March 2015 - Volume 13 - Issue 1
REFLECTIONS, COMMENTS, LETTERS
Mental health and psychosocial support in the face of Ebola in Liberia: the personal and professional intersect. A personal account
This personal reflection is based on the author's experiences, a native Liberian, in her country at the beginning of the 2014 Ebola epidemic. It includes her account of events as Ebola cases and related deaths began to rise and the response appeared inadequate. Examples are presented where a robust psychosocial and mental health response was critically required, but most often lacking. This reflection focuses on the points where the author's personal and the professional life met as she co-led the psychosocial pillar of the national response team on Ebola. It also explores the challenges of leading the mental health and psychosocial component of a complex emergency within a fragile, post conflict state, where the medical and infectious disease component of the response often takes precedence. Additionally, the author's internal struggle that occurred when she was forced to evacuate at the outbreak's peak is explored.
The travellers dance: how Ebola prevention measures affect day to day life
While the international community remains concerned and focused on the potential spread of Ebola out of Africa, the author states that they also frequently ignore the deep psychological pain that the measures implemented to combat the disease are causing within impacted communities, as do the national authorities. She provides a snapshot of this moment in the crisis and highlights the painful impacts, dehumanising measures and makes a plea for international organisations to do more to be mindful of this pain.
Mental illness and health in Sierra Leone affected by Ebola: lessons for health workers
Sierra Leone is currently going through the worst Ebola epidemic on record, creating anxiety and anxiety related, somatic symptoms. Additionally, increased psychiatric morbidity could be expected as a result of the adverse social and psychological consequences of the epidemic, exposing the country's weak, poorly resourced mental health services and highlighting the need for psychosocial interventions and development of psychiatric interventions. Countrywide, there are 20 psychiatric nurses and 150 community health workers trained in the mental health Gap Action Programme and Psychological First Aid. However, in order to strengthen their capacity to deliver psychosocial and psychiatric interventions and to create a potential resource for psychiatric interventions during a major humanitarian crisis, ongoing training and supervision will be essential.
An outbreak of fear, rumours and stigma: psychosocial support for the Ebola Virus Disease outbreak in West Africa
This field report summarises the experience and lessons learnt by the author, who was deployed as an International Federation of Red Cross and Red Crescent Societies psychosocial delegate to Liberia for the Ebola Virus Disease outbreak in July and August 2014. Psychosocial issues encountered in the field, including fear in local communities and among aid workers, the spreading of rumours, heath measures interfering with traditional rituals and stigmatisation are discussed in detail. Also included are suggestions for dealing with these issues and actions taken during the mission. The importance of psychosocial support as a lifesaving matter in this outbreak is also highlighted. Finally, the author calls for initiation of sustainable mental health care and service development in affected countries, in order to maintain the momentum for change.
Psychosocial support during the Ebola outbreak in Kailahun, Sierra Leone
This field report describes the author's deployment as a psychosocial delegate to the International Federation of Red Cross Ebola epidemic response in Sierra Leone during June and July 2014. He highlights the ongoing impact of an epidemic in a post conflict zone, how addressing fear and stigma is essential in social mobilisation and capacity building efforts, as well as providing empowering messages that give hope and foster collaboration between epidemic responders and community members. Additionally, stress management and adequate supervision are essential for staff and volunteer wellbeing and safety during an Ebola epidemic.
How to eat an elephant: psychosocial support during an Ebola outbreak in Sierra Leone
This field report summarises some of the problems, challenges and psychosocial issues facing Sierra Leone Red Cross National Society staff and volunteers, related to the Ebola Virus Disease outbreak, as well as local responses at a time when the rest of the world was just becoming aware of the disease as a real threat. The author provides a brief outline of what was, and is, needed and what she managed to plan and implement to help support the overall Ebola operation in Sierra Leone, as well as improve staff and volunteer support and the training of trainers.
Surviving juntas (together): lessons of resilience of indigenous Quechua women in the aftermath of conflict in Peru
Research into survivors of war has largely focused on suffering, rather than on the resilience, of survivors. This paper presents a cross-sectional survey that examined the factors contributing to the resilience of indigenous Quechua women (n = 151) in the aftermath of Peruvian armed conflict (1980-2000). Regular participation in civic associations, and the migratory status of returnees after the conflict, were associated with higher resilience. In contrast, low levels of education, unpaid occupations and experience of sexual violence during the conflict were all associated with lower resilience. These findings suggest that social policies that revitalise civic society and reduce gender inequalities within education and employment are crucial to enhance women's resilience in post war zones. In this study, the resilience of Quechua women, in particular their association with political activism, offers an unambiguous example of courage and active resistance to extreme adversity.
Measuring suffering: assessing chronic stress through hair cortisol measurement in humanitarian settings
Ever increasing humanitarian crises involve prolonged population displacement, a known trigger for chronic stress, which in turn highlights the need for chronic stress to be addressed more explicitly within humanitarian aid work. This calls for better tools to both assess chronic stress in these situations of extended displacement, as well as methods to evaluate the impact of psychosocial interventions in such settings. Noting these challenges, this paper proposes the use of hair cortisol concentration sampling to measure long-term suffering and stress. By including cortisol hair testing as a quantitative measure to complement existing measures of psychosocial programme surveillance, researchers may better understand the nature of chronic stress. Sampling any sort of biomarker, such as cortisol concentration in hair, raises ethical and logistical concerns, therefore this paper address these issues as well, maintaining that a ‘do no harm’ position should take priority over the decision to measure hair cortisol concentration. Furthermore, as there is also a paucity of evidence regarding the validity of hair cortisol testing on humans, further research will be required.
Comparing a trauma focused and non trauma focused intervention with war affected Congolese youth: a preliminary randomised trial
While there is broad consensus about the need for interventions to help psychologically distressed, war affected youth, there is also limited research and even less agreement on which interventions work best. Therefore, this paper presents a randomised trial of trauma focused, and non trauma focused, interventions with war affected Congolese youth. Fifty war affected Congolese youth, who had been exposed to multiple adverse life events, were randomly assigned to either a Trauma Focused Cognitive Behavioural Therapy group or a non trauma based psychosocial intervention (Child Friendly Spaces). Non clinically trained, Congolese facilitators ran both groups. A convenience sample, waiting list group was also formed. Using blind assessors, participants were individually interviewed at pre intervention, post intervention and a 6-month follow-up using self-report posttraumatic stress and internalising symptoms, conduct problems and pro social behaviour. Both treatment groups made statistically significant improvements, compared to the control group. Large, within subject, effect sizes were reported at both post intervention and follow-up. At the 6-month follow-up, only the Child Friendly Spaces group showed a significant decrease in pro social behaviour. The paper concludes that both trauma focused and non trauma focused interventions led to reductions in psychological distress in war affected youth.