Habib has been told not to drive faster than 100 kilometres per hour on the paved roads, and so at 100 kilometres per hour we travel, the needle of the speedometer never budging as we hoover up the miles, the suspension joints thwacking as we skip over potholes and fly past overladen poda-podas.
A poda-poda, for the record, is what a Toyota Space Cruiser becomes when you crudely paint it blue and yellow, fill it with 15 Sierra Leoneans (maybe an extra half dozen on the roof) and then top it with at least its height again in luggage, water butts, goats and chickens (tied on, no cages). They do something special to the suspension so they lean crazily over to one side and adjust the chassis just so, with the front and back wheels in perfect misalignment, so they move sideways down the road like crabs. And a bit like the cockroach I watched a lizard try to eat, a poda-poda isn’t really dead until it’s in a ditch, crumpled and burnt out.
There are an awful lot of dead poda-podas on the road to Bo.
From time to time we pass through farmland ablaze, the road a narrow strip between plumes of smoke and flames that lick the margin, what little greenery still existing at the end of the dry season put to the torch to improve the land. All along the road men work on the deep trench that – whisper it – will host the new fibre optic cable which has been long promised.
It’s a fun road-trip diversion to watch this trench snake along the roadside, indiscriminately cutting through property and dividing villages. The 20th century is approaching Sierra Leone, and approaching fast. Well, not fast, but at the sort of rate that counts as fast round here.
Almost a fortnight after we arrived here I discovered a message on my phone from Georgie’s father that asked for the one word I would use to describe my first experiences here. By the time I saw the message we had already written at length about our first taste of the country and so the question seemed moot. But now, after some time, the best word I can think of is “Dissonance”. Nothing makes sense in the same way it does back home. This fibre-optic cable, and the internet it promises, is a fantastic example. This is a country where my entire generation does not know the meaning of Tetris, or Super Mario, or why Windows 3.1 was a big deal and whilst this seems, at first glance, to be a trite point I really think the underlying concept is important: This is a country which has found itself arriving at point D without ever having known that points B or C existed – and without any of the metaphorical roads that should have taken them there. There are whole areas of development that have passed this country by in its ten years of brutal war and now it’s putting itself back together in a modern world which it is ill-equipped to understand. It’s like kidnapping Newton and popping him in a space shuttle. Georgie is building a mental health service in a country where smartphones and 3G networks go hand in hand with the fervent belief that mental illness is caused by witchcraft. There is no landline network or infrastructure to build a modern service around; there are DVDs but no TV stations, iPads but never desktops. There are new buildings without engineers or architects to design them. NGOs that drop in infrastructure like Technic Lego to a toddler without providing the means or the knowledge to maintain it. A child falls ill not because of poor diet and hygiene, but because a parent sacrificed their well-being as a gift to the spirits for the benefit of the family wealth. And these are not the backward opinions of ‘munku’ country folk, but the solid convictions of intelligent university educated people in positions of consequence.
It soothes my soul to watch a westerner take Arnica with her breakfast. We are all just as loopy.
On the outskirts of Bo a half mile of Tarmac road is inexplicably missing, replaced instead with the surface of Mars – red and pockmarked, where trucks and cars appear and disappear in the deep potholes, and ocadas pick their way gingerly through the otherworldly landscape. By now I am already taking such things as given and it is Katy, fresh from London and travelling with us to assist Georgie that asks what happened to the road. The answer is at once obvious and sobering: “When the rebels were approaching, Ecomog bombed this road to slow them down.”
We are driving through bomb craters.
14 years after the war, whilst elsewhere the Chinese build sinuous roads as smooth as silk these reminders remain, as do the bullet riddled carcasses of homes throughout the country, collapsing wrecks festooned with strings of laundry.
