**6.3 Additional examinations**

170 Post Traumatic Stress Disorders in a Global Context

Income generative activities have been impaired by the way children perceived them. The activity which did not kick off well enough was truck farming. Boys were saying that *'' cultivating okra, egg-plant was sauce''* meaning that they are ingredients to cook sauces, and that it is women who cook, therefore this activity could not be exercised by men. In a number of regions in Côte d'Ivoire, truck gardening, especially those destined to daily

Poultry also did not fare well. Chick distribution created jealousy in some villages, but children themselves had problems in adapting. Without wasting time, either they ate up the

The activities, which were the most successful, were sewing and carpentry because the children were put in apprenticeship. The boss himself monitored their vocational project. An important rate of early pregnancies was observed. Girls explained that to be considered as a woman, one has to prove one's fertility. To be a mother is to achieve the status of a woman. Excision of the young women was still carried out in this region; girls and boys put it that it is important to do it, if a woman was not excised this would bring bad luck to her husband.

In order to develop a meaningful relief program we first took stock of existing interventions in the region. Next we trained the NGO staffs in the management of traumatic stress symptoms. In the course of fieldwork we constantly modified what information was useful

Activity follow up was made through telephone calls with the field teams who used to call

A number of humanitarian agencies had implemented a number of activities including songs, funny stories, code of living, and promotion of children's rights, literacy campaigns and sports. Those activities, although useful, did not always meet the real needs of the children or led to the relief of required mental health problems of affected children. But those children were preys to anguish, psychic disorders and aggressiveness. Adults were

Psychotropic drugs prescription was dominated by antidepressants (amitryptillin). Generally speaking, these drugs were prescribed in small dose. Drugs prescribed appear in

Number of Children Medication Daily Dosage 34 Amitriptilin 35-75 mg 18 Haloperidol 5-7.5 mg 14 Chlorpromazin 150-200 mg 7 Bromazepam 3-4.5 mg 30 Trihexyphenidyl 5 mg

5 Carbamazepin 400-1,200 mg

Table 3. Psychotropic medications prescribed in the management of mental health problems

consumption are the prerogative of women.

**6. Strategy of intervention** 

**6.1 Activities already implemented** 

**6.2 Medical prescriptions** 

table 3 below.

chickens or some children embezzled the products of the sale.

to adopt in the management of psycho trauma symptoms.

as soon as a need arose or whenever problems cropped up.

not equipped to receive and accept such brutal and violent emotions.

In order to provide comprehensive health care to the children, we referred some of them to other specialists as follows: the children who needed surgical consultation (2), gynecological consultation (1), general medicine consultation (2), ophthalmological consultation (1), ENT consultation (2), and urological consultation (2). It proved important to carry out electroencephalogram (EEG) for 3 children and an x-ray of the lumbar vertebrae for one child. Consultations required that children be sent down to *Guiglo*. As for the EEGs, (which were disrupted later), the children had to come down to Abidjan.

#### **6.4 Psychotherapeutic action**

Beside the activities implemented by the volunteers, such as literacy campaigns, animal breeding, agriculture, training of volunteers and the populations about post-traumatic disorder, a number of therapeutic activities were initiated: family drawing, game, and therapeutic workshops.

Concerning drawing, the instructions were "*draw your house and your family before, during and after the war*"*.* All the children took up this activity, even those who had never gone to school. Their drawings were full of memories of their trauma. The lines were strong, violent testifying to an internal aggressiveness and violence. The dominant colors were black, red and orange. Few children were imagining a return to normal life after the war. They had drawn their house destroyed by the war and which remained the same after the war; not rebuilt but over grown with weeds.

It seemed important to initiate some psychotherapeutic activities. The children had come off, in this context, with objects from their environment, most of the time it was bamboo or raffia. Children with the most important psychic disorders had built objects recalling the war, while those who overcame their problem had drawn houses, churches and cars.

Working tools and activity comment cards were difficult to use because there were no specialized education officers among the field teams. Even if the officers showed interest,

War in Côte d'Ivoire and Management of Child's Post Traumatic Stress Disorders 173

retired in the bush to be excised. A meeting was organized and the matron responsible for that activity empowered us to talk to the girls. When we asked them about their motivation for genital mutilation and pointed that the Government had prohibited such practices, and that some were already mothers (like two of them), one of them argued that excision favors marriage because a non excised woman is a source of evil to her husband. Even if they lose some sensibility during coitus and their libido will be negatively affected, excision is worth being carried out. Our questions seemed to disturb some of the girls, and a dispute even

Before such a practice, the field agents were powerless and villagers barely listened to them. One of them explained laughing that all the talks made by the officer was meaningless because if the woman is not excised she could bring evil to her husband (confirming thus the opinion expressed by the young girl). What could be added if ancestral beliefs are so

At the final assessment of our intervention in August 2008, only 58 children were assessed. Many were the children who had left the area before the project came to an end without an assessment of the impact of the actions undertaken and without a real reintegration. It was hoped that any improvement in the mental health of the children would permit the children to view their future with hope and resume normal life activities for survival after the war. The children who better rebuilt their life were those who returned to school or those who learned sewing: the young girls of *Pantrokin* who enlisted in the sewing project built their own sewing shop; they bought new machines and were receiving customers. One of the boys, Joel, who demonstrated leadership capacities, was handling alone truck farming and breeding. As for the other boys, they had, either left the village or abandoned the project. In *Ké-bouébo* and in *Béoué*, breeding and farming were abandoned. Only the vestiges of a

In general, the children were better off on the psychopathological point of view though of them showed a reactivation of psychiatric symptoms (psychotic disturbances, depressions). The community volunteers seemed to have given up their commitment toward these children possibly for a variety of understandable reasons including lack of funds (therefore no salary),lack of food donation and perhaps because the NGO local agents were no longer

Most of them were boys (60.3%). Girls made up 39.7%. The children revealed the presence of girls among the child soldiers. The girls were used as cooks (20%), fighters (5.22%), dish and

The number of girls used for sexual purposes was not specified. It is difficult to establish a ratio between the numbers of girls out of a total size of children present with the armed groups. In some countries, girls represent up to 40% of the child soldiers, like, for example, within the *Tigres de Liberation de l'Eeclam in Shri Lanka.* Those children are also brought to carry a number of functions as we have seen (Huyghebaert, 2009; Ayissi& Maia, 2004). Girls play different roles on the same day*;* they are fighters, cooks, messengers, spies, nurses, sexual slaves, even *"*captive wives*"*, as it was the case of a young girl we met at *Ké-bouébo.* 

promising project remained (abandoned hen houses, fallow ground).

clothes washers (3.19%), security guards (2.32%) and porters (2.03%).

The overall appreciation of that mission is the following:

there to provide the services they did before.

**8.1 Who are the Ivoirian children soldiers?** 

**8. Reflexions from this experience** 

**8.1.1 They are boys and girls also** 

cropped up.

strong?

their expected involvement in psychotherapeutic work represented an extra work, as they had other activities to attend to (identification of children in need of birth certificates, HIV/AIDS awareness activities). So that, psychotherapy was necessary for a number of children, an activity based on talking with the children, proved impossible for field workers.
