Narrative inquiry into life experiences of refugee women and men

Blackwell Publishing LtdOxford, UKINRInternational Nursing Review0020-8132© 2006 The Author, International Nursing Review (2006) 20065412834Original
ArticleLife
experiences of refugee women and menC. Pavlish
Correspondence address: Professor Carol Pavlish, Department of Nursing, College
of St. Catherine, 2004 Randolph Avenue, St. Paul, MN 55105, USA;
Tel: 1-651-690-6590; Fax: 1-651-690-6941; E-mail: clpavlish@stkate.edu.
© 2007 The Author. Journal compilation © 2007 International Council of Nurses
Original Article
Narrative inquiry into life experiences of refugee
women and men
C. Pavlish
PhD,
RN,
ONC
Professor, Department of Nursing, College of St. Catherine, St. Paul, Minnesota, USA
PAVLISH C. (2007) Narrative inquiry into life experiences of refugee women and men. International Nursing
Review 54,
28–34
Background: Africa is the site of many refugee camps, and non-governmental agencies are often responsible for
providing programmes and services to improve refugees’ quality of life and health in temporary encampments.
Rwanda hosts three refugee camps as a result of the 1994 genocide.
Aim: This research examines meaningful life experiences as narrated by women and men Congolese refugees
residing in a refugee camp in Rwanda.
Methods: Two in-depth interviews were conducted with 15 refugee men and 14 refugee women. Content in the
research text was analysed separately by gender.
Findings: Women’s experiences revealed themes of leaving the good life behind, worrying about their daughters,
feeling ambivalent about marriage and lacking hope. Men’s experiences revealed themes of leaving the good life
behind, having no peace in the heart and fearing the future.
Conclusions: Listening to refugee voices in narrated life experiences provides an opportunity for nongovernmental
organizations to create programmes and services that pertain closely to refugees’ life experiences.
Keywords:
Narrative Inquiry, Quality of Life, Refugee Camps, Refugee Health, Rwanda
Introduction
The United Nations High Commissioner for Refugees (UNHCR
2000) claims that the problem of human displacement in Africa is
expanding and becoming increasingly complex. Approximately
4.6 million refugees reside in African border camps (UNHCR
2003). Refugees are defined as people who have left their usual
place of residence and crossed an international border because of
persecution, armed conflict, or violence. In addition, approximately
9.5 million of the world’s 20 million internally displaced
persons (people who have left their usual place of residence but
remain within their country of origin) are found in Africa
(UNHCR 2000). The United States Committee for Refugees
(2003) in comparing refugee populations to local residents claims
that eight of the 20 countries with the highest ratios of refugees per
local resident are in Africa.
Asserting the need for more qualitative research with refugee
populations, Kreitzer (2002) and Halabi (2005) encourage nurses
to pursue studies that allow participants to describe their own
perspectives. The purpose of this article is to describe a narrative
research study that captures the life perspectives of Congolese
refugee men and women living in a Rwandan refugee camp. The
specific aim of the study was to deepen understanding of the
life experiences of refugee participants in an effort to plan programmes
and services that improve quality of life in the refugee
camp.
Background to the research setting
Rwanda, the most densely populated country in Africa, emerged
from Belgian colonial rule in 1961 with limited land and many
disputes over land rights (Gourevitch 1998; Kane 1995). In 1994,
a massive genocide, initiated by Hutu rebels, created a million
28

Life experiences of refugee women and men 29
Rwandan refugees who fled into bordering countries. When the
war concluded, Hutu rebels fled into surrounding countries,
including the Democratic Republic of Congo (DRC). Still violent,
Hutu rebels created terror among many Congolese citizens who
fled into Rwanda and settled into border refugee camps (Ward
2002). Political violence continues to erupt periodically on the
Rwandan–DRC border.
