Episode: "Caught In The Crossfire"

COLOMBIA | BURUNDI | SIERRA LEONE

Why are there so many paralyzed victims of street violence in Cali, Colombia?

In Colombia, poverty, unemployment, easy access to firearms, and minimal access to education have spectacularly increased the homicide rate, which is currently close to 77 killings for every 100,000 people. In Cali, a cultural phenomenon – the technique of shooting your victim in the back as a means of revenge – has given a specific form to the more generalized urban violence found throughout the rest of the country.

In this episode, MSF treats Colombian young men who are not only victims of violent crime, but also have committed violent crimes in the past and often want to seek revenge when they recover. In fact, after recovering, one patient, Mauricio, shoots the person who shot him. Why does MSF treat people who might continue the cycle of violence?

Like any physicians, MSF doctors and nurses cannot refuse to treat someone based on what they might do in the future. Furthermore, this MSF mission in Colombia includes a psychological component that focuses on prevention of violence. MSF has developed many “psychosocial” programs with a broad approach, focusing on an integrated mix of social, psychological, legal and medical activities. Building trust is central to these psychosocial programs, which strive to reintegrate these young men into existing social structures and to support their transition in various ways.

In this episode, MSF has a psychologist on hand in Bujumbura, Burundi. Does MSF often send psychologists into the field with MDs?

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 can suffer severe psychological trauma.

In some places MSF has developed projects that specifically seek to provide mental health care. In the West Bank and Gaza Strip, for example, MSF teams visit Palestinians in their homes, counseling people trapped in the ongoing conflict, where stress and trauma create a complicated mixture of physical and psychological reactions. Another example is Rwanda, where MSF works with female survivors of the 1994 genocide, many of whom continue to suffer trauma associated with rape and torture eight years on. In Burundi, an ongoing guerilla conflict places extraordinary stress on civilians living under constant threat of random violence. MSF’s psychological program in Bujumbura seeks to help patients cope with this stress through counseling.

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