Dr. McCarthy's Blog

July 13, 2006

2006-08-09T04:50:00.000-07:00

I know, I know. I always say that the most recent group that I’ve trained is the best ever. However, I just finished a three day training with the women from the various organizations who comprised the Violence Against Women group, and they seem very special to me. The experienced counselors are very strong. All have had a great deal of front line experience, e.g. I learned how a medic in the group has successfully helped sex trafficked women to escape from their “owners”. The few interns in the training were bright. They are eager for trauma training for rape victims. I can see many trainers coming out of this group.

This being my last full day in Mae Sot, I finished my 6:00-8:00 pm counseling training tonight at Mae Tao. Dr. May and K. D. John, veterans of the March intermediate training and last week’s EMDR training, have provided the translation the past two nights.
While the group was doing role plays, May said, “I had another case today. She was a woman who is anxious and afraid to go places where there are people.”
“What did you do?” I said.
“I taught her the safe place and she felt a lot better,” she replied.

I really didn’t have to, but I got out of my chair and leaped with joy several times, and then congratulated her on an excellent start to a difficult kind of case. I then went around the room and checked on the trainees’ role plays.

When I came back and sat down, May added to the story. “She was referred to me by a medical student from England,” she said. “The medical student said that she knew that it is called Agoraphobia, but that she didn’t know how to treat it.”

I think this raises the following question. If you were traveling far from home and you developed or exacerbated an emotional disorder, would you want to be treated by someone who’s trained in the West, can name the disorder, but can’t treat it, or would you want to be treated by someone who’s been trained locally, can describe the disorder and actually treat it appropriately?

July 12, 2006

2006-08-09T04:48:00.000-07:00

I was sitting on the floor of the office of the Woman’s League of Burma, having finished the morning part of the second day of a three day counseling training with a group of 15 women from several organizations who have come together to form the Violence Against Women project. Bo Kyaw, my new all-time favorite translator and I were talking about the role plays we’d done thus far and he mentioned that the woman who’d been my first “client” was, Thida Htway, a former political prisoner. He thought she’d been imprisoned for two years and turned to check this with her. She answered that it had been four years and moved over to join us. She shared that she’d been kept awake for eight straight days upon captivity and had experienced electric shock. She then mentioned that she’d been kept in solitary confinement for the next 20 days, a 4x6 ft cell with no light. It was a matter of fact report delivered by an energetic, compelling woman who I’d guess is in her mid thirties. The story was difficult for me to hear and when she described another technique that she’d experienced that I didn’t quite understand, I chose not to ask Bo Kyaw to translate for me. I asked why she’d been arrested and learned that she’d served as an underground source of information for groups resisting the regime. As we talked it came up that she’d received a Human Rights Award from Trinity College. I’d noticed that award three days earlier when I was looking at about seven such plaques that are on display at the museum, looking for Myo Myint or Khun Saing’s names. I told her how close I lived to Trinity and she told me that part of the award is that she can attend there for free if she were to chose to do so. Bo Kyaw later explained that although she was doing important work for her organization, she’d has lost her confidence because she’d been on track as student and now believed that she was too old and couldn’t regain that opportunity.

I thought about her situation and approached her the next afternoon, telling her that I and BBP would like to help her take the next step in her life. Danielle and I have discussed connecting with her and we will sort this out together.

A version of how the counseling center at Mae Tao Clinic came to be:
In January, 2006 there were 15 rape victims who presented to the clinic. Two of these were referred to Khun Tee, a bright, articulate man, who is neither a medic nor a counselor, but whose position at Mae Tao is to organize trainings. He may have been picked because he translated for me in the counseling training of November, 2005 or for some other reason. He was overwhelmed by the pain in the cases and “ran away from the clinic”. In March, 2006 I conducted a five day intensive counseling training for 10 senior medics. On the third day, a woman named Shine, who is part of the Adolescent Reproductive Health Team, spontaneously took over a discussion and proceeded to point out the need for a counseling room at Mae Tao. She pointed out the impossibility of using the VCT room (Voluntary Testing and Counseling for HIV/AIDS) because of the lack or privacy. When the time came to end the training for the day she was still rolling, so I had the class form three groups and brainstorm the rationale and methods for accomplishing Shine’s goal. The groups presented, there was unanimity on the issue, but Shine declined to take the lead and instead drafted Khun Tee, who was again translating, to be the person to interface with Dr. Cynthia and the heads of the various medical departments at Mae Tao.

