In Sierra Leone, creative therapy for Ebola-prevention workers

FREETOWN, Sierra Leone — After carrying out 16 burials across the capital of Sierra Leone, a team gathered at the Red Cross Society to decompress through acting out a skit about Ebola. Along with about 20 other burial workers, they laughed as two men acted out a comedic skit about the danger of transferring Ebola through sex, which featured one of the men dressed as a woman and strutting around the room.

International Federation of the Red Cross–trained burial teams will continue to bury all bodies as if they were infected with Ebola, although there are only two registered cases in the country as of Aug. 16. The virus killed more than 11,000 people this year in West Africa, leaving behind individuals traumatized by seeing their families and friends die and Ebola prevention workers struggling to cope with the impact of what they witnessed.

But through theater, dance and stand-up comedy, this group of burial workers has found an escape. They perform for themselves and family, friends and local communities. Some of the skits have Ebola-prevention messages in them, such as the no-touching policy. Others are just funny anecdotes and stories.

Many of the Red Cross’ 490 burial workers have experienced symptoms similar to post-traumatic stress disorder. Mohamed Sylvan Kamara, 28, said he has nightmares about the corpses he has buried — especially the babies. He said several of his eight co-workers began using drugs and alcohol.

“It’s really hard, when Ebola was at the peak and you go to a place where you meet so many corpses, some decomposed for days. It’s really scary,” he said.

The Red Cross introduced this concept, known as psychological first aid, to the team. The strategy aims to address the immediate needs of people in a crisis, including emotional support.

The organization has applied creative methods of therapy for their workers in other crises around the world. In an email, Millan Martinez Lopez, a psychosocial support delegate with the group, said the strategy varies, depending on the country and the culture. Dance, theater and other local modes of cultural expression are commonly used. Lopez said drama enables people to express their feelings in a way that is easy for them.

“When I think about the performances, that helps me forget about the burial process and other things,” said Kamara.

Sierra Leone went through a brutal civil war from 1991 to 2002 that left 50,000 people dead and 100,000 with amputations from rebel fighters. According to a 2012 report from the World Health Organization (WHO), an estimated 715,000 people were suffering from mental disorders, with only 2,000 receiving formal treatment, partly because of the country’s limited resources for providing mental health care.

With the Ebola crisis, it is likely there has been an increase in mental health issues, said WHO spokeswoman Margaret Harris. In addition to the direct trauma of so much death and illness, the entire country has suffered from despair and lost opportunity, she said.

Representatives from government, civil society and traditional healers formed the Mental Health Coalition of Sierra Leone in 2011. The group has successfully pushed for the creation of an official mental health policy and more mental health training for nurses. But there’s still only one psychiatrist and one permanent psychologist in the entire country, which has a population of about 6 million, according to Joshua Duncan, a coordinator for the coalition.

He said the Ebola crisis compounded the mental strain on the many people still dealing with post-traumatic stress from the war. “A lot of people were terrified. The issue of stigmatization and the issue of running away from one point of quarantine to another does not have a physical motivation. It’s really a mental and psychological issue and that emanates from fear,” he said.

Through help from the Mental Health Coalition, a structure was created that provides Ebola-focused mental health services. The program is run by the Ministry of Health and Sanitation and the Ministry of Social Welfare and Gender and Children’s Affairs, with help from UNICEF and the WHO. Duncan said the program is also training people to become community health officers to treat people with mental illness after the Ebola crisis has officially ended.

However, he said, mental health is still a misunderstood and stigmatized issue in Sierra Leone. “A simple thing like depression or anxiety can knock you off your work, so my drive is to make people realize that when we say ‘mental health,’ do not stigmatize, because any one of us can become a victim of stress or anxiety,” he said.

In Sierra Leone, mental illness is often believed to be the result of demonic possession. Many people still consult with traditional healers when they or their relatives are suffering from a mental illness.

Duncan said the Mental Health Coalition is encouraging traditional healers to visit hospitals where they can be trained by nurses on the clinical reasons behind mental illness.

The traditional healers are open to working with Western doctors on understanding mental health but want to keep their traditional ways alive to some extent. Traditional treatment can include locking someone in a room, helping them relax through calming herbs and talking to the spirits to persuade them to leave the person they’re possessing.

Abdul Bangura, 38, a traditional healer and a representative for the Mental Health Coalition, said, “We respect our culture and tradition. We can look at someone and know there’s a devil problem.”