Feature December 2013
From a death, support for life: The Peter C. Alderman Foundation and mental health care in post-conflict countries

After their son Peter was killed in the terrorist attack at the World Trade Center in New York on September 11, 2001, Steve and Liz Alderman found only one reason to get out of bed each day. They wanted to make a mark in the world for Peter.

Eight months after Peter’s death, they happened to see a Nightline featuring the work of the Harvard Program in Refugee Trauma. They decided that the perfect memorial for their son would be to help trauma victims in war-torn countries to become functioning members of society.

“We wanted to return people to life in his name,” explained Liz, a special education teacher.

The couple set up the Peter C. Alderman Foundation (PCAF – www.petercaldermanfoundation.org), and threw themselves into providing culturally appropriate mental health care for people who had experienced unspeakable violence. There were no role models for this type of work.

“We were in a space where no one else was, and there’s still no one there,” Liz said. She pointed out that post-traumatic stress disorder has been neglected by the United Nations; for example, it was not included in the wide-ranging Millennium Development Goals. This despite the fact that in Africa more people suffer from traumatic depression than from malaria, tuberculosis and HIV/AIDS combined.

One billion people, a sixth of the world’s population, have directly experienced torture, terrorism or mass violence through civil war, ethnic cleansing or genocide, according to the foundation.

Billions of dollars are spent in Third World countries fighting disease and alleviating poverty through microfinance. “But if people don’t care whether they live or die, they won’t be able to take advantage of those things,” Liz pointed out.

PCAF currently operates in Cambodia, Uganda and Kenya, and opened the first mental health clinic in Liberia. In each country, caregivers are indigenous people and treatment is based on cultural norms. The foundation signs a written agreement with each government, which provides clinic space and psychotropic drugs. In fact, the government’s willingness to participate is one of the criteria — along with an intact infrastructure and relative stability — for choosing the countries in which the foundation works.

In addition, PCAF has provided training for caregivers in places where ongoing conflict makes it impossible to establish ongoing programs. By training trainers, the foundation has built capacity in 22 post-conflict countries on five continents. For the past six years, it also has sponsored an annual multi-disciplinary Pan-African conference on psychological trauma in war-affected societies. Conferences have been held in Uganda, Kenya and Tanzania.

Although additional governments are begging for programs, Liz said, the foundation doesn’t enter a new country until funding is in place. It’s a very hard sell, because of stigma, misunderstanding and lack of donor interest. “When people think about depression or other mental problems, they tend to say ‘give them a Prozac,’” Steve said.

“Some people wonder ‘why we need a lot of happy black people in Africa,’” he added. Besides smacking of racism, “this kind of thinking demonstrates that they don’t understand the type of work we’re doing. … Our goal is to return [people] to function.”

The Aldermans take no salary, nor does their daughter, who is PCAF’s chief financial officer. They make an annual donation, raise money through foundation grants, individual donations and the help of a junior board made up of Peter’s friends, and are very judicious in their spending. “We approach things differently than someone with a ton of money. Everything we can scrape together we put into programs,” Steve said.

“We’re fighting an uphill battle. … We’re kissing frogs, looking for a prince.”

Economic impact

Mental, neurological and substance abuse, known as MNS, is the main economic drain holding back developing countries, according to Steve, a medical doctor who specialized in radiation oncology until his retirement after 9/11. He said that the impact of MNS on the global economy is $2 trillion a year. In comparison, total US foreign aid over 20 years is in the billions of dollars; and the entire economy of a small, impoverished country is less than $1 trillion.

Depression is the leading cause of disability worldwide, and is a major contributor to the global burden of disease, according to the World Health Organization.

The enormity of the problem calls for a public health approach, Steve said. “It’s very much a public health model… We’re not doing individual therapy patient by patient; we’re trying for a population effect.”

One of the biggest challenges, Steve said, is to “combine public health and psychiatric expertise in the same cohort,” adding that psychiatrists are skeptical of public health practitioners. “They say, ‘No public health person has ever cured anyone.’”

Public health work tends to focus on the root cause of illness and disease, and in this case the ultimate cause is war. Ending war is “beyond our purview,” the Aldermans say, but they point out that by treating mental illness, the foundation can stop its trans-generational spread.

“Seven of 10 people who are going to get the disease will have the die cast for them by the time they’re 14. If we can catch it early on and mitigate against it, we can prevent it from rising to full-blown syndromes,” Steve said.

In fact, research the foundation conducted in Uganda found that 20 percent of patients were able to return to functioning after only two sessions of psycho-education, where they learned that their response to trauma is normal and expected. They begin to understand that their depression and apathy are not because the soul of someone they killed has come back to haunt them, Liz said.

At the same time, the Aldermans are respectful of indigenous customs. For example, the foundation will not treat a child soldier until he has gone through his own tribal cleansing ceremony.

They spend a lot of time on the ground. “You’ve got to be there,” Steve said. “You can’t make it up in New York or Chicago. You have to go take a look and listen.” Added Liz, “We’re learning so much from being on the ground, and we take good advantage of what we’re learning.”

The couple is now working to build an endowment so the work they’ve done for the past dozen years can continue when they no longer are able to do it.

With all the healing the Aldermans have provided for others, they acknowledge that their work hasn’t touched their personal pain. “It hasn’t healed me,” said Liz. “What it has done is given me a reason to put one foot in front of another… a reason to get out of bed and function at a high level.”

For Steve, the Peter C. Alderman Foundation has served a simple purpose. “I just wanted to be sure I thought of him every day. This was a way to do it.”


 
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