Nigeria Report: Training of Trauma and Bereavement Counsellors

1. INTRODUCTION

https://www.vanguardngr.com/2022/09/60m-nigerians-suffering-from-mental-illnesses-psychiatrist/

Prof. Taiwo Obindo, President, Association of Psychiatrists in Nigeria (APN), says that more than 60 million Nigerians are suffering from mental illnesses. Obindo, who is also the Chairman, Faculty of Psychiatry, West African College of Physicians, Nigeria Chapter, said this in an interview with the Newsmen on Sunday in Abuja. “Mental healthcare is in a sorry state given that we have more than 60 million Nigerians suffering from various mental illnesses and the fact that only about 10 per cent of them were able to access appropriate care. We are left with more than 90 per cent who are unable to access care and this group is called the treatment gap for mental illnesses,’’ Obindo said. He said the gap was as a result of various factors like the knowledge gap in which people do not have appropriate information about the causes and treatment for mental illnesses. Obindo said some factors hindering the management of mental illness in Nigeria included myths and traditional beliefs; inadequate mental health facilities and number of mental health professionals. According to him, the few available mental health facilities were located in the city centres. “Knowing that 60 per cent of Nigerians live in the rural areas, they do not have access to appropriate are and have to travel long distances to access facilities,” Obindo said. He also said that the number of mental health practitioners was low as it fell below the ratio recommended by the World Health Organization. According to him, the few that were trained were often eager to leave the country.“The environment in which we practice, the security situation and the remuneration that people were given in the country tend to push them out”. He said one major component of the National Mental health policy was the integration of mental health into primary healthcare, which was yet to be achieved after nine years.

2. BACKGROUND

Violence in the south east of Nigeria has reached crisis levels. Over the past months, land invasions by “Fulani Cattle Herders” have increased. Locals say these are not cattle herders. They were young pastoralists who carried knives and sticks. The current wave are “armed Fulani militias”, carry AK47’s and wear battle fatigues. They have established camps in the forests near local communities, attack local farmers, killing the men and raping the women. In many areas there are now food shortages and hunger – farmers are too scared to go to their lands. There are no statistics of the number of people killed. Sources in Nigeria say that more than 36 000 have been killed to date. There is no camp for the IDP’s. They are scattered around the state and trying to survive on the streets because

they were forced to leave their houses unexpectedly when the armed Fulani militia raided their villages, destroyed their homes and livelihoods and murdered their loved ones. They live in fear of being attacked and hide in bushes, sleep in abandoned houses and scavange for food. They suffered trauma having watched family members killed, their bodies dismembered, women and children raped; leaving them mentally deranged, starving and fighting for survival on the streets. Their farms were taken away from them and destroyed as the Fulani militia flattened the land with cattle, leaving it barren and infertile.

In Benue State alone there are now over 2 million IDP’s. Nobody knows how many are in Anambra, but the numbers could be similar.

Mental health amongst the local population is further negatively affected by the exponential increase in kidnappings. Fulani militia go around the state kidnapping Priests, Nuns and ordinary civilians to hold them for ransom. This occurs daily, and everywhere. The Sisters have a High School in Umuchukwu. They have even reported cases of pupils being kidnapped while standing at the side of the road waiting for transport. Local residents live in constant terror of being kidnapped, and are now afraid to leave their houses.

With farmers unable to go to their fields to plough, plant and harvest, there is now food insecurity in the South East for the first time in its history. There is no food in the markets. And if there is, it is unaffordable. For instance, a year ago a tuber of yam costed 500 Naira. At present, the same tuber of yam cost 3 000 Naira – a six-fold increase in price. Food insecurity contributes to mental health issues.

Anambra is still haunted by the spectre of the Biafra war (1967 to 1970) when over 3 million people were killed in what is now considered to be a deliberate genocide by starvation. The same seems to be happening now. The government is not allowing food to be imported from the North of Nigeria to the South East, further exacerbating food insecurity.

