Africa

Welcome to Bangui International: Reflections of a psychologist in the CAR

By Gail Womersley 1 April 2014

GAIL WOMERSLEY is a South African psychologist who just returned from six weeks in the Central African Republic, where she worked primarily with Doctors Without Borders staff members to help them deal with the trauma and devastation they were witnessing on a daily basis. This is her account of arriving in Bangui, and of an average working day in the capital.

The plane lands on the Bangui airstrip. I scan the landscape greeting the passengers: it’s a makeshift camp a few metres away where literally thousands of refugees have sought safety for the past couple of months. It’s a visual mess of mattresses, goats, colourful clothes, and corrugated iron. I’m hit with the smell of people and animals in 38 degrees heat. Estimates of how many people there are now at the airport range from 60,000 to 100,000. I turn to my colleague who’s travelling with me: “It’s hard to get my head around the vast number of people here.” We take an hour to get through customs, after which time an airport official tells us not to leave the airport and to follow her to a waiting area instead. The sharp features on her face create a strong impression of insistence. All we understand from her is that we will not be leaving the airport for a long time. Conflict has erupted and the route into town is closed.

We grab our bags and step outside the airport building, where we are met by the sight of hundreds of people sitting in the airport parking lot…seeking protection within the structure of the airport walls. In the distance: gunshots. I realise that we’ll be here at the airport for a while and attempt to make sense of the crowd of people meeting me a few paces outside the airport building. Most of the children are eerily still but some brave ones greet me with big waves and beaming shy smiles. I see a woman crying and resist an impulse to give her a hug.

One boy catches my attention. His name is Tshigo and he’s 12 years old. At least, I think that’s what he’s saying. His voice is so soft and timid among the chaos that I have to strain my ears and tune into his French. What strikes me about him is the way in which he’s so intently focused on the child sitting on his lap – a younger brother of around two years old. He’s gently stroking his brother’s hair and laughs with the mixture of pride, bemusement and apology of a parent when his little brother burst into tears at the sight of me. “He’s scared of you,” he explains. It’s not surprising.  I may well be the first white person he’s seen. Who knows what the family has been through in the last few weeks. Speaking to his mother earlier, she told me that they had been camping at the airport for a month. She remains hopeful that the family can return to their home once more – and wasn’t sure if the house had been looted or not. For the moment, they had only taken a mattress and some belongings. They had already run out of whatever little food they had managed to bring.

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The little toddler remains on Tshigo’s lap, big fat silent tears quietly rolling down his cheek. Tshigo is taking great pains to amuse him, attempting to create a little fantasy game to detract from the grim reality of their situation. I get the sense that he is incredibly proud of his parental role – possibly showing off to me a little. He beams with pride when I comment on what a caring big brother he seems to be. On a deeper level, being strong and having a little brother to care of may be a defence mechanism for his own protection against overwhelming feelings of fear.

A shriek, a whistle, a bang. Silence. Another shriek. It’s more gunshots from what sounds like a semi-automatic rifle. People jump down on the ground. All of the humanitarian aid workers and press officers stranded at the airport crouch down too, and in moments of silence attempt to run, whilst still crouching as low as possible, to the inside of the airport building. In that split second, I decide to leave my baggage where it is and duck quickly into the airport building as soon as possible. I have no way of judging how close the shots are and don’t want to take risks. Inside, it’s calmer. Press officers set up some sound equipment and are testing microphones. I see some people exhausted from the night’s flight sleeping on the stationary conveyor belt. There are some hurried introductions among the ten MSF staff at the airport who are sitting on their bags in a safe corner of the room :“Ah, you’re from South Africa? I love Cape Town…” “Which section are you working for?” “Tu parles le francais?” Another shriek pierces the air. “I’ll be working in Bangui for two months…” “I’m the nurse working in Bangassou…” It feels like a dream. We sit and wait, nervously glancing towards the door at each sound of gunfire and speculating as to what the causes of the sounds are.

Eventually, the same stern airport official leads us through the deserted customs control area to the “VIP lounge,” a room up a flight of stairs and protected by four walls. She’s angry that we didn’t listen to her instructions to go earlier. We’ll be safe here. I’m struck by the incongruity of it all – here in the VIP room, we can order coffee, recline on comfortable couches and share precious chocolate and cigarette supplies – all whilst watching “the action” from a window. We see some French soldiers arriving in tanks. The gunshots continue. Another shriek and all of us look up, clearly on alert. We wait for the MSF car. It might be hours.

