Mental Health &amp; Psychosocial Support https://www.pih.org/ en Strengthening Mental Health Care Alongside Religious and Traditional Healers In Liberia https://www.pih.org/article/strengthening-mental-health-care-alongside-religious-and-traditional-healers-liberia <span class="field-wrapper">Strengthening Mental Health Care Alongside Religious and Traditional Healers In Liberia</span> <span class="field-wrapper"><span lang="" about="/user/4512" typeof="schema:Person" property="schema:name" datatype="">jdelzo</span></span> <span class="field-wrapper">Fri, 10/08/2021 - 11:58</span> <div class="field-wrapper field field-node--field-large-intro-text field-name-field-large-intro-text field-type-text-long field-label-hidden"> <div class="field-items"> <div class="field-item"><p>Patient living with schizophrenia receives care, restored to family through innovative partnership</p> </div> </div> </div> <div class="field-wrapper field field-node--field-photo field-name-field-photo field-type-image field-label-hidden"> <div class="field-items"> <div class="field-item"> <picture> <source srcset="/sites/default/files/styles/article_xlarge/public/2021-10/valarie_ma-kebbeh_resized_hed.webp?itok=hpKHXwjf 1x" media="all and (min-width: 1200px)" type="image/webp"/> <source srcset="/sites/default/files/styles/article_large/public/2021-10/valarie_ma-kebbeh_resized_hed.webp?itok=0GvDVNtX 1x" media="all and (min-width: 900px) and (max-width: 1199px)" type="image/webp"/> <source srcset="/sites/default/files/styles/article_xmedium/public/2021-10/valarie_ma-kebbeh_resized_hed.webp?itok=_TgsX7F6 1x" media="all and (min-width: 640px) and (max-width: 899px)" type="image/webp"/> <source srcset="/sites/default/files/styles/article_medium/public/2021-10/valarie_ma-kebbeh_resized_hed.webp?itok=VbbatNir 1x" media="all and (min-width: 450px) and (max-width: 639px)" type="image/webp"/> <source srcset="/sites/default/files/styles/article_mobile/public/2021-10/valarie_ma-kebbeh_resized_hed.webp?itok=cma-Lwkf 1x" type="image/webp"/> <source srcset="/sites/default/files/styles/article_xlarge/public/2021-10/valarie_ma-kebbeh_resized_hed.jpg?itok=hpKHXwjf 1x" media="all and (min-width: 1200px)" type="image/jpeg"/> <source srcset="/sites/default/files/styles/article_large/public/2021-10/valarie_ma-kebbeh_resized_hed.jpg?itok=0GvDVNtX 1x" media="all and (min-width: 900px) and (max-width: 1199px)" type="image/jpeg"/> <source srcset="/sites/default/files/styles/article_xmedium/public/2021-10/valarie_ma-kebbeh_resized_hed.jpg?itok=_TgsX7F6 1x" media="all and (min-width: 640px) and (max-width: 899px)" type="image/jpeg"/> <source srcset="/sites/default/files/styles/article_medium/public/2021-10/valarie_ma-kebbeh_resized_hed.jpg?itok=VbbatNir 1x" media="all and (min-width: 450px) and (max-width: 639px)" type="image/jpeg"/> <source srcset="/sites/default/files/styles/article_mobile/public/2021-10/valarie_ma-kebbeh_resized_hed.jpg?itok=cma-Lwkf 1x" type="image/jpeg"/> <img src="/sites/default/files/styles/article_xlarge/public/2021-10/valarie_ma-kebbeh_resized_hed.jpg?itok=hpKHXwjf" alt="Ma-Kebbeh smiling while standing in a doorway" typeof="foaf:Image" /> </picture> </div> </div> </div> <div class="field-wrapper field field-node--field-caption field-name-field-caption field-type-string-long field-label-hidden"> <div class="field-items"> <div class="field-item">Over the the past two years, Ma-Kebbah’s (pseudonym) mental health has significantly improved, as she receives continuous care from PIH Liberia’s mental health team. Photo by Jason Amoo / PIH</div> </div> </div> <div class="field-wrapper body field field-node--body field-name-body field-type-text-with-summary field-label-hidden"> <div class="field-items"> <div class="field-item"><p>In 2019, Ma-Kebbeh (pseudonym) began to show signs of schizophrenia. She talked to herself, refused to eat, and experienced hallucinations. According to her, strange things were happening.</p> <p>“There was blood on the curtains and a dog entered our house,” she says. “And there was a big snake in the bathroom. My husband’s little brother killed it.”</p> <p>Her family believed she was under spiritual attack and dismissed the thought of a potential mental illness. Hoping to protect her, her husband sent her 250 miles away from their home in Monrovia to her mother’s house in Harper, but this did not help. She was then sent to several churches by her mother and sister with the hope that prayers would heal her. For a year, they tried to rid her of the “demons” attacking her by using pepper, burning incense, and sprinkling her with Holy Water. Nothing worked.</p> <p>Eventually, Ma-Kebbeh was taken by her mother to a church in Harper, where she was tied to a palm tree upon arrival to ensure she didn’t run away, as she had in the past due to her condition. Meanwhile, Prophet Samuel Howe called Garmai Cyrus-Biddle, PIH Liberia’s mental health coordinator, to immediately alert her of the situation.</p> <p>Finally, Ma-Kebbeh’s journey took a turn for the better. PIH Liberia's mental health team had created a partnership with the church to provide care for patients such as Ma-Kebbeh, in collaboration with the Maryland County health team. Originally launched in 2018 to help those with depression, the mental health quality improvement initiative has since expanded to include patients with other mental health disorders, such as schizophrenia—which affects 20 million people worldwide. PIH mental health staff and the Maryland County health team work with traditional and religious healers to ensure continuous care for patients by training them to identify and refer people with common mental disorders from the community to health facilities for treatment. This is much needed in southeastern Liberia, where <a href="https://www.pih.org/article/mental-health-care-homeless-begins-clean-t-shirt-warm-meal-and-bath">mental health services</a> are limited, so residents often turn for relief to traditional medicine and witchcraft.</p> <figure role="group"> <img alt="Prophet Samuel Howe at church " data-entity-type="file" data-entity-uuid="ee371510-cb05-4e4c-9a8d-351b1e6a4d9e" src="/sites/default/files/inline-images/Prophet%20Samuel%20Howe-Photo.jpg" width="1795" height="1009" loading="lazy" /> <figcaption>Prophet Samuel Howe leads a religious service for patients and church members in Harper, Liberia in 2021. Photo by Jason Amoo / PIH</figcaption> </figure> <p>When Garmai got Howe’s call, she traveled to the church to meet Ma-Kebbeh, who was hesitant to receive care but eventually consented to counseling and—in turn—medication. For a month, the mental health team continued to visit and provide high-quality care for Ma-Kebbeh out of the church.</p> <p>“It makes me very happy for us to work together,” says Howe, “because when the mental health patients come to me, when Garmai and her team were not here, I didn’t have any medicine to give them...So now, when I get a patient like that, I call them to come.” In time, Ma-Kebbeh was transferred to nearby Partners In Health-supported health facility, J.J. Dossen Hospital, to continue treatment. After consulting with the mental health team for a few hours, she was discharged to her family in Harper and continued to visit the mental health clinic at the hospital for regularly scheduled appointments. In addition, Ma-Kebbeh was visited at home weekly by a PIH mental health psychosocial assistant who counseled her and monitored her progress.</p> <p>Since PIH began providing care, her health has significantly improved; she no longer talks to herself, she is comfortable being around others, and moved back to Monrovia to live with her husband and three children. She continues to make the trip to Harper every other month to visit a mental health clinician and refill her medication.</p> <p>“I got hope,” Ma-Kebbeh says. “I am grateful to God for the delivery and grateful to PIH for the treatment.”</p> </div> </div> </div> <div class="field-wrapper field field-node--field-programs field-name-field-programs field-type-entity-reference field-label-above"> <div class="field-label">Programs</div> <div class="field-items"> <div class="field-item"><a href="/programs/mental-health" hreflang="en">Mental Health</a></div> </div> </div> <div class="field-wrapper field field-node--field-taxonomy-tags field-name-field-taxonomy-tags field-type-entity-reference field-label-above"> <div class="field-label">Related Categories</div> <div class="field-items"> <div class="field-item"><a href="/mental-health-psychosocial-support" hreflang="en">Mental Health &amp; Psychosocial Support</a></div> </div> </div> <div class="field-wrapper field field-node--field-do-not-show-in-pih-news field-name-field-do-not-show-in-pih-news field-type-boolean field-label-above"> <div class="field-label">Do not show in PIH News</div> <div class="field-items"> <div class="field-item">Off</div> </div> </div> Fri, 08 Oct 2021 15:58:03 +0000 jdelzo 8042 at https://www.pih.org PIH’s Five S’s: Essential Elements for Strong Health Systems https://www.pih.org/article/pihs-five-ss-essential-elements-strong-health-systems <span class="field-wrapper">PIH’s Five S’s: Essential Elements for Strong Health Systems </span> <span class="field-wrapper"><span lang="" about="/user/4512" typeof="schema:Person" property="schema:name" datatype="">jdelzo</span></span> <span class="field-wrapper">Wed, 06/30/2021 - 14:03</span> <div class="field-wrapper field field-node--field-large-intro-text field-name-field-large-intro-text field-type-text-long field-label-hidden"> <div class="field-items"> <div class="field-item"><p><meta charset="UTF-8" />The staff, stuff, space, systems, and social support behind<b>&nbsp;</b>our everyday work&nbsp;<meta charset="UTF-8"></p> <p>&nbsp;</p> </div> </div> </div> <div class="field-wrapper field field-node--field-photo field-name-field-photo field-type-image field-label-hidden"> <div class="field-items"> <div class="field-item"> <picture> <source srcset="/sites/default/files/styles/article_xlarge/public/2021-06/2021_PIH-5-Ss_PIH-5-Ss-blogpost-2_1.webp?itok=bQ6NSbxp 1x" media="all and (min-width: 1200px)" type="image/webp"/> <source srcset="/sites/default/files/styles/article_large/public/2021-06/2021_PIH-5-Ss_PIH-5-Ss-blogpost-2_1.webp?itok=FeCsbJpC 1x" media="all and (min-width: 900px) and (max-width: 1199px)" type="image/webp"/> <source srcset="/sites/default/files/styles/article_xmedium/public/2021-06/2021_PIH-5-Ss_PIH-5-Ss-blogpost-2_1.webp?itok=wiz59iKt 1x" media="all and (min-width: 640px) and (max-width: 899px)" type="image/webp"/> <source srcset="/sites/default/files/styles/article_medium/public/2021-06/2021_PIH-5-Ss_PIH-5-Ss-blogpost-2_1.webp?itok=ISvVO00C 1x" media="all and (min-width: 450px) and (max-width: 639px)" type="image/webp"/> <source srcset="/sites/default/files/styles/article_mobile/public/2021-06/2021_PIH-5-Ss_PIH-5-Ss-blogpost-2_1.webp?itok=zhmo1gP1 1x" type="image/webp"/> <source srcset="/sites/default/files/styles/article_xlarge/public/2021-06/2021_PIH-5-Ss_PIH-5-Ss-blogpost-2_1.jpg?itok=bQ6NSbxp 1x" media="all and (min-width: 1200px)" type="image/jpeg"/> <source srcset="/sites/default/files/styles/article_large/public/2021-06/2021_PIH-5-Ss_PIH-5-Ss-blogpost-2_1.jpg?itok=FeCsbJpC 1x" media="all and (min-width: 900px) and (max-width: 1199px)" type="image/jpeg"/> <source srcset="/sites/default/files/styles/article_xmedium/public/2021-06/2021_PIH-5-Ss_PIH-5-Ss-blogpost-2_1.jpg?itok=wiz59iKt 1x" media="all and (min-width: 640px) and (max-width: 899px)" type="image/jpeg"/> <source srcset="/sites/default/files/styles/article_medium/public/2021-06/2021_PIH-5-Ss_PIH-5-Ss-blogpost-2_1.jpg?itok=ISvVO00C 1x" media="all and (min-width: 450px) and (max-width: 639px)" type="image/jpeg"/> <source srcset="/sites/default/files/styles/article_mobile/public/2021-06/2021_PIH-5-Ss_PIH-5-Ss-blogpost-2_1.jpg?itok=zhmo1gP1 1x" type="image/jpeg"/> <img src="/sites/default/files/styles/article_xlarge/public/2021-06/2021_PIH-5-Ss_PIH-5-Ss-blogpost-2_1.jpg?itok=bQ6NSbxp" alt="PIH 5S&#039;s " typeof="foaf:Image" /> </picture> </div> </div> </div> <div class="field-wrapper field field-node--field-caption field-name-field-caption field-type-string-long field-label-hidden"> <div class="field-items"> <div class="field-item">Across all PIH sites, we value the 5S&#039;s: staff, stuff, space, systems, and social support. Graphic by Maggie Zhang / Partners In Health</div> </div> </div> <div class="field-wrapper body field field-node--body field-name-body field-type-text-with-summary field-label-hidden"> <div class="field-items"> <div class="field-item"><p style="text-align:start">When we think of health system strengthening at Partners In Health (PIH), we always refer to five key elements: staff, stuff, space, systems, and social support. We call them the “five S’s” and use them to guide our work every day. Each element is equally important in providing high-quality care to our patients in the <a href="https://www.pih.org/countries">11 countries</a> where we work, responding to emergencies and building and reinforcing strong, long-term health systems, in collaboration with government partners. Each "S” is essential; eliminating just one of them results in a weaker health system.</p> <p>The following is a definition of each of the 5 S’s, with concrete examples of our work:</p> <figure role="group" class="align-center"> <img alt="PIH 5 S's: Staff" data-entity-type="file" data-entity-uuid="cc71919e-577f-47ca-a898-015c822cf0b3" src="/sites/default/files/inline-images/2021_PIH-5-Ss_PIH-5-Ss-horizontal-02.jpg" width="2000" height="1050" loading="lazy" /> <figcaption><em>The PIH team has grown significantly since our founding in 1987. Graphic by Maggie Zhang / Partners In Health</em></figcaption> </figure> <h3> </h3> <h3><b>1. Staff</b></h3> <p>With more than 19,955 global staff, we make it a priority to have well-trained, qualified teams in sufficient quantity to respond to needs around the globe. The roles of our staff are diverse and fall into nearly two dozen categories, such as community health, mental health, operations, nursing, program management, development, and communications.</p> <p>We prioritize hiring staff from the country where they work and are proud to note this is true for 99% of PIH’s clinical staff, programmatic staff, and community health workers.</p> <p><a href="https://www.pih.org/article/answering-call-nurse-offers-compassionate-counseling-clinic-teens">Meet some of our staff, including a nurse</a> who runs adolescent and youth-friendly services in Sierra Leone, traditional and clinical <a href="https://www.pih.org/article/mexico-midwives-offer-care-rooted-ancestral-tradition">midwives in Mexico</a>, and <a href="https://www.pih.org/article/navajo-nation-community-health-representatives-provide-essential-support-amid-covid-19">community health representatives on Navajo Nation</a>.