Adrian Sutton is a Child & Family Psychiatrist previously at the Winnicott Centre, Royal Manchester Children’s Hospital. For some years now he has been visiting an area in Uganda that had suffered over a generation of war and dislocation.


In particular he has been and remains in contact with a children's village in Gulu run by SOS Villages. He has done some teaching while visiting there and is currently with them and the local child psychiatrist again. Establishing a link could be an extremely productive exercise for all parties. The village itself takes in orphaned and abandoned children and allows them to keep contact into early adulthood. As anyone can imagine, along with significant levels of poverty and continuing threats of dislocation, the enduring depth and extent of mental pain and emotional distress can be great, as can be the enormous capacity of people there on the ground to make extraordinary efforts to give these children and young people an “ ordinary enough” and safe life. Nor can the personal determination and emotional strength of the young themselves be overlooked.


When circumstances, including electricity supplies and communication networks permit, Adrian is writing up his experiences and observations to share with others. We at PETT hope you will find his communications interesting, and your comments are most welcome.


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 Letter One


The 250 mile journey north from Kampala to Gulu for my eighth two week visit provides a good opportunity for observation and reflection on three years of travel to the medical school at the University of Gulu. The University was established in 1999 and admitted its first medical students in 2004 – it was two years later before Gulu was re-designated from being a “conflict zone” to “post-conflict”. My admiration for those who dared to hope and implement the project is unstinting: for those who came to study it must have taken similar personal resources and courage. From the frantic, frenetic activity of Kampala a newly surfaced road leads out to a quieter, lush landscape and road works where upgrading of this main route to the largest town in Northern Uganda and Southern Sudan is slowly progressing. But much of the route is at best broken at the edges and in many places severely potholed, leading to a course more akin to a yacht trying to make way against a direct headwind. The massive articulated lorries which have been part of the indication of economic growth in South Sudan are now joined by some Ugandan army vehicles, reminding me that South Sudan is now again in civil war and refugees are returning to Northern Uganda to join those who had not yet managed to return home from the previous conflict. When I arrive in Gulu I hear of a refugees’ school of 1200 children but only 7 teachers in nearby Arua.


Gulu hasn’t changed much in the last eight months but the new market will soon be finished to replace the old which had emerged through use over time but had been overwhelmed by the influx of people and disruption of the insurgency which lasted from 1987-2006. This was a town of “Internally Displaced Peoples’ Camps” with populations of thousands and “night commuting”- families with vulnerable old and young members making their nightly trek into the town from outlying villages to find refuge from the threat of the Lord’s Resistance Army under Joseph Kony. An army ‘recruiting’ through child abduction, capturing their recruits through making them kill their family or friends – in some instances even being made to eat their victims. Now the IDP camps have gone but their legacy remains in terms of the gross social disruption and need to reclaim the previous farm land that could not be worked when families had had to leave. Add to this the scourge of AIDS… Most of the NGOs have gone as well – apparently numbering 1000 at their peak but now around 40.


Alongside my contribution to the joint work between Gulu Medical School and the University Hospital of South Manchester, I also join staff from the mental health unit, particularly those working with children. Gulu is unusual – it has a child psychiatrist who works with a small multidisciplinary team funded by Children for Tomorrow and The Peter Alderman Trust. They carry out research and clinical work with children who are victims of the violence and are developing the work of general child mental health capacity building. On my last two visits we have been to teach at the SOS Children’s Village – part of an international organization with four projects in Uganda. The organization has community projects and runs the children’s villages which take in orphaned and abandoned children and provide care and education with support through into adulthood. The first visit was prompted by a clinical referral – a 7 year old boy who was a danger to the other 12 children in his house cared for by one house mother (the village cares for 120 children in 12 houses with 17 house mothers). He had been cared for until the age of three by an elderly woman after abandonment: his plight captured by the description “his only friends were the monkeys”. His carer later also told me her story – of having to choose between carrying her children or her terminally ill husband to safety when the LRA arrived. She found his remains in their burnt out hut when the LRA departed. She is desperate for help in trying to protect the other children she is responsible for as well as how to try and help this boy. Not only does she fear for their lives, she fears for her livelihood and any consequences for her children, as she believes she could for held accountable for this very disturbed young boy’s behavior.


I have remained in contact with the head of the Children’s village and on my last visit, at very short notice, she arranged a second half day teaching session from me for her Mothers and teachers. Sarah is a gently strong, thoughtful and intelligent Ugandan who is only too aware of the difficulty of the task her staff undertake and does not take a punitive position when difficulties arise with children such as the young boy I had met. We have arranged to meet to follow on with the teaching and to discuss with my local colleagues how they might provide clinical input and teaching in the future.


I am eagerly awaiting our meeting and will write further with news of these.  


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