The Mobile Member Care Team as a Means
of Responding to Crises: West Africa
Page 2

There are aspects of certain African cultures that seem to enhance one’s ability to endure hardship. Some of the themes I have observed in many Africans that seem to promote resilience and community are: 

• A lack of entitlement. Not always expecting to get what you want or what you think you have a right to helps one to endure disappointments and the failure of others.
  
  
• A tendency to apply grace when mistakes are made.
  
  
• An expectation that life will be difficult—not being taken by surprise when bad things happen.
  
  
• A strong sense of family and community—loyalty to one’s relatives, clan, and tribe are extremely important.
  
  
• A high value placed on generosity and hospitality—this means giving freely to and welcoming others who are in need or who have less than you.

The Trauma Healing Workshop—A Workshop for African Christian Leaders

In 2004, our team was asked to help facilitate a trauma workshop that had been developed by staff from a mission that focuses on Bible translation into African languages and the application of scriptural principles to every day life in Africa.  The workshop was particularly designed for Christian community leaders from African countries that were currently or had recently experienced the trauma of war or ethnic conflict.  The participants of this workshop came from Burundi, Uganda, Democratic Republic of Congo, Chad, Nigeria, Ghana, Côte d’Ivoire, Liberia, and Sierra Leone.
They all had personal stories of trauma, experienced in their hometowns, because of war and ethnic conflicts.  Some of the violence was related to rebels seeking to destabilize the country and overthrow the ruling party.  Some of it was related to two ethnic groups at odds with each other.  Other violence related to tensions between Muslims and Christians.

One man described being in a bus that was ambushed.  When the perpetrators left, 20 people had been killed.  Another man talked about working with children who had been kidnapped and forced to be soldiers.  He worked with a boy who had been forced to club his mother and then watch as other children were forced to club her to death.  Another man described his personal trauma of losing his father, sister-in-law, and six year old nephew during a raid on his village by Muslim fundamentalists.  His father was a retired pastor and was shot and killed in front of his own house. 

Still others talked about the kinds of atrocities that they had witnessed themselves or heard about from friends and family during the wars in their countries.  They spoke openly about women being raped, sometimes with inanimate objects, people’s arms and hands being chopped off, brothers selling their sisters for sex with soldiers, pregnant women being disemboweled, people being made to clap and dance as their houses burned down, and people being buried alive. 

These were the images, the sounds, and the memories that people brought to the workshop. For many, the way to deal with these experiences had been just to try to forget them and to concentrate on moving on and helping others.  Some were restricted by misconceptions of how Christians should deal with grief (i.e., that they should not show any grief or sadness, but should immediately move into a joyful or triumphant state).  These misconceptions had blocked genuine healing from trauma. 
We started each morning in a classroom setting using a textbook that was specifically developed for Africans (Hill, Hill, & Bagge, 2004).  Each chapter opens with an illustration from an African village setting.  Half the group received their lessons in French and the other half in English depending on their country of origin.    Topics included how emotional wounds can be healed, the process of grief and how to help people who are grieving, how to help children who are traumatized, how to help women who have been raped, helping people with AIDS, caring for the caregivers, a process for releasing emotional pain, forgiveness, dealing with ethnic conflicts, and crisis contingency planning.  We looked closely that the kinds of spiritual questions that people ask during these types of events like, “Why does God allow suffering?”   During these teaching sessions, our process included lecture, large and small group discussion, role-plays and demonstrations, stories and case studies.

All but one of the 28 participants were men and for most of them this was the first time they had publicly discussed the topic of rape, which has typically been a taboo subject.  We talked about the physical and emotional impact of rape on a woman and the kinds of things that make it worse for her (i.e., being blamed or ignored).  We discussed ways that women who are raped can be helped medically as well as psychologically.  Many of the men indicated that they never knew how women were affected by rape, and they committed to hold rape awareness seminars in their home towns as a way of more supportively responding to rape victims. 

After the teaching sessions, the group went into their separate language groups and began to translate the written lessons into their own mother tongue so that these things could be taught in their home villages when they returned.  Their translations were later checked by the staff to ensure true understanding of the meaning of the material, leading to accuracy of translation.

The group also had the opportunity to ask questions of the professional counselors present or to meet with them individually if they wanted.  Some of the questions included things like wondering how to help a brother who had been forced to drink blood and was now having nightmares or wondering how to help a friend who had been very angry and violent since the war.  I had individual counseling sessions with several men from Côte d’Ivoire with the assistance of a translator.  Many of them came asking for help with their children who were manifesting post-trauma behavioral problems such as regressive behavior, acting out, and difficulties in school. 

