MAKENI WAR WOUNDED PROJECT

MAKENI WAR WOUNDED PROJECT

PRIMARY CARE INTERVENTION FOR THE SEVERE PHYSICALLY AND PYCHOLOGICALY TRAUMATIZED

PRIMARY CARE INTERVENTION FOR THE SEVERE PHYSICALLY AND PYCHOLOGICALY TRAUMATIZED

PROFILE OF TRAUMAPROFILE OF TRAUMA

People were displaced as they fled into the bush to escape the rebels

Displaced people went into desparate survival mode to secure food, shelter, safety and security.

They moved from village to village avoiding the rebel advance When apprehended by the rebels in the bush they were raped, amputated, and/or killed

The survivors carry physical and psychological wounds.

People were displaced as they fled into the bush to escape the rebels

Displaced people went into desparate survival mode to secure food, shelter, safety and security.

They moved from village to village avoiding the rebel advance When apprehended by the rebels in the bush they were raped, amputated, and/or killed

The survivors carry physical and psychological wounds.

THE AMPUTEETHE AMPUTEE

There are the surgically amputated who required removal of their limb(s) after sever gunshot injury became gangrenous.

There are those who were amputated by the rebels with machete and axe. Those who survived eventually arrived in Freetown seeking the protection of the government forces.

Displaced people were sheltered in a large camp in Freetown When rebel forces entered Freetown amputations continued to occur Amputees are either displaced from the hinterland villages or from the urban areas such as Makanie or Freetown.

There are the surgically amputated who required removal of their limb(s) after sever gunshot injury became gangrenous.

There are those who were amputated by the rebels with machete and axe. Those who survived eventually arrived in Freetown seeking the protection of the government forces.

Displaced people were sheltered in a large camp in Freetown When rebel forces entered Freetown amputations continued to occur Amputees are either displaced from the hinterland villages or from the urban areas such as Makanie or Freetown.

MEDICAL CARE AFTER THE AMPUTATION

MEDICAL CARE AFTER THE AMPUTATION

Those who received surgical amputations in hospital due to gunshot wounds developing gangrene received the medical and surgical services available at the time.

Those who suffered amputations at the hand of the rebels went for extended periods of time without medical care.

Some patients describe having to pay to have their stump washed, antibiotics, and pain medications.

Some have been fitted with prosthesis. However functional assessments and vocational retraining is critically needed

Those who received surgical amputations in hospital due to gunshot wounds developing gangrene received the medical and surgical services available at the time.

Those who suffered amputations at the hand of the rebels went for extended periods of time without medical care.

Some patients describe having to pay to have their stump washed, antibiotics, and pain medications.

Some have been fitted with prosthesis. However functional assessments and vocational retraining is critically needed

PREMORBID FUNCTIONINGPREMORBID FUNCTIONING

Those from the villages were farmers, traders, drivers, crafts-persons, parents, grandparents, husband, wives, etc.

As one woman described bitterly “ I was a person of status”. She was a trader, wife, and mother.

Those from the city described similar roles and relationships prior to trauma and diplacement

The President of the Association of Amputees lived with his wife and children in his home in Freetown on the day the rebels came to his door. They threatened to take his 14 year old daughter. She escaped and he fought them. He subsequently lost both arms in below the elbow amputations.

Those from the villages were farmers, traders, drivers, crafts-persons, parents, grandparents, husband, wives, etc.

As one woman described bitterly “ I was a person of status”. She was a trader, wife, and mother.

Those from the city described similar roles and relationships prior to trauma and diplacement

The President of the Association of Amputees lived with his wife and children in his home in Freetown on the day the rebels came to his door. They threatened to take his 14 year old daughter. She escaped and he fought them. He subsequently lost both arms in below the elbow amputations.

DisplacementDisplacement

People displaced lost most if not all their pre-morbid roles

They lost relationships, community and family. They lost the capacity to provide for basic needs.

They lost hands, arms, and legs.

People displaced lost most if not all their pre-morbid roles

They lost relationships, community and family. They lost the capacity to provide for basic needs.

They lost hands, arms, and legs.

PSYCHOSOCIAL PROFILEPSYCHOSOCIAL PROFILE

The victims were from multiple ethnic groups, Limba, Temne, Mandingo, etc. Their prior roles were that of farmers, miners, traders, tailors, drivers, They were from the Western area, Southern , Northern, and Eastern Providences They were male, female, mother, grandmother, father,and grandfather. Some had amputations after gunshot wounds became gangrenous. Some had amputations at the hands of the rebels as a tactic to induce fear and hence control and expose the powerlessness of the government to protect

They suffered above the elbow, below the elbow, above the knee, right left, and bilateral amputations.

The victims were from multiple ethnic groups, Limba, Temne, Mandingo, etc. Their prior roles were that of farmers, miners, traders, tailors, drivers, They were from the Western area, Southern , Northern, and Eastern Providences They were male, female, mother, grandmother, father,and grandfather. Some had amputations after gunshot wounds became gangrenous. Some had amputations at the hands of the rebels as a tactic to induce fear and hence control and expose the powerlessness of the government to protect

They suffered above the elbow, below the elbow, above the knee, right left, and bilateral amputations.

PHYSICAL SIGNS SYMPTOMS AND SYNDROMES

PHYSICAL SIGNS SYMPTOMS AND SYNDROMES Bronchitis Cholera Dysentery Cataracts Diarrhea Ear infections Fever Fungal Infections Hypertension Headache Malaria Nausea

Bronchitis Cholera Dysentery Cataracts Diarrhea Ear infections Fever Fungal Infections Hypertension Headache Malaria Nausea

Osteoarthritis Pneumonia Pelvic Inflammatory Disease

Rash Sickle Cell Disease Septic Joints Trismus UTI’s Wound infections Yeast Infections Leprosy

Osteoarthritis Pneumonia Pelvic Inflammatory Disease

Rash Sickle Cell Disease Septic Joints Trismus UTI’s Wound infections Yeast Infections Leprosy

PSYCHIATRIC SIGNS SYMPTOMS AND SYNDROMES

PSYCHIATRIC SIGNS SYMPTOMS AND SYNDROMES

Anxiety Depression Thought Disorder Nicotine Dependence

Alcohol Abuse Posttraumatic Stress Disorder

Schizophrenia

Anxiety Depression Thought Disorder Nicotine Dependence

Alcohol Abuse Posttraumatic Stress Disorder

Schizophrenia