Connect to share and comment

A diverse look at global health issues.

The lingering wounds of Liberia’s 14-year civil war

Tackling post-traumatic stress disorder and mental illness, one case at a time.
140318 liberia mental healthEnlarge
Liberian Mike Otis Myers, 29, former child soldier and PTSD patient in Nimba County, February 2014. (Molly Knight Raskin/Courtesy)

NIMBA COUNTY, Liberia — In Nimba County, northeastern Liberia, the most visible signs of the country’s 14-year civil war are finally fading. Ethnic tensions have calmed, bombed buildings are being rebuilt and the economy is showing modest growth.

But the deepest wounds of the conflict are difficult to see and slower to heal. They are the psychological scars of war, and even after a decade of peace they are crippling people this small African nation.

“When I think about the war I just cry,” said 29-year-old Nimba resident Mike Otis Myers. “I survived, so I’m lucky. But when I think about what happened I feel so bad.”

When Myers was 10 years old, rebel soldiers kidnapped him from his family home in Nimba and forced him to fight in a unit of child soldiers. His commanders also forced Myers to take drugs, claiming they would give him the courage to kill. Myers eventually escaped, but he had nowhere to go. Liberia was still engulfed in violence, and he had lost most of his family. He sought refuge in Ivory Coast and Ghana, where he joined groups of displaced youths who made a living from petty crime and drug trafficking.

Myers moved back to Liberia in 2012 when a family member promised to take him in and fund his education. But the return to Nimba reignited his most painful memories of the war. Today, Myers struggles with depression, hopelessness and marijuana addiction. He’s in school and dreams of becoming a police officer, but because of his symptoms he’s falling behind.

“I feel so ashamed,” said Myers, who has a tall, lanky build and downcast eyes. “I try in school but I have trouble remembering things.”

Myers is not alone in his struggle. Studies show more than 40 percent of Liberians suffer symptoms of post-traumatic stress disorder (PTSD) related to the war. In areas like Nimba, the largest of Liberia’s 15 counties, expert say the rates of PTSD and other mental illnesses are even higher. For people who suffer, there’s almost nowhere to turn; Liberia has only one trained psychiatrist and one psychiatric hospital for a population of 4 million.

The global statistics are also alarming. According to the World Health Organization, as many as 85 percent of people with serious mental illness in the developing world have no access to treatment. And by 2030, the WHO predicts that depression will be the leading cause of death and disability worldwide.

“People don’t see mental illness as a serious problem, but in Liberia many people are dying from it,” said Aaron Debah, a registered nurse and the only health worker certified to treat mental illness in Nimba County, which has 400,000 people.

In 2011, Debah graduated from a program led by the Atlanta-based Carter Center that trains Liberian nurses and physician’s assistants in a three-month crash course in mental health. He returned to a hospital in Nimba where he teaches medicine, but the hospital is now at risk of closure and the administration can’t afford to pay Debah a salary. For now, Debah says he’s teaching for a living, but volunteering his own time to see mental health patients, one of whom is Mike Otis Myers.

Debah, also a survivor of the war, urged Myers to check into Liberia’s only psychiatric hospital, E. S. Grant in Monrovia, so he could obtain medication and attend support groups. But the hospital is more than five hours by car from Nimba, and Myers wants to stay in school. Because of this he’s turned to Debah, who regularly counsels him at no cost.

“When I see people with PTSD I know that we share some of the same experiences,” said Debah. “I feel obliged to help them.”

To counsel Myers, Debah uses basic psychotherapy techniques he learned at the Carter Center. He talks to Myers about the war, and teaches him coping strategies, like engaging in church, sports and after-school activities to relieve his depression.

To some, this model of mental health care might sound too rudimentary to make an impact on a deeply traumatized country like Liberia. But an increasing number of studies show that the training of local health care providers to identify and treat mental illness is cost-effective, easy to implement and, most importantly, successful in reducing rates of PTSD, depression and other mental illnesses. Programs in Uganda, India, Congo and Pakistan have demonstrated that group talk therapy is a highly effective for major depression.

After only a few months of treatment, Myers says his symptoms have improved. He hasn’t quit marijuana, but has cut back and stayed in school. Most importantly, he feels hopeful.

“For the first time in life I dream of becoming a good person,” Myers said.

Debah says Myers’ progress is just one example of the efficacy of mental health care in traumatized populations, even when it’s delivered at the most basic level.

“It may seem small to some people, but I know we are making a big impact,” he said.

Without any government support or access to medication, Debah is limited when it comes to treatment. Myers knows that if his symptoms worsen, his only option will be the long trip to Monrovia’s psychiatric hospital. He and Debah pray that someday Nimba, and all of Liberia, will have a functional mental health care system to treat people with PTSD. Until then, they say they will keep working together.

During a recent appointment with Debah, Myers expressed his frustration with the occasional intensity of his symptoms, and laments the years he lost in exile.

“I can’t continue to waste my life,” Myers said. “Anything I can do to help get rid of the bad feelings helps me.”

With this sentiment, Debah reassured him that he’s on the road to recovery. “You have the desire to change,” he said. “And because of that desire, I know the change will come – even if it’s gradual.”

Molly Knight Raskin is an author and journalist, most recently with "The NewsHour" on PBS. She writes frequently about psychology and mental health, and is working on a documentary film about trauma in Liberia, West Africa.

More from GlobalPost: Opinion: Mental health, the 'ugly stepchild of the global health movement' 
 

http://www.globalpost.com/dispatches/globalpost-blogs/global-pulse/mental-wounds-liberia-war