.
Also
shop
keepers
are
falling
 victims
 of
 looting
 of
 their
 goods.
 People
 employed
 by
 the
 State
 such
 as
 teachers,
 health
 staff,
military
etc.
say
that
their
salaries
are
late
and
sometimes
not
paid
at
all.
 

 Opportunities
(e.g.
education,
employment)

 During
the
‘80s,
60%
of
the
children
attended
primary
school.
This
number
was
down
to
32
 %
in
1998,
after
that
there
are
no
statistics
available.
The
situation
is
likely
to
be
worse
by
 now.
 More
 boys
 than
 girls
 attend
 school.
 About
 12
 %
 of
 the
 children
 attend
 secondary
 school.
Not
even
one
out
of
ten
girls
go
to
secondary
school.

 
 The
 insecure
 living
 environment
 has
 a
 devastating
 impact
 on
 children
 and
 youth.
 The
 fact
 that
sometimes
entire
areas
are
being
emptied
as
the
inhabitants
flee
and
gather
in
urban
 areas
results
in
children
not
being
able
to
pursue
their
education.
The
psychological
effects
 resulting
 from
 witnessing
 traumatic
 events
 on
 children
 and
 youth
 are
 also
 that
 they
 are
 unable
to
concentrate
and
learn
in
school.
The
unemployment
rate
being
high,
many
young
 people
 feel
 hopelessness,
 are
 idling
 and
 abuse
 drugs,
 and
 are
 also
 running
 a
 high
 risk
 of
 being
 recruited
 to
 rebel
 groups.
 Girls
 are
 vulnerable
 to
 being
 forced
 into
 a
 dependency
 relationship
with
a
boyfriend
who
can
assist
her
financially.

 
 70
%
of
the
population
lives
in
the
countryside
working
with
agriculture.
The
conflict
makes
 the
situation
even
harder
when
it
comes
to
official
employment.