Interview with Dr Ventevogel

Continuous bombing, a lack of medication, deciding which of several million traumatised people should be seen by the few aidworkers available - these are just a few examples of the problems mental health workers face working in war-torn countries.  Dr Peter Ventevogel is Editor in Chief of the international journal of mental health, psychosocial work and counselling in areas of armed conflict, Intervention.  The journal is published by Lippincott Williams and Wilkins for the Dutch non-governmental organisation War Trauma Foundation, a foundation that provides knowledge, expertise and funding to local aid agencies which help survivors deal with the psychosocial consequences of war. He is also technical advisor on mental health at the non-profit organisation HealthNet TPO, which helps local communities to restore healthcare infrastructures.  Dr Ventevogel talks to Ranadi Johnston about how Intervention tries to address some of these problems.

A major challenge mental for health practitioners is trying to decide how to allocate meagre resources. "We have populations that are massively distressed ... you'll find that almost all of the survivors are distressed," says Dr Ventevogel, "With a limited number of trained psychiatric staff working in these areas, it is not physically possible to help so many people. You need to select your target group very carefully, which is a challenge for professionals in post-conflict areas." 

"To give an example of my own working experience - I was in Burundi, I was the only psychiatrist at a certain moment, there were eight million people and there were two qualified psychiatric nurses and a few qualified clinical psychologists.  In that context, of course, you need to make very tough choices and use your minimal resources in such a way that it works for the benefit of the most (people)."

In these situations, practitioners cannot treat patients on a case-by-case basis, "because you won't get very far" says Dr Ventevogel.  Health care workers need to reach as many people as possible with limited resources, he says.  "For example, (by) training general health staff; strengthening existing community structures, women's organisations and women's groups so they can deal better with the distress of people in their communities." In addition, media campaigns via the radio provide entire populations with basic information about mental health.

The lack of materials and financial resources is also a real challenge, says Dr Ventevogel, "In the case of psychotropic drugs, we work with those in the essential drugs list of the World Health Organization (WHO), which are, for mental health, only ten, and that includes epilepsy.  That may seem  ridiculous, but that is what we have, and we can do small miracles with it, once we have them."

Another problem is that while there is a wealth of scientific information about treating mental health problems, most of the suggested therapies are only tested in western context. "Much of the evidence is not tailored to situations where the readers of Intervention work - which are post-conflict, or even actual conflict, situations." says Dr Ventevogel . "There is a lack of context appropriate information about interventions," he says, "particularly those that you can carry out without sophisticated psychotherapy, without sufficiently trained staff, without the latest psychotropic (drugs) and with a population that is massively distressed. In inner city London or so, we could offer weekly psychotherapy but does that actually help in a non-western post-conflict society?"  Dr Ventevogel says some of the articles in Intervention are now trying to address this. "We have people trying to define locally valid indicators for those who are most in need."

One area that lacks media representation is the long-term effect of war and violence on the mind-set of people and on the collective mental health status of the people.  "Many effects of long term violence are not only expressed in individual psychopathology but also in disrupted relationships - in dysfunctional families, in mistrust within communities.  So then you get collective traumatisation - societies whose social fabric has been affected by events.  And that can have a lot of social and psychosocial consequnces, such as increase of sexual violence, domestic violence, children who find it difficult to concentrate in school."  So war has a more pervasive effect than is normally reported, says Dr Ventevogel.  The scope of Intervention has therefore  widened to include the effects of war on societies.  If you narrow your focus to what people have lost during the war, you might misconstrue the problem, he says.   "We feel that you need to look at the whole picture. ..." 

 "What you see now in more recent volumes is more and more attention on resilience," says Dr Ventevogel. "The focus is not solely on the significant numbers of people affected by violence.   We know that now, but the interesting thing is, 'How are people still able, after so many years of adversity, to continue, somehow, some way, with their lives.  That's interesting!"

As for the effects of war on soldiers - "Now that is a contested thing. From time to time you'll hear that organisations are trying to this.  In Sri Lanka there was an initiative recently where they wanted to work with perpetrators of violence - we had some articles in the journal as well. That is definitely something that we would like to discuss more in the journal because we are looking for the debate."

The Official Journal of the War Trauma Foundation: www.wartrauma.nl

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