Later, Moses, one of Georgie’s nurses, will tell how he stayed in his home throughout the war, of how a child no more than 7, drugged and dragging an AK47 by the butt, hefted the weapon and pushed the muzzle into his chest. Told him to bring him food or be killed. By the time the west got involved the war was more or less done and for all the undeniable brutality, horror and murder, there’s a strange sense that waiting until then might just have been the least worst thing we could have done. By the end everyone was sick of fighting. No-one wanted to carry on and now, for all the anger and inequality that still bubbles below the surface, it doesn’t feel personal, and maybe in time it can be channeled for good. Like everything here the war was complex with interconnecting reasons that go far beyond the scope of this tale – or my ability, so fresh in country, to tell it. But there was no simple good/bad, rebel/government, tribe a/tribe b. At any given time I’m not sure to what extent anyone knew who or what they were fighting for or against; factions came and went, splintered and fought amongst themselves and anyone with a gun could declare themselves part of an army without any formal connection: RUF commanders would frequently hear of success in battles they never knew they were fighting. Seemingly few battles were fought between soldiers; the ordinary people bore the brunt. It was a vicious and personal war, fought less between villages than between villagers: disaffected youth taking horrific revenge on a patriarchal society where life was cheap and women and children nothing more than commodities controlled by the ruling class.
To this day, and despite an amazingly rich and varied life, the Second World War remains the defining point of my Grandfather’s experience. It is a point to which the rest of his life, his character and personality has been anchored. He, and the men of his generation, can stand tall and say, “we did this for our country”. Yet here you have a country of young men, involved often against their will in a decade long attempt to destroy each other and not one of them can lay claim to that same sense of pride, honour and fulfilled duty which has allowed our grandparents’ generation to deal with the horrors they undoubtedly encountered. And furthermore, the distress and the challenges that these men face – many of them just drugged up children at the time – are now considered the result of witchcraft amongst the people who would help to care for them. And this is, of course, before you even begin to consider the victims still living amongst their assailants.
There is a loud clackering sound as we drive over a narrow old iron bridge raising us above a thin stretch of water below. We are at the end of the dry season and eagerly await the rain.
“That is the talking bridge.”
Still crossing it , I focus in on just how loud it is. Augustine goes on, “The bridge talks and tells the villagers who is coming – during the war they would run and hide in the bush every time they heard the bridge talk.”
Driving around Bo and the surrounding district visiting different cheifdoms I look out of the car and see stunningly wild forest and bushland; I see a red, dusty, holed and dangerous road, I see a very different form of life happening outside the car window than the one I left behind in the UK; I see people standing at wells pulling up their buckets of water. Women scrubbing clothes on washboards and men sitting outside huts sleeping in the heat of the day or selling mobile phone credit and cold drinks. Shirtless men pass with machetes coming from the farm and bushland, and children wander around confidently carrying huge loads of water and coal or wood on their heads.
I see life but having spoken with other people, I wonder if Sierra Leoneans may see something different.
We drive through one small town and pass a boys’ secondary school. The nurses tell me that the boys from the school were “wicked” during the war. Then they describe how the rebels entered the town, looted, tortured and set fire to people and places and recruited the majority of the schoolboys to join them, they even made a base in the school until they were ready to move on to Bo.
On a different stretch of road I am told about a battle that took place there between the rebels and the government soldiers, each side facing each other across a thin barely paved road – neither side a professional force after years of war, just kids pumped full of drugs and alcohol by their commanders, haunted by what they had done and what would happen to them.
One man we meet jokes that no-one in Sierra Leone is mentally healthy – “how can we be after that war?”
In every Peripheral Health Unit we visit we’re met by vacant looks when we mention mental health. No one has seen any cases. Until we start discussing the possible symptoms – problems sleeping, endless fatigue and physical pain, low mood – and then it doesn’t take long before people start to add “nightmares”.
What I see when I look out of the window – at the lives and homes we pass – and what they see must be two different things – my mind is eager to see more and learn more but I would imagine that their minds may want to forget for fear of reliving.
