Monrovia — The deep wounds on Joe Turner’s wrists and ankles were strangely golden – a result of the gentian violet antiseptic used to keep them clean by the nurses at ES Grant, Liberia’s only psychiatric hospital.
His family, terrified by his rages, had kept him tightly bound for days. Somehow he was able to work himself loose and escape, but a brother found him and brought him to the hospital in a quiet neighbourhood of Paynesville, in the capital, Monrovia.
Turner’s case, diagnosed as acute psychosis, is not unusual for ES Grant and its increasingly busy out-patients department. Whatever troubled him was accentuated by alcohol and drugs, according to Barkon Dullah, the acting nursing director. “It’s hard to establish what he’s been taking, probably marijuana, but maybe other drugs we don’t know about.”
Shaven-headed, wiry and intense, Turner was “a little bit aggressive” when he first arrived at ES Grant but had improved, said Dullah. He was expected to spend two to three weeks in the 73-bed hospital, given sedatives to help him rest and detox, and group counselling sessions on alcohol and drug abuse.
Seven years after the end of its civil war, Liberia is still trying to free itself from the trauma of the conflict; with only a rudimentary healthcare system, it is a struggle for those affected by the fighting. In dealing with the new challenges of rebuilding their lives, they first need to recognize they need help, and then find it.
Dullah suspected Turner had been in the war. Sitting in a cramped office of the hospital administrator, lighting his umpteenth cigarette, Turner guessed where Dullah’s questions were leading. He said he “didn’t see anything” during the war as he was a refugee in neighbouring Cote d’Ivoire, emphatically denied he ever held a gun, and added: “I don’t abuse women and don’t disrespect people.”
But the story he told of his life seemed no less traumatic: three of his five children were dead, he had recently lost his wife and was struggling to keep his family together on a labourer’s wage. Regardless of whether bad war experiences haunted him, or he had lived peacefully in a refugee camp, Turner was clearly unwell.
The stock image of the Liberian war is of a wild-eyed urban youth decked out in a wig. But according to a June 2010 MICROCON Research Working paper, ex-combatants “[do] not seem to have been any more idle, marginalized and alienated than any other group of young men in Liberia”. Many people fought, but not all were hardcore fighters: most joined the various militia “for the sake of protection for themselves, their families and their communities”.
But that did not lessen the impact of the 14-year civil war. Research by Kirsten Johnson published in 2008 in the Journal of the American Medical Association, found that 44 percent of the adult household population had symptoms associated with post traumatic stress disorder (PTSD). The difference between former combatants and non-combatants was 57 percent and 37 percent respectively.
“Demographically these are the highest figures I have ever read,” psychologist Judith Baessler, a consultant to the Mother Patten College of Health Sciences, Monrovia, told IRIN. “The war lasted too long and too many bad things happened.”
When your focus is solely survival, horrors can be endured, noted Baessler. “It doesn’t mean you are okay, it just means you go on living as best you can … Little scars are there, but when you are struggling so hard you don’t have the luxury of looking into yourself.”
Peace raises new challenges. “All that internal stuff, depression and suicidal ideation, can break through as life gets less tough. You need different skills rather than being able to run and hide, and poverty becomes a stress factor,” said Baessler. “You are no longer satisfied – the kids might not be in school, you don’t have a job.”
In the rural areas, poverty is tempered by traditions of communal support; that can also extend to cleansing rituals aimed at overcoming the past. But although the purpose of the ceremonies is to move forward, “you can be grieving silently inside; the grief still comes and you cry in the mornings”, said Grace Boiwu of the Mother Patten College trauma counselling programme.
Communicating and understanding trauma are culturally bound. “Open mole” is a specifically Liberian disorder – increasingly regarded as short-hand for PTSD – where it is believed the head opens and the brain and soul leaves the body. There can be physical symptoms, such as dizziness and high blood pressure, but with “no word [in Liberian vernacular] to describe depression or anxiety, you say ‘open mole'”, Alice Vahanian, head of mission for Médecins du Monde (MDM) in Liberia, told IRIN.
Women in particular have suffered as they have tried to reintegrate or cope with the past. “Some women were perpetrators [of violence], some were victims. In some small communities they were fighting for recognition, and behaved violently. ‘If you don’t accept me, fear me’. After the war some became pregnant to identify themselves as women … [but do] not have the means to take care of the child,” said Vahanian. Former fighters do not often make the best parents, she added.
Fear of more war
Formal sector employment in Liberia is estimated at 15 percent and the literacy rate 56 percent. A GDP growth rate of 7.1 percent in 2008 has not yet translated into a marked rise in living standards and opportunities. In Liberia’s urban “ghettos”,