For this installment, we profile a clinical/community psychologist who is now working as a volunteer mental health expert for Doctors without Borders.
What does a community psychologist do?
Living Community Psychology highlights a community psychologist through an in-depth interview intended to highlight the personal and professional lives of those working in our field. The intent is to personalize Community Psychology as it is lived by its diverse practitioners. These past columns contain a wealth of life advice gleaned from over 60 profiled community psychologists, from graduate students to retirees, representing an invaluable resource for community psychologists.
*All columns are available online, at http://www.scra27.org/publications/tcp/tcp-past-issues.
Cindy Scott was born to teen parents in Southern California so that “we grew up together.” While her (pregnant) mother finished high school at night, her father went to work. Later, her brother, like their father, also dropped out of high school. As a high school senior, Cindy volunteered at a local shelter, hanging out with abused and runaway youth, many of whom were close to her age. She was impressed with how the staff provided support to these traumatized kids, and this experience became formative for her future.
Although Cindy had never known anyone who had attended college, she entered a local junior college, considering a career in probation or parole. “However I quickly discovered that I did not want to be viewed as a cop. I wanted to help people get their lives back on track.” When she transferred to California State University, Sacramento, she pursued a double major in Criminal Justice and Psychology. While her family was proud that she completed college, they wondered when she would get a “real job” and questioned whether a job helping people would provide the financial stability she needed for the future.
Cindy’s first post-college job (1983) was working with disadvantaged youth in the Sacramento Job Corps Program. Then she moved to Miami, FL to work with a faith-based organization which facilitated a multi-denominational church partnership aimed at bringing women (including sex workers) off the streets and channeling them to intervention services and programs. Miami at the time was a complex blend of poverty, racism, and ethnic tensions that was mixed with the historic African-American community, Haitian refugees, wealthy Cubans, and Cuban refugees who were dumped on the shores of south Florida during the Mariel Boatlift.
After one year, Cindy returned to work for a Job Corps Center in the “Little Havana” district of Miami. She ran the counseling department for the Center that housed about 100 youth, ages 16-21, in a program where they could earn a GED and obtain job skills. Another 100 youth came into the Center from their homes in the community. The complicated social dynamic in Little Havana played out within the Job Corps site: drug houses were prolific, with the surge of crack cocaine on the market. Cuban community members were passionate about retaining their cultural heritage and clashed with the native-born African-American Corpsmen. Salvadorian youth, fresh from fighting a war, were trying to integrate into the program, while Virgin Island students had left their peaceful island communities to an unsafe inner city context. To relieve the tension and increase cross-cultural sensitivity, Cindy promoted focus groups and videos about increasing multi-cultural awareness and problem solving. The staff also was embroiled in the tensions and mirrored the same attitudes displayed by the students. Her Job Corps supervisor became a powerful influence, introducing her to the social dynamics of oppression and social justice. “We would watch and discuss hours of documentary films about social change.” Issues related to racism, social justice and cross-cultural communication became pivotal in Cindy’s development.
Cindy also volunteered at a Haitian church on Saturday nights, assisting a youth program. That program is being sustained by the original youth who are now running the program and also developing youth programs in their home communities in Haiti. “It was often uncomfortable, being frequently the only white person around, but I loved working in these urban contexts with people from other countries.”
After 7 years working for Job Corps, Cindy observed that many of the brightest youth, although they were offered the opportunity to complete their education, still were burdened by their family legacy of tragedy and oppression. She needed more skills to work with families, so applied to the Marriage and Family Therapy Master’s program at Fuller Theological Seminary in Pasadena, CA. Attending a school where she could merge spirituality and psychology was a dream come true. “I wanted to become a more congruent person rather than compartmentalize my work and my spiritual life.”
Cindy again moved across the country, living with her grandmother while taking classes at Fuller. She wasn’t prepared for the culture shock of moving from the inner city into a scholarly community that was primarily White males and to a counseling profession that was geared to setting up private practice psychotherapy. On the other hand, she loved Fuller’s emphasis on systems level analysis, from the micro to the macro-levels. By socializing with the international students and attending an African-American church that embraced social action, “I could breathe again.”
One friendship became key as she considered pursuing a doctorate in psychology. A Kenyan student, Francis Kamau, challenged her worries about financial risks. Having an infectious faith, he put her student debt into context – “$100,000 – is that all, for an education?” He has continued to be her Pastor, friend, and mentor, and her first trip to Africa was to visit his projects in Nairobi.
