A MARK FOR PETER
by Elizabeth and Stephen Alderman, MD
Although Pete no longer existed, as parents, we still had that need to do for him and we really struggled to find a way to honor his life. Yet, there was nothing we could do for Pete. About eight months after his death we realized that Pete was killed because of terrorism and if we could help those people who had survived terrorism, war or torture, but were still unable to live their lives, then this was the perfect memorial for Peter.
We are dedicating our future to rebuilding post-conflict societies by returning victims of terrorism and mass violence to productive lives. One billion people, one-sixth of humanity, have directly experienced torture, terrorism or mass violence. More than 50% of the survivors were no longer able to lead functional lives because of incapacitating traumatic depression or PTSD. They can’t work or care for their families. Children can’t attend school. Many can’t even leave their beds.
We started with fuzzy notions of how to memorialize our son. We had been married for forty years and never agreed on anything. We considered building a playground, or endowing a chair at a university. But that wasn’t Peter. Then, one night in June 2002, bleary-eyed from months of mourning, we saw a Nightline program that featured Richard Mollica, MD, the director of the Harvard Program in Refugee Trauma (HPRT), a division of the Massachusetts General Hospital. He talked about the emotional wounds of survivors of terrorism and mass violence…invisible wounds. They were Cambodians, Iraqis, Rwandans, and Afghans, people whose psyches had been scarred by violence and trauma, just like ours.
Shortly after the program, we tracked down Dr. Mollica, a world expert on the treatment of traumatic depression and PTSD in war-affected populations. A week later we were meeting with Dr. Mollica and the staff of HPRT. They had set aside an entire day to meet with us. We remember remarking to each other afterwards that this was the first time we felt we were in an emotionally safe place following Pete’s death.
Dr. Mollica told us that he wanted us to be involved in a worthwhile project, one that “would make a mother proud”. He had an idea that had never been done before and therefore was unable to secure the necessary funding. He proposed a training seminar that would teach physicians and psychologists from post-conflict countries around the globe to diagnose and treat war-affected victims, each in his own country. Dr. Mollica strongly believed that cultural appropriateness was the keystone to mental healthcare for post-conflict societies. In view of this, he concluded that training indigenous mental healthcare givers was the most effective way of healing their own wounded populations. Since psychiatry is extremely limited in most of the developing world, the seminars would emphasize the training of general practitioners, psychologists, the few psychiatrists we could find, and doctors from ministries of health. Professional experts from all parts of the globe were chosen to teach the course and share their expertise.
We established the Peter C. Alderman Foundation (PCAF) as a 501c3 non-profit charity that would alleviate the suffering of victims of terrorism and mass violence in post-conflict countries by providing indigenous physicians and other local caregivers with the tools to treat mental anguish using Western medical therapies combined with local healing traditions.
Since we first met with Dr. Mollica in 2002, HPRT has directed five annual training seminars, funded and produced by PCAF. We have attended each week long session in Orvieto, Italy. It is in an intimate setting and we have the opportunity to develop close relationships with healthcare professionals from around the globe. Some of their stories are heartbreaking. We remember vividly the last night of the fourth training seminar. It had been a particularly emotional week. Dr. Yousif (not his real name) from Iraq received a phone call from his wife telling him that he was on a “hit list”, and to not return home. As he told us, there was no way he could not go home. He had a wife, three young daughters and an extended family to care for. The mood of the seminar was somber. At the end of our last dinner a Rwandan doctor played a cassette tape and began to dance to beautiful, soulful African music. Shortly, the rest of the Africans began to dance with him. Then a very staid doctor from Bosnia joined them doing her own dance. Soon the entire room was dancing and laughing, including an 80 year old professor of psychoanalytic theory. We were taking many pictures trying to capture the exultant mood. Liz later said “I found the tears streaming down my cheeks. This was a microcosm of how the world could be; black, white, and Asian, Sunni, Shi’a, Buddhist, Christian and Jew, all celebrating life together. It made me think back to the prior year when a Bosnian roomed with a Serb and they both thought it was a hoot”.
Based on relationships that we established at the annual trainings, we soon began to investigate the possibility of establishing mental trauma treatment centers in several post-conflict countries. Our criteria for doing so consisted of an intact infrastructure, relative peace and stability and the government’s willingness to participate with us as stakeholders.
