We had a wonderful two days with the counsellors at the Kandy Cancer Society, who had invited us to do two workshops on basic clinical skills and talking about sex. We were blown away by the counsellors’ openness and could not have been treated with more warmth or hospitality. A brilliant two days!
Today we visited the National Institute for Mental Health in Colombo, a large psychiatric facility responsible for the care of 1006 inpatients at present. We were given a tour of the site by Samutthana counsellor, Duminda. We visited a perinatal unit, female and male forensic wards, the intensive care unit, female and male wards, geriatric wards, the learning disability unit and various rooms used to engage inpatients in occupational activities. In many ways the facilities exceeded those available in the UK. In other ways, the model and provision of care were very different; inpatients’ behaviour is controlled largely through sedation and ECT, for example.
It was an eye-opening day and we were grateful for the visit, especially as we were accompanied by Rebecca, a new Samutthana volunteer and experienced mental health nurse. Her insights gave us a very different perspective on the care being delivered at the NIMH. We were also grateful to be invited to discuss the role of Clinical Psychology in mental health services and had interesting conversations with current trainee psychiatrists, who were keen to learn about CBT and other psychological interventions.
After a long bus to Kandy, we’re preparing for a two-day workshop at the Kandy Cancer Society. Time for bed!
A frantic day of moving out of the flat, preparing for the 14 hours of teaching we’re giving this week, and delivering a two-hour lecture to the Sri Lanka Volunteers (SLVs). The volunteers are primarily Psychology graduates from the UK working in Sri Lanka as volunteer teachers and support workers.
We wanted to give them skills for thinking about their work with people in Sri Lanka; in particular, how to assess and think about clinical presentations from a psychological perspective. We went through the basics of an assessment interview and taught the basic ‘5P’ model before thinking about how they might apply these skills in their current roles. Feedback from the day was good and we managed to overcome our fears of role-playing in front of an audience! A big thank you to our two colleagues, Rebecca and Louise, for helping out tonight.
Yesterday we joined Louise and her hosts, Sinead and Chris, to celebrate Australia Day. Like kids at Christmas, we overate on cheese, hummus, pizzas and ‘plain’ food. We were so grateful for the comforts of home!
Today is our last day with Tim and Becky as tomorrow they leave for India. We celebrated with a beer (or two) and some Japanese food in Nawala. We’re going to miss them loads but get to see them in March before they head back to the UK.
Today we delivered teaching to BSc and Msc Psychology students studying at the Horizon University in Colombo. They were interested to know more about the role of a clinical psychologist within mental health services, what a clinical psychologist does, and how you might become one. The teaching went well with lots of helpful reflections from our audience.
This morning we met with The Foundation of Goodness, a team of 136 people working in both the southern and northern regions of Sri Lanka. The FOG adopts a holistic approach, seeking to empower people in the rural areas of the country through providing physical health care facilities, psychosocial support, education, skills training and sports development programs to people across the lifespan. They also have a special focus on women’s empowerment.
The founder, Kushil Gunasekera, explained to us how he had initially wanted to give back to his home town of Seenigama, and had started to offer skills-building sessions in schools in the village in an effort to empower the local community. This work continued for five years and was proceeding well until disaster struck in the form of the 2004 tsunami. The area was devastated as was much of the systems Kushil had worked so hard to implement.
Undeterred, Kushil started again, this time seeking to implement a more holistic model in which a range of areas of development could be pursued by people locally. With an influx of aid following the tsunami, The Foundation of Goodness was able to grow quickly and now has a campus in Seenigama comprising over 30 centres. The key challenge, Kushil told us, is how to finance and resource these centres, and the FOG relies heavily on donations and volunteers to continue their work.
Following the end of the civil war in 2009, the FOG decided to try and take the lessons learnt in Seenigama and apply them in the northern regions of Sri Lanka. This is a relatively new project but one that has been successful in helping to empower over 13,000 people living in the areas most heavily affected by the fighting.
Fazana Ibrahim, head of the psychosocial team, met with us to discuss what would be most useful in terms of teaching and training provided by Samutthana. She explained that her team work with people living with domestic violence, substance misuse (particularly alcohol misuse within fishing communities), child abuse, phobia, and stress. She was keen to receive training in each of these areas but felt that the most useful input we could provide at present would be a one-day workshop on basic clinical skills. We have agreed to offer this training to the 10 members of FOG’s psychosocial team some time next month. We are excited to visit the centre in Seenigama, which we have heard so much about and which is clearly carrying out some unique and inspiring work.
Today we met with Mumtaz Faleel, National Coordinator for the charity Emerge Lanka Foundation in Sri Lanka.
Emerge works with girls aged 10-18 who have survived sexual abuse and are testifying in court against their perpetrator(s). In Sri Lanka, Child Protection services will become aware of children who have been sexual abused either through direct reports from the survivors themselves or when a child is admitted to hospital due to injuries sustained as a result of the abuse. The child is then removed from their family home under the assumption that they are either unsafe at home (where the abuse may have occurred) or the parents are responsible for allowing their child to be abused and therefore unfit to parent. The child is often unaware that they will be removed from their home which can be a further trauma in itself.
In most cases, the parents do not want the child to remain at home as this would bring shame and stigma to the family. In Sri Lanka, there is a culture of victim-blaming and most children are held responsible for having been abused; for example, a girl is told that she is “too pretty” and therefore asked to be raped. Children removed from their family homes are often unable to return to their home province, let alone their original family home, because of the stigma and blame associated with having been abused.
