A bid to blend old, new to heal Uganda

Doctors, faith healers address mental trauma from civil war

September 10, 2007|By Scott Calvert | Scott Calvert,SUN FOREIGN REPORTER

GULU, Uganda -- As an 11-year-old, Alfred Odida did awful things. He killed people with machetes, he abused the dead. He says he had no choice. The rebels who abducted him forced the young boy to commit atrocities, as they have thousands of children during northern Uganda's long civil war.

Now 18 and safe, he sat with a psychiatrist recently to discuss his lingering mental trauma, such as the haunting visions he has of victims coming back for revenge. "I think it's the spirits of those people," he said, his brow crinkled in an expression of worry.

Antidepressants and antipsychotics have largely calmed his demons, said Dr. Thomas Oyok. And that makes Odida a rarity in a country with 20 psychiatrists for its 26 million inhabitants. Here, people dealing with emotional turmoil are far more likely to turn to traditional healers, pastors or counselors, if they seek help at all.

Oyok, a Ugandan psychiatrist, is trying to even out that imbalance. He has linked up with a small American foundation established to help societies around the world, including Cambodia and Afghanistan, cope with the anguish caused by mass violence.

Besides training indigenous health workers in Western ways, the Peter C. Alderman Foundation aims to foster closer ties between two camps often suspicious of each other: physicians and traditional healers, many of whom say they can appease angry spirits with herbs and ritual animal slaughters.

"A lot of these countries, Uganda for one, have rich traditions of traditional healing," said Stephen Alderman, who started the foundation in memory of his 25-year-old son, who was killed in the Sept. 11 attacks on the World Trade Center in 2001.

"It would be crazy," he added by telephone from his home in Bedford, N.Y., "if we tried to lay [only] Western medicine on these people who have cultures that predate ours by years and years and years."

Good practices

In attempting to build bridges with these medical workers, the foundation plans to help organize one-on-one sessions with healers to reinforce their good practices, such as letting patients vent emotions at length. Dangerous methods -- tying up patients or withholding food -- will be strongly discouraged. Some healers have received training to dispense antipsychotic drugs in certain cases and to refer serious cases to a psychiatrist.

The Alderman Foundation has trained 35 medical doctors and psychologists from 12 countries through the Harvard Program in Refugee Trauma. It has also opened two "psychotrauma" clinics in Cambodia and one in eastern Uganda, paying staff salaries in return for government-supplied psychotropic drugs.

Early next year, the second Uganda clinic will open here in Gulu, bolstering Oyok's ability to treat patients at the modest government clinic. He says the timing is good, given what he predicts will be a spike in trauma-related disorders.

Hopes are high that peace talks will end a 20-year war between the rebel Lord's Resistance Army and Uganda's government. While he wants peace as much as anyone, Oyok expects a surge in post-traumatic stress disorder as more people leave de facto refugee camps and return home to villages -- the scenes of so many abductions, rapes and killings.

The United Nations says 700,000 people have left the camps -- dangerous, squalid places that are hardly conducive to good mental health. Still, more than a million people have yet to depart for rural areas.

"I'm sitting on a minefield as far as PTSD is concerned," Oyok said, referring to a condition that can cause people to sleep poorly, startle easily, remain constantly on edge and relive traumatic episodes. "When they go back, they will get a shock. That is when I'm expecting the problems."

The stakes go well beyond individuals' mental health. Happier people, he says, are generally more productive and more peaceful.

Oyok, an affable man of 56, is one of three psychiatrists in all of northern Uganda. The low number is partly due to the paucity of doctors of any kind in this impoverished East African nation. It also stems from widespread doubts that unquiet minds need medical intervention.

Rift between workers

Here even physicians harbor prejudice against psychiatrists, said Dr. Seddie Alibusa, hired by Alderman to run the Tororo clinic in eastern Uganda. Chuckling, he said some Ugandan doctors label him and fellow psychiatrists as "mentally ill." In the general population, he and Oyok agree, most people first try a traditional healer, or maybe a pastor or priest.

Some members of the medical community are uneasy with traditional healers. Oyok tells of a doctor who, during a visit to a village, tried to get the police to round up all the healers and cart them away.

But Oyok said he wants to work "hand in hand" with traditional healers. He even persuaded one to obtain the antipsychotic chlorpromazine to complement the herbs and cactus leaves he prescribed.

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