Thursday 28th February

Aside

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Last night I was awakened by the sound of the rain falling on the roof of the accommodation block in which I was staying. The rain was falling hard and fast in what sounded like very large drops. Despite the fact that it had woken me from my sleep, it was a welcomed sound. I resisted the temptation to run outside and dance in the rain…just. Yesterday evening was very humid, and I could feel the air clearing with every drop. I managed to drift back to sleep.

We had an early start this morning. Breakfast was taken and we made our way to the venue of today’s workshop; The Holy Rosary Sisters’ Counseling Centre. This is the same venue that Beate had used to deliver the introductory workshop last year (I had only facilitated workshops in Freetown last year). It was great to meet some new faces, and see some familiar ones too (George and Victor whom I had met yesterday). We had our youngest workshop attendee ever today – 3 month old Precious came along with her mum Margaret. Precious stole the show. She was as good as gold; one of the most contented babies I have ever met. Corinna fell in love instantly. The African maxim that ‘it takes a village to raise a child’ very much applied today. Every one took a share to pop out and see how Precious was doing in the room next door.

Beate and I structured the content of the workshop around the structure of the advanced workshop that we had delivered in Freetown. We tweaked a few things on the basis of our reflections of how things had gone in Freetown and the feedback that attendees had provided about that particular workshop – flexibility in action!! We made time during the day to focus on practical skills and exercises that the attendees can apply in the work that they do with clients. After role-playing these exercises in front of the group, we wrote-up key points and guidance on the flipchart paper at the front of the room. It was great to see the enthusiasm that people displayed in taking their notes from the flip-chart pages during the breaks.

We were honoured to have Prof Nancy Peddle from Chicago in the workshop today. She has been coming to SL since 1996 and founded the LemonAid Foundation to support the training of psychosocial interventions in SL. I have read with admiration the work that Prof Peddle has done her, but it was great to meet her and learn more about her work. So many connections have been cemented during this visit, and we are hopeful that these will lead to important opportunities for collaboration.

After the completion of today’s component of the workshop, we met with Sister Angie who heads up the Holy Rosary Sisters’ Counselling Service. She is clearly an intelligent and driven women who has doing much to promote the training of counselors in SL. We told her about Heather Weaver and Carmen Valle and suggested that she contact them to see about the potential for linking in with the Enaling Access to Mental Health Sierra Leone project. We are doing our bit to help connect the dots and facilitate a joined up approach to mental health in SL…

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Wednesday 27th February

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Beate had arranged for us to meet with a man called George Sissie who had attended the introductory workshop that had been arranged in Bo last year. So, we set of this morning first thing to visit George in his place of work – The Child Rescue Centre (CRC). The CRC was launched in 2000, and it is supported financially by the United Methodists Church (UMC). On meeting George I was struck by how open and friendly he was. George welcomed us to the centre and took us into the well designed building which houses the centre’s administration and meeting rooms. Once we were sat in one of the meeting rooms, George explained that at the CRC education is the main focus.

There are 3 different programmes that operate under the auspices of the CRC to directly or indirectly support the education of children. These included:
1) The Residential Programme – This provides children from neglectful or abusive homes, or children living on the streets to come and live at the CRC. Children as young as 4 years old become part of the residential programme and they can stay until the age of 16/17 years of age. There are currently 33 children (both girls and boys) enrolled on the programme. The CRC has capacity for a maximum of 48. The accommodation is arranged into 6 separate homes. Each home has an ‘Aunt’; a member of staff who is responsible for overseeing the conduct of the children living in that particular house.
2) The Child Support Programme – This provides practical and financial support to families who cannot afford to send their children to school.
3) The Fostering Programme – This programme places ‘at risk’ or vulnerable children with foster families. Potentially suitable families are identified through a variety of means including through the church, or families who have been unable to have their own children. Take them back to the community.

The Federation Against Trafficking and Slavery (FATS), amongst other agencies, identify cases that may be appropriate for the CRC. Before children or adolescents move on from the care and support of the CRC, preparations are taken to settle them back with their families (if this is possible and appropriate) or alternatively with relatives living in the communities from which they originally came. At the moment there are 8 young people who are, or have previously been, supported by CRC who are enrolled at university.

