蜜桃传媒

JANUARY MARKS THE PEAK of the dry season in Freetown, Sierra Leone鈥檚 capital city. The harmattan winds blow south from the Sahara Desert, covering everything鈥攖he cars, the sidewalks, the metal roofs of the vendor stalls鈥攚ith a layer of fine red dust. Even the long, flat leaves of the banana trees turn red.

The city juts into the Atlantic Ocean on the westernmost tip of Sierra Leone, a vibrant jumble of pedestrians, motorbikes, and three-wheeled kekehs. But as you head east, toward the Kono District on the other side of the country, the noise and commotion fall away, replaced by open fields of elephant grass, green mountains studded with palms, and mango trees that grow as tall and thick as ancient oaks. Locals call their country Salone听辞谤 swit Salone鈥攕weet Sierra Leone.聽

But there has been much sorrow here in Kono, too. This, for instance, is where Ishmeal Alfred Charles was captured for the first time by rebel soldiers. He was 12 then and his mother had sent him from Freetown to live with his father in Koidu Town, the capital of the Kono District. She thought he鈥檇 be safer there. Instead, rebels attacked Kono two weeks after Charles arrived. They tried to force him to fight for them, but he pretended to be too confused to understand the workings of a gun. So they made the boy a porter instead, piling him with heavy loads of stolen loot. He may have been spared the experience of committing atrocity, but not from witnessing it. 鈥淵ou鈥檇 see them take a girl and go into the room,鈥� he told me, 鈥渁nd they come back out, three men, all sweating, and you heard the girl crying and shouting. Sometimes you just hear a gunshot, like bam.鈥澛�

One day, Charles managed to escape, running into the bush in a moment when the fighters were distracted. He joined up with a small band of fellow refugees walking north toward the safety of the Guinea border. But as the group passed through a town along the way, a new troop of rebels appeared and recaptured them. This time, the soldiers lined Charles and the others into a single-file row. You want the long sleeve or the short sleeve? they asked. 鈥淭hat was when they started cutting the hands off people,鈥� he said.

Charles was fortunate to be spared that fate, and he eventually was able to escape a second time. He was captured once more by local militias before being released. When he returned home, his mother embraced him. She told him that none of it was his fault, and sent him back to school. 鈥淪he was,鈥� he said, 鈥渢he closest friend I鈥檝e ever had.鈥� It has been one of the war鈥檚 enduring tragedies that not every former child soldier was welcomed home so warmly.

THERESA BETANCOURT CAME TO KONO聽for the first time in 2002, only months after the war had officially ended. Back then, the land was ravaged, most of the roads impassable. She had to fly in via a helicopter so loaded with aid supplies and workers that she鈥檇 barely been able to squeeze aboard.聽

She was a Harvard grad student at the time, a year away from finishing her doctorate in maternal and child health. Just a few years earlier, she鈥檇 been a school mental health specialist in Oregon, working with refugee and migrant students struggling to fit in and go to college. Then, in 1995, she signed up for a Spanish immersion program that sent her to a Costa Rica radio station. That year, as the United Nations held a landmark聽to discuss issues especially concerning to women and girls鈥攑overty, education, health, war鈥擝etancourt, with her basic Spanish, helped the station鈥檚 journalists cover the meeting. 鈥淚t opened my eyes to child rights globally,鈥� she recalled, 鈥渁nd exposed me to this world of UN agencies, and the important work NGOs could do.鈥�

Within a year, she was interning for the Office of the United Nations High Commissioner for Human Rights in New York, housesitting for friends and feeding pet rabbits in exchange for a place to stay. In 1998, she started her doctorate work, then began consulting for the UN, and later the International Rescue Committee (IRC). She was sent to Ethiopia, Albania, and the Russian Federation, where she worked with displaced Chechen youth, setting up emergency education interventions and running small studies to see if they helped. It was around this time that she met Marie de la Soudi猫re, then the director of the IRC鈥檚 Children Affected by Armed Conflict Unit. The connection would change her life.聽

At the time, the state of research relating to conflict zones and resilience was in disarray. There was evidence suggesting the importance of social environment to a child鈥檚 recovery after, say, enduring the London Blitz or traumatic wildfires in Australia. But experts were only just beginning to realize how mental health problems such as anxiety and depression express themselves differently in different cultures. And almost no one at the time was conducting longitudinal studies to see how war-affected children fared as they resumed their lives, tracking what helped them and what didn鈥檛.

Psychologists and aid providers back then tended to default to PTSD-focused talk therapy. 鈥淚t was totally a Western model, which was not developed for a traumatic environment,鈥� de la Soudi猫re told me. As the war wound down in Sierra Leone, however, she saw an opportunity. Many child soldiers were being sent to Interim Care Centers, or ICCs, several of which used programming designed largely by de la Soudi猫re. The children would receive physical and psychological care at these ICCs for a few weeks while staff tracked down their families and conducted village-wide 鈥渟ensitization鈥� campaigns so that, hopefully, when the children returned home, they would be accepted.聽

Because of funding challenges, there was limited money to conduct follow-up visits to see how these children were faring after returning to their communities. But de la Soudi猫re, convinced that much more of this kind of study was necessary, managed to scrape up a few years鈥� worth of extra funds鈥攋ust enough to kick off the first stages of a new project to follow these youths for the long haul and discover what really mattered to their future success. She chose Theresa Betancourt to lead the project.