Background research at Gihembe Refugee Camp
While volunteering for the American Refugee Committee, the
researcher offered to conduct a research study on women’s health
at Gihembe Camp. The first phase of the project was a focus group
inquiry to explore refugee women’s perspectives of their own
health concerns. Results indicated that social and cultural structures,
such as gender roles and relationships, strongly influenced
women’s health and well-being (Pavlish 2005). Participants
claimed that many women experience poverty because they have
little education or skills training. Women described a lack of freedom
in expressing themselves, especially in relationships with
their husbands. The participants also discussed frequent episodes
of sexually transmitted infections and partner-related sexual violence.
Seeking more control in negotiating when and how they
have sexual intercourse, participants were especially concerned
about the spread of HIV as well as about frequent pregnancies.
The burden of work was unbalanced; the women were expected to
provide all food, water and clothing for the family and maintain
the health of all family members.
Refugee women also described themselves as feeling ‘poor in
spirit’ and ‘lonely for opportunities’. In an ethnographic study of
how Rwandans perceived the health effects of the 1994 genocide,
Bolton (2001) described depression as a prevalent and direct
result of the 1994 events. The DRC refugees fleeing the Hutu
rebels who were responsible for the Rwanda genocide now reside
in Gihembe Camp. Palinkas et al. (2003) substantiated the prominence
of depression among refugees. Reporting the effect of
depression on attention, cognitive processing, short-term memory
and vigilance, the authors called for research to explore refugee
life experiences as a means of promoting the refugee journey
towards wellness and greater understanding among humanitarian
workers and healthcare professionals who work with refugees.
All of these issues are partially related to the social norms of
gender identity, roles and relationships within the DRC culture.
To develop deeper understanding about cultural norms, social
structures, gender relationships and family life, a narrative
inquiry into meaningful events, people and life experiences of refugee
men and women was initiated. Kanyoro (2002) claims that
understanding women’s situations in Africa requires researchers
to study men’s circumstances as well. Therefore, both men and
women were invited to participate in this study. Two Institutional
© 2007 The Author. Journal compilation © 2007 International Council of Nurses
Review Boards approved this study as meeting the standards for
protection of human subjects.
Method
Atkinson (2002) identified three guidelines for narrative inquiry.
In the first instance, the researcher should not judge or analyse the
storyteller but, should instead, focus on establishing connections
and examining the personal relevance of each story. Second, the
life story can stand independently in offering insights into the
human experience and, third, each life story reveals something
about life.
Narratives contain people’s perceptions and, often, their own
interpretations of meaning derived from lived realities (Green-
Powell 1997; Lawler 2002; Lieblich et al. 1998; Personal Narratives
Group 1989; Polkinghorne 1988; Riessman 1993; Vaz 1997).
Therefore, narratives offer data that have already been interpreted
by the narrator before the researcher even reaches the data analysis
phase of the research process. For example, Riessman 1993,
p. 5) claimed, ‘Narrative analysis – and there is no one method
here – has to do with how protagonists interpret things, and we
can go about systematically interpreting their interpretations’.
Subjectivity is often deeply distrusted in the human sciences, and,
yet, in personal narratives, ‘It is precisely because of their subjectivity
– their rootedness in time, place, and personal experience, in
the perspective-ridden character – that we value them’ (Personal
Narratives Group 1989, pp. 263–264). After examining the significance
of narrative inquiry, Lawler (2002, p. 254) concluded that
‘The truths people produce through such stories are not “truths”
as conventionally understood by positivist social science: nevertheless,
they do speak certain “truths” about people’s (socially
located) lives and identities’. In this study, the researcher viewed
narratives as the raw data that reflected participants’ situated
truths about life at Gihembe Camp.
Two Congolese community health workers recruited potential
research participants. Wengraf (2001) suggested a purposeful
rather than convenience sampling for narrative research. Therefore,
recruiters were asked to select potential participants from
various categories, such as frequent visitors to the health clinic
and marginalized groups in the camp. All 30 refugees who were
invited to participate agreed to participate. One woman participant
could not describe her story without crying extensively, so
the interview was stopped and the participant was encouraged to
seek assistance from a nurse at the camp clinic.