George was due to have a counselling session with one of the young people enrolled on the Residential Programme. He had got consent from the person in advance to allow Hannah and Beate to sit in on the session. Iain, Corinna and myself took left the others to it, and went on a tour of the building. The centre seems to be well organised and run and appears to be benefitting from good financial support. We were fascinated by the large maps of the United States that hung in a couple of the rooms. Whilst we appreciate that this might be linked to the origins of the organisations that fund the CRC, it would have been more pleasing perhaps to see maps of Sierra Leone and/or the African continent.
George brought our visit to the CRC to a close by giving us a tour of the grounds of the CRC and the houses that accommodate the children enrolled on the Residential Programme. The children were all at the school that sits adjacent to the CRC, so all was quiet. We thanked George for his time. We will be seeing if tomorrow and Friday as he attends the Advanced Workshop that we will be delivering in Bo.

Our next visit was to the offices of Medicins Sans Frontieres (MSF) which was a 20 minute drive away from the CRC. MSF first came to SL in the aftermath of the civil war. They have remained in SL as a consequence of the very high rates of infant mortality in the country. The MSF camp at Bo is the size of a village. At the moment there are between 120 and 140 patients at the camp. There are obstetrics and gynaecology wards as well as an Intensive Care Unit. In June and July (during the rainy season) the numbers of patients in the camp can swell dramatically on account of outbreaks of communicable diseases such as Cholera. There is a gynaecologist present 24hrs a day, 7 days a week. Consequently, emergency cases can be brought to the MSF from far and wide. All of the doctors currently working at the camp are from outside SL. In total there are between 20-30 international staff. There are currently no Clinical Psychologists employed there. Hannah had previously worked at the camp for 7 years as a counsellor, so it was great for her to return and catch up with some old colleagues.

We met with Victor (who had attended the ACT introductory workshop in Bo last year) and his colleague Tamba. Victor and Tamba are both counsellors working with MSF. We talked with them about the types of difficulties that they help support clients with. These included problems associated with adapting emotionally to events such as chronic medical conditions, obstetric complications (including emergency hysterectomies), and sexual or gender-based violence. They work across the hospital site and in this respect act in a similar way to a Liaison Psychiatry service in a hospital in the UK. Unlike a Liaison Psychiatry service, Victor and Tamba do not benefit from the support of a Psychiatrist or a Clinical Psychologist. They both highlighted concerns about the lack of supervision available to them and how this serves to inhibit their professional development. Another concern they expressed, relates to the way in which historically medically trained staff at the hospital have been dismissive about the importance of emotional support for patients and the benefits that this can bring. However in recent times, they have been conducting training with staff to help raise their awareness about common signs of emotional/psychological disturbance. This has been embraced by many of the hospital staff. Indeed, one of the Consultant Physicians in the Intensive Care Unit recently put up a poster on the ward outlining indicators for involving the counsellors with patients.

Victor had sought consent in advance from a patient that he was planning to meet this morning about the possibility of Hannah and me observing their session. The woman in question had experienced abdominal pain during the final stages of pregnancy. Having travelled a long distance to the MSF camp from her home, she was immediately admitted to the hospital. An emergency Caesarean-Section was performed. The baby boy was discovered to have hydrocephalus. As yet, on week on, no one had explained the nature of the condition to the woman. She was accompanied into the session by her sister who carried the baby – the woman does not know the whereabouts of the baby’s father.

Victor introduced Hannah and Myself to the woman and her sister, before starting into the session. Victor conducted the session in Krio – Hannah whispered a translation of the dialogue between Victor and the woman to me. In light of the physical and emotional upheaval that that the woman had gone through in recent days, it was no surprise to see how shell-shocked she appeared. I wondered whether Victor would be able to engage her in any constructive way. Victor asked her if there were particular thoughts and feelings that were troubling her at the current time. The woman explained that she is upset and concerned about the size of her baby’s head. She pointed out how parts of the skull felt much softer than others, and how any pressure to the surface of the head upset the baby. The baby at this stage had begun to cry and her sister passed the baby to her mother so that she could breast feed it. The woman expressed her concerns that no one had explained to her what had caused this problem. Victor empathised with the woman and told her that the Consultant had asked him to speak with her about the cause of the problem.