For her doctoral studies, Cindy interned at Didi Hirsch Community Mental Health Center. She taught peacemaking skills in an inner city school and worked on child abuse prevention. She served as a clinician on the Los Angeles County Child Abduction Task Force with child protection, law enforcement and other organizations looking for missing children. After graduation (1999), she worked at several clinical positions, obtaining the clinical hours needed for licensure.
Facing a large student debt of $120,000, she applied to the National Health Service Corps which paid off her student loan, at $25,000 per year, in exchange for practicing in an underserved geographic area — a central California community with a migrant farm worker population. (She was pleasantly surprised that her salary was higher than what she had been earning in Los Angeles, and her living expenses were half those of LA.) She had a nontraditional practice, working out of schools, clinics, vineyards, and homes. Upon observing that the school districts were not complying with laws for educating special needs children, she became expert in advocating for their rights. The parents, many of whom were undocumented and had limited English, were intimidated by the schools. She researched current laws and set about educating the parents to advocate for their own children.
After five years (2002-7), her student loan was paid off, but her job became more stressful in terms of politicization, poor quality control under Medi-Cal and decreasing autonomy. She was recruited to train third-year psychiatric residents at UCLA-Kern County Mental Health Service and manage a mental health adult outpatient unit. Soon after she arrived, she started soul searching. “Was this what I really wanted? I was in my 40s, without a husband or children, free to take risks. I wanted hands-on experience.”
Having worked with several refugee and immigrant communities, she began to picture herself working overseas. She randomly submitted applications to the UN, NGO’s, etc, including to the mental health division of Doctors without Borders (Medecins Sans Frontieres, MSF in French). After only 8 months at UCLA, MSF had a spot for her, in Uzbekistan. Part of MSF’s culture is to reserve 30% of the staffing of its missions for first-timers.
Not normally a risk taker, “I had no idea what I was getting into,” she recalls. After briefings in New York City, she participated in 2-week intensive training in Bonn, Germany. All MSF personnel are trained in all aspects of missions – including security and logistics as well as emergency medical service. Her training included an overnight mock mission in a forest, equipped with a compass and role playing situations they might have to face. In the cold forest, she wondered how she ended up there, not considering herself an adventurous person. Her journey to her Uzbekistan assignment required 11 airport transfers, and the last flight was on a broken down, Soviet era plane with nonfunctional seat belts.
MSF’s niche is as an emergency medical organization, but it also intervenes on broader public health issues and is increasingly addressing mental health issues. MSF’s mental health unit is located within MSF’s public health program, based in Amsterdam. Her assignment to Uzbekistan was disease-targeted, working on a community’s drug-resistant TB epidemic. “Whole families were dying.” She trained counselors to support patients and their families through a two-year, toxic treatment regimen whose severe side effects rendered the patients unable to work. Already very poor, the patients’ adherence to treatment was a huge challenge. Although her contract with MSF was for one year, she extended beyond a second year.
MSF values her community-based skills, encouraging her to report back on her community observations. For example, she informed MSF about an orphanage she discovered, populated by children whose parents had died of TB. “I’m nosey; I like to snoop around.”
MSF debriefs its workers after assignments and encourages them to volunteer for future assignments by posting open positions. However, the workers are urged to take 2-3 month breaks between assignments, to rest and reconnect with their families. (For these short rests, she earns no income.)
Her second MSF assignment was to the beautiful rainforest Highlands of Papua New Guinea (PNG), providing emergency medical care to survivors of family and sexual violence. Although PNG has western-style laws, the Highlands are in practice lawless, with rapists and murderers free to roam the streets. The medical system was overwhelmed and ineffectual, so MSF’s mission was to provide emergency medicine, surgical care if needed, and psychosocial support at the local hospital. (See an Australian TV report on the MSF program, at http://www.abc.net.au/7.30/content/2013/s3939750.htm.) Although MSF typically works in response to disasters, disease outbreak, or in conflict zones (or with refugees fleeing conflict zones), PNG has more casualties than many conflict areas, due to chronic community and family violence.
The PGN Highlanders live in bamboo huts, and it is not uncommon to see people wearing traditional grass skirts. Guns are not readily available in that region, but the people use spears and bush knives, chopping off body parts. Domestic violence is endemic and kept secret, with high suicide rates. She developed a simple scale and educational materials, used to elicit stories from clients who were in turn relieved to finally reveal their secrets of spousal abuse. The staff frequently were, themselves, victims of abuse so their needs had to be attended to also so they could be effective counselors. Much of her work there involved instilling hope in hopeless clients and staff.