Another strategy that we used to facilitate the expression of emotional pain was to give them the exercise of writing a song of lament in their own language.  The elements of this song would include the wrongs that had been done to them, how they felt about it, and some kind of affirmation of their trust in God as their helper and provider.  Each person wrote his or her own song and put it to traditional music and then shared it with the whole group. 

Each evening, a few would come before the whole group and share their personal stories of trauma and pain.   Even though most African men do not cry in public, some of those in our workshop did weep openly as they shared their stories.  For some, it was the first time they had ever talked publicly about what they had experienced.   For many, it was the first time they had shared their pain without having someone give them a pat answer or a sermon or by telling them to stop thinking about it.  The group responded to each person by quietly listening and then gathering around them with expressions of support and praying for them.

During the second week of the seminar, each person was given an opportunity to write down on a piece of paper, the experiences and feelings they had which were bringing them the most pain.  They had a time of personal reflection and then shared these things in pairs.  Afterwards the group came together and in a special ceremony, each person walked to the front of the room where there was a large wooden cross and laid his or her paper at the foot of the cross, symbolizing the act of giving their pain over to Christ, who according to Christian beliefs is the pain-bearer.  Then the papers were gathered up, taken outside, and burned as we all stood watching and quietly singing. 
After this ceremony, one man shared that ever since his house had been destroyed, he had been obsessed with drawing up new house plans.  He would draw plans over and over again and then destroy them.  His wife tried to get him to stop but he felt that it was out of his control.   After taking his wounds to the cross, this man testified that the destruction of his house was one of the things he had written on his paper and he genuinely felt that he had been released from his compulsion to draw house plans.  The way he said it was, “My sickness of ‘house’ has been healed.”

Two nights later, after the “taking our wounds to the cross” ceremony, we had a session where we identified where we ourselves were culpable.  Many people in the midst of trauma have also done things that they were ashamed of or engaged in actions they knew were wrong.  And, many began to realize that they were still holding onto hatred and bitterness towards the people who had harmed them, killed their family members, burned their homes, and committed many atrocities.  It was very hard to let go of this.  Yet, it seemed clear that this hatred and bitterness was the fuel for ongoing pain, deepening wounds, and a desire for revenge that seems to feed the continuing cycle of violence in so many countries.  Forgiveness is a central aspect of the Christian faith.  Jesus forgave His persecutors as he died on the cross and He commanded his followers likewise to forgive their enemies.  However, it’s a command that many Christians struggle with and are loathe to follow, especially when their persecutors have not asked for forgiveness, and even continue to harm them and seem glad for their pain.  Nonetheless, that evening, we all wrote down areas where we needed forgiveness and once again took those things to the cross.  In the testimonies afterwards, many shared that they felt they had now forgiven the ones who had hurt them the most deeply.  And for some, we could see a transformation in their facial expressions – from anger and pensiveness to genuine joy.

The seminar ended with a time of planning for the future.  Specific goals were set for workshops like this to be held in the local areas in the coming months and for us as a group to meet again in early 2006 to assess progress and continue to do translation work together.

One always wonders about the long-term impact or effectiveness of a particular seminar.  Time will tell, but immediately after the workshop, we gathered written evaluations from the participants to try to determine what the significance of the training had been for them.   Many spoke of now having more hope and a decreased sense of anger and sadness.  Quite a few referenced the significance of being able to let go of bitterness and to forgive the ones who had wronged them.  Some referred to the value of better understanding the grief process and their plan to encourage others to mourn more genuinely rather than trying to cover over their feelings and deny their pain. 
Overall, it seems that the aspect of the workshop that most impressed each person and resulted in life change was the process of identifying wounds, symbolically taking them to the cross (surrendering them to a trusted source), and choosing to forgive those who had caused their wounds.  In a world filled with violence that has been perpetuated through the generations, perhaps workshops like these are a start to trying to end the cycle of retaliation and revenge.  
  

The Workshops of MMCT—The Training Strategy

Three workshops currently form the core of our training strategy: Sharpening Your Interpersonal Skills (SYIS), Peer Response Training (PRT), and Member Care While Managing Crises (MCMC). 

Sharpening Your Interpersonal Skills (SYIS)

The SYIS is a four and a half day workshop developed over a period of nearly thirty years by Dr. Ken Williams of International Training Partners.   MMCT has conducted 29 of these workshops over the past four years with 645 participants.  This workshop provides training in key knowledge, attitudes and skills needed for developing and maintaining healthy relationships.  Some of the topics are: listening, building trust, living in community, helping others manage grief, confrontation, conflict resolution, and managing stress.  We facilitate six to eight of these a year in the region with about 24 participants from various mission organizations and countries of service in each workshop.

