Interview with Karen Stewart, mental health officer working in Papua New Guinea

06 October 2008

Papua New Guinea has some of the worst health statistics in the Pacific region and also has one of the world’s highest rates of sexual violence. With an overall estimated HIV prevalence of two percent among adults and pockets of much higher prevalence in some communities, AIDS has become a significant health issue. Violence occurring at all levels of society causes an enormous amount of harm, with physical and sexual violence against women and children (particularly girls) being extreme.

The threat of rape, torture and other violence against the women of Papua New Guinea, particularly sexual violence, impacts their ability to move freely throughout their own community. When travelling throughout certain areas women wear female condoms to protect them, in case they are approached by gang members. Women do not let their daughters out of their sight.

Violence against women and children is a key issue in Papua New Guinea and much of the population know very little about the true nature of domestic violence. The causes of this widespread violence are complex. MSF opened the Women and Children’s Support Centre (WCSC) in Lae, the second largest city and biggest harbour in Papua New Guinea, in February, 2008. By July 2008 the centre had already seen 1,000 patients. Psycho-social counsellor Karen Stewart spent nine months working in Lae as the mental health officer at the WCSC for Doctors Without Borders/Médecins Sans Frontières (MSF).

What are the mental health needs of the Papua New Guineans?
A lot of the women that I saw didn’t know that being beaten by their husband is against the law. Most thought that it was acceptable. There’s the bride price, meaning the man has paid for his wife, therefore, she is property, so why shouldn’t he be able to beat her?
We had to let them know that all they are experiencing after an event like rape is a normal reaction. They have a lot of fear, are anxious or can’t eat, but they don’t know why. We have to show them the link between what happened to them and their reactions.

What are the origins of this project?
Where we are now [in Lae] the centre already existed. There was a Women and Children’s Support Centre in Lae, so it was already working and so we decided that we just needed to strengthen what was already there. So it wasn’t about coming in and starting something new or changing the centre in any way, it was just about expanding what was there.

As the mental health officer for this project, what did you do?
I interviewed and hired counsellors and then trained them. Counselling children of sexual violence is a pretty advanced skill, so I had to move them very quickly through three weeks of intense training. Not only are they counsellors, but they have to manage some very difficult cases, be it suicidal, rape, gang rape or kidnapping. There’s just a lot of stuff that happens in Papua New Guinea.

When I first hire people, I’m seeing the patients and the national staff members work as my translators. But then pretty quickly, within a week to two weeks, they would take over more and more of the sessions. Eventually they would be doing the sessions on their own with me just by their side. As a general rule I didn’t see patients unless it was a high profile patient that we wanted to keep extremely confidential. The counsellors are there to see the patients and I’m there to clinically supervise and keep them on track.

What did you learn from working in Papua New Guinea?
Even after being in Papua New Guinea for nine months, I still don’t understand their culture and why their levels of violence are so high or where does it come from. I’m simply amazed at the resilience of people. After everything that these women go through they continue to move forward, that’s pretty amazing. It was a very good lesson for me to see how much we can simplify counselling, which I’ve known before. You don’t need years of theory and all of that, it’s just that if you stay on some very basic principles you can do a lot. So being able to see how powerful that can be. These counsellors were trained very quickly to deal with very intense cases.

What was the worst case that you saw while working in Lae?
Nine-year-old incest case going on for two years and a child that was so far removed, pretty much catatonic. Non-verbal, not eating, not sleeping and the fact that no one noticed it. I was trying to educate the mother and the response to this child from the mother had been to beat the child, because the child was not responding to her. She was in the corner and her mother would call, call, call her and she wouldn’t come, so she’d go and physically assault her to get her to listen to her. To educate the mother around this and to explain why your child is this way, and then to have her say, “Wow, okay.”

Are the patients receptive to the counselling that is being provided?
Very much so. That story also stays with me because I brought in auntie and grandma and we were talking about symptoms and trying to figure out how to help this kid and the auntie said, “This is just like my daughter, my daughter is the same.”
So I say, “Okay, how old is she?”
“She’s 10.”
“Same house.”
“Yes.”
“Uncle around?”
“Yes.”
So she brought her in and it was the same.

The need for the project is there. We hit 1,000 patients in July, so within six months. The people and even the government are very receptive to MSF being there. The project is going to be the pilot as a model for others, with the long-term goal of 21 centres all over Papua New Guinea. That’s a government goal and that would be phenomenal. Now what we’re hearing people say is why can’t we have this centre here or here, they want it everywhere.

Can the government still maintain this project when MSF leaves?
I think that the genuine awareness is there, but it will be a funding issue. I don’t see that they can support the centre with 12 or 13 staff. The ministry will maybe have two staff so it will definitely be different, but if the quality is there I think that there’s a possibility that it’s sustainable.

What impact does all of this violence have on the people of Papua New Guinea?
The impact and results of the violence are the same on many levels as we see in developing countries. I truly do see that women and children in Papua New Guinea live in a constant low state of terror and have to adapt to a different world. Domestic violence is extremely common; most families are dealing with it in some form. Simple errands or outings are dangerous and avoided if possible. There were times that some staff members would miss lunch and I would suggest that they leave early to go eat and they refused to go alone. They weren’t travelling through a rural area or a jungle, just to the bus stop in town, but they feared travelling alone so they all left as a group at the end of the day.
The work that we’re doing there is having a big impact on the community. Despite the fact that there is so much violence, the success stories that we do have keep us motivated.