FANTASY AND DELUSION...CHILD AND YOUTH CARE TALK

   

There was Blom (flower) and Mielie (a head of maize}. Blom spoke into the one ear and Maize into the other. Mielie said "Just go on and do it!!" Blom said "No! no!!  - that's not you. It's not right".  

Full psychiatric evaluation showed no schrizophrenia. Sometimes Mielie won and sometimes Blom. Given a chioce, we would ask "What does Blom say?"  Where do these id, and ego and superego voices come from ...Ancestors?  Over time we all knew that Blom and Mielie were real heard voices for the boy. 

She was sat with a group of girls in the foyer. Normal girly talk complete with teenage giggles - all very light-hearted. It was comfort for her. She needed this. 

I stood at the tea-wagon. She and two others sat facing it. The rest of the group were on the other side of the coffee table and facing her. 

I say it was what she needed because she was grieving the tragic death two weeks previous of her 21year old boyfriend Len. It was a serious relationship with the promise of marriage when she turned 18 - which was soon.

 Suddenly her eyes fixed on the main door of the facility which opened up into the foyer. 

 "Len! Len! It was a deeply emotional cry. Her body stiffened, her eyes opened wide. She twisted. her body and eyes tracked from the main door to behind her and up the stairs to the girl's dormitory.

"Len! Len!: Then tears,i

'Did you see Len?" one asked. 

"It was Len. Len came. He went up stairs.

 Not one girl questioned it.

When the news came from the hospital that their mother had died, we followed our standard procedure. We asked that the body not be removed until the two were taken by the child and youth care worker to the hospital and the bediside of the mother's body . They took flowers., placed them on the mother's chest, kissed her forehead took her cold hand and said their goodbyes.

 They had to experience the reality of her passing.

Time elapsed as we waited for the family from Zimbabwe. It was a full funeral service attended by the children, with the coffin present. They again had flowers to put on the coffin before it was wheeled out.

 She was cremated and the relatives took the ashes to Zimbabwe .

 Telephone calls were made to the two children from Zimbabwe. On more than one occasion they told us, The Zimbabwe family had said "Your mother is safe with us." Meaning the ashes were urned and on the shelf above the frireplace awaiting internment.

From snippets of conversation the child and youth care worker joined the dots. The two children were living with the delusion that their mother was alive and living in Zimbabwe awaiting an internment  At the hospital, they thought that the mother was just sleeping... she looked like she was sleeping. The funeral was just something we all went to as a Home.

Hasty footwork had to be done. The Zimbabwe relatives were persuaded to bring the ashes to Johannesburg. An internment was arranged. The two children held and placed the  urns into the wall of remembrance.  They were told to tell us all what they remembered about their mother now gone forever. The cubicle was sealed with a plaque. They helped. There were tears....at last !!! Good healthy tears.

A friend brought her to the office "She has not been at all well" she said. "It seems like she's in another world...like she's not connected."  She had asked to see her children.

"Let's talk a bit while we we call the children"...structural delay.

Fear struck suddenly, looking towards the door, "They're coming! They're coming!"

"Who's coming?" 

"They are coming. They are coming to suck my blood and take me away. Only the blood of Jesus can stop them. They are coming."

 "I can call upon the blood of Jesus and chase them away" I said.

 Putting my hands without contact around her head, I said the words I thought were needed. "Out...Out In the name of Jesus.

She stiffened like a board, like a plank of wood, resting her neck on the chairback and her legs outstretched in front of her. Then she slumped into a coma. like state.

The resident nurse was called and the ambulance. Vitals were taken. They were fine.

 The Psychiatric ward did wonders and after three days she was discharged.

At the back of this episode was a true story which had an indelible effect on my practice.

A woman in a psychiatric facility for some or other condition refused to eat. This was unrelated to her diagnosis.  It didn't matter what they brought her, or what they did, they could not persuade her to eat. The doctors and the psychologists did all they could. But...Nope!!

 She was fading, wasting away and would surely die.

 A young intern was the only one who had been part of the treatment procedures asked to be allowed to try. It was agreed. "OK, you try."

he went to her bedside . She said,"Im not going to eat. They are trying to poison me".  '

"You're right he said. They are trying to kill you. They're not trying to poison you. They want yo to starve to death.'

That evening, she ate.

"What did you do?"

Our best qualified professionals tried and she didn't eat. What did you do?"

'I needed", he said "to step into her world for a moment...into her reality. Her fantastic delusion is her reality. I agreed with her reality as a start and worked from there". 

ALCOHOL...CHILD AND YOUTH CARE IN SOUTH AFRICA

 

Certainly more than thrice on my watch, there was occasion for young people to be whipped off to the hospital emergency rooms for a stomach pump. They were not just drunk on alcohol, but unconscious with the risk of alcohol poisoning.