Her third (and more typical MSF) assignment was in Ethiopia, working with Somali refugees fleeing violence, by addressing child malnutrition through psychosocial stimulation. MSF established a hospital in a refugee camp in the desert. There, she camped out in a tent for six months. On the refugees’ long and arduous trek to safety, many children died or became malnourished, presenting as near skeletons. The MSF physicians, overwhelmed by the 500 patients presenting daily, could not account medically for the babies’ failure to thrive once provided with medical care. She found that the mothers, having lost all hope, avoided their ill babies. She trained staff to work with the mothers using animation tools to in turn reawaken the babies’ brains. But this first involved instilling optimism in the mothers that their children would survive if they had maternal nurturing. Cindy also attended to the problems of severely mentally ill refugees; schizophrenics were frequently chained to a tree in the camp by their families. Confused, traumatized, or disoriented patients were often referred to the psychosocial team for longer chats and comfort. This was a luxury for which the doctors and nurses did not have time. They were referred to Cindy – “here’s one of yours,” they would say.
Following a violent incident suffered by another NGO and the kidnapping of two MSF staffers in Kenya, Cindy was quickly evacuated from Ethiopia after only six months. “It was very traumatic for me, not allowed to return to camp to say goodbye.”
Cindy took the opportunity, between assignments, to de-stress – something MSF encourages because assignments are very intense. MSF is generous in allotting days off and encourages its workers to leave their assigned countries to holiday in exotic locales. For example, during assignments, she has rested in Bali and Zanzibar. She acknowledges that the pace of her job is less stressful than for medical staff. “I get more and regular sleep, so I can sustain myself longer than can the medical staff who are constantly in 24-hour emergency mode.”
After Ethiopia, she signed a one-year teaching contract at Fresno Pacific University in California as an assistant professor. They appreciated her hands-on, international work and, hoping to retain her permanently, assigned her classes she loved. She enjoyed the opportunity to read community psychology textbooks again. Since this was her first academic position, she had to create new curricula for a fulltime teaching load. Being a private university, the students tended to be well off and unfamiliar with those “on the other side of town.” The psychology students had only been exposed to clinical psychology, so she devised community-based opportunities for them to experience community psychology, out of their comfort zone.
While teaching, she began itching for “one more hands-on mission” so accepted a fourth MSF assignment, back in PNG — located in the capital city, Port Moresby, building nursing capacity in clinics to treat victims of sexual violence. She collaborated with PNG’s mental health technical advisor in crafting a proposed mental health policy and is setting up a victim support center for the country’s major teaching hospital. While PNG’s laws against violence are humane and progressive, their implementation is deficient. “The staff, although compassionate, generally lacks skills.”
In the first six months of her assignment, she did outreach into the schools, via contacts with PNG’s education ministry. Since then, she has been adapting the Psychological First Aid (PFA) curriculum, used to stabilize people in the aftermath of a traumatic event or disaster, to the PNG context. In so doing, she has identified specific PFA skills that nurses can use to support survivors of sexual and family violence. Through her work in rural areas and in the capital city, she has come to admire the tremendous courage of the health care workers who, working with MSF, risk their own lives (due to the retribution and payback system of informal justice in PNG).
MSF pays for all her field expenses and a small living stipend but not a salary. “This is not the ideal retirement system either.” The financial burden in her first year was considerable because she could not sell her house in California during the recession. Fortunately, her MSF stipend increased over time, but still she makes only 1/8 of what she had been earning at UCLA.
She is only sent on English-speaking missions; if she learned French, she could be posted to more African missions. She frequently works with an interpreter, especially when she wants to observe her trainees’ counseling sessions with clients. She loves living with other MSF staff in culturally diverse communities. Debate (“arguing”) is constant. (She is now living in an apartment with other MSF personnel in PNG.) “I like working with people from other countries. It gives me another perspective on how the U.S. is perceived, although those perceptions are frequently disheartening.”
She has been very impressed with MSF’s values, especially around human dignity. And she feels that MSF does a good job integrating mental health into medicine. However, she would like to move into capacity building, so is considering working with another NGO that addresses mental health from a development and community engagement perspective rather than from an emergency medicine perspective. “I’m into the slow approach, building long term sustainability. Psychosocial interventions take time if they are to be sustained long term.”
At the same time, she wonders how long she can sustain her health in demanding physical locations. She also recognizes that her mother (now widowed and in declining health) needs increasing support. She can envision herself working in the U.S., possibly with refugee populations and/or teaching.
When asked to identify her major professional contribution to date, she points to having empowered her trainees to help their communities. “My legacy is for them to look beyond their own worlds, in hopeless, sometimes oppressive, environments and make a positive difference in their own communities.” In closing, Cindy remarks that the source of her motivation is spiritual – “it defines me.”