Searching for Normal in the Wake of the Liberian War. Sharon Alane Abramowitz

Чтение книги онлайн.

СКАЧАТЬ mental health–related work for little or no compensation.

      Although the intricacies of Dr. Brown’s professional compensation and occupational history may seem to be a sideline, his stonewalling on matters of mental health led Jensen (and later the MOHSW, the WHO, the Mental Health and Psychosocial Coordination Committee [MHPCC], and humanitarian aid organizations) into an effective dead end for nearly five years. Without Dr. Brown’s engagement, Jensen’s work in Liberia was systemically discouraged and counteracted. In 2005 Jensen’s contract was not renewed, and he departed for Europe to await additional contracts and mandates from Liberia that never materialized.

      Four of Jensen’s goals were, however, achieved during his time in Liberia. First, he worked with UNMIL to close the Holy Ghost Mental Home, a sham operation run by “Sister Sarah,” a madwoman with impressive political connections who ran the only mental health institution in Liberia at the end of the war. Sister Sarah’s strategy was to find psychotic people on Broad Street (a busy shopping thoroughfare in downtown Monrovia), offer them charity, and then manacle them and remove them to her “hospital.” At her hospital/ministry, patients were chained in abusive and unsanitary conditions, but Sister Sarah used her hospital as a means to obtain international charitable donations (see Jensen 2004a, 2004b). Jensen explained that without a national mental health policy, it was nearly impossible to persuade either the UNMIL police forces or the NTGL to rescue mentally ill patients suffering severe human rights abuses from a woman with an extensive corruption network. When UNMIL police finally took action, Sister Sarah was tipped off by a contact in government and managed to escape with all but two of her wards, and her operation was driven underground, but continued to thrive.

      Second, Jensen and Immanuel Ballah, Grant Hospital’s chief psychiatric nurse, recruited the German medical NGO Cap Anamur to take over, repair, and reopen the E. S. Grant Mental Health Hospital in the national capital, which had fallen into decline after Dr. Grant’s death. Though Grant Hospital, like other emergency medical organizations, often had trouble maintaining consistent supplies of psychiatric medication,⁴ it was able to ensure the presence of an expatriate psychiatric nurse, and it worked hard to stock generic psychiatric medications, antibiotics, and malaria medications from the WHO’s essential medicines list. Thus Grant Hospital, under Cap Anamur, became the go-to resource for any NGO with a psychiatric case, anywhere in the country. Cap Anamur and MDM, a provider of outpatient psychiatric care, became the sole providers of psychiatric treatment in Liberia, and financially supported their psychiatric services through private charitable donations rather than waiting for nonexistent international humanitarian grants.

      Third, Jensen organized the MHPCC. Founded around the failed “Greenfields Project,” an attempt to create a dedicated space at JFK Hospital for outpatient psychiatric care and referral, the MHPCC soon assumed an important “ownership role” for mental health and psychosocial visibility in national health policy. In principle, the MHPCC was founded in an attempt to institutionalize mental health and psychosocial coordination in conformity with emerging standards (IASC 2007) and to compensate for the lack of mental health coordination within the UN cluster rubric and within the MOHSW. It was, in effect, a “shadow cluster,” voluntarily organized by constituent NGOs and UN partners, the MOHSW, and Liberian organizations like the newly founded Liberian Social Work Association. Under the auspices of the MHPCC, NGOs offering mental health and psychosocial services were to meet monthly to coordinate mental health and psychosocial activities, to lobby government and international organizations, and to establish standards for the licensing and professionalization of a new class of counselors, trauma healers, and psychosocial workers that had emerged during the years of the conflict. After Jensen’s departure, the MHPCC’s ownership transitioned into a joint chairmanship led by Sister Barbara Brilliant, dean of Mother Patern College, and Dr. Brown, which they held for the next five years.

      Finally, Jensen developed and circulated a draft mental health policy to include in Liberia’s national mental health plan, a crucial document for facilitating the health sector’s transition from humanitarianism to development, but without Dr. Brown’s authorship, the documents were viewed as invalid. After Jensen left, the document was lost, as were the completed needs assessments, mental health policy justifications, and network contacts for Liberians and expatriates working on mental health and psychosocial issues. While deputy ministers at MOHSW continued to assure me that mental health was important but “not a priority,” mental health continued to be excluded from coordination at the uppermost levels of the Liberian health sector.

       2007–2009: Mental Health as a “Non-event”

      At the end of 2006, I sat in another air-conditioned, blue room in a quiet corner of JFK Hospital, in the new resource center for the MHPCC. Empty bookshelves and new office furniture, computers, and printers were shoved against a wall, waiting to be used. Behind me were plastic-wrapped printers and chairs, and to my left sat my friend Frank Joscheck, the German psychiatric nurse running Grant Hospital for Cap Anamur. Attendees also included delegates from USAID, the Mother Patern College of Nursing and Social Work, Cap Anamur, CVT, Dr. Brown, a delegate from the WHO, and representatives from Action Against Hunger and MDM. My presence there was unusual but ignored—Frank had insisted that I come as his guest and as a researcher, and no one else seemed to mind.

      Before the meeting opened, Dr. Brown turned to Frank to ask him if he could get him atypical antidepressants not readily available in Liberia. Frank muttered a diplomatic response but complained later to me that Dr. Brown wanted to use Frank’s NGO to gain access to “good drugs” for Brown’s private practice. Frank was particularly annoyed because his own hospital was barely able to obtain these drugs and because Dr. Brown had been invited many times to advise the hospital on matters of care but regularly refused—and then asked for favors.

      The meeting commenced with two items on the agenda: (1) the requirements for social work certification and (2) the drafting of the national mental health policy. The first issue soon became a quagmire of dissent. On the issue of certification, MHPCC members were reacting to the efflorescence across the country of thousands of Liberians who claimed to be “trauma counselors” after participating in one of the hundreds of “trauma-healing” training sessions that had taken place during and after the war. In the entrepreneurial environment of postwar Liberia, “trauma counselor” was a new professional category that could be potentially exploited, and many people carried TOT completion certificates as evidence of their professional credibility. The issues of ethics, qualifications, and professional competency were at stake. MHPCC members feared that “fake” Liberian trauma counselors waving worthless certificates of training completion were a threat to traumatized Liberians. They had good reason to worry. Several participants had heard reports of charlatans, acting as trauma healers, who engaged in Sister Sarah–like human rights abuses like “beating the demons” out of people experiencing posttraumatic stress. Under the guise of counseling, trauma healers in churches, in private practice, or as community members were also reported to be involved in recommending exorcisms, beatings, starvation, sexual violence, witchcraft ordeals, and religious shaming (see Heaner 2010).

      Although these reports were still just rumors, the MHPCC felt a strong need to consolidate professional authority around the title “counselor” to prevent the domain of mental health from becoming an object of ridicule. The debate, this day, was over the MHPCC’s recommendations on the length and types of training, formal or informal education, and professional experience that would merit the title “counselor.” Ultimately the goal was to bureaucratically mainstream thousands of Liberian counselors into a singular regulatory structure.

      The MHPCC’s efforts to develop national standards for counseling and accreditation soon devolved into a nasty case of infighting. One NGO, CVT, recommended that strict state regulations be bypassed or amended, given the institutional flux of the postconflict moment. As long as meaningful and effective efforts were being made to build human and institutional capacity, CVT—a trainer and employer of dozens of Liberian psychosocial workers—felt that on-the-job training and expatriate professional supervision should be recognized as the СКАЧАТЬ