Welcome to Bangui International Airport.

The trauma doesn’t stop here. Some time later, having settled into life in Bangui, I’m conducting a stress management session, when the walkie-talkie starts blaring.

“Couchez couchez! Lie down on the floor. Allez allez.” I dive onto the canvas floor of the hospital tent – my MSF t-shirt already caked in mud from the previous two occasions that morning that we heard gunshots and had to lie down on the floor to avoid being hit by stray bullets. An unseen stone pricks my lower back through the canvas. I wriggle around a little bit to get more comfortable. Who knows how long we’ll be on the ground. Lying down next to me is one of the members of our national staff working at the airport camp. He’d just been telling me how affected he was by the conflict on a daily basis – like many members of the staff, he struggles to sleep at night. During the day, he has panic attacks with heart palpitations and trembling hands. I can’t help but produce an internal sardonic smile at the irony: I had been doing a session of progressive muscle relaxation with him to alleviate the anxiety. Now we are lying alongside each other, staring up at the wall with ears straining to grab any news on the radio or hear any more piercing shrieks of gunshots. I realise that my heart, too, is beating fast. I focus on breathing and listen to the crackling radio: all the expats are giving their location and confirm that they are safely taking cover. “Is this a simulation exercise to test my relaxation skills under pressure?” he asks me. I can’t see his face from where I am lying but I detect a faint attempt at a smile. I also notice that his voice is shaky.

“Yes,” I reply, also allowing the smile to spread across my face – “ and you’ve passed. Congratulations.” We both know that it’s not. The gunshots are real and the dark humour a way to cope.

It’s not unusual. Diving onto the floor has become an automatic response for expats and national staff working here. Sometimes it happens in the evening whilst people are drinking a beer after dinner to wind down. If you’re lucky, you’ll be inside the building, but sometimes you find yourself lying down in the mud outside. More often than not, the conversation continues as normal. Some people might joke in mock irritation at having to re-wash their hair after lying down. It’s surreal. Two nights ago, we heard gunfire followed instantly by the inevitable instruction to lie down: “Couchez couchez.” The two expats I was with had continued their meeting about placing a drug order from the pharmacy the following day. Barely skipping a beat, they had managed to grab all the paperwork on their way down to the floor and only interrupted their discussion on the supply of Paracetamol to confirm their location via radio.

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It’s not the expats that cause me the greatest concern, but the national staff. Many of them continue to live in the airport camp with their families – waiting until a time when it’s safe enough to spend the night in their own homes. One of the most difficult struggles for one staff member is the fact that he was not able to grab his clothes as he fled his home. He has been living in the airport camp for two months and admits to being deeply ashamed about the state of his only pair of now-filthy trousers. “It’s no way for a professional to live,” he sighs. The horrors of a country at war are a daily-lived reality that doesn’t stop. No space is sacred – at work or at home. Sometimes it’s small practical details that really hit hardest. The vast majority of staff members are not able to live at home. The vast majority are experiencing symptoms of post-traumatic stress. Nightmares, flashbacks, insomnia and heart palpitations have all become intimate acquaintances. Yet they come to work day after day – determined to continue with some semblance of a normal routine to survive.

I am fully booked with individual counselling sessions for staff who are deeply affected by the trauma. Remarkably, the majority are competent, dedicated and motivated professionals who, in my personal opinion, are coping just a little too well. I know that the physical symptoms experienced by many are just a transferred indication of psychological distress. One staff member relates being threatened by rebels at gunpoint, his son watching. He denies being affected – proudly reports being able to just focus at work and claims not to be scared at all. I know it’s not true. The general body pain he describes is a physical manifestation of what is now impossible to be felt consciously. Yet I cannot ethically begin to open or explore the Pandora’s box of fear, horror, trauma and distress in the limited time available. The trauma would overwhelm the psyche. Instead, the aim is to boost the coping mechanisms already put in place to ensure daily survival: go to church, focus on work, listen to music, don’t be surprised by the nightmares…and remember to breathe. DM

Main photo by Christian Nestler. Body photos by Pierre Terdjman.

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