OUTLINE OF BARING FOUNDATION FUNDED PROJECT, 2002-2004

Reason Partnership, PTSD Project, Peru

Background

Reason Partnership, formerly Richmond Fellowship International, has been working in Peru since 1997. The charity helped establish Richmond Fellowship del Peru, an affiliated charity, and secured funding to establish drug related programmes in Peru. A mission from London in late 1998, to assess the programmes, followed by a Baring Foundation funded opportunity to bring Peruvian counterparts, plus other counterparts, to London in 1999, culminated in a reassessment of our collaborative approach to mental health issues in Peru.

Two main issues were identified, the first being the lack of rehabilitative programmes within the Peruvian penal system for special needs offenders and the second being the plight of displaced indigenous peoples as a result of the conflict between the Peruvian government and Sendero Luminoso, a Maoist insurgency group operating in the rural areas of the Andes mountains.

The conflict began in 1980 and continued until the early 1990s. Over 69,000 were recorded as dead or missing and over 600,000 became displaced. Through localised health clinics, Richmond Fellowship del Peru established that a significant number of indigenous peoples were exhibiting behaviours associated with Post Traumatic Stress Disorder, but had so far not received recognition of their disorder nor, consequently, any treatment.

The Project

The design of the project had to take into account certain negative parameters. The first of these was that, due to political instability and lack of financial and other resources, the government of Peru was unlikely to be able to offer much support. The second parameter was that the displaced themselves were wary of the authorities, seeing themselves as ‘invisible’ to such authorities and, as a consequence, being treated as ‘invisible’ by the authorities. The third parameter to be taken into account was that there was almost no understanding of PTSD within the host community nor within the displaced community. The fourth was simply one of a difference in language and, consequently, a difference in conceptualisation and understanding.

There were, however, sufficient positive parameters to undertake the project. Despite the lack of official resources and understanding, the displaced themselves provided a resource to be exploited in their favour. The indigenous peoples of Peru, descendant from the Inca, have an extended ‘clan’ system, the “Ayllu”, which has, for centuries, provided a set of social support networks covering everything from farming, house building, rituals to child care.

These systems enabled Reason Partnership and RF Peru to design a PTSD intervention utilising such mechanisms to engage with the affected population in ways and means they could understand and accept as, simply, another support with which there was a degree of familiarity.

Grupos de Ayuda Mutua, (Mutual Self Help Groups), were established in two localities in Lima, where people could come to discuss their experiences. RF Peru also involved the displaced in fiestas for various religious ceremonies throughout the year, health fairs under the auspices of the Ministry of Health, and provided education and training on PTSD at ‘glass of milk committees’, ‘community dining rooms’ and ‘neighbourhood management boards’.

Utilising, strengthening and adding to conceptually appropriate social support systems with the displaced not only embedded knowledge and education concerning PTSD within the displaced population, but also involved the personnel of those Ministries charged with caring for the displaced, primarily the Ministry of Health and the Ministry of Gender and Social Development. This has culminated in a Co-operative Agreement being signed by RF Peru and the Division for Resettlement of Displaced Populations of the Ministry for Gender and Social Development, mainstreaming psychological and psychosocial care as part of the national resettlement programme.