All survivors of sexual abuse are placed in one of Sri Lanka’s 70 “probation homes” until they are 18 or their court cases are resolved. These homes can be either government or privately funded. During this time they may be called to court where they have to relive the sexual trauma multiple times under questioning. Usually nothing comes from the court case; with little forensic facilities it can be difficult to ‘prove’ the abuse occurred. Furthermore, the survivors themselves have to pay for any DNA or forensic testing, and are often unable to do so. Most perpetrators of abuse therefore go free, often seeking revenge for having been accused of sexual abuse in the first place.
Most homes provide some basic education, accommodation and food. Many girls are pregnant when they arrive and therefore some maternity and childcare facilities are also available. However, with little resources many of the girls leave the homes with little skills or training and no social support, often turning to sex work as a form of financial income, or finding themselves caught in a cycle of abusive relationships. This is where Emerge intervenes.
Emerge has 6 staff members currently working with approximately 75 girls aged 10-18 living in three “transitional shelters”. Transitional shelters are probation homes intended to offer a six month stay to girls whose court date is due soon. In light of the shorter nature of these stays, resources such as education and training are therefore not provided. However, as most court cases do not proceed quickly, girls often spend years in these lesser-equipped facilities with no access to a basic education.
We visited one such shelter in the Colombo. The building itself was a large concrete facility with barred windows and no green space. 80 people from a range of different marginalised groups shared a community kitchen and dormitories. With many girls trying to escape the home, the doors were permanently locked. It was incredibly upsetting to see the conditions the girls were living in, and shocking to meet girls as young as 12 pregnant or already mothers through rape. Most young mothers will have no choice but to give their children up for adoption, often having looked after them for many years until the adoption process can be finalised.
Emerge supports the girls through a mentorship scheme and by providing one day a week of life-skills training; this relates to reproductive health, money, banking, healthy relationships, and employment. In addition, they have turned each of the three shelters into a jewellery-making business through teaching the girls how to make beaded jewellery. Emerge report that having an occupation is not only therapeutic for the girls but also helps them to generate enough income so that they when they leave the shelters they are able to set up their own businesses or pursue education. In addition, workers at Emerge have noticed how the girls are often able to express and process different emotional states through the design and colours used in their bead-work. Mumtaz explained how often the girls begin making jewellery in shades of grey and black before using brighter colours as their mood improves. The jewellery is sold both nationally and internationally. You can find out more here: http://emergeglobal.org/
Mumtaz explained that they are not able to provide counselling to the girls; the government provides one counsellor in each of the probation homes/transitional shelters (although the demand far outweighs this resource). However, the staff at Emerge often feel overwhelmed by the difficulties the girls present with and unsure of how to best respond, and would appreciate the support of Samutthana. Issues demonstrated by the girls include: challenging behaviour (including physical violence); self-harm; negative body image; low self-esteem; sexualised behaviours; fluctuating mood; depression; trauma; guilt/shame/self-blame about the abuse (reinforced by sociocultural factors); and difficulties managing emotions. The staff themselves also often feel low in mood and “burnt-out” by the huge demands placed on them, though they work hard to support each other and are a strong team.
We were so impressed and humbled by the resilience of the girls at the shelters and of the work being done by Emerge and are keen to help in any way that we can. We have agreed to think about whether we, or other Samutthana volunteers, may be able to offer some support in identifying psychological needs and responding to challenging behaviour, as these are the two greatest areas of need identified by Emerge at present. We hope to offer some training in either February or March, and to continue to foster our relationship with this incredibly inspiring organisation.
Today we met with the Consortium for Humanitarian Agencies (CHA), who have requested some training for probation officers and psychosocial workers operating in child and adolescent facilities throughout Sri Lanka. In particular they would like teaching regarding child protection issues, identifying abuse, trauma in children and adolescents and the effects of institutionalisation. These are not our main areas of expertise but we’re hopeful that other Samutthana volunteers may be able to help.
One area that is our speciality is talking about sex, a topic which appears to be cropping up across all the organisations with which we meet, as it is a taboo subject in Sri Lanka. CHA and other agencies have requested training in how to talk about and intervene with issues related to sexuality, and it may be that we offer a one-day workshop at Samutthana in response to this need.
Today, after several meetings, we did our first teaching!
We were privileged to lead a session on ‘endings’ with the current MPhil Clinical Psychology students at the University of Colombo. They are coming to the end of two years’ hard-work having trained as some of the very first psychologists in Sri Lanka.
We began by delivering a one-hour lecture on the meaning and importance of endings, how we might facilitate endings in therapy, barriers to discussing endings, and questions we might ask about endings, and by providing our own examples of endings that we felt went well and those we wish had gone ‘better’. We then opened up the session to allow the trainees to reflect on their own training experiences, and how they felt about ending the course and moving forwards in their careers. We were struck by how similar many of their experiences were to our own as recently-qualified clinical psychologists. We were also humbled by the students’ resilience in completing the course despite receiving no funding, not being provided any extra time for research, not having a team of psychologists to offer guidance or supervision, and training in a country where Clinical Psychology does not exist within government services and has little, if any, recognition. Despite all of these challenges, we were impressed by the level of reflection shown by the students and felt grateful to be able to share in this transitional period with them. We also felt extremely thankful for all the support we received in our own training experiences.
The feedback from the trainees was very positive and we feel excited about our next teaching session later this week.