Because of the complexity of the July training, I planned to conduct it away from Mae Tao Clinic where the medics wouldn’t be interrupted by patient care questions and responsibilities. This was a first for this kind of off-site training for the medics, and as the time approached, I was quite worried that something would prevent them from attending. Final arrangements were not approved until the week before the training, but at that time, Dr. Cynthia announced her plan to create a counseling center at Mae Tao Clinic. One could infer that the consistent and increasingly sophisticated trainings played a role in this decision.

I attended three meetings on the counseling center during this trip. Khun Tee and Akiko were at all three, Dr. Cynthia at the second. It will be a joy and privilege to partner with Mae Tao Clinic on this initiative.

July 9, 2006

2006-08-09T04:46:00.000-07:00

I called Myo Myint as arranged at 8:30 am from in front of the UNHCR office. He answered and said that he’d send someone to get me. I don’t know if this was for security for him or convenience for me. I noticed a man having trouble getting his bike across the traffic and attributed it to the beach shoes he was wearing. He turned out to be one of my escorts, and as we rode our bikes together I realized that it wasn’t a beach shoe but the bottom of his prosthetic that I’d spotted. I was escorted to a room in a compound and eventually Myo Myint, former political prisoner entered. He used crutches, since he has no right leg, a right arm that ends just below the elbow, and one or two fingers on his left hand.

I’d been asked to “help him” by one of our recent supporters, but he launched into how he could help me. He shared his history as political prisoner for 14 years in Burma. He told me of his suicide attempt a month ago, the scars on his neck still healing. He also shared his plans to join his siblings in Indiana and his efforts with the UNHCR to accomplish this. We agreed that his recent crisis was over and that he would connect with me when he reached the US and we would reassess his situation and respond accordingly.

He told me that I should talk to his friend, Khun Saing, a Burmese doctor who’d been imprisoned by the regime and had just come to Thailand. He called Khun Saing and I followed the man who’d originally met me down a dirt road on our bicycles, he kicking at the chain to keep it on, and both of us dodging the many cows who were ambling down the path.
Khun Saing is a tall, very thin man who seems about 50. He is staying at the office and museum of the Association of Political Prisoners, but because he has no legal status in Thailand and no documentation, he rarely leaves the compound. He very graciously described his experience, being arrested three times for a total of 13 years. He was kept on death row at one point, but he didn’t specifically say that he’d been sentenced to death. He described being moved from the infamous Insein prison after he and a friend organized a strike inside. I believe that is the friend who was then housed with insane inmates and eventually attacked from behind by one of them and killed. He expressed guilt at not having seen his father before the older man died, too sick at the time to make the trip to the prison where Khun Saing was then confined. He also talked of his sorrow and guilt at having left his colleagues behind in Burma to continue the struggle while he left for Thailand. He also described his current state of depression. I was able to conversationally respond to these issues, citing the responsibility of the dictatorship for his lack of final contact with his father, the understandable emotion of “survivor guilt”. I wondered if his depressive symptoms were actually manifestations of grief, and that resonated with him. He showed me around the one room museum and demonstrated some of the techniques the were used on him and other prisoners. He was enthusiastic about my description of EMDR and we made plans to have him attend one of the trainings in November. I told him I’d call him during the week.

A friend of his is attempting to get him documentation in Bangkok. I told him that Danielle and I would stay in touch with him and told him that if his friend is unsuccessful, BBP would step in and get him what he needs. He was smiling as I left, I think buoyed by the idea of learning something that he can use to help his colleagues. When I stated that he’d left one form of confinement for another, he laughed me off, saying that this was not a four by six foot cell.
I checked in with him two days later and he told me that a doctor and former prisoner friend of his had just arrived. He said that his friend was not as well off mentally as he was , but that he’d told him of the EMDR training and his friend was enthusiastic to take the training as well.

July 7; 2006

2006-08-09T04:42:00.000-07:00

I walked into my room at the Ban Thai guest house and was hit by humidity, fatigue, and sadness. I would no longer be hanging out with five medics and one Burmese doctor from Mae Tao Clinic as well as the five other attendees at our five day EMDR-trauma counseling training. We held the training at a conference center at the outskirts of Mae Sot because it has proven impossible for senior medics to escape their duties to fully attend a training at the clinic. Therefore, we spent five full days together.

