Interview with doctor Alessandro Huber, MSF psychiatrist who has worked for two years in Caquetá, Colombia.

"People sometimes look for someone to listen to them and other times to help them make a decision."

What mental health projects is MSF currently implementing in the Caquetá Department?

MSF has been working in the Mental Health Center in Florencia, the capital of Caquetá, since March 2005 and in other municipal administrative centres of the department with regular brigades since July 2006. These brigades in the municipal administrative centres have probably contributed to making our presence and work visible and have contributed to building the contacts needed to return to the rural area where we have not had access since 2004 due to a security problem. Since July 2007, we have been able to work again in the rural area of San Vicente del Caguán and since January 2008 in Cartagena del Chairá.

Does the population in rural area face the same problems as those in the urban areas?

No, no they aren't the same. The IDPs who arrive in Florencia have fled their villages, having lived an experience of conflict and lost everything. In the rural areas, the people live in the midst of the conflict. They continue living on their farms, with their animals and crops, but have to endure the conflict on a daily or regular basis.

What are the most common pathologies treated?

20% are depressions and more or less at the same level there are adjustment disorders (mainly IDPs that need to adjust to the new situation). There are also relationship problems, abuse and negligence. Then, we encounter anxiety, very few acute stress disorders or posttraumatic stress disorders, probably because they have already turned into more serious pathologies. Acute stress is detected when they come immediately after a traumatic event. When someone has experienced a conflict situation or the assassination of a person close to them, they experience it faraway in the jungle and when they arrive in Florencia one or two weeks have already gone by and the problem is no longer acute.

In rural areas, there's a great demand to see the psychologist. Why?

In these brigades, in addition to clinical psychologists there are also community-based social psychologists –known as mental health promotion and prevention technicians– and one of their tasks is to explain what mental health is. If explained in a simple way, people soon understand what we are referring to by mental health.

For instance, social psychologists explain that people have mental health problems when they suffer from insomnia, anxiety, worries, relationship problems, when they become aggressive with their children or when they no longer want to be alive. Explaining it this way, people understand it well and if they identify it then they want to talk with the psychologist. As MSF is an international organisation, they believe the psychologist is trustworthy and, above all, a person foreign to the village because one does talk about one's problems with the neighbours.

What are people looking for in the mental health consultations?

Sometimes, they are just looking for someone to listen to them and other times, to help them to make a decision.

They are very difficult life stories. Many times conflict-related problems go back to childhood or a young age. In general, ongoing violence perpetrated by armed actors generates domestic violence. I had never seen so many children suffering from violence in their own homes. People take advantage of the presence of MSF, which they know could be their only opportunity, to talk about their lives, stories which condense a lot of misery in a short time.

In addition to the problem of general violence, sexual violence perpetrated inside the family circle mostly against young girls is rampant. Telling their life stories, full of sadness and traumatic events helps them to let off steam.

The other possibility is that people come looking for solutions or help about what decision to make concerning specific issues, for example a problem with their partners or a problem related to the conflict. In these cases, they ask the psychologist for guidance.

It is not always possible to return in the municipal administrative centres and rural areas. Many times patient follow-up is impossible. How do psychologists or psychiatrists work knowing that they may not see their patients again?

We have found out that, under certain conditions, a single consultation can have an impact and can be enough. And we know that it may be enough based on several reasons.  For example, the gratitude the patients express at the end of the consultation, when ex patients for some or other reason happen to meet someone from MSF a long time later and perhaps in another place after having been displaced and thank them or what the family members tell us about how this person has changed after this single consultation.

What kind of population does MSF see in Florencia?

At the Mental Health Centre MSF sees both IDPs and vulnerable populations. About 25 displaced families, including an average of 5 members each, arrive weekly in Florencia, from rural areas. It is a gradual displacement. There is also the kind of displacement to avoid forced conscription of children and 14-15 year olds by one or another armed actor. 
In 2007, 63% of the patients were IDPs and the number of people directly affected by the conflict but who were not displaced increased by 5%. And we attend around 30% of vulnerable people.

After two years working in Colombia, have you noticed any changes to the context?

It is a very long conflict, nearly 60 years. The only change I have seen during this time is that the conflict is increasingly shifting away from the urban areas and concentrating in the rural areas, the jungle. For example, before the roads were unsafe, now at least between municipal administrative centres they are passable. Yet working in rural areas is getting more and more difficult and people continue living in the midst of the conflict.