Asserting that the human impulse to narrate is natural and universal,
Wengraf (2001) proposed the use of minimal structure in
the narrative interview instrument. Therefore, during the first
interview, the researcher elicited narrative by asking participants
to describe memories and anecdotes about significant events and
people in participants’ past and present lives, as well as stories

30 C. Pavlish
about their ordinary days. Atkinson (1998, p. 14) asserted, ‘Wherever
the storyteller goes with the open-ended questions asked,
whatever is emphasized the most in a life story, will highlight what
is most personally meaningful to the teller’. Given the freedom to
choose their own topics and anecdotes, all participants chose primarily
to describe their present context.
The second interview was conducted within 3 days of the
first interview. During the second interview, the researcher first
reviewed, in order, the topics participants described during their
initial session. The researcher then asked the participant for additional
anecdotes about those topics. Wengraf (2001) described
this technique as appropriate for eliciting more in-depth biographical
narratives. All participants continued to describe their
current daily challenges.
Written notes taken during the interviews were immediately
transcribed into written research text. At the completion of all
data collection, a systematic, inductive and across-case data analysis
(Lieblich et al. 1998) was conducted. In the first instance,
research text was separated by gender. Second, the gendered text’s
major content categories were identified. Finally, the content
categories were sorted into themes within each gender. The
researcher attempted to remain as descriptive as possible and
utilized sections of participants’ narratives to verify the themes.
Prevalent themes in women’s lives
Leaving the good life behind
All women (except one) described themselves as ‘being rich’ in the
Congo. Families had milk to drink, fresh food to eat and clothes
they could afford. Women described taking care of their children,
helping their husbands in the fields and selling a cow or marketing
their vegetables to buy necessities. They talked about being
healthy and ‘living in good condition’. Most women did not attend
school while growing up in the Congo. Some women attended
school for a few years but events (such as a brother’s death or a
mother’s illness) abruptly ended their education. Some women
talked about how boys did not like girls who attended school. One
woman stated, ‘What I can remember . . . in Congo is that when
you went to school . . . it is not easy for you to get a husband’.
Another woman said, ‘In the culture of Congo . . . when you grow
up you don’t go to school you take care of others’. Women talked
about being married; some women said they were married in a
church and that the husband provided a cow for the wife’s family.
Other women described how they were ‘taken’ by force and after
the ‘rape’ they just decided to stay with the husband. Five women
were widows, one was separated from her husband, two were
unmarried and six were still married to their husbands.
Women talked proudly about ‘doing business’ in Congo; they
bartered, sold and bought food and other items they needed.
© 2007 The Author. Journal compilation © 2007 International Council of Nurses
Apparently, ‘doing business’ was a significant aspect of their good
lives in Congo. Women described how they would like to resume
doing business, so they can earn money for the food and clothes
they want to offer their children. One woman stated,
When they [World Food Program] give us oil . . . the meaning
of the oil is to sell it or to give it to someone so you can get dry
wood or what you need. Oil is not necessary for us. You can just
give the oil to someone and they can give me a kitenge [traditional
dress] and next time I will use the oil for dry wood. We
make an exchange.
Some women formed a co-op and shared the oil they received.
Each month a different woman would get the money from selling
the shared oil in order to purchase a kitenge. Having something of
value with which to ‘do business’ was vital to all the women interviewed.
Women talked about the importance of procuring a job or
seeking opportunities to manage income generation projects at
Gihembe Camp so they can ‘do business’ again.
All women described the importance of clean and colourful
clothing to Congolese women and how the good life means purchasing
a kitenge when needed. One participant stated, ‘If I don’t
have clothes it makes me ashamed. Neighbours don’t respect me.
They ignore me it seems’. Younger women talk about needing a
kitenge to wrap and carry their babies. Several women described
how in Congo their husbands would offer them a kitenge after a
beating, but here in the refugee camp, when the men do not have
jobs, the wives just get a beating – and no kitenge. Clean clothing
seemed very important to Congolese women. Kitenges seemed to
contribute positively towards their identity as women and seemed
to provide social status for them.
