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Mending Wounded Minds

Illustrations by Dung Hoang

Mending Wounded Minds (continued)

“We select interventions that are relatively low-cost, that don’t require high-level training,” says mental health researcher Judy Bass, “so that the organizations we work with … can actually continue to provide services should they prove to be effective.”

Stopping the Snowball

The topic of child sexual abuse is almost too painful to acknowledge, whether in the industrialized West or in sub-Saharan Africa’s poorest countries. In the past few years, however, health officials in Zambia have begun to confront the issue through awareness campaigns and specialized medical services—in part because of the high prevalence of HIV among young girls, the most frequent victims of sexual predators. Especially vulnerable are AIDS orphans who have lost both parents and must live with relatives or neighbors, some of whom become their abusers.

AMHR’s Laura Murray is overseeing a project in Zambia to introduce mental health care to sexually abused children. The goals are twofold: to ease the immediate effects of trauma, and to head off potentially irreversible damage that could manifest itself in adulthood as substance abuse, risky sexual behavior or mental illness.

“If you don’t treat child sexual abuse, the research tells us it’ll snowball into a lot of adult mental health issues,” says Murray, who, as part of a feasibility study, trained 23 local clinicians in an evidence-based therapy with a strong record of success in treating sexually abused children.

For the past nine months, the clinicians have been providing the therapy to sexually abused children ages 4 to 18 throughout Lusaka. Prior to AMHR’s involvement, no effective therapy was available in Zambia for young victims of sexual abuse. “The therapists are actually meeting with children and parents all over the city: under a tree, at a church, in a house, a school,” says Murray.

Jackie Jere, a counselor in Zambia with a background in educational psychology who has worked with the United Nations High Commission for Refugees, jumped at the chance to train with Murray. “We lack manpower in the field of therapy,” she says. “This was an opportunity for me to gain the skills to become a professional therapist so we can adequately help people who need treatments.”

Jere has found that many individuals who identify themselves as counselors in Zambia, as well as in other developing countries, are not properly trained. “There’s a lot of counseling going on, regardless of the level of qualifications you have,” she says. “A lot of children receive counseling that I think is ineffective.”

The pilot study in Zambia grew out of Murray’s efforts to learn about the mental health concerns of women and children living in a low-income compound outside of Lusaka with a high HIV prevalence rate.

A review of data collected by AMHR-trained local interviewers, who spoke with the women and children, identified a need for mental health services geared to treat child sexual abuse. Forty percent of the women and 30 percent of the children themselves reported “defilement,” or sexual abuse of children, as a problem. The survey also found that 52 percent of women said that orphaned children were seen as second-class citizens by their adopted families.

After reviewing various options for treatment, AMHR settled on Trauma-Focused Cognitive Behavioral Therapy (TF-CBT). The approach has been effective in treating trauma stemming from child sexual abuse, grief, disaster and other causes.

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