</p> <figure role="group" class="align-center"> <img alt="PIH 5 S's: Stuff" data-entity-type="file" data-entity-uuid="79c57a65-26a4-4c25-8364-c2570fbb2cca" src="/sites/default/files/inline-images/2021_PIH-5-Ss_PIH-5-Ss-horizontal-03.jpg" width="2000" height="1050" loading="lazy" /> <figcaption><em>PIH's global supply chain team has 143 members spread across sites. Graphic by Maggie Zhang / Partners In Health</em></figcaption> </figure> <h3> </h3> <h3><b>2. Stuff</b></h3> <p>The list of “stuff” we need is vast and includes everything from proper and ample vaccinations and medications, such as antibiotics to <a href="https://www.pih.org/programs/tuberculosis">treat tuberculosis</a>, to IV fluid and <a href="https://www.pih.org/article/much-we-can-fast-we-can-pih-teams-racing-boost-oxygen-supplies-amid-global-shortages">oxygen supplies</a>. PIH’s global supply chain team has a list of 2,518 different items staff select to streamline procurement orders, standardize requests from health facilities to warehouses, and align with the different protocols in countries where we work. Because of their efforts, our colleagues have the tools and resources they need for care delivery and administration.</p> <p><a href="https://www.pih.org/article/need-know-openboxes-and-supply-chain">Read more about how PIH tracks resources and shipments</a>.</p> <figure role="group" class="align-center"> <img alt="PIH 5 S's: Space" data-entity-type="file" data-entity-uuid="c28717ef-70ab-434b-a813-3c09e0d907ff" src="/sites/default/files/inline-images/2021_PIH-5-Ss_PIH-5-Ss-horizontal-04.jpg" width="2000" height="1050" loading="lazy" /> <figcaption><em>Founded in a single clinic in Haiti, PIH has since expanded to 270+ facilities globally. Graphic by Maggie Zhang / Partners In Health</em></figcaption> </figure> <h3> </h3> <h3><b>3. Space</b></h3> <p>In order to treat patients, we need safe, appropriate spaces equipped with electricity and clean water. Sometimes these spaces already exist, but in most cases, facilities need to be renovated or built from the ground up. In collaboration with our partners, PIH creates, expands, and equips spaces so that they meet clinicians’ needs and provide a healing environment for patients.</p> <p>Some examples of our work include:</p> <ul> <li>Expanding <a href="https://www.pih.org/article/botsabelo-hospital-leading-lesothos-care-and-support-tb-and-covid-19">oxygen production and supported isolation for tuberculosis patients</a> in Lesotho</li> <li><a href="https://www.pih.org/article/improved-water-sanitation-and-hygiene-plans-works-health-facilities-across-haiti">Improving water, sanitation, and hygiene facilities</a> in Haiti</li> <li>Creating <a href="https://www.pih.org/article/youth-friendly-centers-provide-safe-space-reproductive-health-care-services-liberia">youth-friendly reproductive health centers</a> in Liberia</li> <li>Opening a <a href="https://www.pih.org/article/rural-mexico-clinicians-deliver-lifesaving-care-amid-fast-moving-pandemic">specialized unit for patients with severe COVID-19</a> in Mexico</li> </ul> <figure role="group" class="align-center"> <img alt="PIH 5 S's: Systems" data-entity-type="file" data-entity-uuid="55629176-dc0c-453b-aa05-332921917053" src="/sites/default/files/inline-images/2021_PIH-5-Ss_PIH-5-Ss-horizontal-05.jpg" width="2000" height="1050" loading="lazy" /> <figcaption><em>PIH strives to create sustainable, long-term health systems. Graphic by Maggie Zhang / Partners In Health</em></figcaption> </figure> <h3> </h3> <h3><b>4. Systems</b></h3> <p>This area of the 5 S’s seems invisible, but is no less important. Many systems must work in harmony to ensure consistent, quality care for patients around the world, including: a leadership and governance structure for solid decision-making, financial and accounting systems to track income and expenses, supply chain management to ensure well-stocked health facilities, medical informatics expertise for nimble record-keeping, and more.   </p> <p>Here are some examples of essential systems used across PIH-supported countries:</p> <ul> <li> An <a href="https://www.pih.org/article/sierra-leone-clinic-launches-electronic-medical-records-transform-patient-care">electronic medical record system</a> in Sierra Leone</li> <li> A <a href="https://www.pih.org/article/new-distribution-center-software-vastly-modernizes-medical-storage-haiti">distribution center and software for medical storage</a> in Haiti</li> <li> <a href="https://www.pih.org/article/ekip-solid-conversation-dr-sheila-davis">Strong management that uplifts and upholds PIH’s global mission</a></li> </ul> <figure role="group" class="align-center"> <img alt="PIH 5 S's: Social Support" data-entity-type="file" data-entity-uuid="766ac2da-964e-425b-93a0-1acf4a595f5b" src="/sites/default/files/inline-images/2021_PIH-5-Ss_PIH-5-Ss-horizontal-06.jpg" width="2000" height="1050" loading="lazy" /> <figcaption><em>Medical care and social support are critical aspects of patients' well-being. Graphic by Maggie Zhang / Partners In Health</em></figcaption> </figure> <h3> </h3> <h3><b>5. Social Support </b></h3> <p>To ensure effective care, we provide basic necessities and resources including food, housing, transportation, and financial support for patients and their families. PIH’s <a href="https://www.pih.org/article/need-know-social-support">social support programming</a> across all sites focuses on treating the whole patient, not just their condition.</p> <p>Social support has proven an essential part of patient care and made the difference between a patient’s ability to recover from sickness and maintain good health over the long term. This support comes in many forms: <a href="https://www.pih.org/article/right-medicine-young-woman-triumphs-over-mdr-tb">food for patients</a> on taxing tuberculosis treatment regimens, <a href="https://www.pih.org/article/social-worker-extraordinaire-helping-breast-cancer-patients">travel vouchers for cancer patients who need</a> to make regular chemotherapy appointments, or <a href="https://www.pih.org/article/safe-house-helps-women-transition-to-everyday-life-in-peru">safe housing</a> for women living with schizophrenia.</p> <p> </p> </div> </div> </div> <div class="field-wrapper field field-node--field-paragraphs-content field-name-field-paragraphs-content field-type-entity-reference-revisions field-label-hidden"> <div class="field-items"> <div class="field-item"> <div class="paragraph just-text darktext paragraph--id--3952" style="background-color: #fff2df;"> <div class="header__intro body"> <div class="field-wrapper field field-paragraph--field-body field-name-field-body field-type-text-long field-label-hidden"> <div class="field-items"> <div class="field-item"><div class="row"> <div class="columns small-12 medium-6"> <h2>Support PIH's Work</h2> <p class="header__intro-para">Your donation sustains our work as we partner with some of the world’s most vulnerable communities to provide high-quality health care as a human right.</p> <h3>Your donation is:</h3> <ul> <li class="header__intro-para">Tax-deductible</li> <li class="header__intro-para">100% Secure</li> <li class="header__intro-para">Effective, as 90% of every gift goes straight to those in need</li> </ul> </div> <div class="columns small-12 medium-6"><a href="#XBVVYSRC" style="display: none">&nbsp;</a></div> </div> </div> </div> </div> </div> </div> </div> </div> </div> <div class="field-wrapper field field-node--field-programs field-name-field-programs field-type-entity-reference field-label-above"> <div class="field-label">Programs</div> <div class="field-items"> <div class="field-item"><a href="/programs/social-support" hreflang="en">Social Support</a></div> </div> </div> <div class="field-wrapper field field-node--field-taxonomy-tags field-name-field-taxonomy-tags field-type-entity-reference field-label-above"> <div class="field-label">Related Categories</div> <div class="field-items"> <div class="field-item"><a href="/build-systems" hreflang="en">Build Systems</a></div> <div class="field-item"><a href="/infrastructure-improvements" hreflang="en">Infrastructure Improvements</a></div> <div class="field-item"><a href="/mental-health-psychosocial-support" hreflang="en">Mental Health &amp; Psychosocial Support</a></div> </div> </div> Wed, 30 Jun 2021 18:03:35 +0000 jdelzo 7957 at https://www.pih.org Alleviating Stress in a Contact Tracing Workforce https://www.pih.org/article/alleviating-stress-contact-tracing-workforce <span class="field-wrapper">Alleviating Stress in a Contact Tracing Workforce</span> <span class="field-wrapper"><span lang="" about="/user/4621" typeof="schema:Person" property="schema:name" datatype="">rgifford</span></span> <span class="field-wrapper">Fri, 04/23/2021 - 12:34</span> <div class="field-wrapper field field-node--field-large-intro-text field-name-field-large-intro-text field-type-text-long field-label-hidden"> <div class="field-items"> <div class="field-item"><p>Wellness &amp; Peer Support program helps employees manage rising anxiety, emotional toll of pandemic&nbsp;</p> </div> </div> </div> <div class="field-wrapper field field-node--field-photo field-name-field-photo field-type-image field-label-hidden"> <div class="field-items"> <div class="field-item"> <picture> <source srcset="/sites/default/files/styles/article_xlarge/public/2021-04/unitedstates-0421-nikkia-watson-zdeclerck-16-1200px.webp?itok=z48Taaea 1x" media="all and (min-width: 1200px)" type="image/webp"/> <source srcset="/sites/default/files/styles/article_large/public/2021-04/unitedstates-0421-nikkia-watson-zdeclerck-16-1200px.webp?itok=L7M2LITZ 1x" media="all and (min-width: 900px) and (max-width: 1199px)" type="image/webp"/> <source srcset="/sites/default/files/styles/article_xmedium/public/2021-04/unitedstates-0421-nikkia-watson-zdeclerck-16-1200px.webp?itok=mOfyhnYO 1x" media="all and (min-width: 640px) and (max-width: 899px)" type="image/webp"/> <source srcset="/sites/default/files/styles/article_medium/public/2021-04/unitedstates-0421-nikkia-watson-zdeclerck-16-1200px.webp?itok=ZaSnSuHs 1x" media="all and (min-width: 450px) and (max-width: 639px)" type="image/webp"/> <source srcset="/sites/default/files/styles/article_mobile/public/2021-04/unitedstates-0421-nikkia-watson-zdeclerck-16-1200px.webp?itok=bVUqyuxt 1x" type="image/webp"/> <source srcset="/sites/default/files/styles/article_xlarge/public/2021-04/unitedstates-0421-nikkia-watson-zdeclerck-16-1200px.jpg?itok=z48Taaea 1x" media="all and (min-width: 1200px)" type="image/jpeg"/> <source srcset="/sites/default/files/styles/article_large/public/2021-04/unitedstates-0421-nikkia-watson-zdeclerck-16-1200px.jpg?itok=L7M2LITZ 1x" media="all and (min-width: 900px) and (max-width: 1199px)" type="image/jpeg"/> <source srcset="/sites/default/files/styles/article_xmedium/public/2021-04/unitedstates-0421-nikkia-watson-zdeclerck-16-1200px.jpg?itok=mOfyhnYO 1x" media="all and (min-width: 640px) and (max-width: 899px)" type="image/jpeg"/> <source srcset="/sites/default/files/styles/article_medium/public/2021-04/unitedstates-0421-nikkia-watson-zdeclerck-16-1200px.jpg?itok=ZaSnSuHs 1x" media="all and (min-width: 450px) and (max-width: 639px)" type="image/jpeg"/> <source srcset="/sites/default/files/styles/article_mobile/public/2021-04/unitedstates-0421-nikkia-watson-zdeclerck-16-1200px.jpg?itok=bVUqyuxt 1x" type="image/jpeg"/> <img src="/sites/default/files/styles/article_xlarge/public/2021-04/unitedstates-0421-nikkia-watson-zdeclerck-16-1200px.jpg?itok=z48Taaea" alt="Nikkia Watson of Massachusetts " typeof="foaf:Image" /> </picture> </div> </div> </div> <div class="field-wrapper field field-node--field-caption field-name-field-caption field-type-string-long field-label-hidden"> <div class="field-items"> <div class="field-item">Nikkia Watson, care resource coordinator at PIH, stands outside of her home in Stoughton, Mass. Watson, a graduate student in clinical social work at Simmons University, joined the Mass. Contract Tracing Collaborative late April 2020 while also interning at a VA facility outside Boston in the hospice and palliative care unit. By July, Watson had joined the peer support team, devoting half of her time to offering emotional aid to a range of people.</div> </div> </div> <div class="field-wrapper field field-node--field-photo-credit field-name-field-photo-credit field-type-string-long field-label-hidden"> <div class="field-items"> <div class="field-item">Photo by Zack DeClerck / PIH</div> </div> </div> <div class="field-wrapper body field field-node--body field-name-body field-type-text-with-summary field-label-hidden"> <div class="field-items"> <div class="field-item"><p style="text-align:start">Every day, contact tracers dial unfamiliar phone numbers, never quite sure what they might confront on the other end of the line. It could be an anxious, homebound senior who has run out of medicine. Or an immigrant mother worried whether her child’s labored breathing is an asthma flare-up, or COVID-19, or both.</p> <p>Over the past year, workers have reached out to countless strangers offering help through the <strong><a href="https://www.pih.org/ma-response">Massachusetts Community Tracing Collaborative</a> </strong>(CTC), a statewide program launched last April through a partnership between the state and Partners In Health. Contact tracers have made more than 2 million phone calls to adults with COVID-19 and their contacts, explaining the latest medical guidance to prevent transmission of the virus. And care resource coordinators have connected more than 90,000 people to food, housing, and other essentials for safe isolation or quarantine.</p> <p>But what’s the emotional toll on these contact tracers and care resource coordinators, who deal daily with illness, fear, and—sometimes—death. The stress is hard to quantify, but there’s no doubt the work leaves its mark.</p> <p>That’s why in July 2020, acknowledging that these outreach workers might need to vent, or cry, or even scream once in a while, PIH—with the state’s support—established a unique Wellness &amp; Peer Support program open to every CTC staff member.</p> <p>Through case surges and lulls, the program has offered a range of supports. There are one-on-one sessions with trained peer support providers, CTC members themselves who listen, share pragmatic solutions, and refer people to mental health professionals when needed. Since the program’s launch, about 1,000 individual peer support encounters have taken place.</p> <p>And there are one-off and longer-term “Wellness Zones,” which are peer-led gatherings ranging from grief workshops and yoga classes to poetry, cooking classes, and guided meditation.</p> <p>Dayhana Schlosser, a registered nurse, child and family therapist, and director of the CTC support program, helped build this work from the ground up, including training staff volunteers. “These are people who understand the nature of this work and the personal toll it can take,” she said.