All women described the fear they experience whenever they
run out of food. One woman stated, ‘The only thing I am afraid of
is when I don’t have enough food for my children. I think about it
all the time, and it is very hard for me when they come home from
school and I have nothing to give them’. Some women said they ‘do
other things’ that they were not proud of and did not want to talk
about to buy food for their children.
For refugee women, living the good life seemed to include having
the means to ‘do business’, to clothe themselves in the traditional
fashion and to procure necessities for their families.
Worrying about their daughters
Many women described their worries for young girls in the camp.
The women talked about the social pressure young girls experience
to ‘look smart’ when they reach adolescence – which means
they need to buy clothes and body lotion. One woman stated,
My 15-year-old daughter needs body lotion, nice shoes, and
powder for her face. But when she asks for money to buy those

Life experiences of refugee women and men 31
things and I don’t have money I don’t want her to go outside like
other girls and do sex to get money. I prefer to sell the food I get
so I have money to give my daughters so they don’t go outside
for sex.
Another woman talked about her four daughters and said, ‘I
cannot tell you how they disturb me asking for things . . . shoes,
body lotion. One young girl . . . she’s in primary 4 . . . she just told
us she’s pregnant . . . some of the men here just use them. It’s a big
problem. They give them body lotion and then they just use
them . . . then they get pregnant and stop going to school. She’s
just like a street girl in this camp’.
Other women described the way some refugee parents sent
their young daughters to be housegirls in the city, so the girls can
send money to their families in the camp. One woman stated, ‘Life
is very difficult when you have young girls. There are no jobs,
they don’t have anything, so they go to Kigali to look for
jobs . . . sometimes we send them to Kigali to get jobs to get
money . . . and the unlucky ones come back pregnant. After they
deliver the baby, they leave the child with the mother and go back
to Kigali to get a job and send money back’.
Exploitation of young girls was evident in several stories. One
young woman described leaving the camp to care for her older sister
who had malaria, and while she was there, her brother-in-law
raped her, and now she is 7 months pregnant. She said that she
could not tell her sister, and, because her parents were killed in
Congo, she was caring for two younger siblings and concerned
about providing for her new baby.
Worry about daughters was very prevalent among participants.
The vulnerability that accompanies poverty was the primary
source of their worries. If mothers could purchase necessary items
so girls are not pressured to ‘do sex’ or exploited by older men,
participants claimed that worries for their daughters would
diminish.
Feeling ambivalent about marriage
Women narrated both benefits and challenges to being married.
Benefits included having ‘someone to talk to’ and ‘someone to
speak for the family’. For example, widows frequently described
difficulty procuring necessities. One widow said, ‘When you are a
widow without a husband . . . people they do not respect you.
There are some people who are in charge at the camp. When the
house is falling apart you go and talk to them and they say, “I will
come.” You wait, you wait and they do not come and you go again
and they don’t come’. Another widow stated, ‘I don’t have a husband.
There is no one to talk for me. If I don’t give the section chief
something, I don’t get what I need’.
Challenges of being married primarily related to gender roles
and relationships within families. One woman revealed that her
© 2007 The Author. Journal compilation © 2007 International Council of Nurses
husband went to Kigali for almost 4 years and returned to
infect her with HIV. Forced sex and no power to request safe
sex were common issues described by wives. Most women
explained how their workload in caring for families was burdensome.
One married woman said, ‘In general, all duties go to
the women – cooking food, carrying dry wood, going to the
market, going to the UNHCR to get food . . . she’s the one. In
general, men sit at home and not do things. A few of them have
a temporary job in Byumba but most just wake up and sit.
They don’t have anything to do’. Some of the women also
talked about the difficult life for refugee men. One stated, ‘My
husband tries to give me everything I need, but he cannot give
what he does not have’.
