The current crisis in Kenya, involving killings occasioned both by agents of state and the citizenry, has exposed how woefully inadequate our disaster mental health services are. We were ill prepared to deal with a disaster of this (or any) magnitude.
Subsequently I have put together some suggestions for the running of a disaster mental health service at least at this emergent phase. More detailed guidelines will come out after discussions of this and other drafts.
My Suggestions are available here.
Tuesday, January 22, 2008
Friday, January 18, 2008
Let's Free our Children from Bondage of Ethnic Bigotry
Story by: ATWOLI LUKOYE
Publication Date: 1/18/2008 Daily Nation Page 11
A 10-year old boy with an arm sling stares at all visitors at the Moi Teaching and Referral Hospital Accident and Emergency Department.
Asked what happened to his arm, he replies after some hesitation that members of a neighbouring tribe attacked those of his tribe and they had to escape. He describes his escape without emotion: ‘‘They threw stones at the roof of the church so that we do not try to run out. They blocked all the entrances and set the church on fire. I jumped out through the window and ran into the bush. They hit my arm as I ran, and that is how it broke.’’
IN KISUMU, A 15-YEAR-OLD BOY WAS shot in the leg by a policeman responding to a riot. He says: ‘‘All the policemen were speaking with the accent of members of another tribe. They used live bullets to disperse the crowd. I was shot as I tried to salvage some iron sheets from a burnt stall.’’
All around the country, little children are witnessing heightened tribal animosity. Some people are stridently repeating that this conflict is political and not tribal. They need to take some time off and visit with the children who have witnessed the atrocities. Politics is the dress our national ogre, tribalism, is wearing this time round. Next time, it will be land or business rivalry, or even disagreement over resource allocation. But at the very core of the issues is tribe.
Children who have only now grown old enough to speak a few words are repeating disturbing ethnic stereotypes with such ease, one wonders how entrenched they are in their psyche.
They have internalised our communal hates and prejudices and made these their values. They now calmly accept the fact that in some parts of this country, they are ‘foreigners’ always at risk of eviction.
These children have now learnt that nothing is sacred in the struggle for what belongs to ‘us’. Looting, murder, arson and rape are all legitimate ways of getting justice. They cannot now be convinced that stealing is all evil either.
It is said that love is natural, while hate is learnt. We are slowly but surely
incubating a hateful future for Kenya, where certain parts of the country will be inhabitable for some tribes. We have accomplished the difficult task of teaching our children to unlearn the natural love and trust they have for everyone, and have replaced that with hate and bigotry based on such a transient feature as one’s ethnic origin.
The above scenario paints a gloomy picture for the future of our nation. It promises that what is happening in Kenya today will happen again in 15 or 20 years’ time. When these children are strong enough to wield machetes, clubs or even guns, they will settle their differences the very same way they have learnt from their parents. They will loot, they will kill and they will rape in pursuit of what is rightfully theirs. They will make anyone who comes from a different community a target for their anger whenever they feel aggrieved.
All hope is not lost, though. When all has been said and done by the politicians, and agreements have been reached and deals brokered, we will have to examine the effect these eruptions have had on our children and by extension, on the fabric of the nation.
At the individual level, mental health professionals are involved in a crisis response that involves helping the survivors to integrate the traumatic events into a coherent, liveable worldview and reduce psychological distress.
The same process will have to be carried out at the national level, aiming at healing the nation’s wounds and creating a national vision that is coherent and liveable for all our people.
THE TASK OF HEALING THE NATION will fall on all of us, but must be led by individuals who have gained the trust and confidence of the nation, in much the same way that a doctor must inspire confidence in her patient for the therapy to work. A national healing and reconciliation process, by whatever name, must be instituted to embark on the difficult journey of helping Kenyans find themselves.
At the personal level, it will be important for us to make certain rules of etiquette when dealing with each other. For instance, use of ethnic stereotypes must be deemed taboo whether in public or in private. Use of insulting language targeting whole communities must be discouraged whether on the campaign platform or in the privacy of our homes.
Our children should be taught to appreciate the culture of others and not to hold one group to be superior to others simply because they belong to it.
The time to act is now.
Dr Atwoli is a consultant psychiatrist
© 2005 NationMediaGroup All Rights Reserved
18/01/2008
Publication Date: 1/18/2008 Daily Nation Page 11
A 10-year old boy with an arm sling stares at all visitors at the Moi Teaching and Referral Hospital Accident and Emergency Department.
