What Is the Term Mean When a Country Becomes Whole Again
[ Fall 2011 ]
Today, amongst the 87 war-torn countries in which data have been gathered, 300,000–500,000 children are involved with fighting forces as child soldiers.
Some, equally young as seven, commit unspeakable atrocities: killing parents and siblings, assaulting neighbors, torching the villages they in one case chosen dwelling house. Some are forced to serve every bit sexual activity slaves. Many are injected with drugs to adjourn their inhibitions against committing violence.
Once the killing ends, peace treaties are signed and emergency humanitarian missions pull out. But these children'due south sorrows persist.
Theresa Betancourt has made it her mission to understand how to promote their resilience—and ultimately, their healing.
From Child Soldier to Productive Citizen
Betancourt, ScD '03, directs the Inquiry Plan on Children and Global Adversity at the François-Xavier Bagnoud Center for Health and Man Rights at Harvard Schoolhouse of Public Health. For ix years, she has tracked the emotional fate of onetime child soldiers and explored how—and if—this war-scarred cohort can go on to lead meaningful and productive lives.
Using both surveys and one-on-one interviews, Betancourt has painted a psychic portrait of young people—coolly referred to in the academic literature every bit "children formerly associated with armed forces and armed groups"—who struggle to find a place in tattered postwar societies. She is at present adapting and testing grouping interventions for troubled youth in Sierra Leone that accept proven successful in other places riven by violence.
Dust Cloud—or Lasting Care
"We demand to devise lasting systems of care, instead of leaving backside a grit cloud that disappears when the humanitarian actors exit," says Betancourt, who is besides an assistant professor in the Department of Global Health and Population.
In Sierra Leone, assist quickly evaporated afterward the African country'due south crunch was no longer in the news. Today, Sierra Leone ranks 11th from the bottom on the Un Human being Development Alphabetize of 169 nations. Its district health officers are justifiably preoccupied with high rates of maternal and infant mortality. The land has one psychiatrist—who practices in the capital, Freetown, and is soon to retire.
Betancourt's inquiry seeks to prove how onetime child soldiers and other war-afflicted youth may be helped, despite such limited resource, to become contributing members of society as adults. She has disseminated her findings to hundreds of professionals from local and international NGOs and United nations agencies working with Sierra Leone's onetime child soldiers.
She hopes that i day these accomplishments tin be bolstered by a broader continuum of intendance—1 that extends from everyday citizens who give troubled kids encouragement and guidance to frontline community health workers to psychologists and psychiatrists, who tin manage cases needing a higher level of services. In an ideal world, grassroots mental health services would offer a place for sufferers to tell their stories, talk nearly their dreams and ambitions, and develop trusting relationships.
"The postconflict environment is where things break down, merely besides where we can help," she says. "We don't have time to waste."
From Alaska to Africa
Tragedy told by the numbers
Child recruits in the Sierra Leone civil war interviewed past Theresa Betancourt'due south research squad had been severely traumatized by their experiences:
lxx% had witnessed beatings or torture.
63% had witnessed trigger-happy expiry.
77% saw stabbings, chopping, and shooting close-up.
62% had been browbeaten by military.
52% witnessed big-calibration massacres.
39% had been regularly forced to take drugs such as marijuana and cocaine.
45% of girls and 5 percent of boys had been raped by their captors.
27% had killed or injured others during the war.
Betancourt's path to Sierra Leone began in the Alaskan permafrost. She was built-in in a Native infirmary in Bethel, a boondocks near the country's w coast that then numbered most 3,000. Her parents, both Caucasian, imbued the family unit with a passion for other cultures. Her father was a math and science teacher who had joined the Peace Corps in the early 1960s, stationed in Ethiopia. Her mother worked in remote villages for the federal infant learning plan.
In Bethel, where the majority of residents were Yup'ik, Betancourt acquired both an insider and outsider perspective. "My friends were Yup'ik. I had Yup'ik baby sitters. I spoke Yup'ik. We were outside the dominant culture—merely we needed to empathise that civilisation in club to alive well."
Her father's passion for Ethiopia never waned. When friends came over for dinner, he would haul out his slide projector and display pictures from his Peace Corps days. "We were in small-town Alaska permafrost," Betancourt says, "but we e'er knew what Africa looked like."
Initially trained as a counselor using expressive arts in therapy with children, Betancourt started focusing in 1995 on children affected past war. Commencement with the United nations Role of the High Commissioner for Human being Rights, so with the International Rescue Committee (IRC), a New York-based humanitarian organisation, she worked with immature refugees in Republic of albania, Chechnya, and the Eritrea-Ethiopia border, organizing emergency teaching programs and somewhen research initiatives.
