C40 Indigenous Healing of X NWar-Affected Children in Africa Edward C. Green, Ph.D. and Alcinda Honwana, Ph. D. Childrcn in war-torn countries of Af- tions such as Save the Children and the rica and elscwherc are often direct Christian Children's Fund have devel- or indirect victims of violence, and/or oped various types of so-called psycho- C witnhssrs to various horrors associated social programs to assist war-affected wvith war. Children as young as seven or children. port therapeutic tchniques cight are forcibly conscripted and in- for war-affccted children remain at a doctrinated as child soldiers or porters very preliminary stage of development. =1 in several African countrics. Girls as It is not knowNn to what extent westcrn well as boys often suffer, some being psychotherapeutic techniques for forced into sexual or other service at PTSD-which were originally devel- early ages. In conflicts where tcrroriz- oped to treat American veterans of the ing civilians has becomc a routinc Vietnam war-would be appropriate means to political and military ends, and effective for children in Africa and wvomen and children are deliberately other less-developed areas. One of the targeted for torturc and death. Glo- conecrns with the PTSD is the very no- bally, there are at least onc million chil- tion of post-traumatic stress disorder. dren separated from their parents be- In these contexts, it is problematic to cause of war, and there are many thou- talk about trauma as the past (post), if sands Nvho have been traumatized even one understands the notion of violence more directly by wvar. Child victims of to be broader than direct exposure to this sort often exhibit symptoms of war situations (military attacks, post-traumatic stress disorder (PTSD), landmines, etc.), and to cncompass to usc the Western psychiatric label. sphercs like poverty hunger, displace- Symptoms of PTSD and related stress ment and the like. Another concern No. 10 reactions common in children include: with the PTSD lies in its therapeutic July 1999 avoidance/numbing, as in cutting off of feelings and avoidance of situations that provide reminders of traumatic 1K .\Vres r.cv .-ri+,: 1ri,dial! oln lhifi- en--.r, I l dn .. i i.lI riil.l 1 events; insomnia, inability to conecn- .L,F1. 1Il.irarL .\Irc.,. it , puhilicJ 1 trate, "intrusive re-experiencing," such th mric.i .iu,njiin' kintlivig iii .I..arnirlin 1. n i .1. r Ilart 'ji : Li I as nightmares and flashbaclis; lethargy, IK pi rtn.rI1iip l,tv.ten Lii-, \'.,r:.I confusion, fear, aggressivc behavior, so- B 11ai. L*,ilIiiiIlc ,. Ni I.l. dOCl.-.- cial isolation, and hopelessness in rcla- iltt ii IfI Altl, ,Li iii. i It I I.L,r iI- rIM.1 tion to the future, and hyper-arousal as article ir., Lii [i,< :,li,ldi,rr rid cvidenced in hyper-vigilance and exag- sh.uld utln . :atLirbuLtd [v. rl \'.Orld W -t' 4 2 . ~~~~~~~~~~~~~~~~~~~Bail;. iro -r,-,il- .... tv pirtimsr;in1 [01lfi 1iiii gerated startle responses. Baitl: A I L. l uK 1xi.r- in lthlib it In recent years, UNICEF, IUSAID, and hrlli rI,d' ....Il.1iik .,r., idltdr ik various private, voluntary organiza- de'. lt lirnr 2 techniques which are centered on thc individual patient. There is evidence from throughout Africa that mental or Such focus ignores local beliefs in the rolc that aneestral and psychiatric disorders are among the conditions for which malevolent spiritual forces play in the causation and healing modern or western medical help is least likely to be souglht. of thc I,. UI It also underiminies family and commurnity African people generally turn to indigenous forms of therapy involvement and active participation in the healing process. in case of mental health. Empirical studies of the relative ef- During early psychosocial programs for war-affected chil- fcctiveness of different forms of western psychotherapy in dren in Mozambique and Angola. community leaders, tradi- fact show that virtually all psychotherapies do the patient tional healers and families showed tremendous knowlcdgc of some good and all are potentially effective when embedded how to heal the 'social wounds of war in war-affected chil- within social and cultural specificities. This may suggest that dren and adults. Such disorders are in fact quite treatable by as psyehotherapists, indigenous African healers may be at traditional healers, based on indigenous understandings of least as effective as modern medical specialists, especially how war affects the minds and behavior of individuals, and on among those who share a common African culture. shared beliefs of how spiritual forces intervene in such pro- Anthropological research done in Mozambique and Angola cesscs. During the implementation of these programs, people shows that war related psychological trauma is directly linked expressed no need for help in addrcssing children's' specific to the power and anger of the spirits of the dead. The impos- mcntal or behavioral manifestations. WVhat they needed, they sibility of performing proper burials in times of war does not said, was help in finding missing family members and in es- allow for these spirits to be placed in their proper positions in tablishing schools, pre-schools, creating jobs opportunities the world of the ancestors, so thev are considered to be bitter for the youth, and promoting a stable social environment in and potentially