KONO, WHICH IS HOME TO MANY of Sierra Leone鈥檚 diamond mines, suffered mightily during the war. Upward of 90 percent of all buildings in the district are estimated to have been destroyed or damaged during the fighting. When Betancourt arrived in 2002 to begin her work for de la Soudi猫re, the ICC had been set up in an abandoned school made of cinder blocks painted yellow, a grim building riddled with bullet holes. The teens there slept on dirty yellow foam mattresses, but their artwork from the time depicts the facility as a cheerful, colorful place鈥攁 place of reprieve.

Betancourt鈥檚 plan was simple. She would work out of the ICC, creating a list of children who鈥檇 passed through the program before returning home after the war. She assembled a collection of culturally adapted questionnaires to tease out how the children were feeling and what their wartime experiences had been. If all went well, she would continue to check in with these same children through the years in 鈥渨aves鈥� of follow-up surveys, keeping track of how they fared over time.聽

Betancourt camped in the house of a former warlord. She was an outsider, and she understood that the success of her study would lie in her ability to collaborate closely with local people and organizations. It was then that she was introduced to Moses Zombo. A native of the Sierra Leonean city of Kenema, Zombo was a former linguistics student who鈥檇 helped people forced to flee their homes during the war. He had a knack for in-depth interviewing, and found Betancourt鈥檚 project compelling. Over time, he would become one of Betancourt鈥檚 closest colleagues, an essential link to the children she hoped to learn from.聽

With no electricity, Zombo and Betancourt worked by flashlight late into the night. He gathered a team of local research assistants鈥攆ormer teachers and social workers鈥攁nd Betancourt trained them on how to obtain informed consent and conduct interviews. Over time, they recruited a total of 529 children for the study. Most had been taken by rebels at around age 10, though some had been as young as two. They鈥檇 been held for three to four years on average. Most had been beaten, sometimes daily. Nearly half of the girls and about 5 percent of the boys reported that they鈥檇 been raped. About a quarter of the children said they鈥檇 killed or injured others.

The team completed the initial research wave in 2002, and then conducted its first follow-up in 2004. Then de la Soudi猫re鈥檚 IRC funding dried up. But Betancourt found enough money to keep the project going. By 2006, she鈥檇 become an assistant professor at the Harvard T.H. Chan School of Public Health, and with funds gathered from sources such as USAID, she was able to conduct additional follow-up waves in both 2008 and 2016, each time adding to the research detailing how the lives of these former child soldiers were unfolding.聽

THERESA BETANCOURT (N脡E STICHICK) grew up in Bethel, Alaska, where her family settled following her father鈥檚 Peace Corps service in the 1960s. Bethel was a remote community with a population of around 3,000 back then. Many homes鈥攊ncluding the log cabin she grew up in鈥攄idn鈥檛 have indoor plumbing, and most of the roads were unpaved. But Betancourt thrived in the conditions. She caught fish in a coffee can and learned to dogsled. In the summer, she would spend long afternoons on the lake behind the house, pushing herself on a raft her father had fashioned for her out of an old door. She learned early to respect and learn from the culture of Bethel鈥檚 majority native Alaskan Yup鈥檌k population. She learned native stories and dance in school, and her babysitter taught her the Yup鈥檌k language. 鈥淭o me, it was just free and amazing and fascinating,鈥� she told me.

Moses Zombo marveled at Betancourt鈥檚 adaptability in Sierra Leone, her effortless embrace of a life of bucket baths and meals of rice and dried fish eaten off a communal plate. 鈥淵ou couldn't be coming from Boston and like this!鈥� he recalled thinking. But to Betancourt, it was like coming home. 鈥淚 was ready for that,鈥� she said, alluding to her upbringing in Alaska. 鈥淚鈥檇 already had the cold version.鈥�

She was ready for something else she found in Sierra Leone, too: the way that a child鈥檚 life can be shaped by his or her upbringing. When Betancourt was growing up, her mother worked in early child development. 鈥淎nd I remember,鈥� she said, 鈥渟eeing what happened with a child with encephalitis or fetal alcohol syndrome or Down鈥檚 syndrome that wasn鈥檛 being picked up and given the family connection and care that it needed.鈥�

IT NO LONGER REQURIES A HELICOPTER to get to Kono, a testament to Sierra Leone鈥檚 rebuilding efforts in recent years. In January, I made the six-hour drive from Freetown with Mahmoud Feika, the data manager at Caritas Freetown鈥攁n important local partner organization that works closely with Betancourt in Sierra Leone鈥攁nd our driver, Peter French. As we neared Koidu, a green sign by the side of the road identified the way to the 鈥淎mputee Lodge.鈥�

