by Br. Luca Perletti

I came back to Italy a few days ago after spending five months in Sierra Leone. These were intense months of planning and setting in motion activities that focused – after the installation of the laboratory at the Holy Spirit Hospital of Makeni – on the training of counsellors through a theoretical and practical programme; on psycho-social support for four hundred families; and on the reorganisation of a number of basic health-care centres (PHUs), the first entrance door into the health-care system of the country. Half way through (the project will come to an end in December), I would like to make some observations in continuity with my previous observations on the subject of resilience, the natural capacity of this people to deal with a thousand adversities.

My thoughts take as their point of departure the question about the relevance of our action which is described as psycho-social because it unites humanitarian aid (in the form of a cash transfer) with aid of a purely psychological character. I wonder whether dealing with this dimension has sense or is it not another one of our ‘riches’ which has been exported to an alien culture? This article of mine does not have any scientific claims – it has the value of personal reflections that I had to address in the field. I will therefore begin with the difficulties that were encountered – which in a certain sense would advise against an initiative involving psychological help – to then observe that a need exists to express emotions which are often taken for granted and not dealt with. To sum up, I would like to end by saying that what we are doing has sense. I will do this basing myself on the facts and experiences encountered in the field, recorded in from my personal diary.

  The evenings passed in the company of the Superior of the Saverians in Makeni, Fr. Luis Perez (a Spaniard), were a breath of fresh air. We spoke about and shared everything and even more: not only news but also reflections. One evening we talked about the difficulties of inculturation and of the challenges involved in introducing messages and techniques that are extraneous to a local culture. This is especially the case for some of the programmes of the overall project of the Camillian Task Force. Indeed, the psychological approach uses abstract concepts (wellbeing or malaise; emotions and feelings) which are alien to those who in order to define themselves have to refer to concrete situations and objects. There is no being well that is separate from the body and this in the local language people do not say ‘how are you?’ but ‘how is your body?’. This is because the body – which is so tangible – is the first indicator of wellbeing or malaise. In other words, there is no concept of wellbeing that is separate from the immediate, objective and perceivable feeling of the presence or absence of disturbances. Our European language – which is habituated to philosophical and abstract concepts – here finds itself ill at ease because it does not create bridges of communication but only confusion. Good, beautiful, right and wrong, wellbeing or malaise do not exist unless they are tangible. This is a barrier that is at times frustrating because questions which for us are self-evident encounter as answers bewildered expressions and silence. A psychological approach based on speech here encounters all of its limitations and ineffectiveness. Not because the local culture does not communicate. Indeed, everything is based on communication; perhaps no other population makes such use of communication through the colourful and detailed description of facts and events. It is simply that local communication does not mange to engage in abstraction and to go beyond concrete, lived and described reality.

I will not enter into an analysis of why an incapacity to engage in abstraction if applied to moral choices runs the risk of not seeing good and evil in themselves and seeing each choice on the basis of the effects or results that are obtained or hoped for. We encountered an interesting case of this kind in a group of young teenager girls who were orphans where moral assessment (which was obvious for us!) of their choices was not so obvious for the group, where some of these girls accepted the possibility of ‘selling themselves’ if this allowed them to support their families that were in a state of difficulty and their orphan siblings. I would like to quote the following words from my diary of that day: ‘I was shocked! I admired the freedom of thought of some young girls who thought that keeping their families alive at the cost of their own bodies was worthwhile. How can I allow myself to judge? In fact…starting with the most elderly, they began to die one by one by one’.

Another difficulty of psychological action is connected with what seems to me to be a characteristic of the local culture. This culture is characterised by uniqueness, the overall and totality (in English one would say ‘wholeness’) which is so different from our tendency to break things down, to create watertight compartments, and to distinguish between what is physical, psychological, spiritual, social and so forth. Our medicine, to take an example, has created a very large number of branches of knowledge whereas traditional healers – alas sadly famous during this epoch of Ebola – attend to the body and the soul at the same time without distinguishing between what is biological and mental. In our programme of psychological intervention we had to face up immediately to this cultural heritage which sees a whole in the various dimensions of life whereas we – through our schemata and models – instead applied an approach made up of ‘sectors’. We are used to dividing things in line with schemata whereas in this land everything is a part of life in a flow that does not know separations or compartments. It is impossible to translate concepts such as a ‘support conversation’ (just to give an example) because in this culture that is rich in communication, this is proper, practical and even a ‘support’ at one and the same time. In a questionnaire that was distributed to 400 families that belonged to the programme is was truly difficult to ask them to describe the kind of meeting that they had had with the counsellor of reference because each individual meeting was everything at the same time and could not be reduced to dealing with the presumed malaise or difficulty which cannot be separated from real life and from the need to find answers and solutions to it.