Victor proceeded to tell the woman and her sister about hydrocephalus. He reassured them that it was not caused by something that she had done incorrectly when she was pregnant (families and communities can sometimes blame mothers for abnormalities in newly-born children). The woman was keen to learn if there were any treatments available to treat the condition. Victor explained that there was no medicine or treatment available at the hospital, nor was there any treatment available in all of SL to treat the condition…. Silence. No reaction, just a blank stare of resignation accompanied by a deafening silence. My head was spinning. No treatment available in the whole of SL…. I am not naïve, I’m aware of the limitations associated with health care in low income countries, but there it was, laid out in front of me in all its brutal clarity. To have a shunt inserted in the skull to remove the fluid and release the pressure on the brain, the mother would need to take the child to Senegal. This woman and her family cannot afford the cost of travel, or the cost of the follow-up care. This child will be dead in early childhood as a result of a condition that can be treated in the UK.

This is one of the many thousands of children born every day in low and middle income countries that will die as a result of inadequate healthcare resources. A daily human catastrophe. But this is the child that I met today, and this is the child that I cried for today.

Victor worked sensitively to explain that he would be working with the women and her family in the coming days and weeks to support their needs as they adjust to what has happened. Victor will be attending the Advanced workshop tomorrow. I believe that Beate and myself will be able to provide him with some additional skills and techniques to help him with the important work that he is engaged in. It has been a difficult day, but a day that has filled me with a renewed sense of purpose. Tomorrow provides an opportunity to help us all explore the glimmers of meaning and hope that can emerge even from the darkest of times. Out of darkness comes light.

Tuesday 26th February

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This morning we went into the centre of Bo to visit the market and to also buy some rice and other food-stuff for the amputee village that we had made plans to visit later in the day. On the way to the market we stopped off at some street-side tailors who make traditional shirts. Iain and myself purchased a couple of particularly stylish designs. I look forward to wearing mine when I am presenting to colleagues and other interested parties about the work that we have been doing in SL.

The market in Bo sits behind and between the buildings that lie along one particular street front. The numerous stalls that constitute the market are huddled together under a low corrugated iron roof. The ground under foot is uneven and the route that you walk through the market is narrow and meandering. The numerous vendors and customers that are squeezed into the tight space could be likened to bees working their way around a hive. All in all the market was quite a claustrophobic spot. Add in strong smells of fish, various other food-stuffs and body odour and you start to get a sense of how rich an experience it really is.

Beate was keen to get some material to make a dress for her niece’s birthday present. As we negotiated a price, I felt a tugging at the hairs on my left arm. As I looked down my eyes met those of a young child looking up at me. He then went back to pulling at the hairs on my arm. Clearly freckles and ginger arm hair are things that children don’t get to see much of in SL. After a price had been agreed for the material, we then purchased the food for the amputee village. On leaving the market we went to a nearby tailor/seamstress. Beate choose a design for the dress and provided the seamstress with her niece’s measurements. We then made our way to a café called Sabbagh for lunch.

Sabbagh’s air-conditioned interior provided some welcome relief from the temperatures outside. Once we were fed and watered it was time to hit the road to the amputee village in Bumpe. Traveling in the jeep in SL is a myriad of sensations. The air-conditioning does little to stifle the heat, so it is better to turn it off and wind the windows down. But winding down the window and allowing the air to blow in is like putting your head in front of a hair-dryer. Waves of heat meet your face, but the movement of air prevents the temperature becoming too unbearable. Closing your eyes, allows your sense of hearing to tune in to the everyday sounds of travelling in SL; beeping horns, the sound of the motorbikes that most people use to travel on the roads, and the snippets of Krio, Themne or Mende (amongst other languages) that can be picked up as the jeep speeds past people on the roadside. Looking out of the jeep you can see the people walking along the road (many of whom are carrying large loads on their head), the dust rising from the road, and the cars, buses and motorbikes coming towards you. Many of the minibuses that double up as taxis have messages pained on the front of the vehicle such as: ‘God is Great’, ‘We Are Covered in The Blood of Christ’.

Bo’s electricity supply is normally provided by a hydro-electricity plant. This works well during the rainy season. In the dry season there is a power house in the city which is meant to generate additional power to support the electricity supply. Unfortunately this has been out of commission. This means that there is currently an electricity black-out in the city. The lack of appropriate action by the government of SL has fuelled suspicions that Bo is disenfranchised by the state. The suggestion in some quarters is that the government in Freetown want to limit the growth and prosperity of the country’s 2nd largest city to ensure that resources and development are focused on Freetown. These claims are however contentious. However, there are traditional rivalries and historical factors that may be at playing a part here.

The journey to the amputee village in Bumpe, took 90 minutes along bumpy and dusty roads. Beate had made this trip 3 years previously and has visited each time that she has visited. The rebels during the civil war had used the amputation of limbs as a weapon of terror. People trying to flee the advancing rebels who were caught had their hands cut off and they were told to go back to their chiefdom and tell their Paramount Chief that this is what happens if his people support the government.