The results of years of neglect by the central government, and deliberate marginalisation of the Igbo’s, rooted in long standing tribal hostilities, are now becoming apparent. Instead of protecting the population from the Fulani invaders, the government Police and Military are compounding the brutalization of local communities. Soldiers and police frequently go from village to village, assaulting residents and taking away young men – often never to be seen again. Young men are dragged off at police and army roadblocks for “offences” ranging from having dreadlocks to wearing earrings. They are brutally assaulted and often disappear never to be seen again. The fear of police and military confirms the fact that local people have no recourse, further impacting negatively on mental health.

Travel by road is now impossible, and does not happen anymore.

The Handmaids of the Holy Child Jesus have an outreach that provides humanitarian assistance to the displaced and victims of attacks. The Sisters have identified a need for psycho-social support. There are no psycho-social services in Anambra. Hence the idea of training community members as trauma and bereavement counsellors. The objective is to deploy the trained trauma and bereavement counsellors in their various communities, to provide psycho-social support.

3. TRAINING WORKSHOP

The Handmaids of the Holy Child Jesus engaged with Anima Wellness (https://animawellness.co.za ) to do the training. Ekene Obi, the Director, is an accredited trainer, and was born and grew up in Anambra – he is therefore familiar with local conditions. He travelled with his team member, Verna Yerebakan, who specialises in community mobilisation.

The training took place from 23 to 27 August 2022 at St Jude’s Catholic Church in Umuchukwu. The Sisters selected 30 trainees. On the first day of the training, 57 people showed up. This highlights the great interest in psycho-social support and the need for it. Some trainees came from as far away as Isuochi, in neighbouring Abia State.

4. TRAINING CONTENT

The following was covered during the training:

1. TOWARDS A DEFINITION OF TRAUMA

Types of Trauma

Examples of Traumatic Events

2. TAUMA’S REACH

3. WHAT IS THE IMPACT OF TRAUMA?

4. BRAIN STRUCTURE

5. PHYSIOLOGICAL RESPONSE

The Impact of the Flight or Fight Response

The Impact of the Freezing/Submit Response

The Impact on the Body

6. PSYCHO-EMOTIONAL RESPONSE

‘Normal’ Memory

Memory During a Traumatic Event

The Critical Moment

The Shattering of Worldview

The Emotional Impact of Trauma Events

Severe Trauma Reactions

a. Re-experiencing the Trauma

b. Emotional Numbing and Avoidance

Repeated Trauma Impact

Symptoms and Timing

Post Traumatic Stress

Checking for Post Traumatic Stress

Untreated Trauma Symptomology

The Goal of Debriefing

7. PHASES OF CRISES AND TRAUMA

THE THREE PHASES OF TRAUMA

a. THE IMPACT PHASE (24 to 36 Hours)

b. THE RECOIL PHASE (36 hours to 3 Months)

c. REINTEGRATION / REORGANISATION PHASE (3 Months +)

HOW DO WE MANAGE TRUAMA?

8. THE DEBRIEFING PROCESS

THE FOUR PHASES OF DEBRIEFING

A. The Fact Phase

B. Exploring the Emotion and Thought

C. Structured Reaction

FOLLOW UP

VOLUNTEER DEBRIEFING

Phases of Recovery

Every trainee was given a copy of the manual. The didactic training took four days. On the fifth day, trainees performed role plays to access what they had learned. The course evaluation was also conducted. All trainees said that it was a life changing experience.

On the last day all trainees were given a certificate of attendance. For the final lunch, 30 homeless victims of Fulani attacks were invited to join.

5. UNEXPECTED CONSEQUENCES

Many of the trainees were themselves traumatized, but only became aware of this during training, as they were learning what trauma is. Their trauma was dealt with by Ekene Obi, who gave them private counselling sessions.

6. FOLLOW UP

During the second week, Vernalee and James accompanied Sr Nkiru to see the beneficiaries, and to accompany the trainees to their villages.

7. CONCLUSIONS

The training was very successful, and clearly addressed a tremendous need in the society. Since this training was conducted, requests have been received to do the same training in Benue State and Abuja (Nigeria), Bamenda (Cameroon) and Nampula (Mozambique).

PHOTO REPORTAGE

The Community Being Served