Once again The Carter Center is in the midst of providing relief to a health-related crisis in Liberia. This time, it’s containing the Covid-19 virus. But unlike the past health and mental health crises, the center has a legacy of in-country experience to aid in its response.
Once the coronavirus was first detected in mid-March in the West African country and began to spread, its government requested the center to assist with prevention efforts and mental health support.
Although as of mid-June there were a comparatively small number of cases for a population of slightly more than 5 million (516 confirmed cases and 33 deaths by mid-June), the recent 40-plus cases identified in a single day prompted heightened concern.
“A day ago we detected about 40 new confirmed cases in a single day,” S. Benedict Dossen, who oversees all of the center’s behavioral health initiatives in Liberia, told Global Atlanta during a Zoom call on June 19 from his home in Marshall, Margibi County, about 32 miles from Monrovia, the country’s capital. “Before we only had three or five up to 11 in a day. One day with about 40 cases made people scared. It increased the fear.”
Fear is an emotion that plagued many Liberians during much of the 1990s until 2003 when the country endured two civil wars. Beyond the estimated 200,000 dead, the survivors included scores of former soldiers, many of whom were children, and traumatized civilians experiencing a range of mental health problems.
“The war had a very significant impact on the country due to the level of destruction, number of lives lost and properties damaged,” Mr. Dossen said. “The impact in terms of mental health was severe and many people are still trying to recover.
“We did not have the proper or systemic processes in place to help people. Treatment was in bits and pieces provided either by the government or international organizations. There was a formal process of disarming and reintegrating soldiers in the society, but no systematic and sustainable structure providing them with effective psychological and social support.”
At the government’s invitation, the Carter Center personnel came in at this point to assist in the implementation of the rule of law through a series of initiatives including access to justice and information and conflict resolution programs.
The center’s Mental Health Program provides technical support to the Mental Health and Psychosocial Pillar (MHPSS Pillar). As part of its COVID-19 response plan, the Carter Center is supporting social workers and mental health clinicians including clinicians specializing in child and adolescent mental mental health through the MHPSS Pillar’s services. It also underwrites and facilitates the mental health and psychosocial support training in collaboration with the government and United Nations partners.
“The Carter Center built a lot of community support throughout the country,” Mr. Dossen said about these initiatives, especially by establishing significant relationships with local chieftains and religious leaders.
Then came the Ebola crisis from 2014-15 at a time when the country had only 50 doctors. “It was scary,” Mr. Dossen recalled. “People didn’t know anything about it and the rate of transmission was very high. Communities feared the virus, which started quickly and spread rapidly.”
“To some extent people blamed the government about certain issues like having a poor health system,” he added. “When it started people did not believe that this was real. They thought it was a ploy by the government to get money from the international community.”
The center helped train more than 500 World Health Organization mhGAP-ig health care workers who, according to Mr. Dossen, can conduct basic screening assessments to manage priority conditions of mental, neurological and substance disorders. Although the mhGAP-ig health workers aren’t licensed to prescribe medicines they can refer individuals to the country’s 342 mental health clinicians who are able to make the necessary prescriptions for their patients.
The center’s involvement has been conducted at the invitation of and in coordination with the National Incident Management System, the Ministry of Health, the Ministry of Gender, Children and Social Protection, the Ministry of Internal Affairs and the Ministry of Justice.
While this government support has been essential, it has been the relationships with the local leaders through the National Council of Chief and Elders that have enabled the Carter Center workers to encourage Liberians to wear masks and participate in contact tracing.
During the Ebola crisis, those who had the virus often were stigmatized and rejected by their communities. With Covid-19 the information sharing is more important and is being taken seriously because social stigma is again prevailing.
Many Liberians have come to appreciate the care and information that is transmitted and, according to Mr. Dossen, they have learned to trust the recommendations provided by their chiefs and elders and also those coming from the Carter Center professionals.
Many comply with the government’s directive to wear masks in public, which even their president George Weah wears regularly, he added.
The Carter Center has helped train 100 contract tracers in the WHO-approved COVID-19 MHPSS methods. Most Liberians diagnosed to have the coronavirus have agreed to comply with quarantine restrictions and the practice of contact tracing has been accepted, Mr. Dossen said.
Some of the basic guidelines such as social distancing and refusal to shake hands are especially difficult for Liberians who tend to be sociable and enjoy meeting and greeting each other with handshakes, he added.
But many people comply. The risks of not following these guidelines are gaining more recognition, especially in Monrovia and Montserrato County where the capital is located.
Mr. Dossen also said that a local mental health services user organization, Cultivation of Users Hope, has played an important role in garnering support among its members. Composed of Liberians who have experienced mental health issues and backed by the Carter Center, it now supports care givers and Liberians with mental health issues.
The organization has played a critical role, he added, through ties to local media and relevant partners to fight the stigma associated with mental health issues and actively promote mental health services delivery at the community level.