The question going in was whether bright, compassionate refugees, with random schooling, could master the concepts and techniques of a trauma treatment which is used throughout the world with proven success by professionals with advanced counseling degrees. As the five 8:30-5:30 days unfolded answers began to emerge. When I saw the comprehension filling into the faces of Lah La Say and Alice on day four, I knew we’d collaborated in something significant. The feedback at the end of the training was positive and I estimate that 9 of the 11 trainees will be comfortable using this method.

March 06’ Trip to the Border; 3/4

2006-03-25T18:05:00.000-08:00

Peggy and I spent the day at Mae La camp with Moe Moe and most of the 40 orphans and the 35 "borders" whose parents are still inside Burma. BBP, through the generosity of Kim and Mark Smith, supports both the orphanage and boarding house. Today was the end of the school year for most of the students. We arrived in the middle of their celebratory competition in which groups of children and individuals sang, enacted words they were given by the moderator and in one case, did a series of flips reminiscent of Jackie Chan. The wonder, of course, is how an orphaned child from one of the most repressive situations on the planet could have the desire to perform, let alone do so with joy and enthusiasm. However, smiles and laughter were the currency of the day.

The made for TV movie part of the day was the top student, who had a significant history of stealing before arriving at the orphanage, saying in his "thank you" speech to Peggy and me that it was when we visited when he was first in the orphanage and saw a few other students talking with us because they'd learned some English, that he decided to apply himself so he could so the same thing some day. He's obviously bright, has had wonderful care under the direction of Moe Moe and the Karen Women's Organization over the past several years and here he is.

Moe Moe is on fire as she spear heads her vision of a Buddha dharma center which is being constructed on land near her house. She reported that most of the Karen are Buddhist, but because of their significantly disrupted lives, have not had much opportunity to learn about their religion, a fact of which many are ashamed. We visited the center which is under construction and her mentor who is a peaceful, cigar smoking man of about 50, who makes his own instruments to preserve Karen culture and has constructed an impressive altar in his house. They will take this project "step by step".

Humbling, awe-inspiring... You make the call.

March 06’ Trip to the Border; 3/3

2006-03-25T18:03:00.000-08:00

Peggy arrived last yesterday and we finished the four day training today. The first ever all day training that we've had the opportunity to provide at the clinic. Asking is everything.

As I mentioned in the first letter, we had real talent in this training. Saw Than Lwin, the head counselor of the HIV/AIDS Voluntary Testing and Counseling Department. Alice, who will go inside Burma in six months to work in one of Dr Cynthia satellite clinics there. Dr May, a Burmese physician who's teaching at the clinic. And Shine, who heads blood transfusion and went on a tear about the need for a separate counseling room/center for counseling for those other than the HIV/AIDS patients. Based on her passion, I gave her the last 45 minutes yesterday and the first hour today. We ended with Khun Tee, the future prime minister of Burma and ace translator, agreeing to head a committee of department heads to investigate this. It's been a BBP dream and now we have Shine articulating it.

Also, L Htoo San articulated one of my dreams when she raised the issue of dealing with the trauma of rape victims on Tuesday. After Shine's hour, we spent today introducing EMDR, the treatment with the most controlled studies dealing with trauma. They were duly impressed and we made plans for a week long 30 hour training in June or July devoted to this one subject.

Also, the Woman's League of Burma approached us for an advanced training for their Victims of Violence committee. This is a Mae Sot group with whom Khun Tee put us together. He, Akiko and Saw Than Lwin will do the three day intro training next week, based on what we covered in our training. Then we'll do a week of advanced training in June or July. These women are on the front line as they go to the victim wherever she is e.g. factory, etc as soon as the rape is reported.

Off to Chaing Mai on Sunday. I have five days with the COERR Program Social Workers and Peggy has three days with the Women's Commission.

March 06’ Trip to the Border, 3/2

2006-03-25T18:02:00.000-08:00

After two days of training at the clinic, I'm very pleased at the way things are going. I have rued the fact that most of our prior trainees have either left Thailand for a third country or have been promoted to middle management at the clinic and are hardly available for a visit, let alone a training. However, the follow up to the November training is demonstrating that we seem to have tapped into a very talented pool of medics who seem to be at the top of the care delivery pyramid and are hungry for mental health training, both for direct service delivery and for dissemination into the community. We have a great translator in Khun Tee and Akiko Tanaka, PH.D., who is spending a year at the clinic, is collaborating in the training as well as finding a new career as a videographer. Dr May, a Burmese physician working at the clinic has attended most of the sessions. Khun Tee is also acting as our agent, having lined up a meeting for me with the Paloung Action Committee for a training next week for 20 people on Domestic Violence. I'm already booked, but there's a strong possibility that Akiko and our top trainee, Saw Than Lwin will be able to do it.