Aside from the personal growth that many experience through this workshop, we see other benefits, too: we as an MMCT team are coming to know many missionaries in the region and are identifying the natural “people helpers” that are potential peer responders for the future.  In addition, we are able to begin working relationships with mission leaders who take the workshop, which later makes a difference when we are called in as consultants during crisis situations.  Also, missionaries from several organizations who have worked in the same area for decades are sometimes for the first time in a setting where they can build community and informal support networks across organizational lines.  This is crucial on the front lines of mission work and far too often not the case.  Additionally, for many of these cross-cultural workers, it may be the first time they have interacted with a psychologist.  This gives them an opportunity in a non-threatening environment to develop a relationship with a mental health professional and break down negative stereotypical views about them. 

Peer Response Training (PRT)

Building on the basic interpersonal skills covered in the SYIS, the PRT is a six-day workshop designed for those already coming alongside their peers as helpers.   The PRT workshop requires an application process that includes recommendations from their SYIS facilitators affirming their basic interpersonal skills; from their mission leader confirming their confidence in them, their availability to serve and the mission’s intention to use them once trained; and from a mission peer who expresses confidence in their interpersonal skills in crisis situations. 

MMCT has offered this workshop three times and has trained 51 cross-cultural workers to be peer responders.  Participants learn about the typical impact and effects of crisis, the potential pathological effects, how to make initial contact and how to provide one on one psychological first aid.  The workshop also includes personal assessment of attitudes towards suffering.  Other topics include when and how to make referrals and ethical issues such as confidentiality and boundaries.  The last session of each day is a coaching group time when a group of four participants meets with the same staff person to share with one another what they have been learning and experiencing.  These coaching relationships lend themselves to ongoing post-workshop mentoring through email, phone and occasional visits as we travel through the region. 

Recently there was a renewed eruption of fighting in Côte d’Ivoire and about 200 missionaries were evacuated from the country (some of them for the third time).  They were scattered to at least four surrounding West African countries.  In each of these locations, peer responders who had been trained by MMCT were involved in providing practical help in housing, food and child care as well as emotional and social support and the opportunity to talk about the crisis they had just experienced.  At the time, all of the MMCT staff were off the continent and so were only able to provide coaching and mentoring from a distance.  The feedback we received from the recipients of the peer debriefing care was very positive.  One organizational administrator wrote the following to us following the crisis:  “The Peer Responders met together a couple of times in Dakar to determine how best to handle all the different missions and needs.  It was GREAT to see!  Our group not only had a group debriefing, we also had Peer Responders come to talk with the children, youth and one on one individual debriefings.  I was so thankful for how well our group accepted the whole concept and heard over and over how helpful it was for them.  You all have done a great job of training people.”  Though we still need objective measures to determine the efficacy of our programs, it was good to see that during a major crisis situation, those who had been trained to respond were available, worked cooperatively across organizational lines, and were very appreciated by the community they served.

Member Care While Managing Crises (MCMC)

By participating in the five-day MCMC workshop, a mission leader will learn about normal responses to crisis and how to support others through the necessary stages of grief after loss or trauma.  We address the strategic role a mission administrator plays in member care while managing crisis situations. Given the evidence that team cohesion and trust in leadership are two key factors in the mitigation of acute stress reactions in traumatic situations, this training is a particularly key strategy in trying to enhance the strength and skills of organizational leaders and increase their leadership competence in crisis situations (Fawcett, J., 2002).  Specific topics include: the impact of crisis; developing policies, procedures, and protocols; the dynamic of trust for leaders in crisis situations; confidentiality and communication; information management; assessment of vulnerable members; unique needs in cases of suicide, sexual assault or evacuation; leadership styles in crisis; the when, why and how's of debriefings and crisis committees.  From 2000-2004 MMCT conducted four MCMC workshops with 86 organizational leaders and managers.

After the evacuation of about 200 missionaries from Côte d’Ivoire, a regional administrator who had been through this training and has also been involved on our Governing Board wrote the following related to the efficacy of the MMCT crisis training:  “Congratulations, if you were to die tonight I think you could rest in peace because MMCT-WA is a total success in that an evacuation of a large country is taking place with no members of MMCT-WA on the continent and yet every mission group seems to be well cared for through the joint efforts of an army of trained peer debriefers.   So
yea, the hours registering people, writing materials, hauling suitcases from airport to airport, workshop training, coaching and sleeping in less than adequate conditions has paid off.  Six years ago that wouldn't have happened, or at best it would have been a fumbling attempt.  Now because of MMCT there is a sort of missions without borders
happening where the various mission communities are no longer in their own little boxes, but they know and are friends with others through common workshops and training and now they are helping each other and working for each other's well being.”