</p> <h2>Seeking a Wellness Zone</h2> <p>At first, Wellness Zone uptake was slow, Schlosser said, in particular during surges when it seemed impossible to take time away from the pressing work. By September, though, CTC staff members—possibly feeling the need to bond with others and make meaningful connections—began flocking to the sessions. A survey at that time found that more than 90% of respondents reported that participation had positively impacted their overall health and wellness. That compared to a survey four months prior, in which 20% to 30% of the workforce said they had no idea where to turn for work-related mental health support.</p> <p>Since the fall surge, there’s been a “significant” increase in Wellness Zone participation, said Schlosser, who started at the CTC as a care resource coordinator. About 500 people joined in around the time of the U.S. Capitol riots on January 6. The average session draws 45 to 50 people.  </p> <p>“I think this has been hugely helpful for many people,” Schlosser said. “There is just a myriad of feelings to process, from needing help talking through a tough call, to facing the huge disparities in the circumstances of the cases, to the personal stuff. A lot of folks in this workforce are grieving themselves, and navigating the work when you've had someone pass away is really tough.”</p> <figure role="group"> <img alt="Dahyana Schlosser" data-entity-type="file" data-entity-uuid="d6a6a1df-913f-4d28-b6bc-ac9c08511eff" src="/sites/default/files/inline-images/unitedstates-0421-dahyana-schlosser-zdeclerck-07-800px.jpg" width="800" height="533" loading="lazy" /> <figcaption>Dahyana Schlosser, Wellness &amp; Peer Support Program Manager at PIH, stands outside of her home in Brockton, Mass. <br /> Schlosser is a registered nurse and child and family therapist. She directs the support program for staff in the Mass. Contract Tracing Collaborative. Photo by Zack DeClerck / PIH</figcaption> </figure> <p>Indeed, these workers are in a unique—and uniquely stressful—situation, said Dr. Giuseppe “Bepi” Raviola, PIH’s director of mental health. They were hired quickly, during a crisis, and placed in the position of being quasi-health workers, when many were not actually health workers. Raviola says early on there was an aggressive push to provide <a href="https://www.who.int/mental_health/publications/guide_field_workers/en/">Psychological First Aid</a> training for contact tracers so that they could effectively address the acute mental health and psychosocial needs of people affected by COVID-19. But it soon became clear that some contact tracers themselves were “enduring significant distress” as they supported people remotely and dealt with high levels of physical illness, economic challenges, and personal losses caused by the pandemic.  These new hires, he said, needed a dedicated space “to buffer them and provide initial support.”</p> <h2>A Breaking Point</h2> <p>Paula Bowden Alayne, of Sacramento, CA, was among the first cohort of contact tracers hired in mid-April 2020. She’s no stranger to on-the-job stress; she previously worked as a training officer in San Quentin prison teaching corrections staff how to treat death row inmates more humanely. </p> <p>But after six months as a contact tracer, Bowden said, the reality of the work became oppressive. “Talking to people who are sick and potentially dying was getting to be too much,” she said. “It got so it was hard for me to get out of bed. I felt overwhelmed. I think I was getting depressed—like mine was part of a community depression. It was bad and getting worse.” </p> <p>There were some cases Bowden just couldn’t shake, like one couple on her call list. He was positive, she was waiting to see if she’d been infected. Bowden checked in daily. On Monday, Tuesday, and Wednesday, things were stable. On Thursday, no one answered the phone. Same on Friday. On Saturday, the wife picked up. Her husband had died that morning. “That was kind of my breaking point,” she said.  But she’d committed to the job, and she needed the income.</p> <p>Bowden reached out for help and was quickly connected to a CTC peer support person. “We had a conversation, she listened and empathized,” Bowden said. “She gave me a choice: ‘You can walk away from this, or stay.’ It was so powerful to sit with someone who had done this job, knew the ins and outs. She gave me permission to do what I needed to do. That permission and our conversation gave me all the power back, my depression lifted, and I got my energy returned. I kept doing the job.”</p> <p>Soon after, Bowden applied to become a peer support person herself. She says this position has allowed her to lean in even further to the meaningful work of helping people, both at the individual level and through the groups she leads, such as a six-week session on managing grief.</p> <p>Bowden recalled working with a staff member who was feeling hopeless, with tremendous difficulty making calls due to a death in the family.  Bowden, with her experience practicing meditation, helped this individual begin to work through the personal grief and feel more grounded, she said, “like life had meaning again.”  </p> <h2>Rising Depression and Anxiety</h2> <p>To be clear, members of the peer support team are not trained psychiatrists, therapists, or counselors; when they suspect even the slightest indication of more serious mental illness in a peer, they can elevate concerns to Schlosser and also refer people to professionals and follow up to make sure no one gets lost in the system.</p> <p>The mental health toll of COVID-19 has been pervasive, with about <a href="https://www.kff.org/other/state-indicator/adults-reporting-symptoms-of-anxiety-or-depressive-disorder-during-covid-19-pandemic/?currentTimeframe=0&amp;sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D">4 in 10</a> adults in the U.S. reporting symptoms of anxiety or depressive disorder, up from 1 in 10 in the pre-pandemic period, according to a Kaiser Family Foundation survey. Many adults report a range of negative impacts on their mental health and well-being, such as “difficulty sleeping or eating, increases in alcohol consumption or substance use, and worsening chronic conditions, due to worry and stress over the coronavirus.” Among adolescents, rates of suicidal thinking and attempts were up by 25% or more during several months in 2020 compared to similar periods in 2019, an <a href="https://pediatrics.aappublications.org/content/pediatrics/early/2020/12/15/peds.2020-029280.full.pdf">analysis </a>of patients, ages 11 to 21, found.</p> <p>This rising stress is a worldwide phenomenon. Since the start of the pandemic, PIH global staff have expressed similar concerns about the increasing distress faced by health care and other providers, Raviola said. So, the peer support model developed in Massachusetts is now being adapted to meet the needs of global colleagues, from Lesotho and Peru to Mexico and Malawi.  </p> <p>Raviola said with the inequities that COVID-19 has further exposed, from structural racism to political extremism and economic disparities – in combination with various stresses related directly to COVID-19 itself – all sites should have staff support programs in place: “We can't afford not to do it since health care workers will continue to be at the convergence of these issues.”</p> <h2>Emotional First Aid</h2> <p>Accompanying patients through some of their toughest moments has kept Nikkia Watson, 28, motivated over the past year. A graduate student in clinical social work at Simmons University, Watson signed on to be a care resource coordinator with the CTC in late April 2020 while also interning at a VA facility outside Boston in the hospice and palliative care unit. By July, Watson had joined the peer support team, devoting half of her time to offering emotional aid to a range of people. </p> <p>“Mostly, I provide concrete steps to calm anxieties,” Watson said. “This work is really hard, plus all of us are dealing with emotions and issues in the lives we live outside of this.”  In this role, Watson has worked on confidence-building skills with a young contact tracer having trouble coping with competing demands, and she helped an older woman struggling in secret with anxiety to connect with a mental health provider. “I have definitely referred people to get professional help,” Watson said. We’re not here to be therapists, we are here to make people feel better about the work.”</p> <p>All of it, even the moments that are crushing, have been deeply satisfying, she added.</p> <blockquote> <p>“For me personally, and for the folks we’ve helped, it’s the first time people have seen a work environment that is caring—not only caring about productivity, but caring about their mental health. Most folks are coming from a setting where it’s, ‘Do your job and whatever your problems are, deal with that on the outside.’ What’s unique here is we care about what’s going on; how can we make you feel seen, validated, supported. Those aren’t things you usually get at a job.”</p> </blockquote> <p>As the pandemic appears –perhaps – to be winding down in Massachusetts, Watson has been considering her own future goals. “I’ve seen a lot of grief,” she said. “I’ve seen people just diagnosed and then I’ve seen them hospitalized, and also in the end, going to hospice and dying. It’s a full circle experience that you don’t often get to see. I talk to them at the beginning and see them at the end, and all of this makes me want to be part of the healing profession even more. I think hospice is going to be my new thing.” She adds: “It’s amazing to support people in their darkest times. It’s laborious sometimes, but it’s also so gratifying.”</p> <p> </p> <p> </p> </div> </div> </div> <div class="field-wrapper field field-node--field-programs field-name-field-programs field-type-entity-reference field-label-above"> <div class="field-label">Programs</div> <div class="field-items"> <div class="field-item"><a href="/programs/mental-health" hreflang="en">Mental Health</a></div> <div class="field-item"><a href="/programs/social-support" hreflang="en">Social Support</a></div> </div> </div> <div class="field-wrapper field field-node--field-taxonomy-tags field-name-field-taxonomy-tags field-type-entity-reference field-label-above"> <div class="field-label">Related Categories</div> <div class="field-items"> <div class="field-item"><a href="/tag/covid" hreflang="en">Covid-19</a></div> <div class="field-item"><a href="/mental-health-psychosocial-support" hreflang="en">Mental Health &amp; Psychosocial Support</a></div> <div class="field-item"><a href="/tag/add-term-0" hreflang="en">United States</a></div> </div> </div> Fri, 23 Apr 2021 16:34:15 +0000 rgifford 7844 at https://www.pih.org Amid COVID-19, Delivering Mental Health Care To Thousands In Peru https://www.pih.org/article/amid-covid-19-delivering-mental-health-care-thousands-peru <span class="field-wrapper">Amid COVID-19, Delivering Mental Health Care To Thousands In Peru</span> <span class="field-wrapper"><span lang="" about="/user/3201" typeof="schema:Person" property="schema:name" datatype="">apollard</span></span> <span class="field-wrapper">Wed, 10/28/2020 - 13:30</span> <div class="field-wrapper field field-node--field-large-intro-text field-name-field-large-intro-text field-type-text-long field-label-hidden"> <div class="field-items"> <div class="field-item"><p>App helps screen, increase access to specialists during pandemic</p> </div> </div> </div> <div class="field-wrapper field field-node--field-photo field-name-field-photo field-type-image field-label-hidden"> <div class="field-items"> <div class="field-item"> <picture> <source srcset="/sites/default/files/styles/article_xlarge/public/2020-10/peru_0920_bienestar_wrodriquez_03.webp?itok=-kZHDiP8 1x" media="all and (min-width: 1200px)" type="image/webp"/> <source srcset="/sites/default/files/styles/article_large/public/2020-10/peru_0920_bienestar_wrodriquez_03.webp?itok=9B38X74e 1x" media="all and (min-width: 900px) and (max-width: 1199px)" type="image/webp"/> <source srcset="/sites/default/files/styles/article_xmedium/public/2020-10/peru_0920_bienestar_wrodriquez_03.webp?itok=fGnrTQU- 1x" media="all and (min-width: 640px) and (max-width: 899px)" type="image/webp"/> <source srcset="/sites/default/files/styles/article_medium/public/2020-10/peru_0920_bienestar_wrodriquez_03.webp?itok=wxxkbXXM 1x" media="all and (min-width: 450px) and (max-width: 639px)" type="image/webp"/> <source srcset="/sites/default/files/styles/article_mobile/public/2020-10/peru_0920_bienestar_wrodriquez_03.webp?itok=mTM9H1S2 1x" type="image/webp"/> <source srcset="/sites/default/files/styles/article_xlarge/public/2020-10/peru_0920_bienestar_wrodriquez_03.JPG?itok=-kZHDiP8 1x" media="all and (min-width: 1200px)" type="image/jpeg"/> <source srcset="/sites/default/files/styles/article_large/public/2020-10/peru_0920_bienestar_wrodriquez_03.JPG?itok=9B38X74e 1x" media="all and (min-width: 900px) and (max-width: 1199px)" type="image/jpeg"/> <source srcset="/sites/default/files/styles/article_xmedium/public/2020-10/peru_0920_bienestar_wrodriquez_03.JPG?itok=fGnrTQU- 1x" media="all and (min-width: 640px) and (max-width: 899px)" type="image/jpeg"/> <source srcset="/sites/default/files/styles/article_medium/public/2020-10/peru_0920_bienestar_wrodriquez_03.JPG?itok=wxxkbXXM 1x" media="all and (min-width: 450px) and (max-width: 639px)" type="image/jpeg"/> <source srcset="/sites/default/files/styles/article_mobile/public/2020-10/peru_0920_bienestar_wrodriquez_03.JPG?itok=mTM9H1S2 1x" type="image/jpeg"/> <img src="/sites/default/files/styles/article_xlarge/public/2020-10/peru_0920_bienestar_wrodriquez_03.JPG?itok=-kZHDiP8" alt="A staff member with Socios En Salud, as PIH is known in Peru, does a door-to-door mental health screening with a patient after a chatbot app connected them." typeof="foaf:Image" /> </picture> </div> </div> </div> <div class="field-wrapper field field-node--field-caption field-name-field-caption field-type-string-long field-label-hidden"> <div class="field-items"> <div class="field-item">A staff member with Socios En Salud, as PIH is known in Peru, does a door-to-door mental health screening with patient Nancy Zavaleta Ullón in a neighborhood near the capital, Lima, after they were connected by the Bienestár app.</div> </div> </div> <div class="field-wrapper field field-node--field-photo-credit field-name-field-photo-credit field-type-string-long field-label-hidden"> <div class="field-items"> <div class="field-item">Photo by William Castro Rodríguez / Partners In Health</div> </div> </div> <div class="field-wrapper body field field-node--body field-name-body field-type-text-with-summary field-label-hidden"> <div class="field-items"> <div class="field-item"><p>Maritza Sáenz has been a singer for years; but when her mother died of a lung disease, the music lost its meaning.</p> <p>It was a loss that the resident of Callao, Peru—a rural community outside of the capital of Lima—describes as devastating. Sáenz, a single mother who shares a home with her daughter, grandson, and 85-year-old father, recalls not being able to sleep or concentrate on things that usually brought her joy. It felt like something was missing.