Some women described the hurt and harm experienced when
‘beaten’ by their husbands. In Congo, ‘beatings’ were easier to
accept because ‘he would always give me a kitenge afterwards so I
didn’t mind, but here he can’t do that’. Some women seemed to
accept beatings as part of life in their culture. However, some
women separated from their husbands when the beatings
became very difficult or affected their children. One woman
described how she told the police about her husband’s beatings,
and the police said it was a family issue and they would not
interfere.
Poverty seemed to negatively influence marriage relationships.
One woman described how wives must ‘dress smart’ to
keep their husbands, and so they ‘do sex’ with other men in
order to purchase kitenges. Another woman stated, ‘Sometimes
the husband in the house does not give them what they need, so
they go outside to have sex so they can buy clothes so they can
keep their husband. When the husband knows about it, he beats
his wife’. Some women described being forced into prostitution
in order to procure money for their children’s needs. They
seemed almost resigned to the sad fact that women must sometimes
do whatever they can to provide for and maintain their
families.
Lacking hope
Many of the women described being very sad. Most women
have lost children, husbands and other family members – either
in the war or since leaving Congo. They described being ‘without
hope’ or ‘without a future’. Many said that improvements
were ‘not possible’. One woman stated, ‘When I think of the
future I ask, “what will be my life?” I’m very worried. I don’t see
a future . . . there’s nothing for me in the future. I don’t have
choices . . . I just try to be strong now for my children’. Two
young women who lack parents and care for their younger siblings
talked about wanting to kill themselves, but hesitated
because they feel responsible for their remaining family
members.

32 C. Pavlish
Prevalent themes in men’s lives
Leaving the good life behind
All men described themselves as ‘being rich in the Congo’. They
possessed cows, sheep, goats and chickens, and raised a variety of
vegetable crops. However, because of the civil war, the men had to
relinquish their possessions, either to the ‘rebel robbers’ in Congo
or to the guards at the border when the refugees entered Rwanda.
They had nothing left ‘to do business with’. Living in the refugee
camp where only a few jobs are available, many refugee men
described having ‘hands and force’ but no jobs. They described
being bored and often feeling sick because they ‘think too much
and do too little’. Men wanted work as the means to provide necessities
for their families and develop skills to teach their children. As
a result of unemployment, many men were forced to make difficult
choices. They either accepted dangerous work or they travelled
to Kigali for temporary work, which the men claimed placed
them at high risk for being infected with malaria or HIV. Some
men talked about sending their young adolescent children to
Byumba or Kigali to become houseboys or girls and earn money
for the family. Describing another aspect of poverty, several men
claimed that women, and even wives, who were not ‘strong in
poverty’, often performed ‘sex for money’ and thereby spread
AIDS to men in the camp.
Several men expressed concern about their lack of education,
which was halted because of the war and, as a result, they were ‘not
prepared for the future’. Many of the men felt trapped in difficult
circumstances that offered few choices in being productive and
planning for the future.
Having no peace in the heart
All of the men talked about the obligations of being ‘chief’ of their
families – without the means. Providing their families with shelter,
clothing, food and other material aspects of the good life were
important obligations for Congolese men. However, as refugees,
these men described few opportunities to fulfil their obligations.
Several consequences occur. First, many men expressed shame,
and said they receive no respect from their wives or children when
they cannot ‘be a man’ and provide their families with the necessary
clothing and food. Second, they described ‘trouble in the
family’ and ‘noise in the house’. The men said that wives often criticize
their husbands for the men’s inability to provide for their
families. Because women possess the UNHCR ration card for
their children’s food, some men described how the UNHCR is the
husband to their wives. One man stated,
I’m the one . . . I take her from her family. I must do everything
for her. I gave up a cow for her. After that . . . sometime like
now . . . I can’t give her everything so we start to have trouble.
© 2007 The Author. Journal compilation © 2007 International Council of Nurses
So I’m not the man in the house. So when I can’t do everything
for her it’s hard. So the woman she might call me stupid, she
might call me a dog . . . just call me a dog and then the children
they don’t respect you. If you have money then the children can
go to school and the wife she can respect you.