CARITAS FREETOWN, housed in a small complex of concrete buildings painted dark green and bright turquoise, is located not far from Freetown鈥檚 famous Cotton Tree where, it鈥檚 said, the freed slaves who helped found the city in the eighteenth century rested upon their arrival. The organization first partnered with Betancourt鈥檚 research team on YRI a decade ago. Helping to seal the relationship was Ishmeal Charles, the former child soldier who鈥檇 escaped and been recaptured multiple times. Charles had gone on to graduate from university and he began working with Caritas in 2009. The youth intervention project immediately appealed to him. 鈥淲hen I saw what the YRI was, I said, 鈥極h thank God, this is exactly something that I want to work with,鈥欌�� Charles told me. 鈥淲e always say they disarmed the people in this country with the guns, but we didn鈥檛 disarm the minds of the people.鈥�

The research team at Caritas today consists of nineteen Sierra Leonean research assistants鈥攅leven of whom work on YRI鈥攑lus several expats who are part of Betancourt鈥檚 RPCA program. Among this latter group when I visited was Ryan Borg, one of Betancourt鈥檚 Sierra Leone Program Managers, who is from Connecticut and had been living in Freetown for the past two years.

Borg led me to a work room where her team sat at long tables, transcribing and translating YRI field interviews. When I asked what it was like to work on the intervention, the stories of transformation tumbled out. There were the youths who learned to stay cool in the face of taunting, and also the young women who de-escalated arguments with their husbands with a 鈥淧lease, don鈥檛 make my pot boil!鈥澛�

Unisa Jalloh, a YRI supervisor and lead consultant at Caritas, explained that it can come as a revelation to the young people he鈥檚 worked with that they can have control over their feelings. 鈥淭hey鈥檝e not thought about that,鈥� he says. 鈥淭hey say, 鈥榃ow, so human beings, we have the power to change.鈥欌�� The intervention courses are so effective that those who鈥檝e taken them often pass along the lessons to friends and family鈥攕o much so that when the team goes back, they often find that the youths鈥� caregivers display a statistically measurable improvement in their own emotional well-being.

In 2014, Betancourt and her team published a paper that documented the effects of the youth intervention. The researchers looked at two groups of students enrolled in an NGO-led education program. One of the groups, made up of 222 struggling Freetown youths, received the YRI before enrolling. The other group, consisting of 214 similarly challenged students, did not. The students who took the program demonstrated better behavior and had better school attendance than their peers who did not, and, eight months later, they were six times as likely to still be in school.

BASED ON THESE RESULTS, Betancourt and her YRI collaborator Nathan Hansen, at the University of Georgia, secured a grant in 2016 of almost $3 million from the National Institute of Mental Health to launch a YRI scale-up study. The idea is to determine whether the intervention and the skills it imparts can be made sustainable. 鈥淢illions of dollars have gone into putting programs in place in the developing world,鈥� Hansen told me, 鈥渁nd once the program ends, you go back a few years later, and there鈥檚 no evidence to find it was ever there to begin with.鈥澛�

FOR A LONG TIME, there were no recorded COVID-19 infections in Sierra Leone. But the country, scarred by the recent memory of Ebola, declared a year-long state of emergency on March 24 anyway, shutting down its airport, then its borders with Guinea and Liberia. The first case appeared a few days after that, on March 31. Not long after, the Sierra Leonean government declared a three-day national shutdown and banned inter-district travel.聽

Like universities across the United States, Boston College closed its campuses in March and recalled its international staff. Betancourt and much of her RPCA have remained in the States ever since. But the Youth Forward project was, by luck, in a relatively good position when the pandemic hit. The team had already gathered most of its initial data. But the fate of a crucial follow-up study, slated to begin this fall, is uncertain. Still, Betancourt is already thinking about how the effects of the pandemic should be incorporated into future work her team does with YRI participants. 鈥淏ecause Youth Forward is looking at this nexus between mental health, functioning, and employment,鈥� she said, the recent 鈥渕assive job loss and caving of economies is a potential confounder in the study.鈥澛�

And speaking of mental health, change is happening in Sierra Leone. In 2012, the government released the country鈥檚 first-ever mental health policy and strategic plan, and later established a new Directorate for Noncommunicable Diseases and Mental Health. When the government official Aiah Gbakima spoke at Betancourt鈥檚 Youth Forward Conference in January, he summed up the country鈥檚 emerging consensus this way: 鈥淲e emphasize today that investment in evidence-based programs to confront trauma, depression, and other mental health issues are likewise an investment in human capital and prosperity for all Sierra Leoneans.鈥�

For his part, Ishmeal Charles believes that the nation is better prepared to respond to the mental health challenges of a pandemic than it was during Ebola. 鈥淏efore, a lot of people would say, We are a very strong people, so we are not worried about psychosocial support. We don鈥檛 care, we don鈥檛 worry. But now, a lot of people are seeing that, yes, psychosocial help is obviously needed, and it is crucial that we take it seriously.鈥�

As the pandemic grinds on, meanwhile, there has been plenty of work for everyone. Betancourt and Moses Zombo are working together on a book about the longitudinal study, and, of course, there are data to analyze, papers to organize and digitize, and plans to make. And despite the distance, the RPCA remains in close contact with colleagues in Sierra Leone. 鈥淚 think our team really didn鈥檛 miss a beat,鈥� Betancourt said.