Report from Uganda

credit: Rebecca Tinsley

Author and former BBC journalist Rebecca Tinsley’s organization brings psychotherapy to children devastated by a brutal African war

Imagine how you would feel if the nine-year-old neighbor who killed your husband moved back in next door. Now imagine that dozens of other mentally-disturbed young murderers have arrived in your town.

That is the unthinkable daily reality I found on my first visit to Northern Uganda in 2008. The UN estimates that more than 30,000 children have been abducted and forced to become soldiers during two decades of a devastating war. They were kidnapped and brutalized by the vicious Lord’s Resistance Army, forced to kill or be killed, often murdering their own families. Girls were gang raped and became sex slaves, bearing the children of the officers who abused them – infants who are now stigmatized because of their paternity. More than 80% of citizens were seized at some point during the war, often for years at a time. Every single person I met had a scar from a bullet or knife wound.

The war has now moved elsewhere, and the child soldiers are returning to their villages. My charity, Network for Africa, is there, in this forgotten corner of the country, passing on skills enabling local people to rebuild their devastated communities. We set up farming co-operatives and train people in health, nutrition, women’s empowerment, family planning and improving agricultural techniques.

But how can people concentrate on learning a skill when their surroundings provide triggers that daily plunge them into post-traumatic stress and depression? Forty percent of the people we interviewed admitted feeling suicidal, constantly reliving the atrocities they endured or witnessed. How can a child soldier come to terms with killing his sister to save himself? How can a mother start each day when the child soldier who massacred her baby has returned and is living in the hut next door? And how can we expect villagers to welcome such damaged young people back into their midst?

Northern Uganda is extremely poor, without enough basic medicine like aspirin to go around, let alone electricity or running water. Lack of medical facilities and qualified staff means people still have bullets in them, so it is unrealistic to expect adequate psycho-social care for traumatized people.

Our charity knows that shipping in outside experts to give one-on-one treatment does not work. Westerners will never understand what it is like to live in constant fear of attack by a rebel group that are still at liberty in the bush. Nor can we grasp being haunted by recent memories of enslavement and rape. One of the cornerstones of our psychiatric tradition is assuring the patient they are no longer at risk, and that their continuing fear is irrational. But in Northern Uganda there has been no justice and the perpetrators may return at any time. It’s entirely rational to live in fear, expecting to have to suddenly hide for your life – because that’s how it’s been for twenty two years.

However, two psychotherapists from Missouri have thrown themselves into a pioneering project that tackles these problems head on. Dr. Barbara Bauer and Shelly Evans are volunteers with Network for Africa, using their expertise to train well-respected local leaders and village ‘wise aunties’ in the basics of psychotherapy. Their lay counselors then help and support local people in the most culturally sensitive manner.

Barbara and Shelly’s understanding of local needs is based on interviews, ongoing conversations and village meetings with hundreds of people about their experiences during the war. The results show post-traumatic stress is affecting the very foundations of society, with high levels of suicide, rape, alcoholism, domestic violence, HIV-AIDS, early pregnancy and severe depression. Women and girls very often bear the brunt of these problems, struggling to hold together their fractured families. Yet, say the Americans, the women’s incredible courage, enthusiasm and resilience makes the project work.

Twice a year, Barbara and Shelly go to Northern Uganda to run a series of ten-day-long workshops on how to recognize and manage post-traumatic stress. People in Uganda are not accustomed to expressing or analyzing their feelings. Nor do they grasp that emotional distress can manifest itself as physical pain, insomnia or paralysing sadness. Hence, the Americans must start by explaining the meaning of post-traumatic stress, and how to diagnose it. With the assistance of translators, Barbara and Shelly use games and drama to demonstrate standard psychotherapy techniques. Simple exercises like relaxation and imagining a safe place can help calm ever-present anxiety.

After their intensive course, Barbara and Shelly’s ‘graduates’ are given bikes to reach distant villages. Already the lay counselors are having a positive effect, with villagers reporting they are better able to work, study and sleep. However, Barbara and Shelly will continue running their workshops and refresher courses for the foreseeable future, aware they have only just scraped the surface of local needs. They devote hours of each trip to processing the feedback and conversations with their team.