Another man also described the difficulties encountered when he
could not fulfil his gender-related obligations, and stated,
When my wife sees a neighbour . . . has a new kitenge . . . she
says, ‘you can see you are not husband to me’. It’s very difficult
for us. Sometimes we just want to remember when we could
buy clothes . . . but they don’t understand, so they start to complain
and say, ‘You don’t have anything to do’. When they start
to complain like that . . . you just leave and walk around all day.
If things get really hard I go to my wife for money . . . if you say
that you will use the money to get a job . . . she gives it to you
real quick and then you go out and get a job and bring back
some money and we are all very happy. We stay in peace for
three or four weeks. Then it starts all over again.
Several men talked about how men without money often beat
their wives. One man stated, ‘Men are chief of the family but now
they have nothing to do so they beat their wives and start shouting’.
Trouble in the family was described as a very difficult consequence
of having the responsibilities of being chief without the
means available to enact the role.
Another aspect of being a Congolese man is having the money
and time to share beer and talk with other men in their communities
about subjects such as politics and economics. Without
money, men felt very sad, ashamed and lonely, and could only sit
by themselves. One man described his loneliness and isolation
from both family and friends. He claimed, ‘There is no peace in
the heart when you don’t have all those things I said’.
Fearing the future
Several men described the frightening circumstances of fleeing
from the rebels. Men sadly lamented the lack of peace in their
homeland. Several men described how rebels invaded a different
refugee camp in which they were living and killed family members
and friends. A life of fleeing violence has repercussions and refugee
men talked about how they fear being moved closer to the
DRC and worry about forced repatriation by UNHCR and Rwandan
government officials. Many men expressed little hope that
there will ever be peace in their homeland. Most of the men lost
siblings, previous wives, or children during the ‘rebel robber’
attacks and they worry about what will happen to them and their
families in the future. They also voiced considerable concern
about starting life anew without the necessary resources – especially
since they felt they were wasting their most productive years

Life experiences of refugee women and men 33
in the camp. Eagerness for income generation projects was always
evident. Several men claimed repatriation would be easier if they
had the means to restart their lives in Congo. One man stated,
‘Even we adults are afraid of the future if we aren’t prepared for it’.
Discussion
At least three study limitations are noted. First, participants
expressed fear about being audiotaped. Even though many narrative
researchers stressed the importance of tape-recording narrative
interviews (Atkinson 1998; Green-Powell 1997; Wengraf
2001), the researcher decided that establishing trust was even
more essential than verbatim statements for accurate data collection
(Obbo 1997; Vaz 1997). Therefore, the researcher altered her
original plans to audiotape, and instead, wrote extensive notes
during the interviews which might have resulted in some lost
data. Second, all interviews were translated from the spoken
Kinyarwandan language to English, for which a Rwandan woman
served as the translator during all interviews. However, it is
acknowledged that meaning can potentially be altered during
translation. In the third instance, results cannot be generalized to
other refugee populations and situations. The contextual nature
of narrated experiences offers deeper understandings of life
in a specific time and place and from specific participants’
perspectives.
Three knowledge claims with several nursing implications
seem warranted from this narrative study. In the first instance,
results yielded practical knowledge about participants’ experiences
at Gihembe Refugee Camp. Hatch & Wisniewski (1995,
p. 127) stated that narratives ‘reveal experiences of real people, in
real situations, struggling with real problems’ and asserted that
narrative research results offer practical knowledge useful for
problem solving. Poverty, stagnation, mental distress and strained
gender relationships were reported to have many health effects
for refugees at Gihembe. Therefore, the findings offer support for
nurses to expand the refugee health agenda beyond treatment for
physical illnesses. Planning health programmes and services that
address the social, economic and political contexts for refugees
seem indicated by the data in this study.