Meeting the people of the village brought a real mix of emotions. It was shocking to see the wounds that people had sustained, but the warm welcome that was extended to us was very touching. We spent time with the villagers; learning Mende from them and having a giggle. Some of the very young children had never seen Caucasian people before. They reacted differently. Some were keen to come over and say hello, others however were quite scared. Perhaps these children were the better judges of character!

Before leaving the village we had a meeting with the local paramount chief (Joseph T. Kposowa III). It was interesting to have my first interaction with one of these local leaders. There are 14 of them in total in the southern region. He had lived in London for several years and was interested to hear about where we were from and the work that we are doing.

Following are meeting we made our way back to Bo. It has been a very humid start to the evening. The clouds have been gathering overhead and it feels like it might rain. The internet connetion in Bo is very poor, so apologies for the delay in getting these posts out.

Monday 25th February

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The morning began with a visit to Detective Inspector Alhaji Sensesie who is the regional commander for the Family Support Unit (FSU). The FSU originally started as a pilot scheme called the Domestic Violence Unit in the aftermath of the war 2002/3. The FSU operate from regional divisional centres in SL. The Makeni FSU office is part of the Northern Province regional set-up. The Makeni office covers 10 districts. Unlike many of the other FSU offices across the country, the Makeni office benefits from the services of a social worker to help support the victims that they work with. We spoke with him about the work that the FSU have been doing in Makeni. I asked about obstacles that the unit face in trying to prosecute individuals who have perpetrated intimate partner violence.

 

Detective Inspector Sensesie stated that individuals might be reluctant to come
forward because they are fearful of reprisals from the perpetrator or other
members of the community. He stated that victims of sexual assault often
couldn’t afford the medical tests to provide forensic evidence to support their
claims. There are also limitations in SL about whether someone can be prosecuted for crimes if they have moved away from the jurisdiction where the alleged crime took place. An important consideration is the financial security of the women reporting the abuse, their husband might be jailed – and the victim is left to wonder who will provide financial support for her  and the family. There is currently a large backlog of cases waiting to be heard in the SL. It was interesting to reflect on the extent to which this conversation mirrored what we had discussed with Amie Kandeh earlier in the trip.

 

Beate asked Detective Inspector Sensesie about the possibility that police men could be complicit in miscarriages of justice e.g. Accepting bribes or not taking approprite steps to ensure that there was a case to answer.  He said that there was anti-corruption unit (CDID) that was working hard to minimise the risk of corruption. In addition, in order to safeguard the safety of individuals prepared to testify against alleged perpetrators of Intimate partner violence, the FSU offers witness protection. The FSU also has a remit to combat female genital cutting – a practice that has been widespread in SL and in some areas has been an important pre-requisite for a women to find a husband. In 2007 the ‘Child Initiation Act’ outlawed actions such as these that are associated with ‘secret society’ action against children.

 

The conversation turned to the possible reasons why men engage in Intimate Partner Violence (IPV). Detective Inspector Sensesie does not believe that it is related to poverty per se. Instead he believes that societal attitudes are an important contributory factor e.g. the belief among some men that they ‘own’ women that they marry. This can lead to men believing that they act with impunity. On several occasions during our visits to SL, local people have suggested that in Themne culture it is a ‘sign of love’ to physically abuse women. Detective Sensesie was categorical about stating that no sane person could ever claim that this was the case. He was also very clear in saying that this was absolutely no defence in law.

 

Detective Inspector Sensesie talked about the important outreach to communities that the FSU is involved in: talking to school children; television  adverts and radio programmes to campaign against domestic violence; and liaising  with the permanent chiefs who have great power and authority in rural areas. The Permanent Chiefs are instruments of the central government. Regular meetings are held with them to discuss how IPV should be dealt with in the absence of the FSU  and police in their areas.

 

Detective Inspector Sensesie also highlighted how new legislation passed in SL has outlawed the rape of women by their husband.  Our final question focused on how the FSU will develop in the future.  There are plans to make FSU independent from the police to protect confidentiality and guard against corruption. A priority issue is enhancing the Forensic examination aspect of their work.