In 2002, at the terminate of a bloody 11-yr ceremonious state of war, Betancourt made her initial trip to Sierra Leone to work with the boys and girls at that place. "The offset time I met with sometime child soldiers, what struck me was that they looked really petty, really young. They told me they were 13 and 14, but they looked eight. They were malnourished and wearing tattered clothes.
I couldn't fathom what they had seen."
Betancourt has now been tracking more than 500 former child soldiers, many of whom are growing into machismo and starting their own families. Her main questions: What helps immature people suffer this feel and still thrive? What qualities of the individual, the family, and the environs shape resilience? How can constructive interventions, resonant with the local civilisation, be delivered by community members who receive special preparation and routine supervision?
Groundbreaking Inquiry Tells the Story
Betancourt believes both numbers and words are needed to take the measure of a kid soldier's trauma. Equally a outcome, she relies on both quantitative and qualitative methods in her research efforts. In her longitudinal report, she uses a detailed questionnaire to arm-twist the boys' and girls' war and postconflict experiences. Her local staff conduct in-depth qualitative interviews of the children and their caregivers, along with focus groups in the community.
Much of the existing scholarship on intergenerational relationships in war-exposed populations is based on the experiences of Holocaust survivors. Betancourt'south piece of work is, therefore, groundbreaking. Her nine-yr project following male and female child soldiers in Sierra Leone is Africa'southward showtime such prospective study.
And a 2007 report that Betancourt co-authored was ane of the showtime randomized controlled trials of mental health interventions among African adolescents affected by war—and one of only a handful of trials of psychological treatments for low conducted in a developing country. Amidst other things, she has shown that constructive treatments—and clinical trials of these treatments—are viable in poor, rural, illiterate, state of war-torn communities.
A Barbarous Circle
In Sierra Leone and elsewhere, former child soldiers endure nightmares, intense sadness, intrusive thoughts, and recurring violent images. Not surprisingly, those who committed extreme acts of violence, or were its victims, tend to suffer the most persistent mental health problems and need the virtually intensive care.
Frequently, these children take difficulty with community relationships after their release. They struggle with guilt and shame. They are labeled as different or untrustworthy, which, in a vicious circle, deepens their sense of isolation. In their home communities, they are blamed for having destroyed lives, homes, holding, and society itself. Those who are socially isolated are especially vulnerable to addictions and abusive relationships.
Girls face up a compound burden. They are more than likely to suffer depression, anxiety, and post-traumatic stress disorder, compared with boys. Some have returned to their communities having had unwanted pregnancies during their times with rebel groups. At home, they face the double stigma of having participated in violence and existence seen as "impure," regardless of their state of war experiences.
Hundreds Taught to Work with Onetime Child Soldiers
HSPH Fellowships
En route to earning her doctorate in 2003 at HSPH, Theresa Betancourt received crucial financial assist. In 1998 and 1999, she was awarded a Taplin Fellowship, which paid her expenses. In 1998, she held a Saltonstall Fellowship at the Harvard Centre for Population and Development Studies, which helped launch her field research on the Chechnya conflict. In 2008 and 2009, she received the Julie Henry Junior Faculty Development Award, which supported Betancourt'southward Family Strengthening Intervention projection in Rwanda, a airplane pilot study to bolster resilience and forestall mental health issues among children in postgenocide Rwanda whose families are affected by HIV/AIDS; the research led to a National Institute of Mental Health grant.
To grapple with these problems, Betancourt and her colleagues accept looked to existing testify-based mental health interventions that aid violence-affected youth manage their emotions and build interpersonal skills. The goal is to forge connections to families and communities, and give children the
wherewithal to negotiate the adversities they often encounter. Ideally, such approaches are linked to educational and job programs that restore civilian roles—since returning to school or securing a livelihood are prime number sources of confidence and motivation in the children.
Betancourt emphasizes that direct, sustained handling of war-affected children is the task of local partners. "I like to stay put in a place, develop relationships, and keep working at things over time," she says. Despite the oppressive content of her piece of work, she is neither bleak nor drawn to philosophical discussions about the nature of skillful and evil. As she puts it, "I'm very businesslike." Married to a physician specializing in wellness inequities, and the mother of two young children, she has a noticeable lightness of spirit.
Distress Has a Local Significant
Betancourt is planning pilot studies that utilise components of cognitive behavioral therapy and an arroyo known every bit grouping interpersonal psychotherapy that has proved successful in relieving depression amid children—some former soldiers, some not—crowded in refugee camps in embattled northern Uganda. Group interpersonal therapy is based on the idea that the roots of depression, and the mechanisms for healing information technology, lie in people'southward relationships with others. Young people who accept all experienced the aforementioned ordeal tin can share support, wisdom, and understanding.