To sum up: whereas we make distinctions, our brothers and sisters of Sierra Leone integrate! And this is understandable because their ladder of needs begins with the lowest rung…hunger, survival, and the urgent aspects of life. I realise that it was a great blessing to live in a culture that had handed down centuries of riches at the level of thought and in a society that allowed me to go beyond basic needs and able to meet the ‘highest’ needs. Those who have not had this blessing are forced to put them all together and to try to provide an answer to them starting with those that are most compelling and cannot be put to one side! To sum up: difficulties in engaging in abstractions/conceptualisations and an inability to ‘compartmentalise’ make it difficult to implement a support programme that is purely psychological in character.

Nonetheless, the social component makes it effective and this explains the success that it is having, a success measured in a more careful presence at meetings; in greater self-care (clothing); and in careful listening to other people…that is to say, starting with basic needs does not contradict the process of psychological support but is an integral part of it!

     I would like here to move towards the end of my article and say that what the Camillian Task Force does has meaning. I will do this drawing fully upon my travelling companion, my daily diary in which I noted down my experiences and thoughts. I am referring here to my comments of the last week of my stay. ‘This week I had an opportunity to address the effectiveness of our project starting with the criticisms that were made of me by some priests of the diocese of Makeni. I do not dismiss these criticisms. Instead, they offer me food for thought, in particular as regards the following two points: economic support in the form of ‘drops’ (the cash transfer), in the view of some generates dependency and does not develop a capacity for enterprise (a); the success of the project (the evident increase in prosperity) is linked to economic help (b). These are pertinent and legitimate observations which challenge the mind to develop ‘lateral thinking’.

Faced with the first observation, the immediate answer is that ours is not a humanitarian and development project: economic help was only a liberal act to support the trials of those who had to manage the complex situations connected with Ebola. However, from the answers and agreements it emerged that the use of money was directed towards that essential expenditure that placed in the second row by economic straightened circumstances, for example education and health. The answers of the head of the families of those 400 families that were selected confirmed the studies on the cash transfer according to which it generates capacities for expenditure in the sectors of education and health in up to 75% of cases, without taking into account that this method respects the dignity of individuals…

As regards the second observation, I am not so ingenuous as to think that our action can be separated – when considering its evident impact – from economic help. But at the same time I do minimise the role of the constant presence of the counsellors, of the monthly self-help meetings, of the solidarity and the nearness that is generated. We put together the conditions so that this could occur and if wellbeing is evident then we should only take note of this with pleasure. The question here is whether economic help is a locomotive and determining factor in achieving this wellbeing. There is no doubt that it is where basic needs are compelling and a welfare system of protection does not exist. The hierarchy of values should be respected and we could not have met emotional needs if we had not first taken into consideration and met those relating to subsistence. When a certain prosperity has been reached, we are challenged to strengthen self-valuing and to create self-reliance, so that the temporary benefit becomes lasting and sustainable. This part of the programme is the one we want to engage in during the second six-month period, transforming current resilience into a stable form of self-valuing and a capacity for micro-economics.

     At the same time, and the group of Lungi, in the Parish of St. Joseph, has demonstrated this, there is no economic help that can put out the fire of emotions. You can give all the money that you want but you can never silence the emotions caused by the death of loved ones, deaths that are so sudden and without the possibility of suitable mourning and detachment. There has always been, and there will always be, room for words of comfort, for listening, and for drying tears as support for mere economic help. Even when life presses with its urgent and compelling realities, a soul will never cease to claim a space all of its own so as to be able to weep for loved ones who are no longer there and find a meaning to the many ‘whys’ that have not been avoided’.

To sum up: a psycho-social project will have meaning only if it integrates various dimensions so as to create a holistic approach in line with the sense of unity and wholeness of this people! It will thus be able to help to strengthen the destiny of the people of Sierra Leone in living that incurable and irreducible resilience that makes them get up after every blow; their joy and the happiness of faces that smile and are ready to erupt into songs of joy; their openness to life in the gift of welcoming the weakest, children, so that there are no longer any orphans; and their capacity to give way to the new, to the foreigner and to the different.