In the community, you will frequently here of the “community volunteer counselor” and of their efforts to provide “psychosocial support”. What isn’t clear is how they go about counseling those in need. These individuals are deemed counselors after a one or two day workshop (a week if they’re lucky). Crisis and trauma counselors in rehabilitation centers for formerly abducted children become qualified to do the work with a bachelor’s in social studies (or less) and no clinical experience. While the international community has recognized the great need for psychological recovery in conflict and post-conflict settings, actors seems satisfied with slapping a superficial, insufficient and unprofessional “band-aid” on the ubiquitous and complex psychological issues. This may be a result of the general absence of mental health practitioners in decision-making positions for programming strategies of INGOs.
I’ve been doing a bit of research on the state of mental health care in Lira and have come up with disheartening results. Here is an example of a short interview I had at the main hospital a week ago. The “mental health clinic” was three weeks old. It was staffed by one Psychiatric Clinical Officer (education equivalent: 2 years after high school) and two psychiatric nurses (one was still enrolled). For an office, they were given the tiny room that hosted the electrical breaker for the entire hospital; the room wasn’t painted and the ceiling was leaky.
Me: What do you use as a screening tool for diagnosis and treatment?
PCO: The ICD-10
Me: Okay, do you have a copy of the ICD-10?
Me: Any photocopies?
Me: So, how do you know if you’re asking the right questions?
PCO: I learned all the diagnosis in school.
Me: Do you make referrals for counseling services?
PCO: No, I learned how to do that in school too.
Me: How many clients do you see in one week?
PCO: Around 200.
This man was doing the best that he could, but it was obvious that he needed some help.
I will be going to Italy in Nov. to attend a “Masters Certificate Course” in Global Mental Health: Trauma and Recovery. It is a program run by Harvard University’s program for refugee trauma (since I am unpaid at the moment, they have graciously granted me a full-tuition scholarship!). It consists of two weeks of on-site training in Orvieto and 5 subsequent months of web-based learning. As a component of the program, we will be analyzing trauma clinics in a variety of international/conflict settings. The Concerned Parents Association and I are looking forward to new prospects in bringing a heightened level of mental health expertise into Lira and other Northern districts. Any volunteers? More later…