Other Services of MMCT

Other programs of MMCT include providing assessment, short-term counseling, crisis intervention, and making referrals.  The team has one psychologist who works with other mental health professionals who come for short-term visits.  She is also able to work with a consulting psychiatrist who lives in Côte d’Ivoire when medical evaluations are warranted.  MMCT has been involved in 164 clinical cases and has served 384 cross-cultural workers through psychological intervention over the past 4 years.  Written requests for feedback regarding the effectiveness of this treatment have yielded positive self-reports related to recovery time, ability to remain in overseas service, self-acceptance as opposed to self-criticism, and depth of understanding of normal responses to trauma which has decreased a sense of confusion and inadequacy. 
MMCT also has a resource library in Ghana with over 900 volumes related to issues such as cross-cultural relationships, leadership, stress, grief, and trauma.  These books are lent to any missionary working in West Africa.  Smaller libraries have been established in several other countries. 

Personal Challenges for a psychologist working in West Africa

Multiple Relationships:  Over these four years, I have worked closely with missionaries and cross cultural workers who have been shot at, beaten, robbed, taken hostage, carjacked, had their babies kidnapped, or lost their children or spouses to malaria.  At first, the people I worked with were strangers to me, but as I interacted with workers through our workshops and other events, I became part of the community and formed friendships.  At times I have wondered if every missionary I ever met or socialized with would one day need some kind of crisis intervention.  At first I tried to set apart certain missionaries who would be my friends and for whom I would never provide crisis intervention.   However, this is not practical when there are few other mental health professionals available to help.  In the 14-country area that we serve, there are only three mental health professionals available to serve missionaries and cross cultural workers (including myself).  So, multiple relationships cannot be avoided.  In fact, I think that they can enhance the quality of service as long as a certain degree of objectivity is maintained and as long as the mental health professional maintains healthy boundaries and knows when to disqualify him or herself from service (i.e., when I was evacuated from Bouaké we did not agree to provide counseling for the kids who had been evacuated from the missionary school in the same town.  Instead we helped to arrange for counselors to come from the States who could help them as well as us). 

Chronic Exposure to Stress and Trauma:  We came to care for those working on the front lines and to try to prevent unnecessary psychological/emotional damage resulting from trauma.  And the fact that we live here and are also experiencing our own trauma of war, evacuation, robberies, and cross-cultural stresses does increase our credibility with those we came to serve.  However, we also realize that we have a daily challenge of making sure that we also do not fall prey to burnout or trauma related illnesses. 
Several things have helped in the prevention of burnout for our team members  – a governing board, the nurturance of healthy team relationships, and a balance of work, rest, and fun.

The MMCT Governing Board consists of nine mission leaders who live and work in West Africa.  They embrace the vision of the Mobile Member Care Team and meet with us regularly to discuss our goals, strategies, progress, failures, hopes, and frustrations.  One of their foremost goals is to ensure that we are taking the vacation and rest that we need in order to be renewed and refreshed.  They take this role very seriously and hold us accountable to good self-care.

When much of our focus is on helping others manage conflicts and build healthy team relationships, our credibility hinges on having a well functioning team.   This is a daily goal and is assisted by having a team covenant that focuses on our commitment to accountability, encouragement, open, honest communication, conflict resolution, trust, and consensus decision-making. 

Finding the balance of work, rest, and play is not easy in this setting but seems crucial to our longevity.  There’s a value among missionaries that promotes working to the point of exhaustion or illness.  Our work can be intense and often involves long hours and a rigorous travel schedule.  One principle we try to honor is to maintain Sundays as days of rest and reflection, as a way of rejuvenating and regaining perspective.  Vacations can be a challenge in this part of the world – even a nice hotel on the beach may have disruptions and hassles that increase rather than decrease stress (i.e., there’s no running water or the electricity goes off or rodents are sharing the room with you).  As a team, we are committed to sometimes taking a few weeks off the continent on a regular basis for retreat and focused reading.

Few Mental Health Professionals:  It’s a challenge to be in a place where there are so few mental health professionals.  Often times when I am working on a case or in a difficult situation, I use the phone or e-mail to consult with fellow mental health professionals in North America.  But, this is costly and time consuming and I can’t get immediate feedback.  This is a luxury that we take for granted in North America.  Before I came to West Africa, I worked in a community mental health setting where consultations, supervision, and case staffings were daily events.  Staying up to date with clinical knowledge and getting consultation in areas where I do not have as much expertise is a continual challenge.

