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.

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