Complexo do Alemão, Rio de Janeiro, is made up of 13 deprived communities marked by violence and poor living conditions. Frequent conflicts leave the population trapped, living in an environment of fear and stress, with little in the way of healthcare.
Since October 2007, MSF has been providing psychosocial care to people with problems triggered by violence, such as anxiety and depression. MSF teams have carried out more than 1,300 consultations with patients of all ages but mostly children and adolescents. Below, Colombian psychologist Milena Osório, programme coordinator in Brazil, talks about the project.
How important are psychosocial services in a project like the one in Complexo do Alemão?
The mental health aspect is probably what best meets the population’s needs. Of course there are many medical needs, but the psychosocial programme is a private, confidential and neutral space where people can be heard without being judged. They can sit down and discuss their problems with psychologists who can help them mobilise their own resources in order to deal with the stress. This is something completely new to this community because people are so used to living in suspicion. They have to be careful of what they say and whom they say it to. Talking to somebody else about a violent event that they have witnessed may be misinterpreted as if they were denouncing something for example. And this could have an impact on their personal safety. Often they don’t want to talk to family members, so as not to worry them. It is very difficult.
In your opinion, what is most urgently needed?
There is a circle of silence here, which the people must keep in order to survive. It is a very oppressive silence and it had to be broken. It was very important to give people the opportunity to express what they used to keep inside. There is also the issue with children: most people wanted some support for their children, as they were not doing well at school, had behaviour problems and were afriad.
How does the service work?
We have a team of two psychologists working 5 to 15 sessions, though there is some flexibility. It is a brief therapy session, very objective, because MSF did not want to provide a kind of support that would make people dependent. The goal is to help people learn to live better with the problems they have, as they will face the same difficulties over again. It is very different from what you would do in cases when the patient is exposed to one single traumatic event in life.
Was the psychosocial service planned from the start of the programme?
Yes, but the project was inspired by others run by MSF in places of urban violence, such as Haiti and Colombia and we did not know what type of support we would provide until we got here and did some research. In the first few months, we had between 3 and 4 patients each day. People were testing our services. We have now done more than 1,300 consultations.
What are the main problems found in an environment marked by violence?
The physical, psychological and social violence that people face in the community ranges from an injury in a confrontation to stigmatisation, prejudice and other forms of violence. There are high levels of stress-related problems which can lead to physical problems, such as high blood pressure, panic attacks, breathlessness and palpitations. There are also a lot of depressed people who have lost family members, but can't talk about it.
Can you speak out about the things you see and hear on this project?
Ensuring confidentiality is the key to this project’s success. There has been an increase in the number of patients precisely because they know we are serious about confidentiality. Speaking out is important, but we will always keeping the promise of confidentiality that we make to our patients.
You have said that many patients are children. How do you work with them?
Working with children is not easy, as we also have to work with their parents. A lot of the time the parents are scared and they don’t know how to deal with the situation or how to help their children. We have to make them aware of how children react to fear, to a noise that they don’t like. This is also one of the most difficult parts of the work.
How does the psychosocial work fit with the medical programme?
They always go together. If a patient shows emotional problems when they are being seen in a medical capacity, they are provided with emergency psychological care. In this case, the doctor calls the psychologists to give some support to these patients. When a patient goes through the medical screening, the nurse will often realise that the problem is psychological rather than medical and will refer the patient to the psychosocial services.