The Overwhelming Need:  Simply put, when someone is in an environment where he or se is surrounded by genuine need and suffering, it is a challenge to not become overwhelmed and to feel hopeless or weary.  I am constantly aware of my limitations and weaknesses.  I have to continually go back to the priorities we have set and the vision we have, and try to resolve each day to do my part to contribute to them.  To try to do more is to burn out.  To do less is to forsake compassion. 

The Mobile Member Care Team—West Africa was started in 2000 with a goal of providing crisis response and training to missionaries in West Africa.  It is the first team of its kind but we and our Global Advisory Board envision other teams like this being set up in other parts of the world.  While the types of stresses and trauma may be different, many of the principles of intervention would remain the same.  Our strategy is to identify staff who can help to implement the MMCT model in other parts of the world and to train them through an apprenticeship with MMCT in West Africa.  We hope to begin doing this within the next couple of years.

Another future goal is to conduct outcome research in order to assess more objectively the effectiveness of the MMCT model in enhancing coping skills and preventing maladaptive responses to trauma in this setting.  A research project is currently underway in a collaborative effort between MMCT and Dr. Frauke Schaefer of the Duke University Health System entitled “Coping with Stress and Trauma in Cross-Cultural Mission Assignments.”  The purpose of this study is to provide a more accurate estimate of the prevalence of PTSD symptoms, depression, and anxiety symptoms among missionaries in West Africa as well as to identify resilience factors that help them cope. This will help us to do a better job of evaluating the needs in the field and to customize our services to respond to those needs.

Why do I do this kind of work?  The living conditions are difficult, the income is negligible, and the risk for secondary trauma is high.  But, I wouldn’t trade this work for anything.  When I’m sitting across from a missionary family and experiencing the thrill of being a part of their personal growth and recovery or when I’m in the midst of a workshop and looking at relationships forming and conflicts being resolved or when I’m enjoying the closeness and companionship of my teammates knowing that we’ve been through some of the most incredible experiences together (i.e., lying in a hallway while shells went off close by), then I know that I’m exactly where I’m supposed to be.  By God’s grace, I’ll endure the hardships and continue to walk the road that I encourage others to walk.

Websites for further information

The MMCT website www.mmct.org
The International Training Partners website www.itpartners.org

References

Carr, K.F. (1997). Crisis Intervention for Missionaries.  Evangelical Missions Quarterly, 33 (October), Wheaton, IL: Evangelical Missions Information Service.

Carr, K.F. (2004).  Who Are the Better Missionaries: Those Who Leave or Those Who Stay?  World Pulse, Vol. 39(7), Wheaton, IL: Evangelical Missions Information Service.

Fawcett, G. (2003).  Preventing trauma in traumatic environments. In J. Fawcett (Ed.). Stress and Trauma Handbook (pp. 40-67), Monrovia, California: World Vision International, 2003.

Fawcett, J.  (2002). Preventing Broken Hearts, Healing Broken Minds. In Y. Danieli (Ed.)
Sharing the Front Line and the Back Hills (pp.223-232), Amityville, NY: Baywood
Publishing  Company.

Fawcett, J. (Ed.) (2003).  Stress and Trauma Handbook.  Monrovia: California: World Vision International.

Greeson, C., Hollingsworth, M., & Washburn, M. (1990). The Grief Adjustment Guide.
Sisters, Oregon:  Questar Publishers.

Hill, M., Hill, H.,  Bagge, D., & Miersma, P.  (2004).  Healing the Wounds of Trauma. 
Nairobi, Kenya: Paulines Publications Africa.  

Jerome, D. & Carr, K. (2002). Mobile Member Care Teams. In J. Powell & J.
Bowers (Eds.). Enhancing Missionary Vitality (pp.399-407), Palmer Lake,
Colorado: Mission Training International.

Jerome, D. (2001).  Mobile Member Care Team – West Africa:  Our journey, and Direction. In K. O’Donnell (Ed.). Doing Member Care Well: Perspectives and Practices From Around the World (pp.117-126).  Pasadena, California: William Carey Library, 2001.

Reissman, F. (1990). Restructuring Help: A Human Services Paradigm for the 1990’s. American Journal of Community Psychology, 18 (2), 221-230.

Williams, K.  (2002).  Sharpening Your Interpersonal Skills.  Colorado Springs, Colorado:  International Training Partners, Inc.

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