10/25/2013 09:09 am ET Updated Dec 06, 2017

The Story of a South African NGO -- Freud Goes to Alex


When South Africa became a democracy in 1994 we celebrated the passing of the old order and toasted our new country with the certainty of a great new future. Our joy at our freedom was soon diluted by our anxiety over the signs of severe social dislocation and psychological distress that we saw all around us. While we had indeed emerged from an oppressive history it was clear that we were a traumatized and damaged nation. We grieved for our fragmented society and thought about what we could do help address the next phase of our struggle.

My husband Tony and I were first generation South Africans whose parents had fled the turmoil in Europe before WW2. We had become South Africans through and through! Tony owned a building adjacent to Alexander Township that had once housed the family business. When it became vacant in 1999 we saw a chance to make a contribution. Alex, as it is know by its familiar abbreviation, needed a mental health centre we thought, as we started to do our homework.

Alex lies a few kilometers to the north east of Johannesburg. It was founded as a freehold township in 1912 when it was declared a location for 'natives and coloureds', in keeping with the racially constructed landscape of apartheid. While it has a rich and distinctive social, cultural and political history, it remains on the whole, an impoverished black ghetto for the marginalized and dispossessed. Inadequate infrastructure and services, poor housing, overcrowding, extreme poverty, unemployment and serious crime put Alex's population at serous risk.

Freud and his followers had revolutionized our thinking about child development. Today there is increasing recognition of the importance of intervening early in the lives of vulnerable children. The most damaged section of the population in situations of social disclocation is always the most dependent and innocent. When Nelson Mandela became our President his words resonated with us. "The reward of the ending of apartheid will, and must be, measured by the welfare and happiness of our children."

While all children are faced with developmental challenges that have to be negotiated, many township children are burdened with spirals of emotional suffering that arise from poverty unemployed parents, absent parents or neglectful, overburdened, depressed single mothers, physical and sexual abuse and an HIV/AIDS epidemic that robs children of their childhoods as well as their parents.

We were both practising psychotherapists that informed the decisions we made. We employed artisans from Alex - builders, electricians, plumbers, bricklayers, bricklayers, painters, tilers - and spent almost the whole of 1999 changing the building from an industrial site of offices and warehouses and a warm and welcoming community mental health centre. And we named it Ububele and registered it as an educational and psychotherapy trust.

Ububele, an Nguni word like Ububtu, encompasses more than its literal meaning which is kindness. It extends to include the idea of compassion and concern for others, a central ingredient of mental health. The root of the word is amabele, a breast that represented a nurturing mother - the epitome of love and caring. It made sense to begin with a therapeutic pre-school which would give us access to the community that we wanted to serve - and seek out folk to train as lay mental health workers.

We furnished a well equipped pre-school which opened at the beginning of 2000. Children have a regular pre-school programme for the day - 7.30am. - 4.30am while psychologists monitor their emotional development. Three play therapy rooms were set up where children in need of individual attention can be taken into play therapy. Now 13 years later the school has 65 children, six teachers for the 3 year olds, four year olds and 5 & 6 year old group, intern psychologists and their supervisors who work with them. And most important an excellent cook who prepares the two meals a day. While the pre-school performs a valuable service to a small number of children, its influence radiates out. Parenting skills are supported as parents are counselled. In addition this gave us a rich field of observation as we developed other interventions.

One example closely linked to the pre-school is the Ububele Persona doll project, designed as a therapeutic intervention for children between three and seven years. It has become an integral part of the work in the pre-school as well a offering a wider training for community health workers, teachers and psychologists in the wider community. The persona doll is a life size rag doll that has a detailed personality and life history worked out by the practitioner during her training. This creates a "suspension of disbelief" phenomenon that allows the children to relate and communicate with a doll in a group setting. In the pre-school each teacher has her own doll that visits her group regularly and helps the children to become familiar with their emotional worlds. While this enhances emotional literacy when used by the teacher our professional child psychotherapists use the dolls as an effective therapeutic intervention, especially when crises arise such as the death of a parent or the rape of a four year old.

Now as we come to the end of 2013 we have travelled a hard road and come a long way. The pre-school has thrived and grown as Ububele has expanded into a well established organization, linked through effective partnerships with national, international and community based bodies. Many programmes have been developed around community based preventative and therapeutic interventions, all informed by the needs, experiences and challenges of the members of the community.

Major scientific and well researched advances in the neurological development of the infants' cognitive and emotional development confirm that neglect, abuse and under-stimulation of the infant can lead to the diminished capacity of the brain and emotional stunting. Ububele has followed the lead of USA and European research in addressing this early relationship between parent (especially but not exclusively between the mother and child) as well as the Harvard Centre for the Scientific Study of the Infant and the work of the Anna Freud Centre in London. The Ububele project derived its name from the Zulu word Umdlezane, which refers to an indigenous practice during the past-partum period when the women in the family prioritize a mother's relationship with her baby. They take over the practical running of the homestead, freeing the mother to focus on her baby. It is not only the necessity of the mother-infant attachment that is crucial but also the quality of the attachment indicating that indiginous knowledge has long recognized the value of secure attachment.

The Ububele Baby-Mat is a brief intervention within three township primary health care clinics. 200 mothers a day bring their infants to be weighed and inoculated at these under-resourced township clinic. A mat is set up in the corner of the room and mothers are encouraged to speak with a psychologist and a translator (we have 11 official languages) about any emotional or attachment issues that worry them. Often the initial presenting problem appears "medical" e.g. latching, diet, evacuation difficulties but our psychologists have become skilled in identifying a whole range of other problems. These range from depression, unwanted pregnancy and ambivalence towards a new baby, abandonment by a partner, poverty and inadequate housing and isolation from family support which is common among people fleeing poverty and political unrest, especially in other African countries. When a psychological problem is identified the mother is referred to Ububele for further help.

In keeping with our motto " Service through Training and Training through Service" Ububele offers training to professionals, lay counsellors, early childhood development practitioners and childcare workers who work with infants and children, and their parents and caregivers. Our focus is on the child, from conception to the age of seven years. Ububele's remains mindful of the importance of research and was fortunate to be able to partner the University of the Witwatersrand , and the Anna Freud Centre in London in researching the attachment relationship between mothers and their babies in local shelters for single mums. This research has been extended to include a home visiting programme whereby carefully selected and intensively trained women from within the Alex community pay house/shack visits to vulnerable mothers and their infants.

An awareness that South Africa is unlikely to produce enough mental health workers to meet the extensive need has led Ububele to offers quality training in experiential group work for professional and lay counsellors, "Working with Groups" has been running for eight years in six weekly modules, each consisting of three full days. Counselling and facilitation are used in a range of settings, including bereavement work with children and supportive work with nurses, teachers, social auxiliary workers, community home carers. This course is accredited by the Institute of Group analysis in London. Ububele regards this training as an important contribution to the building of capacity in the mental work field.

Our most fervent wish is that our Government will come on board and see the necessity of replicating our programs all over the country. We're working at it.