So, things are hot and good and we've got some footage to prove it.

Day Eight

2005-06-30T08:08:00.000-07:00

Today I continued as international aid worker, meeting with SAW. I finally understand their programs and our funding. They have seven programs.

0-5 Safe house for children (Alternative to Abandonment) funded by The Women's Commission

2-5 Pre School funded by BBP

5-17 Life Pages School funded by BBP

5-18 Children Crisis Center USCRI

12-25 Adolescent Reproductive Health Program USCRI

Women's Crisis Center USCRI

Crisis Center for Women with HIV/AIDS Currently no funding

They've asked USCRI to fund the HIV/AIDS program but were turned down on the grounds that USCRI is too invested in them. They receive $3500.00 per month from them whereas they get $1400.00 from us.

Today they had two requests of me. The first was money to cover the work permits that the 10 migrant teachers at Life Pages need to travel to work without threat of arrest. That will come to $1360.00. The second request is to increase the pre-school funding so that they can go from 29 to 40 students. This would be another $175.00 per month. I strongly believe we should do both. This is such a strong organization and the programs are superb. I visited LIfe Pages today and saw 150 students and the 10 teachers in action. They have 30 more registered, but don't have room. I believe we can absorb this and the story is so inspiring, in the midst of extreme oppression, quality emerges and thrives.

I told them we would talk and I'd get back to them.

I have two more projects that I'm discussing, but believe they would have to be totally owned by an interested BBP supporter. One is art and one is sports/games, but more on those later.

[Note: I apologize for the the lack of chronological order with this posting. This was originally written on the Eighth of Jack's trip.]

Epilogue

2005-06-20T13:08:00.000-07:00

The following vignette stands out as I prepare to leave for the US.

In the final meeting with Saw Than Lwin, his cell phone rang as we sat in the tea shop discussing his role with HIV/AIDS. He looked at the message and didn't take the call but launched into a description of the case which the call was about. He said that his patient is a woman who has HIV/AIDS and whose older daughter was dead, having contracted the disease from the mother. The woman's husband died two months ago, also from HIV/AIDS. She has two remaining children, an eight year old with HIV/AIDS and a four year old who is not infected because of the woman's collaboration with the Mae Tao Clinic's Mother to Child Transmission program.

The issue at hand was the fact that the older daughter had just contracted TB and that Saw Than Lwin was afraid that the younger daughter would become infected. He'd placed a call to SAW to see if they could help.

He then returned the call and spoke for a long time, as we sat without any way of knowing how the call was going. He got off the phone and was relieved. SAW had agreed to place the mother and older daughter in their new Crisis House for Women with HIV/AIDS, which is currently unfunded. The eight year old daughter will be able to go to the Life Pages School which BBP funds. SAW had agreed to place the younger daughter in their Safe House for Children, which the Women's Commission funds until the TB infection clears. The four year old will also be able to attend the Preschool which BBP also funds.

A compassionate system that works.

Day Eleven

2005-06-16T06:09:00.000-07:00

A very interesting meeting this afternoon with Saw Than Lwin, the head of the HIV/AIDS home based counseling program. I was thinking we'd discuss the ways that BBP could enhance the counseling capacity of the HIV/AIDS workers and begin to address the trauma of the victims of HIV/AIDS. His focus, however, was on the basic economic and medical needs of these patients infected with the virus. He reported that the compliance and counseling had improved dramatically since World Vision had begun providing for the basic nutritional needs of this group. The role of psychologist and international aid worker are closely connected in this setting. I asked what he thought he'd need to make a difference and he thought $15,000 Baht per month ($375.00) to provide for medicine to combat the opportunistic infections that plague this population. An interesting addition to our growing list of worthy targets.

Spent three hours with Angela designing a training for camp social workers in October which could serve as a model for combining training and training of trainers. We'll see.

Flying out tomorrow morning so this is the last report of a very enlightening trip.