Asked what happened to his arm, he replies after some hesitation that members of a neighbouring tribe attacked those of his tribe and they had to escape. He describes his escape without emotion: ‘‘They threw stones at the roof of the church so that we do not try to run out. They blocked all the entrances and set the church on fire. I jumped out through the window and ran into the bush. They hit my arm as I ran, and that is how it broke.’’
IN KISUMU, A 15-YEAR-OLD BOY WAS shot in the leg by a policeman responding to a riot. He says: ‘‘All the policemen were speaking with the accent of members of another tribe. They used live bullets to disperse the crowd. I was shot as I tried to salvage some iron sheets from a burnt stall.’’
All around the country, little children are witnessing heightened tribal animosity. Some people are stridently repeating that this conflict is political and not tribal. They need to take some time off and visit with the children who have witnessed the atrocities. Politics is the dress our national ogre, tribalism, is wearing this time round. Next time, it will be land or business rivalry, or even disagreement over resource allocation. But at the very core of the issues is tribe.
Children who have only now grown old enough to speak a few words are repeating disturbing ethnic stereotypes with such ease, one wonders how entrenched they are in their psyche.
They have internalised our communal hates and prejudices and made these their values. They now calmly accept the fact that in some parts of this country, they are ‘foreigners’ always at risk of eviction.
These children have now learnt that nothing is sacred in the struggle for what belongs to ‘us’. Looting, murder, arson and rape are all legitimate ways of getting justice. They cannot now be convinced that stealing is all evil either.
It is said that love is natural, while hate is learnt. We are slowly but surely
incubating a hateful future for Kenya, where certain parts of the country will be inhabitable for some tribes. We have accomplished the difficult task of teaching our children to unlearn the natural love and trust they have for everyone, and have replaced that with hate and bigotry based on such a transient feature as one’s ethnic origin.
The above scenario paints a gloomy picture for the future of our nation. It promises that what is happening in Kenya today will happen again in 15 or 20 years’ time. When these children are strong enough to wield machetes, clubs or even guns, they will settle their differences the very same way they have learnt from their parents. They will loot, they will kill and they will rape in pursuit of what is rightfully theirs. They will make anyone who comes from a different community a target for their anger whenever they feel aggrieved.
All hope is not lost, though. When all has been said and done by the politicians, and agreements have been reached and deals brokered, we will have to examine the effect these eruptions have had on our children and by extension, on the fabric of the nation.
At the individual level, mental health professionals are involved in a crisis response that involves helping the survivors to integrate the traumatic events into a coherent, liveable worldview and reduce psychological distress.
The same process will have to be carried out at the national level, aiming at healing the nation’s wounds and creating a national vision that is coherent and liveable for all our people.
THE TASK OF HEALING THE NATION will fall on all of us, but must be led by individuals who have gained the trust and confidence of the nation, in much the same way that a doctor must inspire confidence in her patient for the therapy to work. A national healing and reconciliation process, by whatever name, must be instituted to embark on the difficult journey of helping Kenyans find themselves.
At the personal level, it will be important for us to make certain rules of etiquette when dealing with each other. For instance, use of ethnic stereotypes must be deemed taboo whether in public or in private. Use of insulting language targeting whole communities must be discouraged whether on the campaign platform or in the privacy of our homes.
Our children should be taught to appreciate the culture of others and not to hold one group to be superior to others simply because they belong to it.
The time to act is now.
Dr Atwoli is a consultant psychiatrist
© 2005 NationMediaGroup All Rights Reserved
18/01/2008
Wednesday, January 16, 2008
More Mental Health Resources
I will be making available more mental health resources on this blog.
One can access the American Psychiatric Association Journals (Free for many developing countries.
The Royal College of Psychiatrists' Publications are also available here.
Psychological first aid collated materials shall be made available from time to time as they become available.
Request for more material in your comments and we shall try to come through.
One can access the American Psychiatric Association Journals (Free for many developing countries.
The Royal College of Psychiatrists' Publications are also available here.
Psychological first aid collated materials shall be made available from time to time as they become available.
Request for more material in your comments and we shall try to come through.
Monday, January 14, 2008
Disaster Mental Health Services in Kenya
During this current crisis in Kenya, Mental Health professionals need to know that they have a major role to play in preventing psychological distress from developing into later mental problems among the affected population. Another role is in helping people come to terms with what happened and to process it, coming up with a coherent world view that is not informed by anger and hate.