</p> <p>It wasn’t until she began speaking with a psychologist through Socios En Salud, as Partners In Health is known in Peru, that things began to turn around.</p> <p>“Today, I feel more relieved,” says Sáenz, who speaks with her counselor on the phone. “She understood me, despite the distance, and knew how to treat me.”</p> <p>Sáenz is one of nearly 5,000 Peruvians who have accessed mental health services through PIH since the start of the pandemic. This mental health support comes as part of PIH’s COVID-19 response in Peru, where PIH has provided more than 22,800 COVID-19 tests and offered more than 3,000 people social support, including medicine, food, and housing assistance.</p> <p>“When we connect people, both physically and emotionally, within a community or a family [with] the resources they need, we will be providing them better opportunities,” says Carmen Contreras, director of mental health in Peru.</p> <p>PIH <a href="https://www.pih.org/country/peru">has worked in Peru</a> for more than 20 years. Its <a href="https://storymaps.arcgis.com/stories/20f763426fe444b382cecc1e3eacc370">mental health work</a> there has included providing tuberculosis patients with psychological support, establishing a safe house for women living with severe mental health conditions, and training local residents as community health workers, who refer patients to mental health centers and connect them with care.</p> <p>During COVID-19, that work has adapted to also include group and individual counseling for families mourning the loss of loved ones, as well as an innovative messaging app called Bienestár. The app, run by PIH’s team of local psychologists and community health workers, offers mental health screenings and connects patients with care virtually. It currently serves three of the communities where PIH works.</p> <p>Catherin Rodríguez, who supervises PIH’s work in the Trujillo community, says mental health is crucial for everyone. That’s because it’s never just one person who is affected. Mental health has ripple effects—on a family, a household, and a community.</p> <p>“It is essential for a person to be concerned about their mental health,” says Rodriguez, “because this action can be replicated at home with their entire family and so, little by little, be concerning for overall health.”</p> <p>Stigma, says Contreras, is also a barrier to accessing mental health care. Yet people have to realize they are not alone in experiencing difficulties. “Emotions are part of being human,” she says.</p> <figure role="group"> <img alt="Carmen Contreras is director of mental health in Peru." data-entity-type="file" data-entity-uuid="97095cfc-1521-4595-96f6-c6bb89f58a90" src="/sites/default/files/inline-images/peru_0920_carmencontreras_wrodriquez_04.JPG" width="800" height="532" loading="lazy" /> <figcaption>Carmen Contreras is director of mental health in Peru. Photo by William Castro Rodriguez / Partners In Health.</figcaption> </figure> <p>Contreras has seen SES’s mental health work evolve over the years. That journey has been both professional and personal—especially this year.</p> <p>“A close relative of mine nearly died from COVID,” she says. “It was actually very difficult for my family. I spent a month dealing with that…we were all devastated.”</p> <p>Much of that devastation came from the fact that her family, like many others affected by COVID-19, didn’t know how to tell other relatives when their loved one’s condition was worsening.</p> <p>“With COVID, we need to work on that,” says Contreras, whose relative has since recovered. “It’s not just oxygen, or saturation, or the lungs; it’s also how we deal with our emotions.”</p> <p>A pandemic and the uncertainty it brings—from work to health care to housing—takes a toll not only on physical health, but on mental health. That makes a mental health response to the pandemic all the more vital.</p> <p>For Sáenz, the journey has been difficult. But she is making music again.</p> <p>“It has been very beneficial for me to have a psychologist by my side,” she says. “Now, I can breathe. I don’t feel pain in my chest. The oppression that I had I was able to lift thanks to the specialist’s help.”</p> </div> </div> </div> <div class="field-wrapper field field-node--field-programs field-name-field-programs field-type-entity-reference field-label-above"> <div class="field-label">Programs</div> <div class="field-items"> <div class="field-item"><a href="/programs/mental-health" hreflang="en">Mental Health</a></div> </div> </div> <div class="field-wrapper field field-node--field-taxonomy-tags field-name-field-taxonomy-tags field-type-entity-reference field-label-above"> <div class="field-label">Related Categories</div> <div class="field-items"> <div class="field-item"><a href="/mental-health-psychosocial-support" hreflang="en">Mental Health &amp; Psychosocial Support</a></div> <div class="field-item"><a href="/peru" hreflang="en">Peru</a></div> </div> </div> Wed, 28 Oct 2020 17:30:29 +0000 apollard 7682 at https://www.pih.org Finding the Way Back Home, One Conversation at a Time https://www.pih.org/article/finding-way-back-home-one-conversation-time <span class="field-wrapper">Finding the Way Back Home, One Conversation at a Time </span> <span class="field-wrapper"><span lang="" about="/user/366" typeof="schema:Person" property="schema:name" datatype="">mlawrence</span></span> <span class="field-wrapper">Fri, 10/16/2020 - 13:35</span> <div class="field-wrapper field field-node--field-large-intro-text field-name-field-large-intro-text field-type-text-long field-label-hidden"> <div class="field-items"> <div class="field-item"><p><span><span><span><span><span><span>PIH Liberia psychosocial worker Helena Wesley is on a mission to help people who are “lost” and on the streets in her native Maryland County</span></span></span></span></span></span></p> </div> </div> </div> <div class="field-wrapper field field-node--field-photo field-name-field-photo field-type-image field-label-hidden"> <div class="field-items"> <div class="field-item"> <picture> <source srcset="/sites/default/files/styles/article_xlarge/public/2020-10/MentalHealth_Helena_HarperStreet_web.webp?itok=nH0yyuXP 1x" media="all and (min-width: 1200px)" type="image/webp"/> <source srcset="/sites/default/files/styles/article_large/public/2020-10/MentalHealth_Helena_HarperStreet_web.webp?itok=hEUHBwJY 1x" media="all and (min-width: 900px) and (max-width: 1199px)" type="image/webp"/> <source srcset="/sites/default/files/styles/article_xmedium/public/2020-10/MentalHealth_Helena_HarperStreet_web.webp?itok=jDqN26Bb 1x" media="all and (min-width: 640px) and (max-width: 899px)" type="image/webp"/> <source srcset="/sites/default/files/styles/article_medium/public/2020-10/MentalHealth_Helena_HarperStreet_web.webp?itok=pI5J0nLs 1x" media="all and (min-width: 450px) and (max-width: 639px)" type="image/webp"/> <source srcset="/sites/default/files/styles/article_mobile/public/2020-10/MentalHealth_Helena_HarperStreet_web.webp?itok=acpABuS1 1x" type="image/webp"/> <source srcset="/sites/default/files/styles/article_xlarge/public/2020-10/MentalHealth_Helena_HarperStreet_web.jpg?itok=nH0yyuXP 1x" media="all and (min-width: 1200px)" type="image/jpeg"/> <source srcset="/sites/default/files/styles/article_large/public/2020-10/MentalHealth_Helena_HarperStreet_web.jpg?itok=hEUHBwJY 1x" media="all and (min-width: 900px) and (max-width: 1199px)" type="image/jpeg"/> <source srcset="/sites/default/files/styles/article_xmedium/public/2020-10/MentalHealth_Helena_HarperStreet_web.jpg?itok=jDqN26Bb 1x" media="all and (min-width: 640px) and (max-width: 899px)" type="image/jpeg"/> <source srcset="/sites/default/files/styles/article_medium/public/2020-10/MentalHealth_Helena_HarperStreet_web.jpg?itok=pI5J0nLs 1x" media="all and (min-width: 450px) and (max-width: 639px)" type="image/jpeg"/> <source srcset="/sites/default/files/styles/article_mobile/public/2020-10/MentalHealth_Helena_HarperStreet_web.jpg?itok=acpABuS1 1x" type="image/jpeg"/> <img src="/sites/default/files/styles/article_xlarge/public/2020-10/MentalHealth_Helena_HarperStreet_web.jpg?itok=nH0yyuXP" alt="Mental health care in Harper, Liberia, often involves working with people who are homeless and living on the streets" typeof="foaf:Image" /> </picture> </div> </div> </div> <div class="field-wrapper field field-node--field-caption field-name-field-caption field-type-string-long field-label-hidden"> <div class="field-items"> <div class="field-item">Community psychosocial workers and other members of the PIH Liberia mental health team collectively make more than 520 community visits a month, on average, to support people with mental health conditions and their families in Maryland County.</div> </div> </div> <div class="field-wrapper field field-node--field-photo-credit field-name-field-photo-credit field-type-string-long field-label-hidden"> <div class="field-items"> <div class="field-item">Photos by Marian Roberts / PIH </div> </div> </div> <div class="field-wrapper body field field-node--body field-name-body field-type-text-with-summary field-label-hidden"> <div class="field-items"> <div class="field-item"><p><span><span><span><span><span><span>People struggling with mental health conditions who have stopped receiving treatment or taking medication—and as a result have seen their conditions worsen and may be homeless—are sometimes called “lost” patients. </span></span></span></span></span></span></p> <p><span><span><span><span><span><span>In Maryland County, Liberia, Helena Wesley has made it her mission to find them. </span></span></span></span></span></span></p> <p><span><span><span><span><span><span>Wesley is from Maryland County and has worked since 2015 as a mental health community psychosocial worker for Partners In Health. During that time, she has tracked and connected with more than 20 people, so-called “lost” patients, and reintegrated them with their families, communities, and dignified treatment.</span></span></span></span></span></span></p> <figure role="group" class="align-right"> <img alt="PIH Liberia psychosocial community worker Helena Wesley" data-entity-type="file" data-entity-uuid="f956c2a3-0573-4d57-af01-6c7bde3f0c7f" src="/sites/default/files/inline-images/MentalHealth_Helena_profile_crop300.jpg" width="300" height="364" loading="lazy" /> <figcaption>Helena Wesley, PIH Liberia psychosocial community worker </figcaption> </figure> <p><span><span><span><span><span><span>“Because I grew up in Maryland, I know almost every family, and so when I was deployed into the community, I saw it as an important sense of duty to find and help people with mental illness,” she said.</span></span></span></span></span></span></p> <p><span><span><span><span><span><span>Those 20 represent just her most significant cases. Wesley and her colleagues on the PIH Liberia mental health team collectively conduct more than 520 community visits a month, on average, to support people with mental health conditions and their families.</span></span></span></span></span></span></p> <p><span><span><span><span><span><span>PIH Liberia’s mental health program is community-based, linked to health centers and enriched by hospitals, with a rights-based approach to building resilient health systems. PIH has helped integrate mental health care delivery across the country by developing an outreach program for the homeless, psychosocial support, and electronic medical records, while piloting quality improvement projects to increase referrals from traditional healers. </span></span></span></span></span></span></p> <p><span><span><span><span><span><span>Clinicians deliver care within a mental health referral system and have been trained to accurately screen and diagnose people for mental health conditions. The team works extensively at the community level to provide care and educate community members about mental health conditions through patient-led radio broadcasts, training, and engagement with traditional and faith-based healers.  </span></span></span></span></span></span></p> <p><span><span><span><span><span><span>For Wesley, the job often means talking with her neighbors—and the conversations aren’t always easy.</span></span></span></span></span></span></p> <p><span><span><span><span><span><span>When Wesley began working with PIH, she regularly visited families who she knew included someone with mental health conditions, or who community members suggested she visit. She soon realized, though, that most of those families didn’t know the whereabouts of their relatives with mental health conditions. </span></span></span></span></span></span></p> <p><span><span><span><span><span><span>Due to stigma and other factors, people with mental health conditions who leave their homes often don’t do so willingly—they may not be receiving dignified care at home, or even may be forced out by their families. </span></span></span></span></span></span></p> <p><span><span><span><span><span><span>In such situations, Wesley searches in local marketplaces and public gathering spaces, to find people and try to enroll them in PIH’s mental health program.</span></span></span></span></span></span></p> <p><span><span><span><span><span><span>When she is able to find someone who has been lost and is struggling with mental health conditions, Wesley says, the first thing she does is call them by their name and offer them something to eat. Helping someone with basic needs goes hand in hand with emotional support. </span></span></span></span></span></span></p> <p><span><span><span><span><span><span>“I engage them in conversation and use physical contact, like a pat on the shoulder or back, to show them I care and gain their trust,” she said. “After a few of these conversations, I am able to convince them to return with me, back home to their family, in order to gain the family’s support and begin treatment at PIH-supported health facilities.” </span></span></span></span></span></span></p> <p><span><span><span><span><span><span>Wesley acknowledged that she often faces challenges in her work, as many people with mental health conditions have experienced stigma and discrimination. But she remains determined and does all she can to help people start treatment and get better. </span></span></span></span></span></span></p> <p><span><span><span><span><span><span>When people are in treatment, Wesley visits them at their homes or a health facility in the morning and evening, every day, to monitor their progress and well-being.</span></span></span></span></span></span></p> <p><span><span><span><span><span><span>In addition to caring for patients, Wesley also works to raise local awareness about epilepsy, HIV transmission, the importance of adhering to medication, and stigmatization within her community, as part of PIH-Liberia’s community health programming. In the past year, the Liberia mental health team conducted 194 activities with communities.   </span></span></span></span></span></span></p> <p><span><span><span><span><span><span>Community members trust her, she said, and often refer potential cases to her.  </span></span></span></span></span></span></p> <p><span><span><span><span><span><span>“PIH’s work in promoting mental health services in Liberia is making an impact. And that is why I am motivated—seeing patients who were rejected and very often abused on the streets due to their mental state accept treatment and reunite with their families gives me so much satisfaction,” she said. “It is very fulfilling to have patients in recovery now call my name and chat with me whenever they see me, or when I visit them at home.”</span></span></span></span></span></span></p> <p><span><span><span><span><span><span><img alt="PIH Liberia's mental health team hosted nearly 200 community activities last year" data-entity-type="file" data-entity-uuid="9c428d0b-7342-4dfd-885d-bd28a34c911b" src="/sites/default/files/inline-images/liberia_summary_mental%20health.png" width="800" height="2000" loading="lazy" /></span></span></span></span></span></span></p> </div> </div> </div> <div class="field-wrapper field field-node--field-programs field-name-field-programs field-type-entity-reference field-label-above"> <div class="field-label">Programs</div> <div class="field-items"> <div class="field-item"><a href="/programs/community-health-workers" hreflang="en">Community Health Workers</a></div> <div class="field-item"><a href="/programs/mental-health" hreflang="en">Mental Health</a></div> <div class="field-item"><a href="/programs/social-support" hreflang="en">Social Support</a></div> </div> </div> <div class="field-wrapper field field-node--field-taxonomy-tags field-name-field-taxonomy-tags field-type-entity-reference field-label-above"> <div class="field-label">Related Categories</div> <div class="field-items"> <div class="field-item"><a href="/build-systems" hreflang="en">Build Systems</a></div> <div class="field-item"><a href="/tag/community-health-workers" hreflang="en">Community Health Workers</a></div> <div class="field-item"><a href="/education" hreflang="en">Education</a></div> <div class="field-item"><a href="/food-water-housing" hreflang="en">Food, Water, Housing</a></div> <div class="field-item"><a href="/mental-health-psychosocial-support" hreflang="en">Mental Health &amp; Psychosocial Support</a></div> </div> </div> Fri, 16 Oct 2020 17:35:22 +0000 mlawrence 7675 at https://www.pih.org Innovation: Marking 10 Years of Mental Health Care in Haiti https://www.pih.org/article/innovation-marking-10-years-mental-health-care-haiti <span class="field-wrapper">Innovation: Marking 10 Years of Mental Health Care in Haiti</span> <span class="field-wrapper"><span lang="" about="/user/366" typeof="schema:Person" property="schema:name" datatype="">mlawrence</span></span> <span class="field-wrapper">Fri, 10/09/2020 - 14:38</span> <div class="field-wrapper field field-node--field-large-intro-text field-name-field-large-intro-text field-type-text-long field-label-hidden"> <div class="field-items"> <div class="field-item"><p><span><span><span><span><span>Emergency response to the&nbsp;devastating 2010 earthquake has grown&nbsp;into a system of care that now serves thousands of patients and has become a&nbsp;model for overcoming systemic and structural challenges</span></span></span></span></span></p> </div> </div> </div> <div class="field-wrapper field field-node--field-photo field-name-field-photo field-type-image field-label-hidden"> <div class="field-items"> <div class="field-item"> <picture> <source srcset="/sites/default/files/styles/article_xlarge/public/2020-10/Haiti_0110_NegMawonToned_DWalton_1200web_0.webp?itok=gZHLdFoD 1x" media="all and (min-width: 1200px)" type="image/webp"/> <source srcset="/sites/default/files/styles/article_large/public/2020-10/Haiti_0110_NegMawonToned_DWalton_1200web_0.webp?itok=5oL_YDOT 1x" media="all and (min-width: 900px) and (max-width: 1199px)" type="image/webp"/> <source srcset="/sites/default/files/styles/article_xmedium/public/2020-10/Haiti_0110_NegMawonToned_DWalton_1200web_0.webp?itok=dSbpP5oO 1x" media="all and (min-width: 640px) and (max-width: 899px)" type="image/webp"/> <source srcset="/sites/default/files/styles/article_medium/public/2020-10/Haiti_0110_NegMawonToned_DWalton_1200web_0.webp?itok=DSQwVQWL 1x" media="all and (min-width: 450px) and (max-width: 639px)" type="image/webp"/> <source srcset="/sites/default/files/styles/article_mobile/public/2020-10/Haiti_0110_NegMawonToned_DWalton_1200web_0.webp?itok=5N1aItqg 1x" type="image/webp"/> <source srcset="/sites/default/files/styles/article_xlarge/public/2020-10/Haiti_0110_NegMawonToned_DWalton_1200web_0.jpg?itok=gZHLdFoD 1x" media="all and (min-width: 1200px)" type="image/jpeg"/> <source srcset="/sites/default/files/styles/article_large/public/2020-10/Haiti_0110_NegMawonToned_DWalton_1200web_0.jpg?itok=5oL_YDOT 1x" media="all and (min-width: 900px) and (max-width: 1199px)" type="image/jpeg"/> <source srcset="/sites/default/files/styles/article_xmedium/public/2020-10/Haiti_0110_NegMawonToned_DWalton_1200web_0.jpg?itok=dSbpP5oO 1x" media="all and (min-width: 640px) and (max-width: 899px)" type="image/jpeg"/> <source srcset="/sites/default/files/styles/article_medium/public/2020-10/Haiti_0110_NegMawonToned_DWalton_1200web_0.jpg?itok=DSQwVQWL 1x" media="all and (min-width: 450px) and (max-width: 639px)" type="image/jpeg"/> <source srcset="/sites/default/files/styles/article_mobile/public/2020-10/Haiti_0110_NegMawonToned_DWalton_1200web_0.jpg?itok=5N1aItqg 1x" type="image/jpeg"/> <img src="/sites/default/files/styles/article_xlarge/public/2020-10/Haiti_0110_NegMawonToned_DWalton_1200web_0.jpg?itok=gZHLdFoD" alt="The Neg Mawon statue in Port-au-Prince, Haiti, remained standing after the 2010 earthquake that launched PIH&#039;s efforts to support mental health care in Haiti " typeof="foaf:Image" /> </picture> </div> </div> </div> <div class="field-wrapper field field-node--field-caption field-name-field-caption field-type-string-long field-label-hidden"> <div class="field-items"> <div class="field-item">The Neg Mawon statue, which commemorates the men and women who freed Haiti from colonial rule, remained standing despite the destruction of Haiti’s 2010 earthquake. The natural disaster spurred PIH&#039;s work to build a system for mental health care in Haiti that has grown ever since, and has served more than 6,300 patients at PIH-supported health facilities over the last five years. </div> </div> </div> <div class="field-wrapper field field-node--field-photo-credit field-name-field-photo-credit field-type-string-long field-label-hidden"> <div class="field-items"> <div class="field-item">Photo by David Walton / PIH</div> </div> </div> <div class="field-wrapper body field field-node--body field-name-body field-type-text-with-summary field-label-hidden"> <div class="field-items"> <div class="field-item"><p><em>Content advisory: This article talks about sensitive issues including suicide and mental illness.</em></p> <p> </p> <p><span><span><span>Tatiana Therosme gathered herself for a moment before talking about a young woman, born with HIV, who battled severe depression for years because of stigmatization and mistreatment resulting from people’s perceptions of her diagnosis. </span></span></span></p> <p><span><span><span>Therosme first learned of the woman, Fabiola Noel, through a fellow staff member for Zanmi Lasante, as Partners In Health is known in <strong><a href="https://www.pih.org/country/haiti">Haiti. </a></strong></span></span></span></p> <p><span><span><span>“I was the primary clinician provider, and the nurse called me because she had tried to kill herself,” said Therosme, community health worker supervisor for Zanmi Lasante. </span></span></span></p> <p><span><span><span>What followed was a relationship of support and clinical care that has stretched over years, ever since that phone call.</span></span></span></p> <p><span><span><span>Therosme and other members of Zanmi Lasante’s mental health team quickly began seeing Noel regularly. Therosme learned that Noel’s peers had repeatedly treated her badly, as had a teacher at school. </span></span></span></p> <p><span><span><span>“Because of the context of her HIV, because of the context of stigmatization…she really faced many, many difficulties,” Therosme said. </span></span></span></p> <p><span><span><span>Zanmi Lasante’s ability to support Noel and treat her clinically for anxiety and severe depression—caring for her mental health, as well as physical—is a testament to a mental health system that arose after Haiti’s devastating 2010 earthquake, through a partnership with Haiti’s national government. </span></span></span></p> <p><span><span><span>Over the past decade, that system has grown to serve a population of more than 1.3 million across Haiti’s Central Plateau and lower Artibonite regions, providing care for depression, psychosis, epilepsy, and many other mental health conditions and neurologic disorders.</span></span></span></p> <p><span><span><span>Between January 2016 and September 2019, for example, Zanmi Lasante’s mental health system <strong>delivered more than 28,000 patient visits</strong>, and <strong>served more than 6,300 patients at supported health facilities.  </strong></span></span></span></p> <figure role="group"> <img alt="Patients wait to receive care at PIH-supported University Hospital at Mirebalais" data-entity-type="file" data-entity-uuid="dc9072f4-a7a9-4415-9e57-e52f1da80bdf" src="/sites/default/files/inline-images/Haiti_0316_HUM_CAvila_16_web.JPG" width="800" height="533" loading="lazy" /> <figcaption>Patients wait outside Klinik Extern at University Hospital in Mirebalais, Haiti, in 2016. (Cecille Joan Avila/PIH) </figcaption> </figure> <p><span><span><span>A recently published article details those 10 years of growth, and describes the development of a comprehensive, community-based mental health system in the Caribbean nation, where public mental health services previously were not able to match what was needed. Additionally, the article describes challenges to care stemming from Haiti’s ongoing political and social instability, and finds that despite those challenges, high-quality <strong><a href="https://www.pih.org/programs/mental-health">mental health care</a></strong> can be delivered not only in Haiti, but also in other low-resource settings around the world.</span></span></span></p> <p><span><span><span><strong><a href="https://www.cambridge.org/core/journals/global-mental-health/article/development-of-a-comprehensive-sustained-community-mental-health-system-in-postearthquake-haiti-20102019/3F231A447792BDD499EC1C4C3A6C760E">The article</a></strong>, “Development of a comprehensive, sustained community mental health system in post-earthquake Haiti, 2010–2019,” was published in February by <em>Cambridge University Press</em> in the journal Global Mental Health. Co-authors include Pere Eddy Eustache, director of mental health and psychosocial services for Zanmi Lasante; <span>Dr. Giuseppe “Bepi” Raviola, PIH’s director of mental health; Therosme; and several others. </span></span></span></span></p> <p><span><span><span>“The dedication of various staff across Zanmi Lasante and PIH to maintaining the system and improving the model has led to ongoing program growth and longer-term commitment to build a better system, (offering) hope that anyone in Haiti living with a mental disorder can have access to free, quality mental health care,” the study states. “We can expect that the perception of the Zanmi Lasante program’s relevance as an antidote to despair from mental suffering, both in communities and in the health system, will only increase the demand for services with time.”</span></span></span></p> <p><span><span><span>Noel, whose name has been changed to prevent further abuse, is an example of how much people can achieve when the crushing burdens of mental disorders are lifted. </span></span></span></p> <p><span><span><span>Therosme recalled that Noel assumed she would die young because of her HIV, so she never believed she could become a nurse or clinician. </span></span></span></p> <blockquote> <p><span><span><span>“I remember working together to see what her next plan could be,” Therosme said. “She didn’t think she could make it, but she worked and completed her studies.”</span></span></span></p> </blockquote> <h2><span><span><span><strong>Support, not stigma</strong></span></span></span></h2> <p><span><span><span>Eustache said much of delivering mental health care in Haiti is about helping people understand that the trauma they are living with can be alleviated, and that receiving clinical care and local support are positive steps that should be shared, not stigmatized. </span></span></span></p> <blockquote> <p><span><span><span>“The history of Haiti has been a history of violence. Structural violence, political violence, everything. People are exposed to poverty, and what I call social violence. And the new aspect of violence is what I call environmental, ecological violence,” Eustache said. “Sometimes people are living with trauma, and they are unaware of that.”</span></span></span></p> </blockquote> <p><span><span><span>Eustache said ecological trauma from many sources can affect Haitians. “For example, every time there is a heavy rain, in the slums, walls collapse, followed by casualties,” he said. “Deforestation is strongly active in the destruction of the environment. This is what I call ecological violence. </span></span></span></p> <p><span><span><span>“Drought caused by deforestation creates a cycle of hunger, pushing people to cut trees and make charcoal, destroying the environment, which becomes more and more threatening for people who are more and more vulnerable to trauma,” he continued. </span></span></span></p> <p><span><span><span>Eustache said many of the people who receive mental health care from Zanmi Lasante show behaviors that are related to trauma they experienced in the past, and now appears in other forms.</span></span></span></p> <p><span><span><span>“This is something we live on a daily basis,” he said. </span></span></span></p> <p><span><span><span>“People don’t know how to phrase it, how to verbalize it,” Eustache added. “But we need to remain aware that Haiti is a country that has been prone to trauma.”</span></span></span></p> <p><span><span><span><span>The earthquake on Jan. 12, 2010, struck about 15 miles southwest of Port-au-Prince, Haiti’s capital. The disaster killed nearly 300,000 people, injured hundreds of thousands more, and devastated social services and health care infrastructure. </span></span></span></span></p> <p><span><span><span><span>In the weeks that followed, Haiti’s Minister of Health contacted Zanmi Lasante to request support in developing a national mental health system. </span></span></span></span></p> <figure role="group"> <img alt="Zanmi Lasante's mental health care serves communities including Cange, Haiti " data-entity-type="file" data-entity-uuid="d951cb62-1587-4d95-8936-6b5ff7ea4e5f" src="/sites/default/files/inline-images/012308_Cange_1183_web.jpg" width="800" height="533" loading="lazy" /> <figcaption>Zanmi Lasante's mental health system has grown to serve thousands of patients in Haiti's Central Plateau and lower Artibonite regions, including at this PIH-supported facility in Cange, Haiti.  (Photo courtesy of Rose Lincoln / Harvard News Office) </figcaption> </figure> <h2><span><span><strong><span><span>Service, not scarcity </span></span></strong></span></span></h2> <p><span><span><span>The ministry’s request, initially made in February of 2010, was based on Zanmi Lasante’s previous success in addressing HIV and TB from a community-based model of care. That model included mental health services, with community health workers playing a key role in providing access and support.  Government and health leaders in Haiti believed the model also could be effective for addressing the growing burden of mental illness, itself, as an independent issue outside the framework of any other disease. </span></span></span></p> <p><span><span><span>“After the earthquake we were aware that the need for mental health would be huge, and we needed to understand those expectations,” Eustache said. “So, we started thinking about a mental health program.” </span></span></span></p> <p><span><span><span>Eustache and Raviola worked closely together, starting the week of the earthquake, to bring to reality a model for a community-based program that could be tried and tested in the regions where Zanmi Lasante works.</span></span></span></p> <p><span><span><span>Therosme took Eustache’s comment a step further, saying that Zanmi Lasante jumped on the opportunity to build a structured mental health program that could fill gaps in staff recruitment, training, development of mental health specialists, and more.  </span></span></span></p> <p><span><span><span>Those gaps had long been significant in Haiti, where the majority of people addressed mental health care through traditional treatment channels, such as religious leaders and local healers. Language barriers and local customs often enabled religious and community leaders to build trusting relationships with patients, as opposed to doctors in Port-au-Prince or other urban areas, often far from people’s homes. Financial barriers also played a role. </span></span></span></p> <p><span><span><span>Eustache said that at Haiti’s two psychiatric hospitals, Beudet Hospital and the Mars and Kline Psychiatric Center, both in Port-au-Prince, the government pays clinicians’ salaries, but remaining costs are laid on patients and their families.</span></span></span></p> <p><span><span><span>That means people from rural areas often cannot afford to not only travel to the capital, but also support a hospitalized family member during extended care. As a result, many people would avoid traveling to Port-au-Prince and instead seek local care from traditional healers.</span></span></span></p> <p><span><span><span>These were just some of the factors forming the backdrop as an initial assessment, begun in March 2011, examined the setting for mental health programs in Haiti. </span></span></span></p> <h2><span><span><span><strong>Building a system</strong></span></span></span></h2> <p><span><span><span>The project began with an initial assessment of the local context—beliefs, attitudes and perspectives related to mental health care practice, and priorities. It engaged 15 focus groups and included 11 individual interviews with community members, community health workers, facility-based health workers, people living with mental illness and their families, and religious leaders, including houngan or voudou priests, manbo or voudou priestesses, and Catholic and Protestant priests. </span></span></span></p> <p><span><span><span>The assessment found that, for respondents, the stressful conditions related to poverty experienced in many parts of the country, exacerbated by the earthquake, left everyone vulnerable to all manifestations of sadness and dysthymia, depression, suicide and psychosis. </span></span></span></p> <p><span><span><span>It also found that traditional healers desired a formal mental health system, including psychological treatments, with which to collaborate. </span></span></span></p> <p><span><span><span>This informed Zanmi Lasante’s commitment to build a formal mental health system, in large part, as a response to the devastating disaster. The growing team began by developing care pathways and protocols for depression, psychotic disorders and epilepsy, with the support of Grand Challenges Canada.  </span></span></span></p> <p><span><span><span>“We consider that the earthquake has been an opportunity to raise awareness, and raise funding, to help us maintain the program and make sure that more and more people can get access to care that we are providing,” Eustache said. “We lost 300,000 people—that’s huge for a small country like Haiti. We say that these people shouldn’t have died for nothing.”</span></span></span></p> <p><span><span><span>Zanmi Lasante’s immediate mental health response after the earthquake was providing care for people who had been displaced and were staying in temporary camps. That work evolved into community-based care, built on the foundation of community health workers and referrals to clinics or hospitals, where clinicians could assess patients and develop long-term care plans. </span></span></span></p> <p><span><span><span><span>“What was accomplished by Zanmi Lasante in developing this system has been truly remarkable,” Raviola said. “Clinicians worked under the most challenging circumstances to support people living with unaddressed mental disorders that pre-existed the earthquake, trauma from the earthquake, the effects of additional disasters including the cholera crisis and multiple hurricanes, as well as political violence. The Haiti work also laid the groundwork for PIH’s cross-site learning collaborative in mental health care delivery, which to us represents a model of trans-national dialogue and sharing of experiences and lessons.” </span></span></span></span></p> <p><span><span><span>Between 2010 and 2015, the Zanmi Lasante and PIH cross-site teams developed a system based on five key skill sets for delivering mental health care in low-resource settings, and five key implementation rules.  These include:</span></span></span></p> <p><span><span><span><em>Skill sets:  </em></span></span></span></p> <ul> <li><span><span><span>case-finding, engagement, follow-up, and psychoeducation; </span></span></span></li> <li><span><span><span>targeted psychological interventions; </span></span></span></li> <li><span><span><span>medication management; </span></span></span></li> <li><span><span><span>supervision and consultation; and </span></span></span></li> <li><span><span><span>quality oversight</span></span></span></li> </ul> <p><span><span><span><em>Implementation rules: </em></span></span></span></p> <ul> <li><span><span><span>assess context; </span></span></span></li> <li><span><span><span>identify and map priority care pathways; </span></span></span></li> <li><span><span><span>specify decision support tools; </span></span></span></li> <li><span><span><span>use QI practices; and </span></span></span></li> <li><span><span><span>address sustainability, management, and capacity-building</span></span></span></li> </ul> <p><span><span><span>This process of describing the essential, effective elements of a basic system of care informed learning processes at other PIH sites in important ways, as the PIH cross-site team developed dialogue across all of the sites to build similar, and different, models of care based on local priorities. The Haiti case, for example, is now a key teaching tool for a course at Harvard School of Public Health called “Case Studies in Global Mental Health Delivery.” </span></span></span></p> <h2><span><span><span><strong>Stability, amid instability </strong></span></span></span></h2> <p><span><span><span>All of the skill sets and implementation rules tested in Haiti are delivered in a social and economic setting that has been turbulent, not just in the earthquake’s aftermath, but also in very recent years and to the present. </span></span></span></p> <p><span><span><span>Three different presidents have served Haiti since 2015, amid constitutional crises and frequent civil protests, fueled by allegations of electoral fraud and government misuse of billions of dollars. </span></span></span></p> <p><span><span><span>In 2016, Hurricane Matthew ravaged southern Haiti and displaced 175,000 people, many of whom faced a cholera epidemic, and food shortages brought by widespread damage to crops and livestock.</span></span></span></p> <p><span><span><span>By 2017, 38,000 people were still living in displacement camps built after the 2010 earthquake. The following year brought more waves of street protests, both peaceful and violent, during a new period of national lockdown, known as peyi lòk. Schools closed, roads were blocked, and the country was brought to a standstill, slowing the economy and worsening poverty. </span></span></span></p> <p><span><span><span>All of these crises have had significant effects on the well-being of clinical staff and caregivers themselves. </span></span></span></p> <p><span><span><span>“At a human level, significant challenges currently make service delivery extremely difficult due to the contingencies of the daily reality that providers, coordinators, and managers have been facing over the past decade, a situation that has worsened since 2017,” the 10-year paper notes. </span></span></span></p> <h2><span><span><span><strong>‘We still need to fight’</strong></span></span></span></h2> <p><span><span><span>Despite all of those challenges, Zanmi Lasante’s mental health team has continued to show up, every day, to provide vital care and support—to people including the young woman with HIV. </span></span></span></p> <p><span><span><span>Therosme said that woman now is a nurse administrator and social worker in a Zanmi Lasante hospital, accompanying people with HIV and tuberculosis, supporting their care and social assistance. </span></span></span></p> <p><span><span><span>“She’s come far—she never imagined a day when she would be where she is now,” Therosme said. “Now she is talking about having a child.”</span></span></span></p> <p><span><span><span>Eustache was sitting next to Therosme as she spoke, and noted her emotion. </span></span></span></p> <p><span><span><span>“Tatiana is moved to tears telling this story,” he said. </span></span></span></p> <p><span><span><span>Eustache said that Zanmi Lasante’s mental health mission is at its core about <em>connection</em>, in a country that remains essentially divided into rural and urban societies. Rural Haiti, he said, “has been totally excluded in terms of services and access to care,” along with education, public services, and more. </span></span></span></p> <p><span><span><span>“Historically, Haiti has been going as a nation with two different societies—like two trains going in the same direction that cannot meet together,” Eustache said. “In our work as Zanmi Lasante, we say that our main goal is to make these people part of the whole society, with access to care that has been denied to them.” </span></span></span></p> <p><span><span><span>Joining those train tracks will require continued collaboration between Zanmi Lasante, PIH mental health programs around the world, and other partners across Haiti. </span></span></span></p> <p><span><span><span>“All we have accomplished as milestones is a joint effort from the Zanmi Lasante mental health program and the PIH cross-site mental health program,” Eustache said. “This is a joint effort, with a team spirit.</span></span></span></p> <p><span><span><span>“(And) we have not done enough,” he added. “We still need to fight, to work.” </span></span></span></p> <p> </p> </div> </div> </div> <div class="field-wrapper field field-node--field-paragraphs-content field-name-field-paragraphs-content field-type-entity-reference-revisions field-label-hidden"> <div class="field-items"> <div class="field-item"> <div class="paragraph just-text darktext paragraph--id--3328" style="background-color: #e1e4e2;"> <h2 class="center">A Note from PIH&#039;s Mental Health Team </h2> <p class="header__intro header__intro-para"> The Zanmi Lasante and PIH mental health teams are hopeful for the ongoing evolution of their work. They credit the Zanmi Lasante workforce and the communities they serve for enthusiastically accepting the challenge of building this system. It is hoped that the impact of this work can serve as an effective platform for further advocacy for scale, and broader systems change for mental health in Haiti.<br /> <br /> “Nap viv e nap kontinye! – We are alive, and we will continue!”</p> </div> </div> </div> </div> <div class="field-wrapper field field-node--field-programs field-name-field-programs field-type-entity-reference field-label-above"> <div class="field-label">Programs</div> <div class="field-items"> <div class="field-item"><a href="/programs/mental-health" hreflang="en">Mental Health</a></div> <div class="field-item"><a href="/programs/research" hreflang="en">Research</a></div> </div> </div> <div class="field-wrapper field field-node--field-taxonomy-tags field-name-field-taxonomy-tags field-type-entity-reference field-label-above"> <div class="field-label">Related Categories</div> <div class="field-items"> <div class="field-item"><a href="/build-systems" hreflang="en">Build Systems</a></div> <div class="field-item"><a href="/tag/human-rights-and-justice" hreflang="en">Human Rights and Justice</a></div> <div class="field-item"><a href="/mental-health-psychosocial-support" hreflang="en">Mental Health &amp; Psychosocial Support</a></div> <div class="field-item"><a href="/research" hreflang="en">Research</a></div> <div class="field-item"><a href="/tag/article-0" hreflang="en">Research/Innovation</a></div> <div class="field-item"><a href="/training" hreflang="en">Training</a></div> </div> </div> Fri, 09 Oct 2020 18:38:49 +0000 mlawrence 7670 at https://www.pih.org Study Reveals Immense PTSD Burden Among Haitian Youth https://www.pih.org/article/study-reveals-immense-ptsd-burden-among-haitian-youth <span class="field-wrapper">Study Reveals Immense PTSD Burden Among Haitian Youth</span> <span class="field-wrapper"><span lang="" about="/user/3201" typeof="schema:Person" property="schema:name" datatype="">apollard</span></span> <span class="field-wrapper">Thu, 09/10/2020 - 11:30</span> <div class="field-wrapper field field-node--field-large-intro-text field-name-field-large-intro-text field-type-text-long field-label-hidden"> <div class="field-items"> <div class="field-item"><p>Researchers with Partners In Health (PIH) found in a recent study that young people in Haiti are made especially vulnerable to mental health conditions by their chronic exposure to stressful life events.