海角大神

Dr. Sylvain Gomossa looks at the three students in front of him, curious how they鈥檒l react to what he is about to say.

鈥淲e used to tie people up with big, heavy chains. Even right here in my office.鈥�

The young men remain impassive. Dr. Gomossa looks disappointed.

鈥淎nyway, it鈥檚 out of fashion now聽鈥� we don鈥檛 do that anymore,鈥� he says. 鈥淪hall we continue the tour?鈥�

The students quietly trail the psychologist, jotting down notes in battered notebooks as he leads them through this ramshackle collection of buildings: the only specialized psychiatric and mental-health ward in the Central African Republic.

Covered in cracked and peeling paint, the men鈥檚 and women鈥檚 sections contain little more than rows of sagging beds and drooping mosquito nets. The main office is piled with stacks and stacks of yellowing, dusty files. Patients鈥� relatives fill the hospital: Some sit together on blankets spread in the shade; others tend small fires where they cook for their hospitalized family members. Generators hum, and a man chops down weeds with a machete.

The students take it all in with wide eyes.

They will spend the next few weeks interning here, at this specialized ward in Bangui鈥檚 General Hospital, as part of a newly reinstated psychology program聽鈥� and, their professors hope, the beginning of a more sustainable solution to the mental-health crisis across this country in conflict.

When the first class graduates later this year, they will more than quintuple the ranks of Central African psychologists. Dr. Gomossa is one of just two permanently based in a country of roughly 4.5 million people, many of whom have experienced war at close range聽鈥� including students in the program.

Most psychologists here are foreigners brought in by nongovernmental organizations, crucial support for a system demolished by war. But these psychologists-in-training hope to apply their intimate understanding of the conflict鈥檚 effects on their communities, and themselves, to build more homegrown care.

鈥淎fter what my country has gone through, I just wanted to help my brothers and sisters,鈥� says Wilfrid Odilon Guimendego, one of the student interns touring the hospital. 鈥淚 want to use my studies to help traumatized family members reintegrate into society.鈥�

鈥榃e were studying post-traumatic stress, and I was living it鈥�

The Central African Republic has been mired in insecurity and violence for decades, but today鈥檚 crisis emerged in 2012: the year the S茅l茅ka, a coalition of rebels from the marginalized northeast, began a long march on the capital, Bangui, and left havoc in their wake. In 2013, after the S茅l茅ka toppled the government, rival militia groups called the Anti-balaka started to organize, and a bloody struggle broke out. Though the conflict was about power and resources, not religion, the fact that the S茅l茅ka are predominantly Muslim and the Anti-balaka fighters mostly 海角大神s and animists has led to vicious interreligious violence.

The S茅l茅ka gave up power in 2014, and the country elected former prime minister Faustin-Archange Touad茅ra as president in 2016. In recent years, the U.N. peacekeeping presence has kept the capital relatively calm. But fighting continues in the rest of the country, which is controlled by a complex web of armed factions, many of whom consistently target civilians. Thousands have died, and a fourth of the population has been uprooted from their homes. An eighth peace deal was inked in February, but one of the signing groups has already walked away.

Even before the crisis, the mental-health ward was understaffed and underfunded, employees say. Since then, the number of patients has nearly doubled, to about 1,500 per year, Dr. Gomossa estimates. Most of them, or their loved ones, have experienced trauma.

鈥淢y cousin was forced to watch as rebels burned someone alive. Then, they made him stay by the body,鈥� says Mr. Guimendego, the student intern. 鈥淢y cousin used to be gentle, but that experience turned him aggressive. He鈥檇 slam doors. He鈥檇 yell. He鈥檇 threaten people with knives and sticks. He had nightmares.鈥�

Mr. Guimendego was already studying psychology, and brought his cousin to the mental-health ward for treatment. He himself is working through trauma, he says聽鈥� struggling to trust people, and jumping when he hears a car backfire, for fear it is gunshot.聽

He鈥檚 far from the only one. Tatiana Mossoua is now working on her thesis on children鈥檚 anxiety and trauma. On Sept. 25, 2016, she was at home with her niece in Bangui when they heard a burst of gunfire. Within seconds, members of a local militia were breaking down the door.

