I can't believe I am sitting sandwiched between three Sierra Leoneans; two newly qualified psychiatric nurses and a representative from a partner organisation in Enabling access to mental health Sierra Leone. Habib is driving, reggae blasting out, and Katy (the British Volunteer nurse) is sitting in the front.
10 years ago I was living in Medellin in Colombia and I had a dream that I wanted to work in international mental health.
A quick Google search in 2004 from Colombia told me that that field of work did not exist yet! There were prospects – a few psyciatrists here and there and people playing around with terms like 'psychosocial counselling' and 'trauma counselling' – many with unclear routes – but nothing certain, no one was hiring and seemingly a coherent global mental health movement was still a way off.
10 years later I am bouncing down a “road” in Sierra Leone, sandwiched by my two best Sierra Leonean Psychiatric nurses discussing the supervision session we have just carried out with one of the CHOs trained by a training programme I developed in 2012 whilst volunteering with this programme.
10 years ago I never imagined that I would be able to fulfil my dream job, let alone do it with Ian, the love of my life at my side, and as I bounce down the road in Bonthe district I think the only thing missing is him.
Not that there was any space left in the car this time.
The Enabling Access to mental health project car is 20 years old and has been resigned to just going between Makeni and Freetown on a relatively good road. This is not a good road. Bonthe does not have a good road in it if I am honest.
For this trip the University of Makeni has lent us one of their newer cars, a Toyota Hilux nicknamed the “black car” because a kindly soul has attempted to spruce up the interior by repainting the dashboard in glossy black paint. They've done a good job, too, carefully painting over all of the switches, labels and warning lights. Despite this we're lucky to have it because driving out to the chiefdoms to visit the trained CHOs is difficult. The distances we cross involve driving for a few miles, taking a “ferry” over the river and then driving a bit more.
The ferry is a long thick wire cable connecting one side of the river to the other, and then at our feet long planks of wood are tied together into a raft with a wooden ramp so the car can drive on to it. The ferry is just about long enough for one vehicle. You step out of the vehicle and watch as 7 men float us across the river using wooden scoops and paddles to move us along the cable. The whole thing is a very pleasant way to travel, and a welcome break from bouncing along the terrible roads.
Driving around the district and visiting the different health clinics we are met everywhere with screams of “Pom Muy, Pom muy, Pom muy!” from the local children – it's a joyous and excitable shout that is Mende for “white man, white man!” – one of my colleagues observes that “Sierra Leonean children have a loving relationship with white people,” before following that thought with “…Not sure what happens when they grow up…”
Bonthe is the first district where I see mass graves from the war marked by signs.
“2,000 people dug their own graves, were killed, and will lie here forever” one of the nurses says. This was the home town of Made Bio (still a leading politician in the country at the moment and a military leader during the war who at one time acted as the President in about 1995. He is blamed by many for the war continuing so long. I am told that the rebels came to Mattru and pretended to be government soldiers (at that time led by Madde Bio) they shouted to Bio's family “come out, come out, you are safe, your son has the power”. People came believing these shouts and the rebels rounded them up, let them dig their own graves and left them for dead in an unmarked mass grave.
One nurse muses “Our task is large when we think that even the top Politicians in the country must be traumatised by what happened to them and their families during the war”
The buildings in Mattru and Bonthe island that were burnt out during the war are still standing and there seems to be little effort being made to get rid of them.
Much of the district's land has been sold to a mining company searching for rutile, they leave raw red scars on the landscape, a legacy of a policy aimed at long term financial goals but which poses serious short term challenges for those people who give up their homes.
Often the Paramount Chiefs remain as custodians of the land their villagers have occupied for centuries, these Paramount chiefs accept the advice offered to them by their government and the investors and the land is rented to foreign investors on the long-term leases; but the people are left with no way of farming, can't live on the land any more and stand back with perhaps only $100 USD in their hands and watch while their land is stripped bare. $100 dollars can go a long way in this country, but has little practical use in areas of subsistence agriculture, and it certainly doesn't last forever and once it's gone it's gone.
The people are getting angry and the majority of the conversations with the health care staff we meet tell us that drugs and alcohol are the biggest problems they face. They describe the number of people drinking all day every day and say they feel there is nothing to be done: “We can't interfere, people can do what they want”, they say with resignation. I try and make the distinction that when people are being admitted to hospital because of the amount they are drinking or because of the drugs they are taking that perhaps they could intervene: use their assessment skills to try and find out why they are drinking so much. The suggestion is met with stares of incredulity: They idea of prying into someone else's business like that is not acceptable. As long as it happens behind closed doors it is of no concern to anyone else.
This is going to be a problem in my new job as Mental Health is mainly about prying into other people's lives.
But I am learning that even if you pry here all you will find is the core belief that if something good happens in peoples lives then it is down to God or Allah. If something bad happens then it is down to Devils/spirits and witch craft.
I acquaint that way of thinking to the psychological concept of “locus of control”. The locus of control for Sierra Leoneans is definitely external.
I have often been told tales from the first few years of the war when the rebels were only in the far eastern parts of the country. The people in Freetown and other cities would ask anyone who had been close to the rebels “do they have tails, like an animal?” there was so much disbelief that humans could do this; it had to be something animal or supernatural. It had to be something external. Even now with Ebola people do not believe it is real. Instead it is International agencies trying to kill Sierra Leoneans, or it is tribal politics and the northerners wanting to kill the south.
There is almost universal acceptance that individuals have no control over their lives; it is all down to external forces. What I am learning is if they have no control then they also do not need to take any responsibility.
There is no sense that they can make things better, they are simply at the whim of God or the government or the international donors.
At least, for now, my nurses are at my whim and I can try and convince them that they do have some control and they can decide how these mental health services play out; some of the nurses are fantastic and are doing incredible things. These nurses in Bonthe are working with acutely unwell patients with no medication and very limited resources yet they are helping. They are stabilising clients and getting them into some line of work to keep them busy and get them earning.
They are walking around Mattru on foot to visit people in their houses. They are working with the police to support young girls who are raped or beaten. They are trying and they are doing it: If I know Sierra Leone they will give God all the praise, I just hope they remember to give themselves some credit, too.
[A quick note – it's a while now since Georgie made this trip, but since the power station went 'bang' about a month ago and our internet provider began “upgrading” the network it's been increasingly difficult to type things in the first place and then get them online. More updates to follow soon!]