harmful to their killers and passers-by. Social which to function. pollution may arise for being in contact with death and bloodshed. Individuals who have been in a war, who killed or were around killings are believed to be potential contamina- IK N o te s tors of the social body Thus, cleansing and purification ritu- als are essential for their rcintegration in the communities. would be of initerest to: In 1994, during the first project in Angola specifically to help war-traumatized children, it was found that children werc already being helped by indigenous psychotherapy, pro- Institution vided by indigenous healers in the form of ritual purification ceremonics. This was provided for both ex-combatants and Add ress children who had either participated in or witnessed blood- shed. The earlier Children and \W,ar project in Mozambique found similar treatments for children. In both countries, these therapies appeared to be effeetive, at least in the short-term. Traditional healing for war-affected children in Letters, c*mments, nd requess for ubicaon Angola and Mozambique seems to consist principally of puri- Letters, comments, and requests for publications should be addressed lo: = fication or cleansing rituals, attended by family mcmbers and the broader community, during which a child is purged and Editor: IK Notes purified of the "contamination" of war and death, as well as Knowledge and Leaming Center Africa Region, World Bank of sin, guilt, and avenging spirits of those killed by a child sol- 1818 H Street, N.W., Room J5-171 dier. These ceremonies are replete with ritual and symbolism Washington, D.C. 20433 E-mail: pmohan@worldbank.org whose details are distinctive to the particular cthnolinguistic group, but whose general themes are common to all groups. 3 In thie day of his arrival his relatives took hlim to the ndtumba This case emphasizes the non-interaction with family and (thte house of the spirits). There he was presented to the ances- friends before ritual cleansing. The child is kept out of the vil- trcd spirits of the family. The boy's grandfather addressed the lage until the ritual is performed, and cannot greet people spirits informing them that his grandchild had returned and and sleep in his bed until the ritual proceedings are over. As thanked the spirits for their protection as his grandsoni was mentioned above, although children may be asked about wvar able to return alive ( ...) Afew days later a spirit medium was experiences as part of treatment, this is not a fundamental invited bv the family to help them performn tle cleansing rituals condition for healing. The ceremony aims at symbolically Jor the boy. The practitioner took tle boy to the bush, and there cleansing the polluted child and putting the war experience a smiall hut covered with dry grass -as build. The boy, behind him, to 'forget" (note the symbolism of being forbid- dressed with the dirty clothes he brought from the RENAMWO den to look back, in the example from Uige). Food taboos and camp, entered the hut and undr-essed himself Thenfirewas set other kinds of ritual restrictions are applied. In the Uige, for to the hut, and an adrdt relative fhelped out the boy. Th-e hut, the example, fish and fowl must be avoided by the cleansed per- clothes and everything else that the boy broughtfrom the camp son for 1-2 months, after which the person must be rcintro- had to be bumned. A clhicken7 was sacrificedfor the spirits of the duced to the food by the traditional healer who officiated at dead andcC the blood spread arountid the rituacl place.After that the ceremony the boy had to inhale the smoke of some herbal remedies, anul The Okupiolissa ritual from Huila in Angola clearly shows bathi himself with uater treated 'with medicine (Fieldnotes, the active participation of the community in these rituals, Iozambique). and strcsses the idea of cleansing from 'impurities. This healing ritual brings together a scries of sNmbolic The community and family members are usuaCly excited meanings aimed at cutting the child's link wvith the past (the and pleased at the homecoming. Wobm-en- prepare themselves war). \Whilc modern psychotherapeutic practices emphasize for a greeting ceremony (..) Some of theflour used to paint the verbal exteriorization of the afflictioni, here through symbolic women's forehetads is thrownt at the child and a respected meanings the past is locked away. This is seen in the burning older womana of the -oillage throws a goturdfilled -ith ashes at of the hut and the clothes and the cleansing of the body. To the child's feet. At the same time, cleanl water is thrown over talk and recall the past is not necessarily seen as a prelude to him as a means of 1ni,io-irka ' ( ... ) the women of the village healing or diminishing pain. Indeed, it is often believed to dance around the child, gesturing *uith hands and arms to open the space for the malevolent forces to intervene. This is ward a-way undclesirable spirits or influences. (...) they each also apparent in the following case from Uige (Angola). touch him with both handsfrom head tofoot to cleanse him of impurities. The dance is known as: IThdlando-w-w-w. 117iel ;c huel- the child or yountg nianl returns home, he is made to ritual is coniplete, the clhild is takent to lus i'll, ql,& and the villag- w-ait ont the outskirts of the village. The oldest wzomanfi-omr the ers celebrate h.is return. A party is held in his home where onlly villtge throes maize flour at the boy and anoinits 1his entire traditional beverages (..) The child must be formally pre- body with a chicken. He is only able to enter the ,lw . 