Day Ten

2005-06-15T07:01:00.000-07:00

My Dinner with Angela

I think it happened more or less like this. I began by stating that I was becoming concerned that in nine days the only thing I'd done that looked like we might be able to repeat in the future was the work with the HIV/AIDS program. As rewarding as the day had been, the follow up in October would not take more than a few days the way things stood last night. She then filled me in on her work with Coerr, the Thai NGO, and her mandate to both facilitate a working relationship between Coerr and the Karen Women's Organization as well as train Thai and Karen social workers of vastly different educational backgrounds to do effective treatment with children. After a while she changed the subject to how fascinated she was in the book I'd sent her on EMDR, the trauma treatment both Peggy and I do in the US. After I explained how it actually worked in my practice, she asked about using it with children and the light bulbs started going off.

We plan to meet tomorrow to make specific plans to spend several days in our next trip in October training those therapists who are the most skilled and proficient in English how to do EMDR on a paraprofessional level as well as teach a larger group our version of Therapy with Children 101. This is a model that lends itself to Peggy's and my plan to return three times per year for about 12 days at a time. Trainees will get new knowledge and skills, have about four months in which to practice the skills with support from Angela, then move on to the next level. The most skilled among them will have the opportunity to go through a process of facilitating trainings, student teaching, co-teaching and eventually training on their own.

I met with Dr Terry today and filled him in on the positive connection we made with the HIV/AIDS peer counselors and VCT Medics yesterday. I reported that both groups expressed a desire to repeat the process on a regular basis and that Akiko would be facilitating both groups. He told me that World Vision has chosen the Mae Tao Clinic over the local Thai hospitals as the place they operate their support programs because of the sophistication of the program. He sees potential for these medics to participate in a TOT (train the trainers) program and then help other programs meet their level of expertise. He was very open to BBP being a part of that.

Day Nine

2005-06-15T06:52:00.000-07:00

Akiko and I spent most of the day with the medics who are on the front lines of the Mae Tao Clinic's response to the HIV/AIDS epidemic in the migrant community. These medics operate out of the Reproductive Health Department, where their mission is to prevent the spread of the virus to the unborn baby. Unlike the rest of the medics at Mae Tao, they operate more like counselors as they attempt to influence people to be tested for HIV/AIDS, break the bad news if the results are positive, weigh the consequences of informing the partner, and then take on the medical care of the patient for as long as the patient remains active at the clinic.

The structure is 10 medics who work in Voluntary Counseling and Testing (VCT), two of who are also Home Based Counselors. There are also six peer counselors who are HIV/AIDS positive patients themselves, who have been trained to visit and support about eight families each. Three of these counselors regularly cross the border into Burma to deal with Internally Displaced families.

We met with Son Than Lwin, the medic in charge of the Home Based program, and four of the peer counselors this morning. Once again, we were struck by the spirit of these people who have not only been driven from their homes in Burma, but are living the precarious migrant existence with a terminal illness. They cited the benefits to their patients that they could talk with someone who was having the same medical experience, and the benefits to themselves that they had a purpose in life.

This afternoon we met with five of the VCT medics. They cited the magnitude of informing patients that they were positive, the strain of dealing with patients who don't want to disclose their status to their partners, and HIV/AIDS patients who come to Inpatient Department to die a lonely death, with no family or money for food or a funeral. They shared feelings and frustrations and were very eager to have an opportunity to continue this process on a regular basis.

Akiko has agreed to meet regularly with these groups through her stay at the end of August. She and I could be in contact via email and we could determine whether there would be a need for a training on specific issues when Peggy and I return in the fall.

Photos from Mae La

2005-06-13T07:01:00.000-07:00

Click on this link to see pictures taken from Drs Jack McCarthy and Akiko Tanaka's trip to the orphanage in the Mae La Refugee Camp.

http://pg.photos.yahoo.com/ph/daniellefox44/my_photos

Day Six

2005-06-13T06:33:00.000-07:00

The human spirit shone through on our trip to Mae La refugee camp to visit the orphanage that was BBP's first funding venture in 2001. The forty children ages about 7-19 gathered around and listened to my greeting, ate cookies as they played with stuffed animals that we brought, and took photos of each other with our cameras. Eventually one of the older boys got up and made a speech of thanks for our continued support. It was hard not to cry in awe and respect. Moe Moe estimates that close to 200 children have lived in the 40 person orphanage in the four years since its construction. After this gathering, four of the older children took us to the site of the construction of the new boarding house for children whose families have been internally displaced by the SPDC inside Burma and have sent their children across the border for safety. These 37 children were sprung on the Karen Women's Organization who appealed to us for funds to build this second facility. Moe Moe told me today that she plans to keep the children from both groups separate, since they have different issues, the former having already lost their parents, the latter in the relative safety of a community of confinement, worrying about the fate of their families inside.

