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After 20 years of private practice, Clinical Psychologist Michael Michalik took an opportunity in 2003 to work with Doctors Without Borders, known internationally as Médecins Sans Frontières (MSF), in the Gaza Strip. It was his chance, he says, to work as a pioneer advancing mental health in an area where families live with constant violence and insecurity. At the ISTSS 20th Annual Meeting, Michalik will be one of several MSF representatives to share their experiences and talk about the organization’s relatively new mission of implementing mental health programs in regions experiencing political violence and trauma.

Doctors Without Borders mental health program in Kosovo, 1999.
Photo by Roger Job.

A 2002 MSF International Activity Report stresses the importance of offering mental health care in addition to physical care: “In any MSF medical project, in any part of the world, there is always a psychological component to the work, if only in the personal interaction between doctor and patient, the ability to listen and the chance to be heard. People living in unstable political situations or living through a natural disaster suffer severe trauma. No one would deny the psychological impact of living with disease, poverty or in conflict settings.” MSF has applied this philosophy to programs in numerous regions, including Sri Lanka, Kashmir, Afghanistan, Colombia, Sierra Leone and Kosovo. MSF also has incorporated psychosocial treatment in its AIDS programs in developing countries.

In Gaza, Michalik says, the needs of the residents illustrate the importance of access to quality mental health care. The families with whom he had worked lost friends and relatives to violence, lost homes, and encountered shootings, injuries and death first hand. At times during the year, young people spent more days attending funerals than going to school. “There was no normalcy to their life,” he recalls.

In fact, Michalik often found the violent and insecure conditions overwhelming, especially as he adjusted during his first 90 days in Gaza. “My first three months there were really about becoming better educated about the conditions, religion and culture,” he says. “I struggled with how effective I could be,” Michalik adds, explaining that the continued trauma experienced by residents sometimes seemed impossible to overcome. It was after the first three months that Michalik began to see results. He realized that the kind of intervention MSF offered to people in their homes did make a difference in their resilience and coping. Some symptoms of stress-related disorders, including nightmares, disruption of sleep, mood swings and poor concentration, showed signs of lessening.

One key to such success is cultural knowledge, says Kaz de Jong, MA psychology, program advisor for MSF mental health programs. It’s crucial, he explains, that mental health practitioners become culturally aware, find common ground and common language with the people they work with, and are willing to learn from those they’re helping. It’s important, he says, to break from the limitations of Western psychological terminology and make human connections based on shared understandings. “It’s not an Einstein thing,” de Jong says of the need for cultural give and take. “It’s demystifying psychology, bringing psychology back to basics.” Both Michalik and de Jong say they’ve learned lessons first hand from their experiences with MSF, and they feel an obligation to share. De Jong, who advocates psychosocial issues within MSF and is responsible for the quality of MSF’s mental health programs, will join MSF field volunteer Carol Etherington, MSN, RN, in presenting a workshop titled “Culturally Competent Care: Can We Train People to Provide It” at the ISTSS 20th Annual Meeting Nov. 16, at 8:30 a.m. Participants in the interactive workshop will share and explore training models designed to help field workers develop cultural awareness and apply that awareness in specific patient care settings. “It doesn’t start with dressing like they do,” de Jong explains. “Be yourself and let them be themselves.”

De Jong, Michalik and Etherington also will be present for a question and answer session at the Nov. 14 and Nov. 15 screenings of the film “Should I Cry?”—a documentary showing MSF counseling programs in Sierra Leone. In addition, Michalik will talk about his experiences in Gaza in a session titled “Family Therapy: Cases from the Gaza Strip, Palestinian Territories” on Nov. 14, at 2:30 p.m.

The MSF Holland Mental Health Program received the ISTSS 2000 Sarah Haley Award for Clinical Excellency. For more information about Doctors Without Borders/Médecins Sans Frontières psychosocial activities, visit www.doctorswithoutborders.org.

Meg Spratt is administrator at the Dart Center for Journalism and Trauma at the University of Washington.