ABSTRACT
The Batwa (Twa), an Indigenous People of southwest Uganda, were evicted from their ancestral forest lands in 1991 due to establishment of the Bwindi Impenetrable Forest. This land dispossession forced Batwa to transition from a semi-nomadic, hunting-gathering livelihood to an agricultural livelihood; eliminated access to Indigenous food, medicines, and shelter; and shifted their healthcare options. Therefore, this exploratory study investigated why Batwa choose Indigenous or biomedical treatment, or no treatment, when experiencing acute gastrointestinal illness. Ten gender-stratified focus groups were conducted in five Batwa settlements in Kanungu District, Uganda (n = 63 participants), alongside eleven semi-structured interviews (2014). Qualitative data were analysed thematically, using a constant comparative method. Batwa emphasised that health-seeking behaviour for acute gastrointestinal illness was diverse: some Batwa used only Indigenous or biomedical healthcare, while others preferred a combination, or no healthcare. Physical and economic access to care, and also perceived efficacy and quality of care, influenced their healthcare decisions. This study provides insight into the Kanungu District Batwa's perceptions of biomedical and Indigenous healthcare, and barriers they experience to accessing either. This study is intended to inform public health interventions to reduce their burden of acute gastrointestinal illness and ensure adequate healthcare, biomedical or Indigenous, for Batwa.
Acknowledgements
We thank the residents of Bikuto, Buhoma, Kebiremu, Kitariro, and Mukongoro settlements in Uganda, as well as the interviewees, for their time and willingness to participate in this research, and their contributions to the larger IHACC project. We would also like to thank community members Evas Ninsiima and Yosam Besigensi, and local researcher Fortunate Twebaze, for their significant contributions to this research as facilitators and interpreters. We remember Grace Asasira, as well, for her meaningful contributions as a local researcher before she passed away. Thank you to Carlee Wright for her assistance in creating a figure for this paper.
Disclosure statement
No potential conflict of interest was reported by the author(s).