</p> </div> </div> </div> <div class="field-wrapper field field-node--field-photo field-name-field-photo field-type-image field-label-hidden"> <div class="field-items"> <div class="field-item"> <picture> <source srcset="/sites/default/files/styles/article_xlarge/public/2020-09/haiti_1016_southpostmatthew_rrollins_060forweb-1.webp?itok=xwOxjHOt 1x" media="all and (min-width: 1200px)" type="image/webp"/> <source srcset="/sites/default/files/styles/article_large/public/2020-09/haiti_1016_southpostmatthew_rrollins_060forweb-1.webp?itok=ftjoLBgb 1x" media="all and (min-width: 900px) and (max-width: 1199px)" type="image/webp"/> <source srcset="/sites/default/files/styles/article_xmedium/public/2020-09/haiti_1016_southpostmatthew_rrollins_060forweb-1.webp?itok=Bu_bXALz 1x" media="all and (min-width: 640px) and (max-width: 899px)" type="image/webp"/> <source srcset="/sites/default/files/styles/article_medium/public/2020-09/haiti_1016_southpostmatthew_rrollins_060forweb-1.webp?itok=KxS-yb1n 1x" media="all and (min-width: 450px) and (max-width: 639px)" type="image/webp"/> <source srcset="/sites/default/files/styles/article_mobile/public/2020-09/haiti_1016_southpostmatthew_rrollins_060forweb-1.webp?itok=H9M9lUiZ 1x" type="image/webp"/> <source srcset="/sites/default/files/styles/article_xlarge/public/2020-09/haiti_1016_southpostmatthew_rrollins_060forweb-1.jpg?itok=xwOxjHOt 1x" media="all and (min-width: 1200px)" type="image/jpeg"/> <source srcset="/sites/default/files/styles/article_large/public/2020-09/haiti_1016_southpostmatthew_rrollins_060forweb-1.jpg?itok=ftjoLBgb 1x" media="all and (min-width: 900px) and (max-width: 1199px)" type="image/jpeg"/> <source srcset="/sites/default/files/styles/article_xmedium/public/2020-09/haiti_1016_southpostmatthew_rrollins_060forweb-1.jpg?itok=Bu_bXALz 1x" media="all and (min-width: 640px) and (max-width: 899px)" type="image/jpeg"/> <source srcset="/sites/default/files/styles/article_medium/public/2020-09/haiti_1016_southpostmatthew_rrollins_060forweb-1.jpg?itok=KxS-yb1n 1x" media="all and (min-width: 450px) and (max-width: 639px)" type="image/jpeg"/> <source srcset="/sites/default/files/styles/article_mobile/public/2020-09/haiti_1016_southpostmatthew_rrollins_060forweb-1.jpg?itok=H9M9lUiZ 1x" type="image/jpeg"/> <img src="/sites/default/files/styles/article_xlarge/public/2020-09/haiti_1016_southpostmatthew_rrollins_060forweb-1.jpg?itok=xwOxjHOt" alt="Road conditions somewhere between Les Cayes and Port-au-Prince" typeof="foaf:Image" /> </picture> </div> </div> </div> <div class="field-wrapper field field-node--field-caption field-name-field-caption field-type-string-long field-label-hidden"> <div class="field-items"> <div class="field-item">Road conditions somewhere between Les Cayes and Port-au-Prince in October 2016. Only a few weeks after Hurricane Matthew left widespread devastation in southern Haiti, heavy rains resulted in additional flooding.</div> </div> </div> <div class="field-wrapper field field-node--field-photo-credit field-name-field-photo-credit field-type-string-long field-label-hidden"> <div class="field-items"> <div class="field-item">Matthew Rollins for PIH</div> </div> </div> <div class="field-wrapper body field field-node--body field-name-body field-type-text-with-summary field-label-hidden"> <div class="field-items"> <div class="field-item"><p><span><span>In August, Haiti’s health care system registered a major victory: the first COVID-19 patient to survive intubation and mechanical ventilation <a href="https://lenouvelliste.com/article/219461/un-premier-patient-covid-19-intube-est-sorti-vivant-de-lhopital">returned home</a> to his family after 29 days at the University Hospital of Mirebalais, the state-of-the-art facility that has served as a lifeline for patients from across the country. </span></span></p> <p><span><span>Yet even a hospital as well-equipped as Mirebalais can do little to alleviate the psychological effects of crises—from COVID-19 to the devastating 2010 earthquake—that have laid bare systemic inequities and compounded the hardships of daily life.</span></span></p> <p><span><span>And as researchers with Partners In Health (PIH) found in a recent study, young people in Haiti are made especially vulnerable by their chronic exposure to stressful life events. </span></span></p> <p><span><span>“We are exposed all the time to different types of trauma,” says Father Eddy Eustache, an ordained Catholic priest and the director of mental health with PIH’s Haitian sister organization, Zanmi Lasante (ZL). “Mental illness in Haiti exists on a large scale, and because of the worsening situation, that need for care continues to grow. So, we think the services we provide should be scaled up at the national level.”</span></span></p> <p><span><span><strong>Expanding Mental Health Services </strong></span></span></p> <p><span><span>Those services began in earnest in the weeks after the earthquake, when “P<span><span>è</span></span>re Eddy,” as he’s known to friends and colleagues, met with Dr. Giuseppe “Bepi” Raviola, PIH’s director of mental health, to plan a coordinated mental health response. </span></span></p> <p><span><span>In addition to the post-traumatic stress disorder (PTSD) it exacerbated, the earthquake revealed just how significant the burden of mental health conditions already was, with high levels of depression, anxiety, and stress having developed over decades of unemployment, violence, and political instability—or what P<span><span>è</span></span>re Eddy <a href="https://www.pih.org/article/pere-eddy-haitis-patron-saint-of-mental-health">has described as</a> the “poverty package.”</span></span></p> <p><span><span>It also <a href="https://www.nytimes.com/2010/03/20/world/americas/20haiti.html">exposed the</a> severe lack of mental health care at that time—just a pair of psychiatrists for a country of 10 million people—and spurred the government and partners to act. </span></span></p> <p><span><span>In the decade since the earthquake, ZL has expanded its mental health team to include 15 psychologists and social workers, who work in 12 clinics across the country. They’ve also trained 156 community health workers to address depression, anxiety, bipolar disorder, epilepsy, and schizophrenia. ZL has also published research around its long-term mental health response to the earthquake, as it built up a comprehensive, sustained mental health system to serve 1.5 million people.</span></span></p> <p><span><span>Still, says P<span><span>è</span></span>re Eddy, they’re fighting an uphill battle and not least because of the persistent stigma associated with mental health conditions. “There’s a lot of fear and shame,” he says. “And as a result, there isn’t the political will to address it.” </span></span></p> <p><span><span><strong>The Burden of PTSD Among Youth</strong></span></span></p> <p><span><span>That led P<span><span>è</span></span>re Eddy and colleagues to study the effects of the earthquake on the mental health of Haiti’s youth. In <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5967385/">the study</a>, published in 2018 in the Journal of Psychiatric Research, P<span><span>è</span></span>re Eddy and colleagues analyzed data collected about 4 years after the earthquake from a mental health assessment conducted at a secondary school in Haiti’s Central Plateau. </span></span></p> <p><span><span>Although the earthquake had centered in Leogane, a city on the southern outskirts of Haiti’s capital, Port-au-Prince, some 90,000 internally displaced persons migrated to the Central Plateau, including many of those who had been injured. </span></span></p> <p><span><span>What the study found was concerning. The mental health assessment had included a Stressful Life Events Checklist—a 13-item questionnaire documenting exposure to a broad range of stressful life events, including sexual abuse, armed conflict, and separation from family. </span></span></p> <p><span><span>Of the 120 students who had filled out the assessment, all reported at least one stressful life event; nearly three-quarters reported witnessing others being physically mistreated, and 42.5 percent said they had experienced physical mistreatment themselves. Additionally, just over 58 percent reported that there was a time when they felt that their life was in danger, and nearly 57 percent had experienced the death of a loved one. </span></span></p> <p><span><span>To the surprise of the researchers, the study found that exposure to an earthquake or other disaster was not significantly associated with having PTSD. Nonetheless, it offered further evidence of the immense burden of PTSD among youth in Haiti. </span></span></p> <p><span><span>“The earthquake did not bring mental illness to Haiti,” says P<span><span>è</span></span>re Eddy, “but it did present to us an opportunity to raise awareness about the urgent need for quality care—to say to the world, ‘Something has to be done.’” </span></span></p> <p><span><span><strong>‘Unity of the Body and Mind’</strong></span></span></p> <p><span>In January, just as the first reports of the novel coronavirus were surfacing in China, Haitians commemorated the 10th anniversary of the earthquake and its more than 300,000 victims. </span></p> <p><span><span>Reflecting on the legacy of the earthquake, P<span><span>è</span></span>re Eddy says it’s crucial for policymakers to understand the importance of mental health—what he calls “the unity of the body and the mind.” Ignoring mental health, he says, will only exacerbate poverty, feeding a cycle that is sure to continue in the absence of quality care. </span></span></p> <p><span><span>“Dr. Farmer described the earthquake as ‘an acute and chronic crisis’ that compounded what was already a very difficult situation,” says P<span><span>è</span></span>re Eddy. “And as our study shows, that’s true of mental health too. The exposure to stress was not a one-time event; it’s a product of the violence and poverty people live every day.”&nbsp; &nbsp;</span></span></p> <p><span><span>Still, he remains hopeful: “We’re taking this opportunity, in the tenth year since the earthquake, to say to all: ‘We want these programs to continue and to grow, so that more Haitians can have access to mental health care.’”</span></span></p> </div> </div> </div> <div class="field-wrapper field field-node--field-programs field-name-field-programs field-type-entity-reference field-label-above"> <div class="field-label">Programs</div> <div class="field-items"> <div class="field-item"><a href="/programs/mental-health" hreflang="en">Mental Health</a></div> </div> </div> <div class="field-wrapper field field-node--field-taxonomy-tags field-name-field-taxonomy-tags field-type-entity-reference field-label-above"> <div class="field-label">Related Categories</div> <div class="field-items"> <div class="field-item"><a href="/taxonomy/term/768" hreflang="en">Haiti</a></div> <div class="field-item"><a href="/mental-health-psychosocial-support" hreflang="en">Mental Health &amp; Psychosocial Support</a></div> </div> </div> Thu, 10 Sep 2020 15:30:10 +0000 apollard 7657 at https://www.pih.org Boosting Support for Survivors of Sexual and Gender-based Violence https://www.pih.org/article/boosting-support-survivors-sexual-and-gender-based-violence <span class="field-wrapper">Boosting Support for Survivors of Sexual and Gender-based Violence </span> <span class="field-wrapper"><span lang="" about="/user/366" typeof="schema:Person" property="schema:name" datatype="">mlawrence</span></span> <span class="field-wrapper">Thu, 08/06/2020 - 10:01</span> <div class="field-wrapper field field-node--field-photo field-name-field-photo field-type-image field-label-hidden"> <div class="field-items"> <div class="field-item"> <picture> <source srcset="/sites/default/files/styles/article_xlarge/public/2020-08/Malawi_1018_NDHWaitingHome_ZDeClerck_25-1024x683.webp?itok=JUjs1dM8 1x" media="all and (min-width: 1200px)" type="image/webp"/> <source srcset="/sites/default/files/styles/article_large/public/2020-08/Malawi_1018_NDHWaitingHome_ZDeClerck_25-1024x683.webp?itok=FRvhIJbE 1x" media="all and (min-width: 900px) and (max-width: 1199px)" type="image/webp"/> <source srcset="/sites/default/files/styles/article_xmedium/public/2020-08/Malawi_1018_NDHWaitingHome_ZDeClerck_25-1024x683.webp?itok=xW5PF4mi 1x" media="all and (min-width: 640px) and (max-width: 899px)" type="image/webp"/> <source srcset="/sites/default/files/styles/article_medium/public/2020-08/Malawi_1018_NDHWaitingHome_ZDeClerck_25-1024x683.webp?itok=GirXBPnM 1x" media="all and (min-width: 450px) and (max-width: 639px)" type="image/webp"/> <source srcset="/sites/default/files/styles/article_mobile/public/2020-08/Malawi_1018_NDHWaitingHome_ZDeClerck_25-1024x683.webp?itok=b8CrLOTY 1x" type="image/webp"/> <source srcset="/sites/default/files/styles/article_xlarge/public/2020-08/Malawi_1018_NDHWaitingHome_ZDeClerck_25-1024x683.jpg?itok=JUjs1dM8 1x" media="all and (min-width: 1200px)" type="image/jpeg"/> <source srcset="/sites/default/files/styles/article_large/public/2020-08/Malawi_1018_NDHWaitingHome_ZDeClerck_25-1024x683.jpg?itok=FRvhIJbE 1x" media="all and (min-width: 900px) and (max-width: 1199px)" type="image/jpeg"/> <source srcset="/sites/default/files/styles/article_xmedium/public/2020-08/Malawi_1018_NDHWaitingHome_ZDeClerck_25-1024x683.jpg?itok=xW5PF4mi 1x" media="all and (min-width: 640px) and (max-width: 899px)" type="image/jpeg"/> <source srcset="/sites/default/files/styles/article_medium/public/2020-08/Malawi_1018_NDHWaitingHome_ZDeClerck_25-1024x683.jpg?itok=GirXBPnM 1x" media="all and (min-width: 450px) and (max-width: 639px)" type="image/jpeg"/> <source srcset="/sites/default/files/styles/article_mobile/public/2020-08/Malawi_1018_NDHWaitingHome_ZDeClerck_25-1024x683.jpg?itok=b8CrLOTY 1x" type="image/jpeg"/> <img src="/sites/default/files/styles/article_xlarge/public/2020-08/Malawi_1018_NDHWaitingHome_ZDeClerck_25-1024x683.jpg?itok=JUjs1dM8" alt="Two women rest at Neno District Hospital’s maternal waiting home. " typeof="foaf:Image" /> </picture> </div> </div> </div> <div class="field-wrapper field field-node--field-caption field-name-field-caption field-type-string-long field-label-hidden"> <div class="field-items"> <div class="field-item">Two women rest in the maternal waiting home at PIH-supported Neno District Hospital in Malawi. A program to improve treatment and support for survivors of sexual or gender-based violence is making significant, lasting changes in the district. </div> </div> </div> <div class="field-wrapper field field-node--field-photo-credit field-name-field-photo-credit field-type-string-long field-label-hidden"> <div class="field-items"> <div class="field-item">Zack DeClerck / PIH</div> </div> </div> <div class="field-wrapper body field field-node--body field-name-body field-type-text-with-summary field-label-hidden"> <div class="field-items"> <div class="field-item"><p><span><span><span><span><span>In Neno District, Malawi, district health records from 2019 showed zero cases of sexual or gender-based violence (SGBV). But no one working in health care in the rural, mountainous district believed that to be true. </span></span></span></span></span></p> <p><span><span><span><span><span>And when staff for Abwenzi Pa Za Umoyo, as Partners In Health is known in <strong><a href="https://www.pih.org/country/malawi">Malawi</a></strong>, began talking about how to strengthen SGBV services, nearly every health worker had a story: The young child presenting with a sexually transmitted disease. The local teacher known for sexually assaulting his students. The woman who had endured years of domestic violence.