In Betancourt's intervention, war-afflicted young people larn that they are not solitary in their experiences and emotions.
"The central is being able to put a discussion to their feelings: sadness, worthlessness, hopelessness, loss of energy, the sense that life is non worth living," she says. "We spend a lot of fourth dimension trying to larn local terms for emotional suffering. In one case intervention and problem solving begins, these immature people no longer feel alone. Their symptoms start to elevator."
Betancourt and her team call their airplane pilot model the Youth Readiness Intervention, because information technology builds readiness to succeed in critical aspects of life such as personal relationships, taking care of i's self, planning for the future, and achieving economic cocky-sufficiency. Meeting weekly for two months, the participants focus on the nowadays: setting goals, curbing loftier-risk behaviors and substance use, reducing trauma-related distress, and boosting customs involvement.
Complementing African Programs and Traditions
A Recipe for resilience
Former child soldiers are not a monolithic population of the emotionally wrecked. "When people think of child soldiers, they think of people who are terribly damaged in some fashion," Theresa Betancourt says. "But I've seen very much the opposite: tremendous stories of resilience, of acceptance, of dearest in families."
In her view, resilience springs from a circuitous environmental of individual traits and social forces. "In one sense, any child who made it through the war alive likely developed survival strategies to navigate a harsh and dangerous surround. Some of these young people, specially those who survived abuse, possess a sense of resourcefulness, which shows up in confidence and a sense that they can control their fate."
Another stiff cistron in resilience is family unit connectedness. When parents openly embrace their sons and daughters and bring them back into the fold, information technology not but sustains the kid simply also sends a signal to the larger community that the boy or girl is worthy of acceptance and care. Going to school, doing homework, and graduating likewise foster a sense of normalcy and regaining lost fourth dimension.
How the wider culture draws meaning from the war and its aftermath besides influences the fate of former kid soldiers. During the postwar, authorities-led process, which has included sanctioned forgiveness and community sensitization campaigns, many young people received the explicit message that their involvement in the land's atrocities was not their fault.
"The groups fit well in collectivist cultures such as in Uganda or Sierra Leone," says Betancourt. "In northern Uganda, we saw very potent effects in girls, more so than in boys. That may be because in these crowded camps—where girls had a lot of responsibilities caring for people, cooking, gathering firewood, fetching water—they didn't have much in the manner of supportive social contacts before coming together other girls in the same situation."
Betancourt'due south locally adapted models also complement what has been initiated in Sierra Leone and other nations, including "sensitization" campaigns that encourage communities to discuss the conflict and the dangers of excluding any stigmatized grouping. Traditional healing ceremonies—such every bit ritual washings and collective feasts—can also marking new beginnings for former child soldiers.
Such evidence-based interventions are far more constructive than the once-popular technique in humanitarian assistance known as "psychological debriefing," in which Western practitioners briefly visit war zones, comport therapies in which victims talk about their traumatic experiences, then leave.
According to Betancourt, "Flight in and asking someone to share their trauma in ane or two sessions, without an ongoing, safe therapeutic relationship, can actually practise more harm than good."
Not a "Lost Generation"
In the aftermath of chaotic civil wars, investments in psychosocial and mental wellness issues are typically phased out as the problem shifts to a postconflict and then a reconstruction phase. "Unfortunately, these children's needs do non follow a similar phasing-out process, particularly when they have been ill-addressed at the outset," says Betancourt. "There is real difficulty in getting funding for this work. Sierra Leone, in detail, is seen as a 'has been' disharmonize: no longer sexy."
What well-nigh worries her is that societies volition write off old child soldiers as a "lost generation." The opposite could be true, she contends: The very qualities that helped these children survive a harrowing experience may also enable them to catalyze alter in their shattered homelands.
And while Betancourt'southward inquiry may seem specialized, many of her findings transcend civilization. "When someone'south a survivor, it means they are nevertheless hither today, despite what they went through," she says. "Information technology would exist terrible if people who had been through events like this saw themselves as hopeless or as victims. A survivor orientation means being able to experience the force of what it takes to make it through such horrendous experiences and even so movement forward in life."
Acquire More than
Register to hear Theresa Betancourt speak during our free HUBweek Panel, "Four Global Health Threats, Four Global Health Opportunities"
Madeline Drexler is editor of theReview.
Source: https://www.hsph.harvard.edu/news/magazine/child-soldiers-betancourt/
0 Response to "What Is the Term Mean When a Country Becomes Whole Again"
Post a Comment