When I was asked to contribute a bio-sketch for the Newsletter, my memories went back to the last evening of the cultural psychiatry conference in Rhode Island in Oct 2004. At the farewell diner the atmosphere was very pleasant. Probably inspired by this atmosphere and by the afternoon symposium, in which four participants (Ron Wintrob, Mitchell Weiss, Riyadh Al-Baldawi and Michael Hollifield) told their life story, a group of residents invited several guests to sit at their table and tell their life story connected to transcultural psychiatry. I was one of those invited.
To my own surprise, I started my story by telling my audience that I was born thanks to Hitler. That attracted their attention and I started to explain: a year before World War II, young men in Holland were recruited into the army. My father volunteered. He was assigned a managerial job and was sent to another part of the country. Because there were not enough barracks, he was housed with civilians. And, as you may have guessed, my mother was part of the family that my father was sent to live with. They married in 1944 and I was always told that when my oldest brother was one month old, he saw the “tommies” (Canadians, English, Americans) parachuting food packages above Rotterdam: the hunger was over!
I was born in 1953, the fourth of five children. In addition to the war, different types of Christian faith have influenced my life. My father was raised in a very liberal family, while my mother was from a very conservative Calvinistic family. My father adopted the lifestyle of my mother after their marriage, which had serious implications for us as children: no outdoor activities, no sports, no bike riding on Sundays, and no dancing, no going to cinemas or street fairs, and even no Christmas tree.
Notwithstanding all these constraints, I received a lot of love; although I didn’t realize that at the time. There was one interest that my mother and I had in common: Africa. She was active in the Christian mission movement and my interest in this faraway, strange world grew through her influence. My father continued his military service in Indonesia for three years shortly after the war, but he avoided talking much about his military life.
During my puberty, I rebelled a lot against all the limitations and rules my parents imposed on us children, and I think from that time on opposition became my second nature, my being in life. Later on I saw the parallel between my life experience and the context of the times in the western world. There was a lot of opposition around me: student revolt in Paris, marches against Vietnam, freedom fighters against their colonial masters. My interest in politics grew and I defended the left wings ideas; even in the church group. In school and university we discussed the future of the world, how to limit the power of capitalism and how to make things better and wealth be more equally shared.
In the meantime, faith had come back in my life. I met a group of evangelical Christians who showed me that it was possible to be a Christian and still have a happy life. I joined an evangelical student association and was quite active in that organization for some years, being energized by some deep religious experiences. I tried to integrate my political ideas with this new-found faith. Accordingly, I joined a movement called ‘religious socialists’.
During my medical training at the University of Utrecht, from 1974-1981, psychiatry attracted my main interest – especially the so-called anti-psychiatry movement, of course – but I was determined to become a tropical doctor. A year-long program in Cultural Anthropology and Medical Sociology at the University of Leiden made me even more motivated.
During that time, I found the love of my life and told her that if she wanted to share her life with me, she should accept going to Africa with me. Fortunately, she shared this interest with me and became active in the ‘third world movement’. We demonstrated together in Amsterdam against nuclear missiles, and were proud that the opposition against these missiles was called “the Dutch Disease”.
To prepare myself for working in the tropics, I worked (1982-83) as a resident in gynecology, surgery and internal medicine, and participated in a 3-month course at the Royal Tropical Institute in Amsterdam. In September 1983, we -my wife, our son and me- went to Nigeria: to Cross River State, an Ibibio area that included a large number of tribes and languages.
We went to the tropics accompanied by the shame of colonial times and its past history of white superiority. In the area we came to, however, the people who lived there had only very good experiences with whites, and we were well accepted from the beginning. Also all our political concepts and ideas became completely irrelevant in this environment and nobody was interested in hearing about them – nuclear missiles were no issue in that part of Nigeria.
Next to my culture shock in adapting to living in Nigeria, this was my main shock: a complete identity switch, or is it better so see this as part of the overall culture shock? My own faith had moved in a more ecumenical direction in the several years before going to Nigeria, but this also became irrelevant, at least in the world outside our doors. Because the hospital was attached to the Lutheran church, we became familiar with the Lutheran faith. The local interpretation of this faith was: everything that happens is the will of God, so if your child dies, or if your village is infected Guinea worm, there is nothing you can do about it. No opposition and no search for how things could become better.
Fortunately, the urge to live and to protect your children is universal and strong, and in daily life a lot of people worked to make things better. Most health workers had an attitude of helping and cooperating. In addition to my work in the hospital, I was the head of the primary health care program, and the tuberculosis program. These responsibilities brought me to a wide variety of villages and tribes. I sat down with village heads and women’s groups, talking about clinics, mother and child care programs and water wells. I did hernia surgery on a kitchen table, to compete with private practitioners who were surgically incompetent, cried about lives lost, wrote many proposals and reports, organized training programs, celebrated weddings and funerals (big ones), survived a major allergic reaction to an ant bite, had another child, was in the news because of a yellow fever outbreak, worked collaboratively with local healers (to the dismay of the Nigerian director), spent holidays in Kenya and Togo. I had no time for research, which was another thing that seemed completely irrelevant in this environment.
