Changing Perceptions of Global Medicine

"Through the CASE rotation as a second year resident, I had the opportunity to continue the work I started as a medical student, focusing on the mental health needs in the Kono District of Sierra Leone. Civil war raged in Sierra Leone between 1991 and 2002 and during that time, many children were raped repeatedly and forced to take drugs to reduce inhibitions against committing violent acts. One of the predominate drugs used to enforce these violent acts was brown-brown, a mixture of cocaine and gunpowder. As such, during my time in Sierra Leone I witnessed many young men, who currently still use this substance, portray symptoms consistent with psychosis. As a result of their substance use and associated symptoms, many were shunned away by people in the community. During my most recent visit in March 2013, I wanted to further characterize the symptoms of these individuals and understand the stigma surrounding mental illness in general, in hopes of developing strategies/treatments to integrate these young men back into the community. Through my experience, I really appreciated the desperate need for skilled clinicians to work in areas were people are too often neglected and in crucial need for help. As there are no practicing psychiatrists in the country, many people have taken liberties in treating the mentally ill. It was not uncommon that I encountered men tied to trees or locked in rooms for months without outside contact, to prevent 'evil' spirits from running loose. I had to do away with my Western ideas/teachings of mental illness and understand the perspective of the Sierra Leonean community. By approaching many people without judgement and motivated by the need to genuinely help, I relied on my expertise thus far, to not only diagnosis, but treat the young men afflicted with the 'evil' spirit.

"As the stigma attached to both mental illness and substance use is so intense, I often found myself making house calls in the middle of the night or early morning to prevent others from noticing the "white woman," who visited the house. Oh yes, I am in fact Black American, however I quickly learned that any person from the US/Europe, based on their style of dress and dialect was considered a white woman! Not only did I experience a true cultural shift, much different from anywhere else in the world I've visited, but my usual understanding of how I perceive myself as Black woman in society was challenged. Overall, the experience in the global mental health project in Sierra Leone, has undoubtedly changed my life and worldview, not only on how psychiatry is practiced, but how medicine on a whole is approached throughout the world. I look forward to continuing my project this upcoming January 2014, as it is sure to be an unforgettable and worthwhile experience. Psychiatry indeed is a life long experience in learning and I am so grateful to have been able to participate in my Sierra Leonean project. I am now convinced my clinical practice and research endeavors, will undoubtedly include some facet of global work!"

Dr. Ayana Jordan, Yale Psychiatry Resident