Second, knowledge gained in this narrative inquiry contributed
context-specific knowledge regarding refugee experiences,
especially the gendered refugee experience. As opposed to generalizable
knowledge that results from statistical analysis on representative
samples, these results provided additive information
about refugee experiences. Expanding the horizon of knowledge
about refugees’ experiences discourages professionals and organizations
from essentializing the refugee experience and, instead,
encourages nurses to contextualize their approach to improving
refugees’ health and quality of life. Even though results cannot be
generalized, nurses can gain deeper insights into the kinds of suf-
© 2007 The Author. Journal compilation © 2007 International Council of Nurses
fering that many refugees experience and the different manner in
which women and men experience suffering.
Third, knowledge gained in this study offered insight into
social and cultural norms and the manner in which these norms
affect health. Many of the specific issues identified by participants
pertained to gender roles and relationships mediated within the
DRC socio-cultural context. Methods to create social structures
that support better health outcomes for refugees, and women in
particular seem necessary. However, improving social and cultural
conditions that promote and support women’s health must
emerge from within the refugee community and within the context
of improving situations for men refugees as well. Kanyoro
(2002) and Oduyoye (2002) asserted that, in Africa, the key to
social change is inclusion. Utilizing participatory approaches
might provide nurses with the opportunity to share in the analysis
of social practices that negatively impact on women’s and men’s
health. Polkinghorne (1988, p. 10) suggested that narrative
inquiry ‘provides the kind of knowledge that individuals and
groups can use to increase the power and control they have over
their own actions’. Planning participatory, health-planning workshops
aimed at community-mediated social change seems significant
to improve health for all refugees.
Conclusion
Expanding, contextualizing and gendering the refugee health
agenda and creating social change that improves the quality of life
for both men and women are the primary health and development
challenges that resulted from this narrative study. New community-based
health programmes designed to address refugees’
concerns are currently being planned in collaboration with both
men and women refugees at the camp. Community organizing
around improving the quality of life has been initiated. Income
generation projects, educational programmes and skills training
are also being developed to improve refugees’ health outcomes.
Participatory workshops that examine social norms on gender
roles and relationship are being implemented. Nurses play a key
role in advocating community change and planning programmes
and services that improve refugees’ contextualized and gendered
health experience and quality of life.
Implications for nursing practice and research
Beyond the data that offered important information to guide programme
planning and healthcare delivery in the Rwandan refugee
camp, this research project offers nurses three other lessons. First,
narrative inquiry seems to be a strikingly valuable and valid
research endeavour. Researching life experiences reveals useful,
contextual information for nurses to apply when working to
improve the lives of human beings. Nestled in life experiences
are human fears, hopes, regrets, injustices, successes, ideas,

34 C. Pavlish
innovations, values, plans, frailties and resilience. Changed lives
can potentially unfold from studying lives. Second, nurses must
look beyond health as simply a holistic experience of individuals,
populations, or communities. Health occurs in the context of the
daily experience – in the context of our collectivity, work, gender,
environment, culture, relationships, politics, economics, social
norms, history, faith and daily lives. Health and well-being are
about the web of human experiences which means that human
beings must accept responsibility for each other and the contextual
conditions in which every person lives. And third, as one refugee
woman implored, ‘I just don’t want you to forget us. We have
given you our concerns. Please don’t forget us’. Rather than avoiding
the ‘choked silence’ (Kanyoro 2002, p. 83) of marginalized
voices, nurses need to purposefully attend those people who live
every day in hopes of being heard. Only then will nurses around
the world realize the International Council of Nurses’ vision of
collaborating to lead all members of our societies to better health.
Acknowledgements
The author thanks American Refugee Committee staff members
Connie Kamara, Huy Pham, Ken Murphy and Ibra Kebe, and also
thanks Emily Murokaheye for her skill in translation – as well as
her valuable guidance and genuine kindness when working with
the refugee women and men in this research project. Research
participants deserve special recognition for their courage and
deep commitment to improve life circumstances for the entire refugee
community. Partial funding was received from the Archibald
Bush Foundation.
References
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