Workers focus on the mental health of victims of tragedy

This article first appeared in the Chicago Tribune A rooster crowed loudly as Dr. Michael Michalik chatted via cellphone from the guesthouse he shares with six other volunteers in the village of Gulu, in war-rocked northern Uganda. The 57-year-old psychologist gave up his private practice in Rockford two years ago to join Medecins Sans Frontieres (MSF), or Doctors Without Borders, and now is on his second mission. In Uganda, the energetic family therapist coordinates a shelter where each night, children ages 4 to 16 seek safety from rebel soldiers, who attack villages to kidnap youngsters and force them into armies. Some nights the shelter is packed with 2,500 boys and girls. MSF is best known for sending doctors into war zones and areas hit by natural disaster to treat the sick and injured. In the early 1990s, however, the organization decided that along with physical injuries, the psychological wounds of those who have suffered the horrors of war and other calamities also should be addressed. Since then, MSF has sent mental-health teams to 43 nations. Currently some 100 psychologists, nurses and other medical volunteers are spread throughout the globe, from Indonesia and India to Angola, Zambia, Uzbekistan and Colombia. "I decided after so many years of practice that I wanted to test my skills in different cultures," explained Michalik, who was surprisingly upbeat despite a cholera outbreak in a village nearby. "Plus I felt it was time to give something back in a humanitarian sense." His first assignment was a nine-month stint in the Gaza Strip, directing mental-health care to Palestinian families living with ongoing strife between Palestinian and Israeli forces. (Israelis also were offered MSF help but had enough trained mental-health professionals of their own.) Michalik visited Palestinian homes and worked to reduce kids' symptoms of trauma, such as bedwetting and aggression. "We modified our techniques to fit their culture," he explained. "It's a Muslim society, so their strong faith is what they use to cope. For example, they would say there are certain things up to Allah, so there was only so much they could do to change the situation. We said, 'Yes, there are certain aspects you can't change, but there are also things you can do.'" To provide a sense of control to mothers and security to children, MSF taught moms to establish a routine for children--waking them up and sending them to school at the same time each day. To help children overcome fears, volunteers talked to them about insecurities and nightmares and had them draw pictures of what they had witnessed. "Our focus is on helping people to cope, to restore some functionality so they can do daily things, and to help them be part of a group, which helps them to survive. Then they can start to process their experiences," explained Amsterdam-based Kaz de Jong, a psychologist and MSF's mental-health adviser. First, small international teams of MSF volunteers meet with local health-care professionals, such as doctors, nurses and local healers, to figure out how to facilitate treatment and support for that region's people. "Together we design what we're going to do and see what works," de Jong said. Local counselors always work under clinical supervision of a mental-health specialist. "We can't come in and say, 'You should do this,'" de Jong said. "Western psychological methods do not necessarily work in non-Western settings. What MSF can do is facilitate and mobilize individual and community resilience, restore self-control and self-help mechanisms. That's what people in a calamitous situation can't do." Each program looks different, depending on the country's culture. If religion is extremely important, imams or priests help MSF mobilize the community. "We ask individuals how they coped in the past when bad things happened, and use those methods, such as meditation or prayer. Or sometimes people just want to be heard because no one in the community is listening, because everyone has a story," de Jong said. "Others want to know that waking up at night and having nightmares is not a sign of going crazy but a normal reaction to abnormal experiences." Psychiatric nurse Carol Etherington was an MSF field volunteer for six years, traveling to Kosovo, Honduras, Tajikistan, Angola, Sierra Leone and New York City. "We found it to be true in every country, that when a war or huge natural disaster hits, people are so shaken to the core, they sort of lose their ability to trust their judgment for a period of time," she said. "That's why it can be so helpful to have outside persons help them be regrounded." She added that worldwide, "people pretty much react with the same emotions to tragedy. They may express their emotions in different ways--rage, weep, withdraw--but the emotions are amazingly similar." The immediate past president of MSF's board of directors, Etherington now uses much of what she learned overseas in Nashville, where she's a nursing professor at Vanderbilt University and does community health work. "In a village somewhere you can't just say, 'We're going to have a group session lasting six weeks.' You might use dance, song, exercise--not just talk stuff. The very same things work here, especially among people who are mistrustful of institutions. Those methods reach some people who would never buy into a traditional psychiatric medical model." In the most horrific of circumstances, MSF's efforts have been remarkable. In Sierra Leone, child soldiers once terrorized adults in a civil war that left 50,000 dead and millions wounded, with thousands with amputated limbs. But the children wanted to rejoin their communities once they gave up their weapons in 2001. MSF coordinated efforts to integrate the children into the community with help from tribal chiefs. "They were allowed to come back provided they weren't provoking anyone, and that they cleaned the latrines and garbage in refugee camps where everyone lived," de Jong said. "They could be part of the community, but they had to start at the bottom." It's difficult to see the world's suffering, de Jong said, and MSF can't stop bullets and wars. "But feedback is positive, and both victims and caregivers see progress, so that's encouraging." Copyright (c) 2005, Chicago Tribune