These goals can be achieved relatively easily through a proces of psychological first aid, and a manual is available here (the Psychological First Aid Field Operations Guide, 2nd Edition). Other useful material can be obtained in the Disaster Mental Health Guidebook for Clinicians all available on the ncptsd website.
Earlier, Critical Incident Stress Debriefing was a popular intervention in disasters to help mitigate the effects of trauma. More recent studies have either shown no effect or even hamful effects with debriefing, necessitating a reevaluation of disaster mental health responses toward a psychological first aid framework.
Responders to most disasters in Japan, the US, Australia and other parts of the world are now embracing Psychological First Aid as the initial intervention of choice, followed by other more individualised approaches with the passage of time.
Debriefing, however, may still be useful for the responders themselves, given that they are more psychologically aware, and may be more willing to verbalise their experiences in order to avoid vicarious traumatisation.
Research Continues.
These goals can be achieved relatively easily through a proces of psychological first aid, and a manual is available here (the Psychological First Aid Field Operations Guide, 2nd Edition). Other useful material can be obtained in the Disaster Mental Health Guidebook for Clinicians all available on the ncptsd website.
Earlier, Critical Incident Stress Debriefing was a popular intervention in disasters to help mitigate the effects of trauma. More recent studies have either shown no effect or even hamful effects with debriefing, necessitating a reevaluation of disaster mental health responses toward a psychological first aid framework.
Responders to most disasters in Japan, the US, Australia and other parts of the world are now embracing Psychological First Aid as the initial intervention of choice, followed by other more individualised approaches with the passage of time.
Debriefing, however, may still be useful for the responders themselves, given that they are more psychologically aware, and may be more willing to verbalise their experiences in order to avoid vicarious traumatisation.
Research Continues.
Friday, January 11, 2008
There's Nothing like 'political' violence; it's all sheer envy
Story by: LUKOYE ATWOLI
Publication Date: 12/14/2007
IN NORMAL CIRCUMSTANCES, when a person hacks a neighbour to death, he is arrested, charged with murder, and if convicted, sentenced to death under the law. If one burns a neighbour’s house, he is charged with arson and is sentenced appropriately.
Clearly, we are not living under normal circumstances today. All around the country, crazed mobs are running around armed with all sorts of simple and sophisticated weapons maiming and killing fellow citizens with abandon.
All this is ostensibly in the name of political activity. No election campaign is complete without supporters of one candidate attacking those of his opponent. Criminal acts have been labelled ‘‘political violence’’ and blame has been laid squarely at the feet of our political class. Politicians are being accused of inciting people and paying for the violence.
THE QUESTION THAT BEGS AN answer is this: Which politician has held a gun to someone’s head and forced them to hack their neighbour with machetes and burn their houses? Is there a politician out there who has threatened a group of people with death if they do not go out and attack his opponents?
Using terms such as ‘‘political violence’’, ‘‘politically instigated violence’’ or ‘‘incitement’’ only legitimises crime and allows people to carry out barbaric actswithout fearing the repercussions.
Murder, arson, armed robbery, carjacking and all sorts of heinous crime attain a sacrosanct status, and the perpetrators cannot be brought to book because their ‘‘political’’ godfathers will raise hell!
The truth is that there is no such thing as ‘‘political violence’’. It appears that many Kenyans live in a state of perpetual envy of their neighbours’ property and perceived success and only need an excuse to dispossess them, even if it means taking their lives. People make personal decisions to harm their neighbour, and then they find a comfortable cover for doing so. The ‘‘political violence’’ tag doesthe job perfectly.
No amount of incitement would otherwise cause a right-thinking man to suddenly attack his neighbour of many years without any provocation. No amount of money would convert a God-fearing upright citizen into one of the monsters we see on TV shouting death threats at people who hold contrary views.
One columnist recently stated that all it would take for the violence to end is for the politicians to say ‘No’. This could not have been further from the truth!
Politicians are under the control of their supporters, not the other way round. They will do whatever is necessary to get them elected. They will happily say no to election violence but complain bitterly when their supporters are arrested and charged with committing the same crimes. However many politicians say ‘No’ to violence, it will not stop as long as Kenyans are still happy when members opposing camps or tribes are attacked and killed during campaigns.