 

As we left the FSU we passed a young lady sitting nursing a 5 day old baby and wearing a solemn look on her face. She was accompanied by numerous extended family members who thronged into the waiting area of the FSU building. It transpired that the baby had been snatched from her mother when they had been staying at the Regional Government Hospital. The suggestion is that another woman who had recently been admitted to the hospital following a miscarriage had taken the baby. On fleeing from the hospital with the baby this women returned to her home. Her family, aware that the baby could not be hers, provided information to the police and the baby was safely recovered. Unfortunately, before the alleged perpetrator of the abduction could be taken into hospital, members of the family of the baby took the opportunity to exercise summary justice on her. She was badly beaten. Dramatic, shocking and tragic events but on parting from Detective Inspector Sensesie, we got the sense that this was just another day for the FSU.

 

The next appointment on our schedule was a meeting with Carmen Valle at the University of Makeni. Carmen spoke about the work that the University of Makeni had been doing to develop the curriculum for the Certificate and Diploma courses in Mental Health that has been offered to a select number of psychiatric nurses in SL. Allow the University of Makeni (a private university) developed  the curriculum, the courses themselves are delivered by the College Of Mental  Health and Allied Sciences which is  part of The University of Sierra Leone in Freetown. Carmen spoke about the ‘Sociology of mental health’ teaching that she had delivered to the students on a visit to Sierra Leone. The conversation with Carmen was fascinating. We spoke about efforts being made to train staff in de-escalation techniques to reduce the need for restraints and chains to be used on patients at Kissy Psychiatric Hospital. We also spoke about plans being made to support the supervision of graduates from the certificate and diploma courses. Carmen and her colleagues have been organising a supervision meeting that will bringing people together in Freetown in March. This will be followed up in April by visits to the graduates in their own community to talk about cases that they have been working on. This pattern will then alternate on a longer term basis. Carmen also spoke about capacity building opportunities that will increase knowledge about mental health in other professional groups. This essentially advocates a ‘training for trainers’ model that will focus on Public Health Unit staff and Community Health Officers.

 

Carmen is hopeful of getting the opportunity to start some mental health related programmes at the University of Makeni; including an undergraduate psychology degree programme. It will be great to stay in touch with Carmen and support her with the important work that she is doing.

 

Our final appointment of the morning was to visit Abdul Conteh. Abdul is a nurse working at The Holy Spirit Hospital in  Makeni who graduated from the Certificate in Mental Health programme and  recently attended our workshop. The Holy Spirit hospital has a trauma and emergency unit. Currently, a retired hand surgeon from Glasgow Dr Martin is working there doing micro-surgery through a project called Resurge. Abdul took us on a tour of the Mental Health Counselling Centre that sits adjacent to the hospital building. Registration for counselling service opened in 2007. Unfortunately it closed down 4 months ago due to lack of funding. However, if Abdul feels that a patient at the office could benefit from a counselling session he will take them over to the building and offer support. The most recent of these appointments happened on the 19th February. If there is an emergency, the person is taken to Freetown. The initiative has been supported in the past by visiting Psychiatrists such as Dr Price from America and Dr Pino from Spain. Abdul spoke about the types of patients the counselling service would have seen. These included people with substance abuse, psychosis, anxiety and victims of trauma. He spoke about the involvement of experts by experience – people who have recovered from substance use problems talking to groups organised for substance use disorder people.  It was kind of Abdul to show us round and take time to talk with us. We wished him well for the Diploma course and went on our way.

 

We stopped for lunch before leaving Makeni. This gave us an opportunity to talk with Pious about how he feels the country is progressing. Together we talked about some of the unethical practices of multi-national companies who are operating in SL. There are suspicions that contracts can be secured through the payment of incentives to key individuals. This can result in large volumes of the natural resources available in SL leaving at cut-prices. There are so considerable disparities in the wages paid to ex-pat workers employed by mining companies and their SL counterparts employed by the same company. On hearing about these stories, it was hard not to feel outraged. A sign in the lobby of the MJ Motel where we were staying in Makeni lists of Mahatma Gandhi’s version of the 7 deadly sins. Number 6 of these is particularly pertinent for our lunchtime discussion. This deadly sin is listed as: ‘Commerce without morality’.

 

After lunch we set off on the trip to Bo. The initial stage of this journey took us along the bumpy and dusty Magbraka Road. We were rattled about the inside if the jeep as we negotiated the pot-holes and uneven road surface. It was interesting to observe the dense foliage that lined the road. After an hour or so of travel along the Magbraka Road we reached the Mile 91 junction where we joined the smoother main road to Bo.

