The Seeds

Just in case if readers ponder why I titled my last blog “Wearing My Other Hat”, I am a person with many hats of trades. Besides being a medical doctor, I am also a counselor and art therapist. It all dated  back more than 10 years ago when I was working in Hong Kong with many underprivileged patients in a government housing estate. Numerous of them were suffering from mental or emotional problems, but due to financial reasons and insufficient services provided by the government, they had limited access to counseling /psychotherapy. In order to care for my patients in a more holistic fashion, I undertook a Master Degree in Counseling. As time went by, I realized that there were some blind spots with verbal psychotherapy or counseling, especially for children, people with language barriers, speech problems or simply those who do not express themselves well with words. Art therapy seemed to be another helpful treatment modality for me to put into my armarium. Consequently, I went to do a postgraduate diploma course (Master degree equivalent) at the  Toronto Art Therapy Institute in Canada. Therefore, working in the mental health field is wearing my other hat in  addition to my regular obstetric-related job.

In a community where it feels like everyone knows everyone, or knows someone that knows someone, I understand why one would have concerns about seeking professional help for mental or emotional issues, especially from an Ethiopian counselor. There are also myths about mental illness being the curse of  devils. Seeking help is  a sign of weakness. All these deter patients from obtaining help.

It cannot be more obvious that the actual demand for mental health services in Ethiopia is enormous while supply is limited. Similar to the medical health care with shortage of trained doctors and nurses, primary care is usually provided by health workers with some training. Counseling is usually done by community counselors (paraprofessionals) who will try to help with simple problems and more complex issues will be referred to psychosocial counselors.

It is now coming into recognition the importance of mental well being and the Ethiopian universities have started psychology as a new subject. They just had their first batch of new graduates in 2011. There are additional  increase in job postings in the newspaper from NGOs hiring psychologists, counselors and social  workers, especially for projects working with with  women and children from violence, physical and sexual abuse, and HIV.

Likewise with all other “new” professions in developing countries, the challenges these fresh graduates face are: lack of supervision and guidance from experienced seniors. They have to explore their own way.  The students were taught all the theories in the classroom but had not gained the actual working experience through practicums. Often they are overwhelmed and intimidated by the heavy workload and complex case scenarios in the workplace. On top they have the extra pressure of being “seniors” to teach  their juniors in 2-3 years time. Lack of access to textbooks and training materials is another major obstacle for continuing further education to advance in the field.

One other frustration for the psychologists and counselors are misconceptions of their job nature and scope of work by the uneducated public. They were often mistaken as “social workers” who can help solve issues about money, food and housing which are of extreme importance to satisfy the basic human needs. Clients will turn down appointments once they discover they cannot be assisted in those arenas.

In order for any foreign aid assistance program to be sustainable in the long run, it is of utmost importance to educate and train the local staff to deliver the services to their  own people. Besides conducting individual art therapy sessions, I also teach students and educate related staff about mental health and art therapy. (Ironically, art therapy is often interpreted by the locals as ART therapy-the antiretroviral therapy for HIV)

I am very surprised to find 3 young psychologists in Bahir Dar, one is working at Grace Centre for Children and Families, one for Alem Children Support Organization (ACSO), and one sadly (like many Ethiopian university graduates) is still unemployed. I am very happy to share with them my knowledge and skills and give them support and supervision with their work. Hence I started up a weekly 3-hour training program in art therapy and counseling with both didactic and practical components.

Topics that were covered include the theories and principles of counselling and art therapy, developmental stages of children- Erik Erikson’s stages of psychosocial development,; motor cognitive theory; Viktor Lowenfeld’s artistic developmetal stages etc., psychoanalytical theories of Freud, …to very practical, work related subjects such as aggression in children , stealing behavior, practical tips in setting up for an art therapy session.

The experiential practical portion of the training session gave the students hands-on experience using the different art materials, experience of using artwork for expression and exploration, learning the different art therapy techniques and mastering some directives such as those used in projective art therapy assessments.

Here are my 3 psychologist students (left to right): Hiwot Yared, Ateneh Abun, Tadesse Haile (future pioneers  in Psychology field in Ethiopia!)

Here are my 3 psychologist students (left to right): Hiwot Yared, Anteneh Abun, Tadesse Haile (future pioneers in the Psychology field in Ethiopia!)

These three young brilliant people are a delight to teach. They are very enthusiastic and keen to learn. They actively engage in  discussions and ask plenty of astute questions. They make full use of their experiential sessions and are very willing to share their reflections on their artwork. Tuesday evenings usually pass by without being aware of time. The three of them are encouraged to form a peer support  alliance for themselves to share and discuss their work experiences and hopefully will expand their network to other parts of Ethiopia and globally to the rest of the world.

Performing the Ulman's manouvre.

Performing the Ulman’s maneuver.

  Just to close this blog with a fancy note. My students were so proud and happy that they were told to be great- great grand students of Sigmund Freud.  Freud is considered by many to be the Father of Psychology. Dr Martin Fischer, the founder of both Toronto Art Therapy Institute and Vancouver Art Therapy Institute, was a student of Freud. All my teachers and supervisors from TATI were taught and trained by Dr Martin Fischer. Thus my students can rightfully claim to be  Freud’s students of the 4th generation down the line. I hope I had sown some seeds of art therapy and counseling in Ethiopia, Africa. I do have faith these brilliant and passionate young people will make the profession  bloom in their country.

