Mental Health Services for Survivors of Mass Violence

The value of the class was endorsed by one former participant. The HPRT toolkit "was very useful and has formed the basis of a... manual that we have developed to train health workers in Uganda working in conflict situations," said Eugene Kinyanda, MD, consultant psychiatrist at the Butabika National Psychiatric Referral and Teaching Hospital in Kampala. During the class, Mollica also gave Kinyanda professional advice as he prepared "to undertake the biggest study to date on mental health in my country."

In much of the postindependence history of Uganda, the country has experienced nearly continuous warfare, armed insurgencies, political instability, population displacements, and family disruptions.

"Until recently it was dangerous, since one could easily be caught up in the conflict and be injured or killed," Kinyanda said. "The [associated] psychological problems are many, the trained therapists are few, and there is too little funding to this area."

Another master class participant, Nesif Al-Hemiary, MD, lecturer in psychiatry and consultant psychiatrist at the University of Sulaimani College of Medicine in Iraq, found the lectures about management of psychological trauma through counseling and psychotherapy particularly helpful.

The classes also "gave me a vision about how to proceed in this field and the impetus to participate in translating the Harvard Trauma Questionnaire into Arabic and Kurdish versions," he said.

So far, 35 doctors from 12 countries have been trained in 4 master classes, according to Steve Alderman. They, in turn, have trained a cohort of 300 people, including psychiatric social workers, psychiatric nurses, teachers, and village leaders.

The upcoming master class, which will invite previous participants, will focus on supervision and support of clinical teams in various countries.

Classes to clinics
The Alderman family, including their adult children, have become personally involved in global mental health services through their foundation. With Mollica, the HPRT staff, and other experts, Liz and Steve Alderman contribute to the master class series.

"We attend them, and afterwards we sit and do a recap of what needs to be changed and improved. During all of this, we make wonderful relationships with these healers," declared Liz Alderman.

On the strength of those relationships, the Aldermans decided to support the creation of clinics in affected countries. Each foundation-sponsored clinic is directed or supervised by master class trainees and exclusively engages local, indigenous caregivers. Each clinic also seeks to partner with local governments, medical schools, and religious institutions.

In March 2005, the HPRT introduced the Alderman Foundation to a clinic HPRT had started in 1994 in Siem Reap, Cambodia. The Cambodian government provided the clinic with space on the grounds of a large hospital, some psychotropic drugs, and some of the consumable supplies. When Steve Alderman visited Cambodia, he arranged for the foundation to provide long-term funding for the clinic and its staff.

Among the special features of the Cambodian clinic are its focus on home visits and its relationship with local Buddhist monasteries. For example, once the patients are discharged from the clinic, the monks maintain a relationship with the former patients to help with any problems and to monitor recidivism. In the first year of operation, the Cambodian clinic had 4000 patient visits and 400 home visits and a 14-month waiting list developed. The Aldermans then opened a second clinic in the country.

In Uganda, the foundation recently opened a clinic in Tororo (eastern Uganda) as an outreach program. It is the first of 3 planned clinics in the country. Additional clinics are planned to be opened over the next several years in Rwanda, Burundi, and western Kenya.