 

It was great to arrive in Bo; Hannah’s home-town. We settled in at the accommodation where we are staying and we immediately headed to Hannah’s house. She had been away from her husband and her three children for 10 days.  It was great to see them all reunited. Our arrival caused a big stir in the local community. A nearby school was finishing up its late afternoon session.

 

As we got out of the jeep, we were spotted by the children. They all started shouting ‘Bumueh, Bumueh!’ (which is Mende for ‘White person’), as they ran towards us. We were literally swamped by at least 60 children all smiles and shouts. Great craic. Once things had settled after a while, we sat outside Hannah’s house and watched a beautiful sunset.

 

Sunday 24th February 2013

Last night we went for dinner in a place called ‘The Clubhouse’. The Clubhouse is operated by a NGO called Street Child Sierra Leone. The profits generated from the sale of food and drink, are used for the charitable work that the organisation does to support the needs of street children in the Makeni area. The turn-over of the organisation is £1.2 million pounds. It seems to be well run and organised. The Clubhouse was full of ex-pats who are living and working in the area. Some of these individuals are working at St Joseph’s School as teachers, others are working for Street Child Sierra Leone, whilst some of the folk have come to Makeni to help organise the Makeni Marathon which will take place in May. Coincidentally we bumped into Carmel Valle. Carmen is an academic psychologist who we were scheduled to meet on Monday morning at the University of Makeni. Carmen is helping to coordinate the University of Makeni involvement in the Enabling Access to Mental Health Sierra Leone project. The EU has founded her post for 4 years. She has already chalked up a year of this contract. She had been working at a University in Madrid prior to taking up her current post. Whilst in her job in Madrid she had organised exchange trips for her students who wanted to travel to Sierra Leone. To facilitate these exchange trips she first visited Sierra Leone in 2008 and promptly fell in love with the country. In 2009 she came to Makeni for 2 months, in 2010 she came for 4 months, in 2011 she came for 7 months, before taking up her contract in 2012.

 

Carmen spoke of the changes that she has noticed in Makeni over the 4 years that she has been coming here. She said that there had been marked deforestation of the road between Freetown and Makeni. She has also noted a marked increase in the number of workers coming from the UK, European countries and South Africa to work for the mineral mining companies that are situated around Makeni. This increase in foreign workers has generated unsavoury business opportunities for local people. Young women from Makeni who are keen to make money to support their livelihood enter into prostitution that is largely driven by mining workers. It is sad to reflect on the desperate steps that people will take to try and better their lives, and how foreign workers exploit this.

 

After leaving The Clubhouse we visited Mem’s – an outside club situated by the roadside. It was a busy spot. There was a DJ playing the type of music that people love here. We got a chance to speak to local people as well as some of the ex-pats that we had previously bumped into at The Clubhouse. It was a very friendly crowd. I got chatting to two people who are working with the Craig Bellamy Foundation. Craig Bellamy has played football for Wales, Newcastle Utd and Liverpool amongst other clubs. He has invested a considerable amount of his own money into setting up a school, soccer academy, and football leagues (both male and Female) in Sierra Leone. About 18 months ago I had watched a documentary about his efforts in Sierra Leone. At a time when footballers are often in the news for all the wrong reasons, it has been very refreshing to learn about The Craig Bellamy Foundation and the great work that it has been doing.

 

We had nothing scheduled for this morning. So after getting up for breakfast at 8.30am, I went back to my room to listen to some music. I also used this time to send some text messages to loved ones.  This morning also provided a great opportunity to wash some clothes. On account of my bald pate, I don’t often get an opportunity to use shampoo, but Beate’s shampoo proved very useful for doing the hand-wash. After I had washed the clothes, one of the hotel staff helped me to hang it out to dry. He asked where I was from. I explained to him that I live in Scotland. He asked if that was part of Britain and I told him it was. He replied by saying ‘The British colonised us’. When he said this, I felt a sinking feeling in my stomach. My understanding was that ‘colonialism’ is a dirty word in Africa. As I did some rapid mental gymnastics to try and figure out how I would respond to this, my friend then said ‘The British are our grandparents, we like them very much’. He proceeded to talk about how the Queen had visited Sierra Leone in 1960, and how she is ‘Grand-mother to the Leonean people’. I appreciate that these views might not be shared by everyone, but it was interesting to hear his take on this. I have been aware of the importance of acting as a good ambassador for Britain on this trip. We have been made to feel so welcome, and I feel that it is so important for us to reciprocate this warmth and repsect.