In shady groves, shabby tiled porches in lazy heat where even the crickets are idle there is a new frontline. Every town proudly displays its allegiance – here the colours of an EU development fund, there the flag of Medicins Sans Frontiers, over here a UNICEF stronghold. Amidst them we travel, Georgie’s rag-tag bunch of misfits, roving the country seeking allies, converts to the cause, spreading a message of compassion and care that must surely underpin the development of the country if it is to leave behind its troubled past. Slowly we advance, picking our way through territory hostile to the message. Often, Georgie is met with skepticism bordering on derision, disbelief and incredulity. She cannot be sure, even, of her own team who are ready with a hair trigger to question the cause. But Georgie is skilled and patient, knows how to draw the questions from the nurses we see and I watch as she coaxes responses and understanding. You can’t change a culture overnight, but there are victories. Two nurses scoff openly when Georgie suggests that when a child is impregnated by an adult, the child’s wilfulness may not be to blame. They are uncomfortable when Georgie suggests the adult might be at fault, but I watch as one nurse softly sneaks back to Georgie, like a cautious creature, gently touches her on the ankle and softly asks her how they might deal with these complex situations. Later I debate with a young social studies student the aggressive nature of a man marginalised in his community, his machismo leaves him almost deaf to Georgie’s reasoning, but I like to believe he finally walks away with some new perspectives.
In Bo town, guarded by a uniformed soldier wielding an MP5, we stay at the premises of Commit and ACT, a local counselling and therapy charity making a real and palpable difference. Georgie and I join the early part of a meeting of women who wander the community, playing music and presenting role-plays educating local people on mental health and rights for women and children. We can only sit and smile and drum our feat along with the uplifting music played by these inspiring and courageous women.
“We are sensitising the community” Hannah tells me – Hannah is a Sierra Leonean trained in ACT therapy – a proper therapist, she does whatever she can for her patients and on this particularly hot evening we are going to the local bars and drug dealers to warn them off selling alcohol and drugs to our patient.
“We want to make friends with them – remind them that this could be their brother, mother, sister, son and how would they want people to react to them”
I ask if it can be that simple and confidently she replies, “Yes.”
So, with the patient’s brothers in tow we walk to the local drug dealers: two young men wearing basketball jersies, inhaling the last drags from their most recently rolled joints. Anxiously they throw away the evidence, come to us and shake our hands; eyes bloodshot and barely able to hold our gaze.
They know immediately of the patient we talk and nod their heads sympathetically, immediately promising to never to sell to him again.
We giggle at how scared they had been that we were police.
Then onto his second favourite place. I stride confidentally into a “local bar” – by which I mean bow my head to enter a space where two thatched palm leaf walls lean together, wooden benches made of individual strips of wood tied together representing the place to sit. They creak unnervingly as I sit down and my fellow bench companions shuffle nervously to rebalance the weight.
All eyes on me until Hannah arrives. She explains again that we are here to talk about a member of their community who is not well. Silence descends on the entire bar and before long we have moved on from talking about one individual to everyone’s experiences of mental illness and what can be done to support people.
“If your mind gets sick can you get well again?” this is about the 50th time I have been asked this – always by someone with a tired looking face well older than their years, eyes that in many lights look almost dead but for a faint flicker of hope, and always always with a drink in hand.
A difficult question to answer in any country, I say that there are treatments and things we can do to support people but it would depend on their symptoms and what was happening; but I can see that I have lost him and the hope begins to fade.
People want to hear that I can give them a pill that will make it all different, stop the pain and memories and make them better, and when I say that we don’t work with medication (there is no psychotropic medication in the country) they return to the jam jar of palm wine, topped up with strong alcohol, that they so often have resting in their hands.
We finish visiting the PHUs in Bo district and start travelling down the beautiful road to Pujehun. Feeling quite dejected and frustrated by the dissonance produced by the nurses behaviours and attitudes we arrive at a small town and meet with a CHO who has taken his training to heart.
As soon as he returned to his place of work he had made posters about mental health and human rights, he had handmade posters on his office walls telling people to treat mentally ill people with respect and dignity. He had separate case records for patients with mental illness and epilepsy and was monitoring them regularly. We sat and helped him talk through possible care plans and ways that he could engage difficult and volatile clients – dissonance resolved – this is what we wanted to see.
Buoyed by that visit the next morning we set off to another PHU in Pujehun and again the road was beautiful. Although Bo and Pujehun border each other Pujehun seems more wild- the roads undulate more and bushes and shrubs flatter the roads more, casting a gorgeous speckled sunlight and then opening up to give us a gorgeous vista.