'o after sented to the chiefs by his parents ( ...) the child sits beside the this itual is complete. After the ritual, he is allowed to greet tis chiefs, driking and talking to them, and this act marks his famnily in the village. Once the greeting is o-ver, he must kill a change of status in the village. chicken, which is subsequently cooked and served to the farn- ily. For tdefirst eight days after the homecoming, he is not al- Thesc cleansing and purification rituals involving child sol- la-wed to sleep in his o-tvn bed, only on a rush mnat n7 the floor diers have the appearance of what anthropologists call rites Durinmg this time, he is taken- to the river and uater is poured of transition. That is, the child undergoes a symbolic change on1 his head and he is given manioc to eat. As he lea-ves the site of status from someone who has existed in a realm of sane- of the ritual, he must not look behind him. tioned norm-violation or norm-suspension (i.e., killing, wvar) 4 to someone who must now live in a realm of peaceful behav- ment programs to sustain the gains achieved in the psychoso- ioral and social norms, and conform to these. In the case pre- cial and emotional sphere, and which cannot be dissociated sented above from Huila, the purified child acquires a ncw from the rest. status which allows him to sit besides the chiefs and interact Therefore, the approach of donor organizations, NGO and with them. Until the transition is complete (through ritual other organizations involved in humanitarian aid for war-af- performance), the child is considered to be in a dangerous fected children should take into account local understand- state, a marginal, "betwixt and between," liminal, ambiguous ings of war trauma and indigenous strategies for dealing with state. For this reason, a child cannot return to his family or it. They should work towards promoting stable, secure, cul- hut, or sleep in his bed, or perhaps even enter his village, un- turally-familiar cnvironments in which children can gain a til the rituals have been completed. sense of competence and security in a more predictable Manifest symptoms associated with PTSD and related world by encouraging self-rcliance through reliable commu- stress disorders reportedly disappear shortly after these cer- nity development projects. their families, or with appropriate emonies, after which the family, indigenous healers and local foster families if necessary chiefs direct attention toward helping to establish an endur- The project of the Christian Children's Fund in Angola tries ing, trusting relationship between the traumatized child and to build upon existing indigenous healing practices and familv members, and with adults of good character. These strengths, and complementing these with its psychosocial in- ritual interventions arc also intended to re-establish spiritual terventions such as those just described. Evaluations of this harmony, notably that between the child and its ancestor project and the earlier "Children and War" project in spirits. The re-establishment of normal relationships and ac- Alozambique have shown that such an informal partnership tivities with other children may not be part-or a major betwecn indigenous healers, with their ritualistic therapies, part-of thesc indigenous healing rituals. But, healers, vil- and donor-assisted programs, with emphasis on the family lage elders, teachers and other child caregivers readily under- and social adjustment of the child, may provide a model of stand this when presented with the idea during project-sup- how indigenous and Western-scientific approaches can be ported training seminars, in both Angola and Mozambique. pursued together to provide maximum benefit to children in Play therapy, drawing, drama, dance and story-telling are need. Furthermore, such a model of cooperation and sharing some of the techniques introduced in thcse seminars. of responsibility serves to validate indigenous healing and bc- There is no doubt that these rituals are instrumental in liefs, which tends to energize and mobilize local people who, building family cohesion and solidarity, and in dealing with ultimately, need to develop sustainable, culturally acceptable the psychosocial and cmotional side of these children s prob- solutions to help themselves. lems. The fact is, however, that they return to an impover- ished countryside struggling with basic survival needs, and many with no schools, hospitals, no vocational training or job opportunities which would allowv them to envisage the pros- pects of a better future. Thus, while these rituals are impor- tant they need to be complemented by community develop- The authors would like to thank the Christian ChildrenwsFlld, Save the Children (USA), the C,ildl.. 1', ,l, I WarProjectand the Displaced Children and Orphans Fund, UISAID, for utse of informationffrom their programrs. We would also like to thank Alike WVessellsfor usefud comments and sugestions. Edward C. Green can be contacted at: egreendc(laol. com Alcinda Hon'ana can be contacted at honwana@beattie.uct.ac.ra