Learning when chance allows

MaryBeth McKenzie is an information officer for the Candian office of Médecins Sans Frontières (MSF), currently visiting the MSF projects in Sierra Leone. These accounts are from her journal reports of her experiences in the field.

Freetown, Sierra Leone West Africa Concrete planning is, at best, difficult in the field. Today was no exception. I had planned to spend my morning in the MSF office, working on stories and gathering information. In the afternoon I was to visit the new MSF mental health clinic in the east end of Freetown. This is not what happened. Yes, I spent my morning researching MSF projects in the northern part of the country, but my afternoon visit, along with all everyone else's plans at MSF, were suspended due to a local protest about the instability in the country. MSF sources had reported rumours that violence was expected at the protest so no travel to the eastern part of Freetown was permitted by the country manager in order to ensure the safety of the team. Happily, I was able to reschedule my work but, certainly for the logistics department, today's delay resulted in deadlines being pushed back - and a much needed generator not being delivered to a clinic. In the end, there was fortunately no violence. However motorized transport and street traffic were drawn to a halt as thousands marched on the British High Commission. I spent my afternoon instead, learning about the Mental Health programme from MSF volunteer, Marie - Helene Pare, the managing director from Quebec City. She came to Sierra Leone on her first mission with MSF, eight months ago. As a clinical social worker, her main tasks were to build and establish a sustaining mental health and counseling programme in a country where the concept of mental health and therapy is very new. MSF began assessing the mental trauma experienced by the people of Sierra Leone, in Freetown, just after the fighting in subsided. Through the survey, it was established that huge numbers of the population had personally experienced or witnessed extreme social violence, death and rape. In response to the type and number of atrocities in Freetown, MSF took the lead to develop a programme to assist the traumatized population. The first step involved a full evaluation of the internal infrastructure of the Ministry of Health. As well, MSF worked with the only licensed pyschiatrist in Sierra Leone, Dr. Nahem (founder of Children Associated with the War - CAW) to conduct a second survey of the people where it was confirmed that everyone in Freetown had been effected by the violent events in early January 1999. By July 1999, the Sierra Leonese Ministry of Health was in full support of MSF opening and operating a mental health facility in Freetown. A virtually destroyed building was donated by the Government to MSF for the project. Marie - Helene Pare worked as the architect to reconstruct the building. As well, she liaised with Dr. Nahem and an MSF consultant to develop a counselling programme appropriate and specific to the context of Sierra Leone. Local Sierra Leonese, both male and female, were recruited during the summer months to work as counselors. Intensive theoretical and practical training followed. The construction of the facility was complete in February of this year (2000). Prior to the conflict in Freetown, seeking such support was not common or even practiced. However since everyone in the city experienced or witnessed such violence, the usual social stigma of seeking psychological assistance was not there. Since the clinic's doors have opened over 100 people currently seek psychological support. Clients range from rape victims, to ex - combatants, to people who have seen families and loved ones mutilated and/or killed. In just one month, the nine counselors have are working at full capacity - and more and more people are requesting assistance. Many of the participants come from the camps of internally displaced people (IDP) next door to the clinic in the eastern part of Freetown and exhibit physical and mental symptoms of extreme trauma. The programme itself is based on four phases:
  • assesment
  • planning - where the client and counselor decide goals and objectives
  • the counseling process itself
  • and evaluation. MSF supports this project by providing funds, programme develoment and evaluation, training, logistics and management.