Women for Women of Sierra Leone provides free medical care, micro-credits, and elementary school education for the victims of the decade long armed conflict that resulted in more than 80 percent of the population being displaced and traumatized psychologically and/or physically. This is a report of the medical mission to provide an opportunity for psychiatric interventions in the context of a primary care delivery model.

1. MAKENI WAR WOUNDED
PROJECT
 PRIMARY CARE INTERVENTION FOR THE
SEVERE PHYSICALLY AND PYCHOLOGICALY
TRAUMATIZED

2. 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

3. 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.

4. 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.

5. 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

6. 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.

7. 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,

8. PHYSICAL SIGNS SYMPTOMS
AND SYNDROMES
 Bronchitis  Osteoarthritis
 Cholera  Pneumonia
 Dysentery  Pelvic Inflammatory
 Cataracts Disease
 Diarrhea  Rash
 Ear infections  Sickle Cell Disease
 Fever  Septic Joints
 Fungal Infections  Trismus
 Hypertension  UTI’s
 Headache  Wound infections
 Malaria  Yeast Infections
 Nausea  Leprosy

9. PSYCHIATRIC SIGNS
SYMPTOMS AND SYNDROMES
 Anxiety
 Depression
 Thought Disorder
 Nicotine Dependence
 Alcohol Abuse
 Posttraumatic Stress
Disorder
 Schizophrenia