Three Clinicians Bring Pioneering Mental Health Services to Liberia

A village healer warned that if she crossed the river, then bad things would happen, but in Regina’s* youth there was no need to worry. She grew up, helped around the house, and married. She visited her husband’s parents on the far bank, but Regina’s family performed the right rituals and no misfortune befell her. Then, one day, Regina again climbed into a canoe and floated across the turgid brown water of the Cavalla. This time the rituals didn’t help.

When nurse and Partners In Health Mental Health Coordinator Garmai Cyrus visited the Buah District of southeast Liberia last year, Regina had been hallucinating for two decades, picking through trash and sleeping in the streets. Her family blamed the river.

Cyrus patiently earned their and Regina’s trust and, months after she first arrived, was able to diagnose Regina with schizophrenia. Much to the relief of all, an anti-psychotic medication proved effective. Regina now lives at home with her family. She’s clean, well-dressed, and easy to chat with. “You wouldn’t believe her transformation,” says Cyrus.

Such are the small miracles that PIH’s three-person mental health team helps perform in Liberia. Across 5,000 sparsely populated square miles of the southeast, Program Manager Bethuel Nyachieng’a, Coordinator Willis “Archie” Yansine, and Cyrus meet mentally ill people where they are, both geographically and spiritually, and do their best to help.

It’s a big job. The three have mentored and offered refresher courses for government mental health clinicians, the majority of whom received a few weeks of training years ago. They have publicized mental health issues, including via radio programs, and established ways to refer patients to specialists. And with their government colleagues, they have treated and followed-up with roughly 1,000 people suffering conditions including epilepsy, psychosis, and depression. “Building mental health in the southeast is very hard,” says Yansine. “It’s just now that people are getting to know about mental health.”

But with each accurate diagnosis, the PIHers are changing that. In one region last year, 166 patients had been diagnosed with epilepsy—ten times as many cases as substance abuse, which is typically far more common. “Everyone was ‘epilepsy, epilepsy, epilepsy,’” recalls Cyrus.

Partly from his previous work in Somalia and Kenya, Nyachieng’a knew that epilepsy’s seizures, tremors, and other symptoms can easily be confused with other conditions. So before changing any treatments, he and local clinicians took another, more thorough pass at diagnosis. The correct number suffering epilepsy proved to be 46, while the others suffered from depression, psychosis, and other ailments. Once accurately diagnosed, patients were placed on more effective treatments.

The team also makes uncommon improvements by venturing beyond hospital grounds. In Harper, one of the major cities in the southeast, Nyachieng’a performed a survey of homeless people, including two former child soldiers who lived on the streets and carried toy guns. All in all, some 43 faced mental health challenges. Nyachieng’a helped stabilize their lives by bringing them rice, reuniting them with their families, or putting them in the care of a nearby Catholic church. Then he treated or followed-up on virtually all of them.

“In the areas you need to reach by canoe, the big challenge is that patients are not seen as patients; they’re seen as possessed by demons,” says Nyachieng’a. But here, too, the team has turned challenges into opportunities. Yansine, for example, joined forces with herbalists and traditional healers. He met them, shared some basic information, and offered to provide the healers with the medical expertise and medication needed for them to expel the demons. “We developed a rapport,” he says. “Now they will call me about the aggressive patients and I will do an assessment and give them the treatment.”

All of this and more have made a big difference in whole communities, but it’s only from faraway that you’d call the changes something as impersonal as “progress.”

Cyrus, for example, grew close with Regina, and found herself learning some very real, very non-allegorical details about Regina’s life before she “ran crazy,” as her family said. Regina lost two children during birth. Her husband abandoned her. And when she crossed the river that portentous day in the 1990s, it wasn’t to taunt fate or the village healer. Regina was fleeing civil war for a refugee camp in Ivory Coast. Mid-stream, a nearby boat capsized, killing friends and relatives. Whatever mythic powers might or might not have been at play, Regina experienced a lot of psychological trauma and had no experts to turn to.

“It’s hard for me to express the feelings,” says Cyrus, “but I am so grateful to be able to work with Regina and other patients.”

*Name has been changed.