Inge Missmahl brings peace to the minds of Afghanistan

23,732 views ・ 2010-09-29

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00:16
So I want to tell you a story -- an encouraging story --
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about addressing
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desperation, depression and despair in Afghanistan,
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and what we have learned from it,
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and how to help people
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to overcome traumatic experiences
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and how to help them to regain some confidence
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in the time ahead -- in the future --
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and how to participate again in everyday life.
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So, I am a Jungian psychoanalyst,
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and I went to Afghanistan in January 2004, by chance,
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on an assignment for Medica Mondiale.
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Jung in Afghanistan --
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you get the picture.
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Afghanistan is one of the poorest countries in the world,
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and 70 percent of the people are illiterate.
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War and malnutrition kills people
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together with hope.
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You may know this from the media,
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but what you may not know
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is that the average age of the Afghan people is 17 years old,
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which means they grow up in such an environment
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and -- I repeat myself --
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in 30 years of war.
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So this translates
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into ongoing violence,
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foreign interests, bribery,
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drugs, ethnic conflicts,
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bad health, shame, fear
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and cumulative traumatic experiences.
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Local and foreign military
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are supposed to build peace together with the donors
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and the governmental and non-governmental organizations.
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And people had hope, yes,
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but until they realized
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their situation worsens every day --
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either because they are being killed
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or because, somehow,
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they are poorer than eight years ago.
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One figure for that:
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54 percent of the children under the age of five years
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suffer from malnutrition.
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Yet, there is hope.
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One day a man told me,
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"My future does not look brilliant,
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but I want to have a brilliant future for my son."
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This is a picture I took in 2005,
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walking on Fridays over the hills in Kabul,
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and for me it's a symbolic picture
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of an open future for a young generation.
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So, doctors prescribe medication.
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And donors
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are supposed to bring peace
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by building schools and roads.
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Military collect weapons,
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and depression stays intact.
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Why?
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Because people don't have tools
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to cope with it, to get over it.
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So, soon after my arrival,
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I had confirmed something which I had already known;
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that my instruments come from the heart of modern Europe, yes.
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However, what can wound us
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and our reaction to those wounds --
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they are universal.
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And the big challenge
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was how to understand the meaning of the symptom
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in this specific cultural context.
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After a counseling session, a woman said to me,
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"Because you have felt me, I can feel myself again,
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and I want to participate again
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in my family life."
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This was very important,
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because the family is central
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in Afghans' social system.
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No one can survive alone.
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And if people feel used, worthless and ashamed,
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because something horrible has happened to them,
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then they retreat, and they fall into social isolation,
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and they do not dare to tell this evil
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to other people or to their loved ones,
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because they do not want to burden them.
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And very often violence is a way to cope with it.
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Traumatized people also easily lose control --
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symptoms are hyper-arousal and memory flashbacks --
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so people are in a constant fear
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that those horrible feelings of that traumatic event
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might come back unexpectedly,
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suddenly,
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and they cannot control it.
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To compensate this loss of inner control,
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they try to control the outside,
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very understandably -- mostly the family --
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and unfortunately,
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this fits very well
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into the traditional side,
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regressive side, repressive side,
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restrictive side of the cultural context.
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So, husbands start beating wives,
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mothers and fathers beat their children,
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and afterward, they feel awful.
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They did not want to do this, it just happened --
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they lost control.
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The desperate try
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to restore order and normality,
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and if we are not able to cut this circle of violence,
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it will be transferred to the next generation without a doubt.
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And partly this is already happening.
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So everybody needs a sense for the future,
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and the Afghan sense of the future
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is shattered.
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But let me repeat the words of the woman.
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"Because you have felt me,
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I can feel myself again."
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So the key here is empathy.
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Somebody has to be a witness
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to what has happened to you.
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Somebody has to feel how you felt.
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And somebody has to see you and listen to you.
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Everybody must be able
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to know what he or she has experienced is true,
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and this only goes with another person.
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So everybody must be able to say,
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"This happened to me, and it did this with me,
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but I'm able to live with it, to cope with it,
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and to learn from it.
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And I want to engage myself
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in the bright future for my children
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and the children of my children,
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and I will not marry-off my 13 year-old daughter," --
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what happens too often in Afghanistan.
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So something can be done,
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even in such extreme environments as Afghanistan.
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And I started thinking about a counseling program.
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But, of course, I needed help and funds.
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And one evening,
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I was sitting next to a very nice gentleman in Kabul,
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and he asked what I thought would be good in Afghanistan.
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And I explained to him quickly,
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I would train psycho-social counselors,
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I would open centers, and I explained to him why.
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This man gave me his contact details at the end of the evening
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and said, "If you want to do this, call me."
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At that time, it was the head of Caritas Germany.
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So, I was able to launch a three-year project with Caritas Germany,
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and we trained 30 Afghan women and men,
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and we opened 15 counseling centers in Kabul.
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This was our sign -- it's hand-painted,
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and we had 45 all over Kabul.
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Eleven thousand people came -- more than that.
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And 70 percent regained their lives.
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This was a very exciting time,
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developing this with my wonderful Afghan team.
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And they are working with me up to today.
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We developed a culturally-sensitive
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psycho-social counseling approach.
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So, from 2008 up until today,
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a substantial change and step forward
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has been taking place.
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The European Union delegation in Kabul
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came into this and hired me to work
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inside the Ministry of Public Health,
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to lobby this approach --
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we succeeded.
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We revised the mental health component
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of the primary health care services
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by adding psycho-social care
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and psycho-social counselors to the system.
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This means, certainly, to retrain all health staff.
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But for that, we already have the training manuals,
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which are approved by the Ministry
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and moreover, this approach is now part
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of the mental health strategy in Afghanistan.
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So we also have implemented it already
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in some selected clinics in three provinces,
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and you are the first to see the results.
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We wanted to know if what is being done is effective.
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And here you can see
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the patients all had symptoms of depression,
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moderate and severe.
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And the red line is the treatment as usual --
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medication with a medical doctor.
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And all the symptoms
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stayed the same or even got worse.
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And the green line is treatment with psycho-social counseling only,
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without medication.
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And you can see the symptoms almost completely go away,
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and the psycho-social stress has dropped significantly,
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which is explicable,
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because you cannot take away the psycho-social stresses,
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but you can learn how to cope with them.
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So this makes us very happy,
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because now we also have some evidence
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that this is working.
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So here you see,
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this is a health facility in Northern Afghanistan,
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and every morning it looks like this all over.
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And doctors usually have three to six minutes for the patients,
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but now this will change.
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They go to the clinics,
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because they want to cure their immediate symptoms,
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and they will find somebody to talk to
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and discuss these issues
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and talk about what is burdening them
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and find solutions, develop their resources,
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learn tools to solve their family conflicts
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and gain some confidence in the future.
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And I would like to share one short vignette.
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One Hazara said to his Pashtun counselor,
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"If we were to have met some years ago,
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then we would have killed each other.
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And now you are helping me
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to regain some confidence in the future."
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And another counselor said to me after the training,
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"You know, I never knew why I survived the killings in my village,
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but now I know,
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because I am part of a nucleus
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of a new peaceful society in Afghanistan."
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So I believe this kept me running.
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And this is a really emancipatory and political contribution
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to peace and reconciliation.
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And also -- I think --
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without psycho-social therapy,
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and without considering this
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in all humanitarian projects,
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we cannot build-up civil societies.
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I thought it was an idea worth spreading,
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and I think it must be,
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can be, could be replicated elsewhere.
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I thank you for your attention.
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10:21
(Applause)
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