鈥淚 couldn鈥檛 reach my husband, so I called a colleague,鈥� she remembers. 鈥淚 told him, 鈥榊ou might be the last person to hear me alive.鈥欌��

Miraculously, she says, one of the militants recognized her and escorted them to safety. But the neighbors were killed, and her home was burnt to the ground.

In the following weeks, she would lie awake at night, reliving the attack.

鈥淲e were studying post-traumatic stress,鈥� she says. 鈥淎nd I was living it.鈥�

Ms. Mossoua began to apply counseling coursework to her own life, and her son鈥檚. The 9-year-old was asking repeatedly about their pet cat, who had disappeared in the attack. Gradually, she started to feel capable in the face of her loss.

鈥淚 asked myself, 鈥榃hy am I focusing on my experience when other people need help?鈥欌�� she said. 鈥淚 started going to IDP [internally displaced people] camps to counsel people. That helped me a lot.鈥�

鈥榊ou need to believe in yourself鈥�

In 2015, when the University of Bangui resurrected its defunct psychology program, Barthelemy Doui was appointed head of the department.

鈥淓veryone聽鈥� and I mean everyone聽鈥� in the Central African Republic has been traumatized,鈥� says Professor Doui, a sociologist by training. He holds up three fingers: the number of times someone held a gun to his head during the initial phase of the crisis, when fighting was commonplace in the streets of Bangui.

鈥淚 am proud because we built this from nothing,鈥� Professor Doui says of the program, which now has 33 students. 鈥淏ut we still lack material and proper facilities. Our students are like nomads, going from campus to campus.鈥�

Students have little access to computers, and copy down notes from cracked chalkboards. Before the program, many had little concrete knowledge about mental health, despite what they鈥檝e witnessed. Across the Central African Republic, many communities associate mental-health issues with possession and witchcraft. And it was not so long ago that 鈥渢reatment鈥� involved chaining up patients.

But these students have something invaluable to offer聽鈥� culturally specific understanding and treatment.

Up to 58 percent of health facilities in the Central African Republic are supported by NGOs, many of them international, according to a 2017 report. Most have brought in their own staff, who typically consult patients in French, a second language to many Central Africans, or through translators. Other NGOs聽run short courses to give Central African health and community workers basic mental-health training. Recently, some organizations have created internships for students in the program, which allows their clinics to provide counseling in Sangho, the country鈥檚 primary language.

Psychology student Gilbert Nguerepayo is interning today at Voix de Coeur, a shelter for street children. A former teacher and father of five, Mr. Nguerepayo took to the work immediately. Several days in, he is already conducting entry interviews in a pale green office. A tall man squeezed into a dress shirt, he sits opposite 12-year-old Caleb, who seems lost in his plastic chair.

The boy explains that he lost his father first, in a car accident, and then his mother died shortly thereafter 鈥渙f sadness.鈥� He moved in with his grandmother, but 鈥渟he beat me, so I ran away,鈥� he explains, pulling up his pant leg to show a long scar. He bends his head forward to show another, slicing across his brow.

Mr. Nguerepayo listens, studying the boy. He knows that street children come and go from the center, often disappearing and returning to the red dirt streets of Bangui.

鈥淐aleb, I have some advice to give you,鈥� Mr. Nguerepayo says, sounding gruff but caring. 鈥淭his is painful and sad. I know it was hard for me when my own mother died.

鈥淏ut we can鈥檛 stop death. It happens to everyone. So don鈥檛 focus on the loss of your parents. Your life will go on. You need to believe in yourself,鈥� he continues. 鈥淗ere, you鈥檒l meet other orphans. They all go to school, they play, they live their lives. So, tell me, what do you want to do with your life?鈥�

鈥淚 want to be president or minister,鈥� says the small boy.

Mr. Nguerepayo smiles, breaking the lines across his face.

鈥淎h! When you are big, I will vote for you.鈥�

He laughs as Caleb鈥檚 face lights up. 鈥淧resident Caleb聽鈥� President of the Republic. Don鈥檛 you ever, ever forget that. Now, go on, that鈥檚 enough for today. Go and join the others.鈥�

Still smiling, the boy slips out the door.

This story was reported with support from the International Women鈥檚 Media Foundation.