Except the vista represents the kind of cultivated land that you would expect to see in Europe – wild forests and bush have been hacked down for 1000s of hectares, and sprouting from the ashen earth are the heads of palm trees being grown to make palm oil and rubber. This was our first experience of “The Company.” Referred to only as this by local people, we hear how a paramount chief has sold the entire chiefdom’s land to the company. The Company cannot have paid much more than $12 an acre per year in rent and in a quick six months have demolished the entire countryside. Villagers can no longer farm, no subsistence farming at all, as all the land is to be used to grow palm trees for palm oil and rubber. People can no longer live on the land that has been their home for years.
The deforestation is total, from horizon to horizon, the work of a foreign multinational referred to only in hushed Orwellian tones, they bought the land from underneath the villagers in a dubious deal with the paramount chief, a man who later entertains us with cold Coca Colas and who has clearly prospered whilst his land is decimated. It is too easy to paint a mysterious foreign conglomerate as the bad guy, too easy to dismiss the obvious investment they have made in the one remaining town. Too easy to scoff at the money they have paid. The chief, as custodian of the land, receives the money, the villagers receive their share. And in return, without choice, they forfeit the land they have farmed for generations, their home, their food source.
In any case, what use is money in a place where there is nothing to buy, and no market for the crops they grow? The poverty here is different from that in the towns, life is tough, for sure, but it is a pre-capital society. – their small patches of land are their very lifeblood. There is so much talk of wealth generation but in a country this fragile what measure of real wealth is cash income? And how well have we done with all of our money, in any case? Of course it is only from a position of arrogant privilege, wafting through in a 4×4 on a whistle stop tour, that you have the luxury to ask yourself whether a poor and simple life here might have its benefits over a complex and comparatively wealthy one elsewhere.
I am occupied showing medical students Kallon and Usina how to sketch on my iPad when this idle thought is put into stark reality.
A ‘mentally ill’ child has been brought for Georgie’s inspection. Even to my eyes, the primary concern with this child is physical, not mental – even here where developmental challenges are lumped in with mental illness it’s heartbreakingly clear that this baby needs medical help – and quickly. And here we are. Two hours from the nearest hospital, in a local health care unit with no doctor, no medicine and no real idea what to do. The mother is almost mute with fear – for her child’s health, for sure, but also – and, strangely almost more so – in the face of us as outsiders. She is reluctant to speak, barely able to communicate.
Childhood illness is a virtual death sentence here. Why doesn’t she take the child to hospital, Katy asks. Because of the cost. 15000 Leones for a bike to take her to Bo. Just over £2. She can’t afford it.
I’m aware that you can’t save every child you meet – and of course, what happens after this and into the future, but this makes me uncomfortable. I am trying to catch Georgie’s eye – for God’s sake we can give her 15,000 if that’s what it takes, but Katy is already a step ahead – “can’t we put them in the car?”
Are we being naive? Or is it too cynical even to wonder that? Of course we can put them in the car, and we do, and we take them to the hospital where medical care is supposed to be free for children under 5 and nursing mothers but, of course, there is no medicine at the hospital and when the father turns up at the hospital and somehow gets the money for the medicine he goes off to the pharmacist and then… He doesn’t return. And eventually the mother absconds from the hospital with the child and how does she get home? We don’t know. And the whole thing is a bitter and uncomfortable lesson for each of us in different ways – and I fear with a chill that is sickening, the thought process I can barely give voice to, that of the parents as to the relative replaceability of a very young child. And if you ask me, all of this surely comes under the heading of mental health and demonstrates how desperate the need is for Georgie’s work, because what human being could possibly be unaffected by all this? The same respect for life Georgie is teaching to those caring for – or coming into contact with – mental illness is the same respect for life that is needed everywhere at all levels in this country. Is wealth the best measure of a country’s success? I’m unconvinced, and money might surely have helped this child, but I think if, instead, you take the value we place on the lives of others as your measure of a nation’s worth – and use that as your building block – then it might give us all something to aim for.
***Should this somehow not be enough for you, our companion Katy has posted her own thoughts beyond the click of these words