Network for Africa plans to broaden the lay counselors’ role: they have become trusted messengers who can pass on essential information about health, nutrition, family planning, and women’s rights. Civil society was destroyed during the decades of war, so our lay counselors are well placed to help rebuild social networks and coping mechanisms.

The project needs financial support from outsiders to pay for the training, equipment and resources necessary to roll out the pilot project, reaching thousands more people. In the words of Dr. Barbara Bauer, “Speaking as someone who has spent my whole professional life treating trauma, the challenge has never been greater. But the rewards are enormous. It’s life-enhancing to watch a community healing itself and rebuilding.”

Shelly Evans adds, “Africans are often portrayed as helpless victims of poverty and war. Yet we’ve found the majority are resourceful and determined, coping in the face of circumstances that would overwhelm most of us in the ‘developed’ world,” she says. “They deserve a helping hand.”

To help Network for Africa click here

Editor’s Note: Rebecca Tinsley, a former BBC reporter, is a journalist and human rights activist who has worked in nine African countries. She founded Waging Peace, a London-based group campaigning on Darfur, and Network for Africa, a charity working with survivors of genocide after the big aid agencies move elsewhere. Her new novel, When The Stars Fall To Earth, is based on actual events of the genocide in Sudan.

13 comments so far.

  1. avatar Baby Snooks says:

    There is an interesting paradox – in Africa we reach out to victims who were traumatized when they became vicitmizers in war and yet in our country we turn our backs on them. In Africa, they are allowed to heal from the trauma. In our country, we give them pills and guns and put them back on the battlefield worsening the trauma instead of allowing them to heal from the trauma.
    We have “been here, done this” now twice. The first time during the Vietnam War. Do we ever learn?

    As for Africa the question is always whether the brutality is a result of their primitive natures or the result of our own that they assimilated into their own.  Heart of Darkness indeed. 

    • avatar docbb says:

      I find the natures of the people in Patongo anything but “primitive.” They are like all people, made up of all types of temperament, intelligence and abilities. But, the use of children as soldiers is an abomination unique to Africa and horrifying in the impact it has made on the young people of this region all of whom were either abducted or spent years hiding and running to avoid capture. And, yes, there are unmet needs in the US, also. We all have to decide where to place our effort. But, in 25 years as a trauma psychologist, I have never seen the extensive damage that has been done to this community. They deserve our best efforts. Barbara Bauer, Ph.D.

      • avatar Baby Snooks says:

        Like everyone else I sometimes engage the fingers before I engage the brain. I should have said “perceived” primitive natures. In many ways, we are far more primitive than the people of Africa. Which is why I made the reference to Heart of Darkness.

  2. avatar Baby Snooks says:

    One of the cornerstones of our psychiatric tradition is assuring the patient they are no longer at risk, and that their continuing fear is irrational. But in Northern Uganda there has been no justice and the perpetrators may return at any time. It’s entirely rational to live in fear, expecting to have to suddenly hide for your life – because that’s how it’s been for twenty two years.
    __________________________________________________

    I wish psychiatrists would understand that the fear is very real for many stalking victims and that a pill a day does not make the stalker go away.  And often produces the “pink elephants” in the room that suddenly are all anyone sees. Oblivious to the very real one lurking about.

  3. avatar Chris Glass` says:

    While I applaud these women for trying to help in Uganda that effort is like using a spray bottle to put out an inferno. The women of Uganda don’t need to be told they have post-traumatic stress it is embedded in the culture. I lived in Japan and Germany as a child after World War 2. Both those countries were recovering economically and socially at the time. Over the years those countries recovered and came to terms with what happened to them as a nation. While I realize that Uganda is not on par with more developed countries we can’t take our American system of rating trauma and apply it as a bandage effort to stem the ongoing hemorrhage. Who do you single out as being most traumatized, the child soldiers or the families of those who were killed by them? These issues will never be sorted out until the war culture is over. Those child soldiers are likely to take up arms again if the fighting comes back into their area. We can’t forget that this is a foreign war in a foreign territory that is ongoing. These people need medical help and a way to support themselves before they can overcome the ongoing psychological stresses of war. I would support a program dedicated to helping villagers learn a trade or plant crops to help themselves on a local level. Real psychotherapy is an ongoing long term event not something to be applied in a workshop.

