In the collection "Writing On the Edge," fourteen esteemed writers chronicle their travels with MSF teams through countries in crisis. Accompanied by Tom Craig's photographs, Martin Amis, Tracy Chevalier, Daniel Day Lewis and others take readers into rarely seen reaches of Colombia, Burundi, Gaza, Uzbekistan, Cambodia, Sierra Leone, Uganda, and elsewhere. In this excerpt, Booker Prize-winning novelist DBC Pierre recounts his journey to Armenia:
With occasional shelling and sniper fire still erupting around the eastern defenses, and having been told in one town that the mayor has a new gun and might be out shooting stray dogs on the street, I hook up with a team from Médecins Sans Frontières, who have large "No Kalashnikov" symbols plastered over their vehicles. These suddenly seem more helpful than the skull design on my snowboarding jacket.
It turns out MSF came here in the immediate aftermath of the 1988 earthquake and just never left. When issues of front-line care were dealt with, MSF crews saw a disturbing residue emerge from the depths of the culture. As a result, and unusually in the world of front-line support, the medical charity decided to channel some of its resources into a project that deals with perhaps the most vulnerable target of trauma and neglect: mental health. From a regional base in the lakeside town of Sevan--a collection of glum Soviet buildings scattered over a high plateau, with a decrepit ferris wheel strangely creaking in the wind at its entrance--young Belgian psychologist Dr. Luk Van Baelen leads me on a journey into the dark world of the uncared-for mind.
Nothing could have prepared me for what I was about to see.
Not far from the house with the missile sits the border town of Chambarak, comfortably settled into the folds of a high valley. The town is a mixture of rural rusticity and post-Soviet neglect, an occasional apartment block rising between traditional houses of lava and stone, and smatterings of hay and dung. Some windowsills sport old US Aid tins as flowerpots or buckets, souvenirs of support long gone. A nutty haze of dung smoke hangs over Chambarak, from ubiquitous solid fuel heaters like large iron shoeboxes with stovepipes attached. The town's market building is a vacant shell, attended every day by a crowd of heavily wrapped men doing nothing and talking about doing nothing. Only one trader is there, selling twigs for broomsticks.
"There used to be nearly 100 percent employment here," says a man. "Now it's nearly 100 percent unemployment. Every day there are five funerals, but never a birth."
The man, like half the town's population of around six thousand, is an Armenian refugee from the town of Artsvashen, seventeen miles over the mountain in Azerbaijan. He left everything behind to flee the war. With the border so close, combat fatigues and military fur hats are more in evidence on the streets here. Armed watchtowers look down from the mountains. When we take our jeep off-road to view the town from a hillside, soldiers quickly appear out of the snows and make toward us. We vacate the hill.
Wandering the icy streets of Chambarak--little more than compacted humps of ice glacially layered with hay and dung--I come to note that there's a feeling around a place that has had shells lobbed at it. Bombs sensitize, not de-sensitize, as is often romantically supposed. There's a quivering nerve that stays raw and bleeding long after the gunfire has stopped.
In the middle of the town there's an old Soviet block that was once either a prison or a collection of miniscule apartments without plumbing. It stands gutted and derelict. Van Baelen takes me inside. "When I first saw this place," he says, "I knew immediately why I was in Armenia."
A fetid stench upholsters the block, sharpening as we move upstairs. The building has been stripped to bare sooty concrete, and in places genuinely gutted by fire. Litter migrates in icy drafts. Some flights up, noises can be heard behind a door. We knock. The door opens onto a cloud of dung smoke from a wood stove, thick enough to burn the eyes and throat. In one room just big enough for a single bed, a small table, and a dresser, sits a woman called Hamest. Three children sit with her. They are refugees. They fled Azerbaijan fifteen years ago. The building is a refugee hostel. A handful of families are camped there still, waiting for a change in their fortunes.
And there's something more: a curiousness, an unexpectedness in the makeup of the family's features and in their manner. The boy has a strangely elongated face and a detached, doleful gaze. Then the father arrives and bids us welcome. And there's something unusual about him too, behind his beard and in his eyes.
Hamest and her husband are mentally retarded. So are all their children. And their life's routine after the door closes behind us is one of unthinkable abuse. Hamest's husband often trades their bread for vodka and drinks with other men in the building, often in that tiny room. He regularly beats Hamest, and there is reason to suspect her daughters suffer sexual abuse at the hands of the men. Hamest's mother is dead, and she has lost all contact with the family she knew when she fled Baku, Azerbaijan's capital, in 1990. She is utterly powerless.
MSF provides Hamest with a grant for electricity, and its psychologist tries to convince her to send her adolescent daughter to a boarding facility, away from the horrors of home. But Hamest is afraid she will lose her daughter as well. I retire from the building with questions. Not least, what are the odds of a mentally handicapped couple finding each other, and going on to raise a handicapped family?
I met a great many people in the Southern Caucasus. And it may be, notwithstanding psychoses brought about by the trauma of war and dislocation, that there are no more mental disabilities here than anywhere else. But there's a great stigma placed on mental disability here, and it attaches to anyone within reach of a sufferer. Sufferers are alone with their problems. Lesser conditions like depression and anxiety are ignored altogether, just taken as another fact of hard life. And this dynamic forms the heart of Van Baelen's project. He has made a start on the task of destigmatization.
Chambarak opened its first MSF day center in 2003. There is one in each of the towns I've visited, staffed with psychologists, social workers, and assistants. They are a hub not just for the disabled, but for the wider community; if only for warmth, coffee, and conversation. Every weekday the center is open for counseling, crafts, music, fitness, anything that brings the twain together in a relaxed and constructive way. Picnics and open days are mounted whenever possible. The able and disabled are mingling.
"We use any excuse for a party," says Chambarak's psychologist, Loussine Mkrttchian. Subscription is steadily growing at her center.
It's also at the day center I see a remembered face. The shepherd who wandered past the house containing the missile. I meet him. His name is Petros, a handsome, weather-beaten, profoundly retarded thirty-five-year-old with airs of great musing and reflection and a fixation with the buttons on his coat. A familiar sight around the district, he simply wanders from morning to night, often in the mountains, often around the prohibited border zone. His family feeds him, but that's as far as his care goes. He's been left all his life to wander. He has never spoken a word.
© WRITING ON THE EDGE: Great Contemporary Writers on the Front Line of Crisis, Rizzoli New York, 2010.