Poverty has often been cited as a reason why people are easily ‘‘incited’’ into committing violent crimes during campaigns. But poverty does not convert one into a mindless automaton that obeys orders from the highest bidder.
Criminals do not reform when they get rich. Nor do good people become criminals when they encounter poverty. Poverty and politics are, therefore, excuses that people use to commit crime and escape punishment.
THE MAJORITY OF POLITICIANS ARE representatives, not leaders, and are incapable of inciting us to do what we are unwilling to do. They cannot come up with any values alien to what their supporters hold deeply themselves. It would seem that the politicians are pawns in this complex game of politics, fulfilling the wishes of those they represent.
Strict, impartial and severe application of the law might be a starting point in dealing with these crimes. Killers must be held personally responsible for their crimes. Arsonists must be punished for their crimes. Once these criminals realise that they have no protection from the law, they may become less willing to accept inducements from politicians to commit ‘‘political violence’’.
Dr Atwoli is a consultant psychiatrist operating in Eldoret
© 2005 NationMediaGroup All Rights Reserved
14/12/2007
Publication Date: 12/14/2007
IN NORMAL CIRCUMSTANCES, when a person hacks a neighbour to death, he is arrested, charged with murder, and if convicted, sentenced to death under the law. If one burns a neighbour’s house, he is charged with arson and is sentenced appropriately.
Clearly, we are not living under normal circumstances today. All around the country, crazed mobs are running around armed with all sorts of simple and sophisticated weapons maiming and killing fellow citizens with abandon.
All this is ostensibly in the name of political activity. No election campaign is complete without supporters of one candidate attacking those of his opponent. Criminal acts have been labelled ‘‘political violence’’ and blame has been laid squarely at the feet of our political class. Politicians are being accused of inciting people and paying for the violence.
THE QUESTION THAT BEGS AN answer is this: Which politician has held a gun to someone’s head and forced them to hack their neighbour with machetes and burn their houses? Is there a politician out there who has threatened a group of people with death if they do not go out and attack his opponents?
Using terms such as ‘‘political violence’’, ‘‘politically instigated violence’’ or ‘‘incitement’’ only legitimises crime and allows people to carry out barbaric actswithout fearing the repercussions.
Murder, arson, armed robbery, carjacking and all sorts of heinous crime attain a sacrosanct status, and the perpetrators cannot be brought to book because their ‘‘political’’ godfathers will raise hell!
The truth is that there is no such thing as ‘‘political violence’’. It appears that many Kenyans live in a state of perpetual envy of their neighbours’ property and perceived success and only need an excuse to dispossess them, even if it means taking their lives. People make personal decisions to harm their neighbour, and then they find a comfortable cover for doing so. The ‘‘political violence’’ tag doesthe job perfectly.
No amount of incitement would otherwise cause a right-thinking man to suddenly attack his neighbour of many years without any provocation. No amount of money would convert a God-fearing upright citizen into one of the monsters we see on TV shouting death threats at people who hold contrary views.
One columnist recently stated that all it would take for the violence to end is for the politicians to say ‘No’. This could not have been further from the truth!
Politicians are under the control of their supporters, not the other way round. They will do whatever is necessary to get them elected. They will happily say no to election violence but complain bitterly when their supporters are arrested and charged with committing the same crimes. However many politicians say ‘No’ to violence, it will not stop as long as Kenyans are still happy when members opposing camps or tribes are attacked and killed during campaigns.
Poverty has often been cited as a reason why people are easily ‘‘incited’’ into committing violent crimes during campaigns. But poverty does not convert one into a mindless automaton that obeys orders from the highest bidder.
Criminals do not reform when they get rich. Nor do good people become criminals when they encounter poverty. Poverty and politics are, therefore, excuses that people use to commit crime and escape punishment.
THE MAJORITY OF POLITICIANS ARE representatives, not leaders, and are incapable of inciting us to do what we are unwilling to do. They cannot come up with any values alien to what their supporters hold deeply themselves. It would seem that the politicians are pawns in this complex game of politics, fulfilling the wishes of those they represent.
Strict, impartial and severe application of the law might be a starting point in dealing with these crimes. Killers must be held personally responsible for their crimes. Arsonists must be punished for their crimes. Once these criminals realise that they have no protection from the law, they may become less willing to accept inducements from politicians to commit ‘‘political violence’’.
Dr Atwoli is a consultant psychiatrist operating in Eldoret
© 2005 NationMediaGroup All Rights Reserved
14/12/2007
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