    • avatar Baby Snooks says:

      These issues will never be sorted out until the war culture is over.
      _______________________________________________________

      Ours is a war culture as well.  No different, really, than theirs. We just like to delude ourselves into thinking it is.

    • avatar docbb says:

      Thank you for your insightful comments. I agree that our efforts in Northern Uganda are but a drop in a very large bucket. Each time I go there (we have made 5 trips) I am all but overwhelmed by the huge need. The aftermath of over twenty years of violence is enormous. Yes, people need more than psychological help. That’s why we also do HIV education and some micro finance. But the focus of this article was on the psychotherapy efforts. When individuals are virtually paralyzed by post traumatic stress disorder, it is difficult to work, learn a trade or maintain a relationship. Alcohol and substance abuse become a way of coping. Domestic violence and the suicide rate soars. All we can do is our little bit. But, if more of us did something, a huge change could be made. And, we are seeing the change. With each return trip, we teach our peer counselors new ways to approach mental health issues. Reports from the outreach program have been very positive. Barbara Bauer, Psychologist and Trainer

      • avatar Baby Snooks says:

        You are probably doing far more than you even realize. These “lay counselors” are what I call “kindred spirits” and nothing heals a wounded soul better than a kindred spirit.

    • avatar sdevans5 says:

      It is nearly impossible to put into words what the people of Patongo are doing with the training they are receiving. Yes, for Barbara and I, it is overwhelming and alone we will not even scratch the surface, but if we can help only a small number, it is absolutely worth it. However, now after two years and five trips, we are not the only ones doing the work. We have trained using a peer counseling model which has resulted in a group of trainees forming an outreach counseling program, as mentioned in the article. Together they are reaching far more people than we could have ever reached. They are holding trainings as well as offering individual counseling. They have reported many success stories. However, we continue to train the outreach counselors and help them with specific cases. It is amazing to watch this community come together to heal. As Barbara mentioned, mental health is not the only area of need in which Network for Africa is offering assistance and education. Not every community that has been through such atrocities is ready for the mental health aspect, but witnessing the trainees eagerly using what they have learned is evidence that they are ready and very capable.

  4. avatar crystalclear says:

    Chris, excellent post.   I agree with every word you posted!

  5. avatar crystalclear says:

    Again, looking at the picture above, we see two beautiful African women.   It is hard to process what these people go through every day of their lives living in conditions that would make a sane person consider suicide.    While my heart breaks for their broken spirits I don’t see any way to help them.

    I do see many ways we can be helping our fellow Americans achieve a better way of living and we’ll actually see the results.

  6. avatar central coast cabin home says:

    How is it, how is it even possible that we have forgotten these people, this war? Shame on us. All that crap with 9/11, I know, I am on the California west coast but what about atrocities on the real West Coast of Africa? Hope my demographics are accurate but I think that you know what I mean. 2 planes destroyed 2 buildings in God forbid hallowed USofA and we act as if we are the only ones who hurt. Well, the USA ethnocentricity needs some work.
     
     

  7. avatar sdevans5 says:

    Network for Africa evaluated this region extensively and interviewed the people, allowing them to voice their needs, rather than assuming from a Western viewpoint what might most benefit the region. Among others, one need that was requested was mental health assistance. As part of the mental health training team, we are very sensitive to cultural differences and have learned a lot about the Acholi culture. We stress to our trainees to let us know when anything we are teaching will not work and together we will find ways to adapt it or simply remove it from our material. We tell them they are the experts in what material will or will not be usable in their culture. In this way, we avoid the irresponsibe, futile force of Western ideas on our trainees and instead, learn from each other.