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Annotated captions of Inge Missmahl brings peace to the minds of Afghanistan in English

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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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(Applause)