This afternoon Iain, Corinna and myself went back to the Clubhouse  for lunch and the promise of getting a chance to watch Scotland v Ireland live in the 6 Nations Rugby Tournament. Unfortunately, the staff were unable to make good on their promise – they couldn’t find it on the numerous channels. We had lunch and then went for a walk through the streets. As been the case throughout are time here we were mobbed by children rushing over to us with big smiles, waving and shouting the obligatory ‘Opotho, opotho’. Iain, Corinna and myself had great fun pointing at each other and shouting with our own broad smiles ‘Opotho, opotho!’. These kids come from very poor families, but the richness of their bright faces is truly a sight to behold.

The group assembled together at 4pm to go and visit a village elder (Aminata) who had attended our workshop here. It was fascinating to get an insight into the place where she lives and to meet her family. There was a loom set up outside her house that she was using to make some of the local fabric that they use to make garments and blankets here. Intricate and time-consuming work, but the end result that incorporates local designs is very impressive. There was a chance to take some photographs, before we returned to the motel.

It has been great to recharge the batteries today and gear ourselves up for the start of the 2nd week in Sierra Leone.

23rd February 2013

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This morning we started with an ‘Eyes On’ exercise. Attendees were encouraged to sit with their chairs facing each other, knees just touching. They were asked to look into each other’s eyes and to notice the various thoughts, emotions and shifts in perspective that emerge e.g. worries about their physical appearance; compassion towards the other person; an awareness of noticing the other person; an awareness of the other person noticing you; and seeing another person who (like all of us) has known joy, pain, and suffering in their lives. It is a powerful exercise that impinges on cultural etiquette and personal boundaries. It has a capacity to evoke many ‘moving away’ behaviours where the person tries to avoid or hide difficult thoughts and emotions that arise during the exercise. The attendees were encouraged to notice these ‘moving away’ behaviours and to be open to their experience. Thanks Corinna for participating in this exercise with me!

I demonstrated the ‘Passengers on the bus’ metaphor to the attendees. Because we had mapped the Matrix out on the floor of the room in which the workshop was delivered yesterday, it was a perfect opportunity to get attendees up on the floor and act this metaphor out over the top of the Matrix. I amended the exercise for application to Sierra Leone by calling it the ‘Passengers on the jeep’ exercise. An attendee (Malvi) was invited to come forward to represent the driver of the jeep. He was situated on the left hand side of the matrix immersed  in sources of suffering in his life; very distant from the valued-life direction in which he wanted to move (i.e. the direction which he wanted to drive his jeep). I asked Malvi about what he thought his valued-life direction was. He spoke about his wish to live a peaceful life; to contribute to the community, and to assist the needy. We then spoke about the various different problems that can arise when we attempt a journey in a jeep in SL. The group shouted out: mechanical failure, flat tyres, rough roads etc.

An attendee was asked to represent ‘mechanical failure’ and step forward to stand on the Matrix in front of Malvi; blocking his route forward. I spoke with Malvi about obstacles that he has faced in attempting to move in his valued life direction of living a peaceful life, contributing to the community and to assisting the needy. He spoke about how frustrated he has been by the negative attitudes that others have expressed to him in the past – we likened this frustration to the mechanical failure that the jeep driver might face. We then likened other sources of suffering such as financial worries and physical health problems to the flat tyres and rough roads that that could provide obstacles for the jeep driver in pursuing his valued life direction. A further two attendees represented these obstacles. Each of the individuals representing these obstacles stood on the Matrix physically blocking the journey forward. The attendees acting as the obstacles spoke lines aloud representing the areas of suffering that they represented.

We discussed how getting caught up with the obstacles might not be the most fruitful way forward. In fact constantly meeting these obstacles head on a continual basis would potential lead us to run out of energy (or the jeep to run out of fuel). We discussed how negotiating problems that arise is part of the rich fabric of life. In this way, we explore the potential importance of bringing these obstacles with us as we proceed. Rather than being an obstacle to us journeying forward in the valued-life direction, our sources of suffering can become passengers in the jeep.

At the mid-morning break two of the attendees took the opportunity to speak with me about difficulties that they have been experiencing in their own lives. It was touching to note the trust that they placed in me to sharing their problems. Drawing on the ACT principles that we had been discussing, I was able to provide them both with some advice.

