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8. Mental Health Services # 1
[This is written from the MSF compound in Abéché, whereto I’ve been partially evacuated. If you’re following the news, you know that things are a bit hairy here in Chad. Rumours abound, but I have no clue what’s actually happening. From the compound we can hear tanks, helicopters, jets, and so on. But no gun-shots.
The Head of Mission (HoM) has, for the time being, restricted all
movement to town or anywhere else, but I got permission to quickly
scoot off to the nearby UNHCR compound where they have internet. It’s
basically a lock-down-and-wait scenario. The HoM and the rest of the
management team continue to work, but the evacuated expats are in limbo. Of the Farchana-team who would have to be evacuated in the case of a crisis, about half went a couple of days ago, myself among them. This was so that if need be, the rest could be moved more quickly, in a single plane-trip. One incident in Farchana camp yesterday led to a gendarme (armed guard) at the camp being shot and killed when he tried to intercept the attempted theft of a truck. Two trucks were stolen (from another NGO). I don’t know the details. Of the persons that were evacuated from Farchana and other projects, about half were evacuated further to Cameroon. Some are providing emergency medical care there, and other are taking their much-needed vacations or early endings of their missions. I decided to stay in Abéché so that I could return to my project ASAP, and so that it there was any need of my services here, I would be around. But to do psychiatry in a war-zone, you need a modicum of stability and some planning, neither of which is in place. I’d need a translator (or two), and then a means to integrate services into the existing network, which is complicated. So it probably won't happen. Current efforts are directed at surgical interventions. I wait, chat with the other “partial evacuees,” play scrabble, and listen to BBC Africa on shortwave radio. There’re the details, and below is the blog I’d been waiting to post. Waiting because I wanted to see more patients and get a better feel for things, but I figure I’ll put the first part out now and see where the chips fall later. Hopefully it has pics attached, but if not, they’ll be added later).]
If people have comments, suggestions, musings, anything!, please write them. I will try and respond when I have more than twenty minutes at a (relatively slow) internet terminal. I have no clue when that will be, though 
February 6th, 2008 at 4:49 pm
Hi Steven, i’m finishing up medical school in NY and have spent some time doing medical work abroad, though I can’t say I’ve ever found myself in the middle of a war zone! What new perspectives/tools do you think you’ll be able to offer to your patients at Farchana? Do you think that being an “outsider” gives you a different perspective on things? I’m looking forward to working with MSF as a medical doctor, and that’s challenging enough, but providing mental health in that situation seems to be an entirely different ballgame.
February 6th, 2008 at 8:37 pm
PTSD, couples counseling, condoms & sex ed, itinerant rights, kids who carry the symptoms of social malaise, ethnocide…hmmm, where to begin? Of the 8 enumerated, only #7 seems to call for medications that may or may not be helpful (or available). Tell us more about “shame”, what the symptoms and varieties are. Most of the issues present themselves as group-based approaches, being social in origin. #1 seems out of your healing reach…unless you fenagle a Sudanese woman who qualifies to create Hakkama: songs to praise or damn individuals – specifically men- during times of conflict.
February 6th, 2008 at 8:44 pm
Actually, I unearthed my native Arabic and remembered that Hakkama means judge, court or arbitrer, Hakkaam means judgment, Hakim=ruler and Hakeem=doctor. Reading on associative transformations and distortions in schizophrenia and thought the phonetic links are also symbolically linked in this particular case.
February 7th, 2008 at 12:26 am
Hi,
I’m just your average Canadian girl, back here at home admiring what you do. I wanna finish up a B.A. in International Development and then do Midwifery. Just wanted to let you know you are doing amazing things- as if you didn’t know- and that we back home are so proud and supportive of people like you. Keeping doing and amazing job and captivating me with your stories!
February 10th, 2008 at 5:22 pm
Hi Steven
I follow your blog every few days and am immensely proud of you and your committment to these people. You have always had a caring way. The visuals and the explanations together make such vivd pictures. We have little or no concept of their lives and often the nothingness/attrocities they live with. I will follow your journey and wishyou all the best of safety
Laurie M
February 12th, 2008 at 10:29 pm
…given your brief incumbency as a psychiatrist, could you possibly comment on whether there is anything ‘odd, weird or idosyncratic’ about faithfully following ‘farchana nights’ and living vicariously through the writer’s experiences?…and what of waking up in the middle of the night with images of hot and dusty foreign lands where a cup of tea costs thousands (the expensive, retro-active consequence of cavities when one returns home from sipping complimentary servings of liquified sugar)!?
yep!- this box is too small. stay safe in abeche! (inthewondertime@gmail.com)