The one really did nearly die. He was 14 years old and was place as  procedure had it from a facility that transitioned boys at that age. At 14, in our facility,  he was put into a so called senior house.

Brandy was forced down him - held and poured down his throat. They said it was initiation. He was to prove he was a senior 

 Deeply unconscious the emergency room had to give him breathing assistance on a ventilator and an immediate stomach pump.

 He was unconscious for three days, He could have died. The father and I sat bedside . Of course there was a threat of legal action. I would e held responsible.

Child and youth care workers in open facilities in particular and in community-based settings have to expect alcohol experimentation and more . Drinking to get drunk is not uncommon. Organisatio'nal procedures are established for dealing with drunk young people. I learnt a lot from first aid courses - how to position them in the recovery position and..and..and. When and how to talk this thing through.

Alcohol stories abound.

The 60 seater bus was pulled up just outside the main gate. The boys loaded themselves in it to go to the annual camp. The very back seat of the bus was highly favoured. A full bus width bench seat. I couldn't understand why it stayed empty

Roll-call. Some senior boys and a staff member not yet boarded. - '"wait.. wait they're coming" There came two large boys. They  were carrying a long roll of blankets in which there must have been something heavy,

"Luggage in the luggage hold

" No.. It's needed for the journey.

"'Well put it on the back seat"'

Then came the staff member...clearly drunk...like, body swaying drunk.

Me: "Off, off. You're not coming like that. I can't deal with this now... when we get back from camp. Just go back to your flat now."

He did.

The bus was a good number of kilometers from the facility when the blankets were unwrapped. Inside, now revealed, was a boy, the brother of one of the resident boys...and what we called an old boy of the residential programme. 

Broad smiles throughout the bus. They had smuggled him onto the bus to come to the camp holiday uninvited and disallowed. They had waited to unwrap him when the bus would not turn back.

 The story behind this was that the brothers had sat with the staff member most of the night, fed him with alcohol and drank together. They then brought him in on their plan. Bribed and drunk he went along with it.

What do we have here? I had heard stories, totally in breach of ethical code, of drinking alcohol with boys. The boys would then say "We will tell if you don't".....whatever . It cut two ways. Child and youth care worker may have provided the boys with alcohol as a bribe to stay silent about something or boys buying drinks for a staff member to do something outside of protocol. Mostly boys who were of, or near to the legal age allowing for its purchase.

Young people come into a programme with gambling addiction, alcohol addiction, substance addiction and more.  

We saw a viral video on Facebook which caused a huge outcry by and youth care workers in South Africa. It showed a young mother sitting at what appeared to be an outdoor picnic. She was drinking from a bottle. It looked like a bottle of cider or one of those fruit-flavoured vodka drinks. She put the bottle to the mouth of an approximately four year old girl obviously her daughter. The mother cheered, laughed and clapped when the little one drank from it Then she opened and gave a full bottle to the toddler as it's own. The child drank. Again the mother cheered, laughed and clapped. 

The Facebook comments from child and youth care workers urged that the mother be identified and charged with abuse. No mention was made however of multi-disciplinary developmental intervention.

I have, in community, seen this very frequently .. such that in a drinking situation, young children put out their hands and cried for a guzzle or a full bottle...like it's a soda pop. It is very scary.

And worse. I have been told stories by  grandmothers of children brought into care, that the mother put brandy in the baby bottle to make it sleep. That, and in some instances welcanol (pinks) a drug popular in the 80's, This to bring about sleep especially when a  sex-worker uses her own home at night.

He was just eight and he had a substantial vocabulary of the names of pills and drinks.

Just a thought. All of this makes cigarette smoking seem rather trivial.

Once a year at year end, the Board of Management held it's end of year function. The idea was two-fold. They would meet staff  who they had not face to faced during the year, They would introduce themselves. Names would be put to faces They would say an end of year thankyou to child and youth care and other staff. 

The Board paid. The Chairperson gave an order for the purchase of the alcohol. There was never any skimping. The help yourself bar had everything...a full drinks bar. Snacks and glasses were bought out.

When the facility moved into a group home setting one of the houses had a large hall used by the previous owner as a caravan repair workshop. That year it was the Board's obvious choice of venue for the year-end function.

 It had to be explained that there would be children and young people in the house  - those who who had no holiday placements with parents or hosts. Secondly the house was a no alcohol , no smoking no drug area. It was not a good idea for the child and youth care workers ,other staff and Board members to be seen to break their own rules. I said it would be OK if there was no smoking and no alcohol.

Panic...a lot of tap-dancing, but we're adults arguments .

They found a training room in the main office building, said that it had to be cleared. "It's small but it will do. We'll have the function here. At least here we can smoke and have alcohol drinks from our bar"