Greene, Claire

School of Public Health

PhD

Tanzania

Tanzania - An integrated intervention for intimate partner violence and mental health for refugees in Tanzania

The Department of Mental Health of the Johns Hopkins Bloomberg School of Public Health, the United Nations High Commissioner for Refugees (UNHCR), Muhimbili University of Health and Allied Sciences (MUHAS) and other partners are conducting a research study in a refugee camp in Tanzani. This 2-year study is aimed at developing and rigorously evaluating an integrated intervention that addresses both (a) mental health complaints through existing evidence-based group intervention; (b) intimate partner violence through an empowerment protocol. It concerns a mixed methods study in which a short period of qualitative research is followed by a randomized clinical trial. We are currently preparing the qualitative phase of the study, and expect to start training interventionists starting in the Spring of 2015.  

Wietse A. Tol, PhD, Assistant Professor, Mental Health

Karibu! Mambo vipi? Habari za nyumbani? Shikamoo? Immediately upon arrival I learned that Tanzania is a country of many greetings  - enough that it took me several weeks of Swahili classes just to learn the essential ones.  Greetings characterize your relationship to the person with whom you are speaking and they set the tone for your conversation.  Interestingly, the response to any greeting is almost always the same – nzuri, poa, and my personal favorite, freshi – suggesting that in Tanzania, you are always good.  In my experience, this is not far from the truth.  From working on a project I am truly passionate about, to experiencing a new culture, to spending the occasional weekend away on the pristine beaches of Zanzibar or the top of the world (well, the 15,000 foot summit of Mt. Meru – close enough), I can say my time in Tanzania truly was nzuri sana (‘very good’).

My experience in Tanzania started in Dar es Salaam and ended in Kasulu.  While these settings couldn’t be more different, the defining features of Tanzanian culture remained consistent.  Dar es Salaam is a large city on the eastern coast with lots to eat (including chipsi maiai, a favorite of most Tanzanians – look it up!), lots of nearby beaches, activities, and unparalleled traffic.  It is a very international city with a constant flow of expats and visitors.  In contrast, Kasulu is a small village in western Tanzania with one main dirt road running through its center and more bikes than cars.  The majority of Kasulu residents are pastoralists of the Waha ethnic group.  It is also the city nearest Nyarugusu refugee camp, the site of my research project. Despite these differences, Tanzanian culture is incredibly unified.  Many policies in the country encourage Tanzanians to experience other regions of their country and build relationships with people across tribal and religious lines.  Characteristics such as tribe, ethnicity and religion - factors that have historically produced tensions in neighboring countries and countries throughout the world - are not divisive, but rather celebrated universally in Tanzania. This aspect of Tanzanian culture is one that I grew to appreciate and admire.

Although the project I worked on was based in Tanzania, our study population is comprised of Congolese females residing in Nyarugusu refugee camp.  More specifically we were interested in exploring and evaluating an intervention to improve mental health and psychosocial wellbeing and reduce intimate partner violence in this population.  Nyarugusu camp is home to nearly 70,000 Congolese refugees, many having lived in the camp for almost 2 decades, and another 80,000 Burundian refugees, most having arrived within the past 6 months due to the political instability in Burundi.  The recent influx of Burundian refugees has exceeded the capacity of the resources available in Nyarugusu and there are currently many humanitarian agencies actively trying to address the needs of the pre-existing and new populations.  Observing the prioritization of basic needs and provision of services in a crisis situation and the coordination of actors involved was incredibly complex and something I had not directly experienced before.  Our research project was planned prior to the crisis in Burundi and thus the changes in the camp had direct implications for our research.  This required us to be flexible and consider the changing needs and priorities of the people in Nyarugusu.  Through this experience I learned much about the realities of conducting research in humanitarian settings and how valuable it is to work in the field.  My experience in Tanzania exceeded my expectations and further strengthened my commitment to global mental health research in humanitarian settings.  I look forward to continuing my work on this project.  Until next time, Tanzania!  Kwaheri!   

1) Downtown Dar es Salaam

2) Hiking Mt. Meru in Arusha

3) Lusia, the Research Team Leader, and I outside our office and the Psychiatry Department at Muhimbili National Hospital in Dar es Salaam.

4) Outside of the UNHCR branch offices in Kasulu

5) the main street in Kasulu

6) Stone Town, Zanzibar

7) View of Mt. Kilimanjaro from Mt. Meru

People

Stefan Baral, MD MPH,MBA,MSc

Director, Key Populations Program

Noreen Hynes, MD MPH

Director, Geographic Medicine Center of the Division of Infectious Diseases

Robert Bollinger Jr., MD MPH

Director, Johns Hopkins Center for Clinical Global Health Education (CCGHE); Associate Director, Johns Hopkins Center for Global...

Joanne Katz, ScD MS,BSc

Associate Chair, Director of Academic Programs

Caitlin Kennedy, PhD MPH,BA

Co-Director, MPH concentration in Social and Behavioral Sciences in Public Health; Associate Director, Center for Qualitative...

Yukari C. Manabe, MD

Associate Director of Global Health Research and Innovation
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