As with the previous day the temperatures inside and outside the room were high. So, the focus again was very much on keeping the action interactive. Immediately after the lunch, I used a ‘body-scan exercise’ to demonstrate the process of mindfully tuning in to the sensations of tensing and relaxing different parts of the body.  Beate then demonstrated the ‘Life Line’ exercise to provide multiple exemplar training for consolidating the ACT processes. This approach originated by Joanne Dahl is very effective at helping attendees to understand the difference between behaviours that are set a ‘moving away from suffering’ agenda and those that are set by attempts to ‘move towards values’. Beate was joined in the facilitation of this aspect of the workshop by Hannah who again made an excellent contribution.

This afternoon provided a chance for attendees to consolidate some of the key learning points through the use of role-plays. To conclude the workshop, people were asked to volunteer one or two learning points that they will take away from the workshop. It was powerful to hear the responses of the attendees. Corinna (who had been feeling under the weather today) soldiered on to help folk to complete post-workshop questionnaires that will contribute to the evaluation of the workshops. We then had some group photos taken of the facilitators, organisers and the attendees which will make a great keep-sake for the future. A number of the attendees were keen to invite us to make visits to their workplaces during our visit. We were touched by this and we look forward to taking them up on these offers. There were no goodbyes at the end of the workshop. We know that we will return and see these people again.

So two of the three workshops have now been completed. We had a celebratory beer together afterwards. There was a heady mix of emotions for us to share: joy, relief and a pinch of exhaustion. The group have bonded really well, we communicate with each other so openly and everyone makes an important contribution. We are looking forward to a day of relaxing tomorrow, visiting the University of Makeni and other projects on Monday and then travelling on to Bo in the coming days.

A ‘Newbie’s’ Perspective

Iain Mays is a 23 year old MSc Global Mental Health student who has travelled over to Sierra Leone with us to complete a qualitative research project (supervised by Prof Andrew Gumley) related to the work of commit and act in Sierra Leone. I have been acting as field supervisor for the project. I was keen for Iain to contribute to the blog. Here is his first entry that reflects on his first few days in Freetown: 

“It’s funny, after just 3 days in Freetown I found myself reflecting on the comfortable rhythm that our team has drifted into. Attending my first ever ACT workshop, ran by Beate and Ross, I immediately felt at home. I was given a nickname based on my height (‘6-by-6’) and that was it I felt a part of the class. It might be strange to say but as a student I was welcomed by accomplished professionals and allowed to connect with them to further my knowledge of ACT . During this first workshop both myself and Corinna, the ‘youngins’ of our Commit and Act family had spare time to talk with local ACT participants who happily opened up about their experiences. We were both in awe of their openness and acceptance of us into their lives. Arriving home from the day I noted how my routine would continue: I would first greet the giant spider above my door and would lie down under my jelly-fish-like mosquito net to listen to the hustle and bustle outside Fr. Konteh’s house. Dinner would follow with much discussion between Ross, Beate, Hannah, Corinna and myself; we find humour in the little things, we reflect on the inspiring moments of the day, or we sit peacefully enjoying each other’s company. For me these comfortable silences had been greatly helped by the ‘Eyes On’ exercise, which was ran by Beate in the ACT workshop. This entailed staring into the eyes of a partner allowing you to see someone else as who they really are and vice versa. The awkward Irish man inside begged me to make an excuse and exclude myself, but despite this vulnerability the exercise allowed me to develop a calming connection with my partner and with it a comforting self-awareness.

This relaxed routine I find myself in has continued as I lie in bed listening to the different sounds at night time and morning. There is the dog who loves nothing more than a ‘mid-night bark’, the bull frogs who flare up at any chance of romance, the cockerel stamping his mark on the morning and the Muslim call to prayer, which, having never heard it in person, I was fascinated by. My parents have always given out to me for playing too much music instead of being comfortable in long silences. They are right; in the past I have preferred to listen to whatever cheesy song is on the go than to listen to my own thoughts, yet here I find myself opting not to plug my earphones in when I’m alone by myself. I attribute this to the mindfulness sessions in the ACT workshop. On Tuesday Ross spoke about his own occasional difficulties in gaining self-awareness in the morning time. He called to mind the simple example of brushing his teeth in the mirror to help develop his 5 sensory experiences and enhance his self-awareness for the start of the day. Pearly whites aside, this helped sum up the ease in which we can become self-aware amongst our thoughts and emotions if we just take the necessary time! It’s an endeavour I hope to continue within this new-found routine in Sierra Leone”.