Challenges of conducting a disease outbreak investigation in a refugee setting

On Saturday, 24 February 2018, PHFP fellows of cohort 2018 went out to investigate a large cholera outbreak in Hoima District, host to Kyangwali refugee settlement in Kyangwali subcounty. Conducting an investigation in a refugee settlement is an experience that is worth sharing. Kyangwali is 76km via the new tarmacked “Oil road” through Bugoma forest which is approximately 2 hours away.

To access the settlement or visit the camp reception where refugees are received, permission from the camp commandant office of the prime minister is sought before any works start. The heart of the cholera outbreak Maratatu B &C camps with diverse culture and ethnic groups from DRC Congo. An investigator required two or three translators which was not only cumbersome but expensive. Its increase the chances of errors in data collected due to multiple interpretation and translation by the interpreters .

In addition, the investigator requires a nose mask, this is for safety purposes since many of the refugees were found to have cough and also to protect yourself from other communicable disease/airborne illnesses. Data collection in the refugee settlement is so challenging. Refugees shift from one household to the next in a very time. The investigator therefore has to collect as much information at one as possible since the possibility of getting in touch with a refugee for another interview is very difficult. To note, refugees get upset so easily (due to the trauma), you cannot interview them over and over again.

Compose yourself very well as an investigator and ensure that your capture as much information needed at that point as possible. The mobile and telecom network is on and off, taking GPS coordinates is also challenging especially when one gets deep into the valley. Another thing about the refugee camp is access to information requires a lot of time. Most refugees don’t know their names, their age and the number of people in a household.

Some households are occupied by more than one family. Notably, refugees expect you to give them money to buy a few things to use, some will ask you to get them jobs. Ensure maximum caution and don’t distance yourself from the VHTs but also avoid to move at night when conducting an investigation in the refugee camp.