I ended the day by doing consultations on two psychotic women with Akiko Tanaka, a UMinn Ph.D. psychologist who is currently in a public health program at UMinn and spending three months at the Mae Tao Clinic. I think we helped with some problem solving, and came away with respect for the selfless compassion of the caregivers and some appreciation of the extent of the man made pain with which they deal.

Day Five

2005-06-10T17:00:00.000-07:00

I'm learning a great deal as I observe the Mae Tao Clinic in action and discuss possible training needs with the medics that we've trained over the years and who have now taken over positions of major responsibility. I struggle to describe the current situation. Perhaps think of a major US hospital with all of it's departments functioning in crowded buildings connected by muddy paths on a space about the size of a football field. The overall sense I get is of competence, compassion, dedication and extremely difficult medical challenges.

A conclusion to which I've come after interviewing these former students and others is that they do not need training in delivering mental health services and if they did, wouldn't have the time to devote to it. I think the place for counseling training at Mae Tao Clinic is in the training program for the nurses and medics. When Dr. Cynthia raised this in July of 2003 those familiar with BBP history will remember that Peggy sequestered herself with a computer for three days and emerged with a 53 page mental health curriculum that takes a teacher through the specific teaching techniques of the key concepts of our training, e.g. Trauma and its Consequences for an overall understanding of the effects of war on the psyches of the victims, Stages of Change for addictions, The Cycle of Violence for domestic violence, and Breaking Bad News for dealing with terminally ill patients.

The BBP mental health team could certainly be available to consult or train the people doing this training of medics. I also think that it would be very helpful to the medics to have the opportunity to meet with Kathy Allden to discuss psychopharmacology. However, the only medics that are constantly faced with counseling as the primary function of their job are those who deal with the HIV/AIDS patients. I'll be interviewing some of their patients next Tuesday morning and then meeting with the counselors in the afternoon. I am hopeful that this experience leads to a plan for specific counseling/trauma training in the future.

I believe this direction would allow the Mae Tao Clinic to take advantage of the particular strengths of the BBP mental health team. I also think that focusing on this issue will allow BBP to work in the intersection of several of the key social action organizations in Mae Sot. For example, the Migrant Assistant Program (MAP) has a major initiative on prevention, Social Action for Women has a BBP supported program for babies who've been abandoned and are in the process of creating a safe house in which women with HIV/AIDS can live with their children, and SMRU has a major HIV/AIDS in the three refugee camps in the greater Mae Sot area.

Also on the upcoming agenda are a meeting with the medics who deal with exploited migrant factory workers and a guy who has a program that deals with former child soldiers.

Stay tuned.

Unfolding

2005-06-07T14:17:00.000-07:00

Things are playing out nicely in my opinion. I'm letting my schedule evolve as the needs and requests arise. I'm also committed to making sure that I make every effort to be mentor/collaborate in everthing I do so that both the trainees are enhanced and that the ideas are sustainable and replicable in the person of my co-trainer.

The past trainings are standing me in good stead. One of my key new partners at Mae Tao Clinic is Khun Ti, a happy customer from a training I did at the EarthRights School in Chaing Mai three years ago.

Gender-based violence, HIV/AIDS, Addictions, Self-care, and managing a traumatized, psychotic safe house resident are all on the agenda for the next few days.

Arriving in Thailand

2005-06-06T08:42:00.000-07:00

I'm in Bangkok today, reading and planning in preparation for the 12 days on the border in Mae Sot and the Mae Tao Clinic. This training seems pivotal to me in that I'm hoping to create a shift in the way we've operated in the past. I hope to be able to work with medics who are dealing with the social/emotional aspect of medicine and develop with them a program to provide them with the training and support they'll need to function effectively. Lisa has asked me to collaborate with a woman who'll be at the clinic for three months who has a Ph.D. in Clinical Psychology and is now working on a degree in Public Health. She's been asked by Dr. Cynthia to work with the medics who are working with the HIV/AIDS population as well as the medics who are developing a domestic violence program.

This seems like an ideal opportunity develop a way to train and support these people. The talent and compassion of the medics has been clear to us over the past five years. The stress under which they work as they multitask amidst tragedy and sorrow has also been obvious. This may be an opportunity to work with medics who are going to be able to focus some of their time on counseling. The long term hope is that within a war situation where both medic and patient have witnessed multiple traumas and in which their society has been torn apart, the sense of powerlessness can be transformed.

The particulars await.