This morning we visited the Don Bosco centre that Hannah Bockarie works at. The building that she works in houses three different projects:
1) A girls’ shelter that employs 10 social workers and 5 assistants.
2) The Hope Project that employs staff.
3) The Hope-Plus employing 6 workers.
We chatted with Peter French the director of these 3 projects. He talked about the links that Din Bosco have with police and other agencies.
We visited the Girls’ Shelter. There are currently 15 girls aged between 6 and 16 staying in the unit. The girls have been victims of sexual abuse, neglect, and/or domestic violence. Hannah spoke about how the majority of sexual abuse and neglect go un-prosecuted. This is due to a failure to give credence to the accounts given by children, and inadequacies in how the police process the criminal proceedings.
We heard the story of how the youngest resident of the shelter came to be there. A resident of Freetown had their mobile phone stolen. As can be the case in SL, the individual consulted the services of a local sorcerer. He told the man that he would identify the phone thief by setting a chicken on fire and looking to see who the chicken ran to – this would be the thief. Unfortunately, the chicken collided with a 6 year old child whose clothes were set alight. She sustained bad burns to her left hand side. Her family unable to cope with the community reaction to the alleged crime left her in care. Tragic.
When we visited, the girls were busy with schooling. They were practicing their sums and their spelling. We sat and chatted with the children and the staff for a while. This is the only project of its type in Freetown. It provides an invaluable opportunity to help bring justice for these children, mediate with families and help rebuild the shattered world of these children.
In the afternoon we had a meeting with Amie Kandeh. Amie appeared in the documentary called ‘Half the Sky’ which had a focus on gender-based violence and female genital mutilation in Sierra Leone. She is a powerful advocate of women’s rights in Sierra Leone. She spoke about the Crescendo project that encouraged women living in rural areas of SL to take photos of something:
1) To celebrate
2) To change
3) Which you want society to change.
She shared some of the photographs that participants had taken. These photos included pictures depicting child labour, women preparing to leave their homes following domestic violence and new born babies delivered by traditional birthing attendants.
Amie mentioned that 60%of alleged perpetrators of gender-based violence return to the home where the abuse is alleged to have happened. Amie spoke about the need for change at local community level, district level and national level. She highlighted the difficulties involved in serving justice in Freetown. She spoke about the important work that the three Rainbow centres that she has established in SL.
Amie drew a contrast to how the community respond to the rape of a woman in SL compared to the rape of a child. She stated that people understand the importance of investing in children because to invest in a child is to invest in that child’s capacity to look after the parents when you are older. This means that communities tend to be very responsive and reactive to the abuse of a child, yet less responsive to the abuse of a woman.
After the meeting with Amie we took the hour journey to Kissy Psychiatric Hospital. it was founded in 1823 and originally housed patients from the whole of West Africa. The name ‘Kissy’ comes from the Kissy tribe that hails from the East of the country. The hospital currently has 150 inpatients. The overall capacity was 400 beds across 10 Wards but many parts if the hospital are derelict.
The only Psychiatrist in SL retired last year. The director of the hospital is called Dr Muana. He is a physician rather than a mental health specialist. He had been assisted by a Cuban Psychiatrist in recent months, but he failed to return back from Cuba after christmas. Dr Muana took the time to meet with us and show us around the hospital. The staffing profile of the hospital includes 3 psychiatric nurses, some general nurses and and lower trained mental health attendants (who constitute over half the workforce). Some of the MHA have worked at the hospital for 20 or 30 years. There are no Clinical Psychologists, no social workers, and no occupational therapists.
Dr Muana clearly cares greatly for his patients. he has been in post for 2 years and has been working hard to agitate for change in the government approach to mental health. He has been heavily involved in the formation of the coalition for Mental Health which links the hospital with other relevant stakeholders like Enabling Access to Mental Health in Sierra Leone. He told us about an upcoming meeting with representatives from the Ministry of Health and Sanitation. Mental Health is now part of the government’s latest strategy document called ‘Agenda for Prosperity’. This has helped create some momentum for implementing the mental health policy that was finalised last year.
Dr Muana stated that there are 20 to 30 referrals to the hospital each month. Relapse rates are high, and absconding rates are also high. Interestingly however many patients opt to return voluntarily when they abscond. Medication is the only treatment available but often there is not much of this available. There is no psychotherapy available.
Psychiatry not a popular career choice for people in SL – it is not viewed as particularly respected career choice. Dr Muana stated that the treatment gap for mental health in SL is 99.51%. Only 0.49% of the population who require help for mental, neurological and substance abuse disorders receive it.
Dr Muana provided us with an indication of the break-down of diagnoses for the current inpatients: 50-60% substance abuse, 22% psychosis, 17% bipolar disorder and 2-3% rates of depression. He stated that the rate for depression is considerably lower than what the WHO global prevalence rates would suggest that it should be. He suggested that this could be an indication of an under-detection of depression in SL. Alternatively, however it may be that depression as a concept is not particularly valid for a SL setting.
Our tour around the hospital was as harrowing as one might expect. The conditions and facilities were basic. Many patients were chained to their beds. But the patients that we saw seemed to be looked after well. The longest stay of the patients currently at the hospital was 40 years. The man in his 70s now and his eye-sight is failing. He was polite and friendly when he chatted with me. He showed me the hand-held radio that he likes to listen to. It seems that he likes to listen to the news. He was concerned that the radio was broken, but when he turned the dial it sparked into life. He seemed contented by this, and he lay back on his bed with a toothless smile. I thanked him, shook his hand and left him.
Dr Muana concluded the tour of the hospital by highlighting the difficulties that they encounter in trying to pump water to the elevated position on a hillside that the hospital occupies. The hospital electricity supply is provided by three generators that each require 3 gallons of diesel per hour. The hospital only gets electricity supply for 8 hours a day.
We thanked Dr Muana and his staff for the time that they had afforded us and we wished them well for the future. Like the old man’s radio, the hospital is less than perfect, on initial inspection it seems to be very broken, but the hospital staff do what they can to reduce the distress that people are experiencing.
It has been an unsettling but valuable day. The stories and images will stay with me for a long time.
Tomorrow we head to Makeni where we will run the next workshop on Friday and Saturday. The Internet there may not be so good, but we will try to keep you posted!