After five years in Nigeria, we went back to the Netherlands in 1988. I worked for a while with an association against leprosy and tuberculosis and spent some time in Kenya and Tanzania with that organization, to evaluate several clinical programs. They had offered me a job in Nairobi, but this did not work out. My wife and children were getting settled in Holland and I had to accept that my career in tropical medicine had to come to an end.
Professionally, I was confused about what to do next. I had developed some interest in public health matters and there was a movement started by the WHO called ‘healthy cities’, which was directed to limit health differences related to ‘socio-economic status’. Rotterdam, my birthplace, had joined this movement, and I got a job in the youth department. I did some research, attended courses in epidemiology, set up a network between school doctors, counselors and social workers, and served as a part-time school doctor in districts with large populations of immigrants. This job offered me several opportunities: to adjust to a Dutch working environment, to develop more skills in immigrant health issues and to do some scientific work.
I re-evaluated my professional life, and more and more I came to the conclusion that my real satisfaction was working with patients. My interest in psychiatry was revitalized by the contacts with adolescents and their parents, and I decided to apply for a job in this field.
My first weeks in the psychiatric intensive care unit in Deventer (1992) are still very fresh in my memory; what a change! Another type of ‘culture shock’ experience. A year later, I was able to enter the official training program, just by luck, I think. The hospital had applied for years to be recognized as a training hospital and suddenly they succeeded. I got the chance to enter the training program in psychiatry. By that time I knew that psychiatry was my field of medical work. I eagerly started to read psychiatry books and articles and worked to improve my skills in making contact with all kinds of patients.
During my training, I spent my ‘elective period’ in a service treating asylum seekers and refugees (Phoenix) and worked with Martin Kooiman. He was a very experienced psychiatrist and was very skilled in making contact with people and at the same time collecting enough information to make a good psychiatric evaluation. Transcultural psychiatry had entered my life, as a very natural development to the next phase.
My work with my present employer, a community mental health institute in the northern part of Holland, started in 1999. My assignments were to set up a mental health program for asylum seekers, and to organize a transcultural psychiatry training program. I wrote a plan and proposed that I would not see patients myself, because I wanted to set up a system in which a large number of people were challenged and trained to work with asylum seekers. They agreed, and so for my own clinical work, I worked with an organization for refugees in Amsterdam (Pharos).
After three years the management asked me to set up a day clinic for asylum seekers and refugees. We put together a treatment team, and after a while De Evenaar (The Equator) was inaugurated (easily written, but everyone knows the process is more complicated). I became the psychiatrist in charge, ended my job in Amsterdam and my family and I moved up north. Patients come from all over the three northern provinces of the Netherlands and recently we got permission to expand to a ‘Center for Transcultural Psychiatry’ and open an out-patient clinic for immigrant adults, children and adolescents. The Center is also involved in training of psychiatrists, and I am a teacher of transcultural psychiatry in the general psychiatry training program for residents.
The job also gave me the opportunity to set up an epidemiological study among asylum seekers and refugees. I had already made contact with Prof Joop de Jong, at the Vrije Universiteit Amsterdam, with the aim of incorporating this study as research for a doctorate, and if all goes well, I will get my PhD in 2007. My collaborators in this study are Hajo Gernaat (also ex-tropical doctor, good analytic mind, good questions) and Ivan Komproe (knows everything about statistics and knows how to explain it), Both have been very helpful to me.
In this study, almost 300 Iraqi asylum seekers and 90 Iraqi refugees were interviewed. Outcome measures are: psychiatric problems, quality of life, disability, physical health and service use, while a broad range of pre-and post migration risk factors were investigated. The study especially focuses on the impact of the lengthy asylum procedure.
I have been able to publish several articles about the study and to present the findings at several conferences and symposia (among them; Rhode Island in 2004, Cairo in 2005, Beijing in 2006). The results have been summarized recently in a report to the Dutch government, emphasizing that the Netherlands’ very restrictive asylum policy has a very negative impact on health.
Meeting with people attending the cultural psychiatry conferences has been very stimulating for me; especially the first such conference I participated in (Rhode Island). I felt honored that my presentation was in a session chaired by Joseph Westermeyer and I met many colleagues with common interest in the scientific TP field, including: Michael Hollifield (right away we made plans to set up a multi-site study), Mitchell Weiss, with his splendid ideas about combining quantitative and qualitative research, and Solvig Ekblad, whom I admire for her work in Sweden. Later on I met Derrick Silove, from Australia, who has an ongoing energy (together with Zachary Steel) to collect information about the health status of asylum seekers and advocate for them with government agencies.
The work with asylum seekers and refugees is challenging and rewarding, but sometimes not easy, as you all know. To do this work several things have been important to me: my tendency to oppose and not to sit back when injustice is done, my loving wife and children, my faith in a loving God, my friends, and my hobby (singing).
In addition to all these supportive resources, there is one more I would like to mention; the feeling of being connected to a wider network of people who share the same interest and (com)passion throughout the world. This is a very important source of inspiration for me to continue both my clinical and research work.
I thank you for providing such a world-wide network.
July 5, 2007