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Wearing My Other Hat

After my first visit to Grace Centre, I was so touched by the work of these missionary volunteers to the children and families in need that I really wanted to help out in one way or another.  Thus, besides my regular weekday work with  the Amhara Regional Health Bureau on BEMONC training, I  volunteer weekends at Grace Centre.

The premises are jam packed with kids, most of them are from broken homes, single parent families, if not  being abandoned. For some, parents may be suffering from diseases such as HIV rendering them disabled to work or may even have died. Facing poverty and many difficulties in life, many of these children have emotional and behavioral problems.

Basic medical care is limited in Ethiopia, not to say mental health care. Awareness of holistic care and mental well being is on the rise and Ethiopia’s universities had produced their first batch of psychology graduates in 2011. Grace Centre was very  lucky to have hired one of the fresh graduates to provide counseling services and emotional support to their children. Obviously demand is much greater than supply and the list of children requiring counseling and therapy is long. I decided to put on my other hat and wrote a proposal to start a weekend art therapy and counseling program for the children. In order for the program to be sustainable in the long run, it is important to start training the local staff as well.

Art therapy is definitely a very new entity to Ethiopia. So far as I know, this is the first art therapy program in Bahir Dar even though this is not the first in Ethiopia. From my limited google search, Artists for Charity is operating a children’s home in Addis Ababa.  Deb Paskind and her 2 students from the Adler School of  Professional Psychology in Chicago had established an art therapy program in Awassa in partnership with Heartland Alliance for Human Needs and Human Rights in summer of 2011.

It is a lovely experience working with the Ethiopian children and a great learning  opportunity for  myself  doing therapy in a completely different cultural setting.

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There are some significant challenges:

Language is  a major issue. With my limited Amharic, I am conducting individual art therapy and counseling sessions with the help of  a translator. Not many local staff can speak English, hence I have to pull them out of their busy routine duties to assist my sessions.

This is Hiwot Yared, Grace Centre's psychologist. She is a great help in assisting me with the translation as well as offering me background information about the children.

This is Hiwot Yared, Grace Centre’s psychologist. She is a great help in assisting me with the translation as well as offering me background information about the children.

Understanding the children and their issues in their cultural context is another challenge. The children are overall shy. It is their cultural way to show respect not to have direct eye contact nor to speak loudly, not to say in front of a ferengi (foreigner). Ethiopian children are strictly disciplined, sometimes even by physical punishment. They are not very open verbally to express their  emotions. (Art therapy just comes in handy as pictures is a universal language for communication and children can express themselves freely through their  artwork)

Under normal circumstances in Ethiopia, art materials and supplies would be an issue. The local stationery stores do carry some color pencils and crayons. The only paper they have available is the A4 white paper for printing. I did attempt to search for paint in Addis Ababa, the capital, but the only paint I could find was for the walls. I discovered myself pretty spoiled  working at Grace Centre. With volunteers bringing in donations from abroad, I was surprised they even had the luxury of different colour markers, chalk,  and even foams for craft making. I did bring along some water colour, paint and brushes myself, so we are well equipped to have fun in art making. The only thing I miss is clay which is an excellent medium to use in art therapy.

Getasew 5 (4)

Power outage is not a problem. We can always go for an outdoor session for more fresh air and sunlight. One day I was caught off guard as we were happily doing finger painting when the water supply suddenly went out. How could I clean up the kid with his face and fingers all covered with paint? OMG, the cleaning staff would be cursing me making all the mess without cleaning up the room after. The next week I was a bit more prepared saving up a small bottle of water and rationed it amongst the kids.

Dawit 7 (3)

Last but not the least is the challenge of my own reactions as a therapist in witnessing the social problems that came along with poverty in the developing world. The most fundamental physiological needs in the Maslow’s hierarchy of human needs are not met. Food and other material supplies are scarce. These children are aggressive hitting their siblings fighting for a banana because they are hungry. They steal a loaf of bread as their family cannot afford. Common themes in their drawings include mostly food, house ( a strong  desire to satisfy their basic physiological needs  for food, shelter and protection) and cars. Food in Freudian psychoanalytical terms can also represent the oral needs for love and nurture.

This is a drawing from a 7 year old boy from a single parent family. The  following are items which he would like to have: a car to take him to see his dad, a book to learn, an apple to taste ( he had learnt about apple from school), an orange to eat and a TV with  remote control. (I think kids in our developed countries should find themselves very lucky having all these things possessed  for granted)

This is a drawing from a 7 year old boy from a single parent family. The following are items which he would like to have: a car to take him to see his dad, a book to learn, an apple to taste ( he had learnt about apple from school), an orange to eat and a TV with remote control. (I think kids in our developed countries should find themselves very lucky having all these things possessed for granted)

This picture speaks it all. This is a drawing by a mentally retarded child. He said this was the hero (mother) with super powers to protect the 2 children.

This picture speaks it all. This is a drawing by a mentally retarded child. He said this was the hero (mother) with super powers to protect the 2 children.

Later he drew the father of the children on a separate piece of paper.He indicated he would like to stick the two pieces of drawings together.

Later he drew the father of the children on a separate piece of paper.
He indicated he would like to stick the two pieces of drawings together.

With the language and cultural barriers, I am not quite sure about therapeutic  benefits of my therapy on these children. However, I am glad that at least I  can provide a safe and nurturing setting for them to express themselves and receive some one-to-one attention amongst a big crowd of kids (They usually have large classes of at least 40 children taught by one teacher) I am so happy to see these children so engaged in doing their artwork and their self confidence and esteem improving over the weeks.  Some of them are even out of their “shyness” running up to give me hugs and high fives when they see me down the street.

Totally Absorbed

Totally Absorbed