We opened the first Peter C. Alderman Trauma Treatment Clinic in Siem Reap, Cambodia in March 2005. The Clinic is run by Dr. Borin, a Cambodian psychiatrist, trained in part by PCAF. We partner with the Cambodian Government who supplies the psychotropic drugs and the clinic space on the grounds of the Siem Reap Provincial Hospital. The Siem Reap Monastery provides spiritual healing and sees all clinic patients weekly in group sessions. PCAF is not a faith-based organization, no one is required to attend spiritual healing sessions, but we do believe that spirituality, altruism and work are important components in the healing process. In Cambodia, many people believe that they have traumatic depression or PTSD because the household gods are either angry with them or have deserted them.
In its first year, the Cambodian Clinic had 4,000 patient visits, over 400 home visits and a 14 month waiting list. The second year we added a satellite clinic in Soutr Nikum to decrease the waiting time. The second clinic operates three days a week. To operate both clinics in Cambodia costs PCAF just $22,000 annually, due to the extremely low overhead we maintain for PCAF in the U.S. and, more importantly, due to the partnerships we established with the Government of Cambodia and the local Monastery . We estimate the value of their contributions to be $73,300 annually - almost three and a half times our financial commitment.
We then went on to open three Clinics in Uganda, a country that has been war-torn for over four decades. Again, following our Cambodian model, we partnered with the Government of Uganda, Makerere Medical School, Butabika National Psychiatric Referral Hospital, the Catholic Church and locally respected NGOs. Our first Uganda Clinic opened in Tororo, on Uganda’s eastern border with Kenya. Little did we know, but we were ideally situated to serve the influx of Kenyan refugees that escaped the violence occurring in the Rift Valley after the Kenyan elections in January 2008. Our Clinic staff was among the first to reach the people who poured across the border, and continues to treat the refugees that still remain in Uganda.
We opened our second Uganda Clinic in Gulu, an area in the north that has experienced 25 years of war with one of the most brutal rebel groups on earth, the Lord’s Resistance Army (LRA). The Gulu Clinic treats many of the 30,000 child soldiers who were formerly abducted by the LRA. Before they are seen at the Clinic, the returning abducted children first undergo their communities’ ritual cleansing ceremonies. Without culturally sensitivity and community acceptance, healing cannot take place.
Our third Uganda Clinic, in Kitgum, another area ravaged by the LRA, opened in June, 2009, and was dedicated by the Ugandan Minister of Health.
We have just begun a partnership with the Government of Rwanda and the U.S. NGO Partner’s in Health, started by Paul Farmer. We are bringing mental health treatment to Partners in Health’s hospitals in Kirehe and Rwinkwavu, Rwanda, and in Cange, Haiti, specifically focused on tackling drug adherence. If a person doesn’t care whether they live or die, they will not adhere to the complicated drug regimen required to treat HIV/AIDS; they will not take the drugs necessary to cure drug-resistant TB; and they will not bother to use bed nets to protect them from malaria. In Rwanda we will also be dealing with the many children orphaned by HIV/AIDS and the 1994 Genocide. There is more trauma around the globe that causes incapacitating depression and PTSD than anyone can possibly imagine.
The Peter C. Alderman Foundation has also started a regional initiative for all of East Africa, a catchment area of 240 million war-affected people. In July 2008 we hosted the first ever annual Eastern Africa Trauma Training Workshop in Kampala, Uganda. Eighty health care workers from eight East African countries were trained to deliver trauma treatment to their victimized populations. In sub-Saharan Africa more people suffer from incapacitating depression and PTSD than from HIV/AIDS, TB and malaria combined. In July, 2009, over 150 health care workers attended from 12 African nations.
The need is everywhere and is growing as war and civil strife continue to make headlines around the world. The Peter C. Alderman Foundation is on the frontlines every day. Since 2003, we have trained more than 200 indigenous doctors and other health care professionals from 21 countries; on four continents…they in turn have trained countless health care workers. PCAF has also opened nine Peter C. Alderman Trauma Treatment Centers in Africa, Asia and Haiti. To date, more than 75,000 victims have been treated in PCAF-run clinics or by PCAF trained personnel.
We have always tried to teach our three children that they could make a difference in the world. Since Peter’s death, we have come to know that this is true. We really believe that if you have the passion to do something, you can accomplish it. You don’t need a vast experience. You don’t need a million dollars. We had neither when we started…only the passion to leave a mark for Peter. We have accomplished far more than we originally believed we could. Through very hard work and a lot of on-the-job training we are now sought out and welcomed into many developing nations around the globe. Our new partners and friends are governments, ministries of health, universities and indigenous religious institutions. We were surprised and very pleased to learn that Barron’s Magazine listed us as “one of the ten most effective small charities in America” in November 2007. And all of this started because of the power of our dream to leave a mark for Peter.
As an Iraqi psychiatrist told us last September 11th: “Because Peter lived; the world is a better place.” We are leaving a profound and indelible mark that Peter existed on this earth.