MAKENI WAR WOUNDED

PROJECT
 PRIMARY CARE INTERVENTION FOR THE
SEVERE PHYSICALLY AND PYCHOLOGICALY
TRAUMATIZED
 PROFILE OF TRAUMA

 People were displaced as they fled into the bush to escape the rebels
 Displaced people went into desparate survival mode to secure food,
shelter, safety and security.
 They moved from village to village avoiding the rebel advance
 When apprehended by the rebels in the bush they were raped,
amputated, and/or killed
 The survivors carry physical and psychological wounds.
 THE AMPUTEE

 There are the surgically amputated who required removal of their limb(s) after sever gunshot
injury became gangrenous.
 There are those who were amputated by the rebels with machete and axe.
 Those who survived eventually arrived in Freetown seeking the protection of the government
forces.
 Displaced people were sheltered in a large camp in Freetown
 When rebel forces entered Freetown amputations continued to occur
 Amputees are either displaced from the hinterland villages or from the urban areas such as
Makanie or Freetown.
 MEDICAL CARE AFTER THE
AMPUTATION

 Those who received surgical amputations in hospital due to gunshot wounds

developing gangrene received the medical and surgical services available at the time.
 Those who suffered amputations at the hand of the rebels went for extended periods
of time without medical care.
 Some patients describe having to pay to have their stump washed, antibiotics, and
pain medications.
 Some have been fitted with prosthesis. However functional assessments and
vocational retraining is critically needed
 PREMORBID FUNCTIONING

 Those from the villages were farmers, traders, drivers, crafts-persons, parents, grandparents,
husband, wives, etc.
 As one woman described bitterly “ I was a person of status”. She was a trader, wife, and
mother.
 Those from the city described similar roles and relationships prior to trauma and diplacement
 The President of the Association of Amputees lived with his wife and children in his home in
Freetown on the day the rebels came to his door. They threatened to take his 14 year old
daughter. She escaped and he fought them. He subsequently lost both arms in below the
elbow amputations.
 Displacement

 People displaced lost most if not all their pre-morbid

roles
 They lost relationships, community and family.
 They lost the capacity to provide for basic needs.
 They lost hands, arms, and legs.
 PSYCHOSOCIAL PROFILE

 The victims were from multiple ethnic groups, Limba, Temne, Mandingo, etc.
 Their prior roles were that of farmers, miners, traders, tailors, drivers,
 They were from the Western area, Southern , Northern, and Eastern Providences
 They were male, female, mother, grandmother, father,and grandfather.
 Some had amputations after gunshot wounds became gangrenous.
 Some had amputations at the hands of the rebels as a tactic to induce fear and hence control and
expose the powerlessness of the government to protect
 They suffered above the elbow, below the elbow, above the knee, right left, and bilateral
amputations.
PHYSICAL SIGNS SYMPTOMS
AND SYNDROMES
 Bronchitis  Osteoarthritis
 Cholera  Pneumonia
 Dysentery  Pelvic Inflammatory Disease
 Cataracts  Rash
 Diarrhea  Sickle Cell Disease
 Ear infections  Septic Joints
 Fever  Trismus
 Fungal Infections  UTI’s
 Hypertension  Wound infections
 Headache  Yeast Infections
 Malaria  Leprosy
 Nausea
 PSYCHIATRIC SIGNS
SYMPTOMS AND SYNDROMES

 Anxiety
 Depression
 Thought Disorder
 Nicotine Dependence
 Alcohol Abuse
 Posttraumatic Stress
Disorder
 Schizophrenia