</span></span></span></span></span></p> <p><span><span><span><span>Emilia Connolly, chief medical officer for PIH in Malawi, stated the problem clearly last October. </span></span></span></span></p> <p><span><span><span><span>“Right now we don’t have a way to track anyone who’s reporting sexual or gender-based violence in the district,” Connolly said. “We know that it happens, we know and all have taken care of survivors in our health facilities, but there’s no tracking.”</span></span></span></span></p> <p><span><span><span><span><span>There also was little guidance or consensus on treatment approaches for survivors of SGBV, and limited understanding of patients’ legal rights or recourse.  </span></span></span></span></span></p> <p><span><span><span><span>PIH in Malawi is working to address those gaps with a program called No Woman or Girl Left Behind, through a five-year grant from Global Affairs Canada that began in July 2019. The grant also is funding the program through PIH in <strong><a href="https://www.pih.org/country/sierra-leone">Sierra Leone</a></strong>, which is one of the most dangerous countries in the world to be pregnant. </span></span></span></span></p> <h2>Advocacy for Women and Girls</h2> <p><span><span><span><span>In addition to reducing SGBV and supporting survivors, No Woman or Girl Left Behind aims to advance sexual and reproductive health and rights for adolescent girls, and support advocacy for those rights in Malawi.</span></span></span></span></p> <figure role="group" class="align-right"> <img alt="Dr. Ariel Wagner" data-entity-type="file" data-entity-uuid="b6bfa9f2-958d-44a2-a1cc-c375c35e2ea1" src="/sites/default/files/inline-images/Ariel%20Wagner_headshot.png" width="334" height="410" loading="lazy" /> <figcaption>Dr. Ariel Wagner</figcaption> </figure> <p><span><span><span><span>“In Neno, we know that SGBV is common but rarely reported; and as a result, survivors are left vulnerable to further episodes of violence and rarely get needed medical care and support,” said Dr. Ariel Wagner, director of primary health for PIH in Malawi. “Moreover, most health care workers have little to no training in the medical management of these cases—for instance, how to perform a physical exam that obtains needed information without causing renewed suffering or trauma.”</span></span></span></span></p> <p><span><span><span><span>Plans for the program were ramping up in October, when Connolly spoke about the gap in tracking. Also at that time, Dr. George Talama, primary health care clinical manager for PIH in Malawi, said he and colleagues recently had visited Queen Elizabeth Hospital in Blantyre, Malawi’s second-largest city and the closest urban and commercial center to Neno. </span></span></span></span></p> <p><span><span><span><span>The Blantyre hospital has a center of excellence for SGBV cases. Talama said he was struck by how the center places Ministry of Health clinicians, a psychiatrist, police, and social services staff all in one place. He said those services were separated in Neno at that time—often located hours away from each other—meaning people who experienced sexual or gender-based violence had to visit the police station before going to the hospital, and then go elsewhere for social services or other needs.   </span></span></span></span></p> <p><span><span><span><span>“So they are lost, and there is no proper documentation in terms of tracking them,” Talama said. “When you manage them under one roof, it becomes easier.”</span></span></span></span></p> <h2><span><span><span><span>Neno Training</span></span></span></span></h2> <p><span><span><span><span>A local training was needed in Neno, Talama said, to bring national SGBV experts together with local police, social workers, and clinicians. </span></span></span></span></p> <p><span><span><span><span>That exact training happened in January. The five-day event connected a government training team—including representatives from the national ministries of health; justice; and gender, children and social welfare—with Neno clinicians, for both the Ministry of Health and PIH, along with two Neno police officers; two district social welfare officers; and the local district magistrate. </span></span></span></span></p> <p><span><span><span><span>The event addressed alignment with national guidelines and best practices for SGBV cases, management protocols, record-keeping policies, and much more.   </span></span></span></span></p> <p><span><span><span><span><span>One of the participants was Willy Chisindo, a Ministry of Health nurse who runs the sexually transmitted infection clinic at PIH-supported Neno District Hospital. He said the event had immediate impacts.</span></span></span></span></span></p> <figure role="group"> <img alt="Nurse Willy Chisindo in Neno District, Malawi" data-entity-type="file" data-entity-uuid="ffc479bf-76e3-41bb-acb4-c133dfabedba" src="/sites/default/files/inline-images/Willy%20Chisindo_web.jpg" width="938" height="596" loading="lazy" /> <figcaption><em>Nurse Willy Chisindo said a January training on sexual and gender-based violence has created significant, ongoing improvements in treatment and support for survivors in Neno District. (Photo by Emily Antze / PIH Canada)</em></figcaption> </figure> <p><span><span><span><span><span>“In the past, we were seeing gender-based violence cases, but we were not very much confident in terms of how to manage them, how to examine them,” Chisindo said. “But now, the whole team of us who attended that training, we are very confident. When we have a client who has been sexually violated or sexually abused, we know what we should really focus on, we know how to provide psychological counselling, we know how to examine them [and] what to look for. Even if we go to court, we know what information the magistrate wants from us, and how to present it.”</span></span></span></span></span></p> <h2>Care and Support</h2> <p><span><span><span><span><span>Before the training, Chisindo had not been aware of Malawi’s statutory rape laws. He now realizes that many of the adolescent patients he has treated over the years have been victims of crime. Going forward, he said, he will be able to share this information with affected patients.</span></span></span></span></span></p> <p><span><span><span><span><span>He also said the new SGBV protocols have improved the quality of care for his patients, by giving him a checklist for patient exams and a clear list of services that should be offered, including testing for sexually transmitted infections, HIV post-exposure prophylaxis, pregnancy testing, and psychological counselling. A mechanism for priority referral of SGBV cases is now in place at Neno District Hospital, and staff are rolling it out in rural facilities, so a traumatized survivor is not left waiting while seeking care. </span></span></span></span></span></p> <p><span><span><span><span><span>The new process is helping to ensure that patients do not fall through the cracks, or miss access to essential services for physical and emotional healing.   </span></span></span></span></span></p> <p><span><span><span><span>Wagner said No Woman or Girl Left Behind is creating ongoing improvements. </span></span></span></span></p> <blockquote> <p><span><span><span><span>“The training is reinforced through close collaboration with partners in different sectors and through a program of ongoing clinical mentorship that provides health care workers with on-the-ground support to change how they approach and manage SGBV survivors who seek care at health facilities,” Wagner said. “Our hope is that by improving the quality of care that SGBV survivors receive from the health care system, more will seek care and ultimately get the treatment and support that they need.”</span></span></span></span></p> </blockquote> <h2>Collaboration with Courts</h2> <p><span><span><span><span><span>The January training also instilled a newfound sense of urgency among the participants, to collaborate and drive change relating to SGBV cases in Neno. Participants formed a district SGBV committee, and members now meet once a month to discuss specific SGBV cases and examine opportunities for inter-agency collaboration. They also have formed a WhatsApp group, to support each other and share suggestions as they encounter SGBV cases in their daily work.</span></span></span></span></span></p> <p><span><span><span><span>“It has been exciting and inspiring to see the collaboration that has grown out of this initiative,” Wagner said. “Through the WhatsApp group, SGBV cases are communicated to partners almost immediately—either from the police, health care workers, or social workers. For survivors who initially come to health facilities, this has enabled us to get the police and courts involved quickly in order to keep survivors safe and ensure that perpetrators are charged and brought to court.” </span></span></span></span></p> <p><span><span><span><span><em>This story originally was published by <a href="https://pihcanada.org/helping-health-care-workers-provide-care-and-support-to-survivors-of-sexual-and-gender-based-violence/">PIH Canada</a>. </em></span></span></span></span></p> </div> </div> </div> <div class="field-wrapper field field-node--field-programs field-name-field-programs field-type-entity-reference field-label-above"> <div class="field-label">Programs</div> <div class="field-items"> <div class="field-item"><a href="/programs/hiv-aids" hreflang="en">HIV/AIDS</a></div> <div class="field-item"><a href="/programs/womens-health" hreflang="en">Maternal Health</a></div> <div class="field-item"><a href="/programs/community-health-workers" hreflang="en">Community Health Workers</a></div> <div class="field-item"><a href="/programs/mental-health" hreflang="en">Mental Health</a></div> </div> </div> <div class="field-wrapper field field-node--field-taxonomy-tags field-name-field-taxonomy-tags field-type-entity-reference field-label-above"> <div class="field-label">Related Categories</div> <div class="field-items"> <div class="field-item"><a href="/advocacy" hreflang="en">Advocacy</a></div> <div class="field-item"><a href="/build-systems" hreflang="en">Build Systems</a></div> <div class="field-item"><a href="/tag/community-health-workers" hreflang="en">Community Health Workers</a></div> <div class="field-item"><a href="/education" hreflang="en">Education</a></div> <div class="field-item"><a href="/tag/human-rights-and-justice" hreflang="en">Human Rights and Justice</a></div> <div class="field-item"><a href="/malawi" hreflang="en">Malawi</a></div> <div class="field-item"><a href="/mental-health-psychosocial-support" hreflang="en">Mental Health &amp; Psychosocial Support</a></div> <div class="field-item"><a href="/training" hreflang="en">Training</a></div> <div class="field-item"><a href="/tag/womens-health" hreflang="en">Women&#039;s Health</a></div> </div> </div> Thu, 06 Aug 2020 14:01:43 +0000 mlawrence 7609 at https://www.pih.org Sierra Leone Ebola Lessons Shaping Massachusetts COVID-19 Response https://www.pih.org/article/sierra-leone-ebola-lessons-shaping-massachusetts-covid-19-response <span class="field-wrapper">Sierra Leone Ebola Lessons Shaping Massachusetts COVID-19 Response</span> <span class="field-wrapper"><span lang="" about="/user/366" typeof="schema:Person" property="schema:name" datatype="">mlawrence</span></span> <span class="field-wrapper">Tue, 07/07/2020 - 15:12</span> <div class="field-wrapper field field-node--field-large-intro-text field-name-field-large-intro-text field-type-text-long field-label-hidden"> <div class="field-items"> <div class="field-item"><p>"From Tonkolili to Tewksbury," as Dr. Joia Mukherjee said, community-based contact tracing has been a foundation of efforts against Ebola and COVID-19.</p> </div> </div> </div> <div class="field-wrapper field field-node--field-photo field-name-field-photo field-type-image field-label-hidden"> <div class="field-items"> <div class="field-item"> <picture> <source srcset="/sites/default/files/styles/article_xlarge/public/2020-07/SL_TonkTewks_Bailor_Gbessay_web.webp?itok=iRbQNr8f 1x" media="all and (min-width: 1200px)" type="image/webp"/> <source srcset="/sites/default/files/styles/article_large/public/2020-07/SL_TonkTewks_Bailor_Gbessay_web.webp?itok=KNIOfU4X 1x" media="all and (min-width: 900px) and (max-width: 1199px)" type="image/webp"/> <source srcset="/sites/default/files/styles/article_xmedium/public/2020-07/SL_TonkTewks_Bailor_Gbessay_web.webp?itok=zwmdDx_C 1x" media="all and (min-width: 640px) and (max-width: 899px)" type="image/webp"/> <source srcset="/sites/default/files/styles/article_medium/public/2020-07/SL_TonkTewks_Bailor_Gbessay_web.webp?itok=fvIkWfOX 1x" media="all and (min-width: 450px) and (max-width: 639px)" type="image/webp"/> <source srcset="/sites/default/files/styles/article_mobile/public/2020-07/SL_TonkTewks_Bailor_Gbessay_web.webp?itok=ZEKe6IOH 1x" type="image/webp"/> <source srcset="/sites/default/files/styles/article_xlarge/public/2020-07/SL_TonkTewks_Bailor_Gbessay_web.JPG?itok=iRbQNr8f 1x" media="all and (min-width: 1200px)" type="image/jpeg"/> <source srcset="/sites/default/files/styles/article_large/public/2020-07/SL_TonkTewks_Bailor_Gbessay_web.JPG?itok=KNIOfU4X 1x" media="all and (min-width: 900px) and (max-width: 1199px)" type="image/jpeg"/> <source srcset="/sites/default/files/styles/article_xmedium/public/2020-07/SL_TonkTewks_Bailor_Gbessay_web.JPG?itok=zwmdDx_C 1x" media="all and (min-width: 640px) and (max-width: 899px)" type="image/jpeg"/> <source srcset="/sites/default/files/styles/article_medium/public/2020-07/SL_TonkTewks_Bailor_Gbessay_web.JPG?itok=fvIkWfOX 1x" media="all and (min-width: 450px) and (max-width: 639px)" type="image/jpeg"/> <source srcset="/sites/default/files/styles/article_mobile/public/2020-07/SL_TonkTewks_Bailor_Gbessay_web.JPG?itok=ZEKe6IOH 1x" type="image/jpeg"/> <img src="/sites/default/files/styles/article_xlarge/public/2020-07/SL_TonkTewks_Bailor_Gbessay_web.JPG?itok=iRbQNr8f" alt="Dr. Bailor Barrie (left) and Gbessay Safa" typeof="foaf:Image" /> </picture> </div> </div> </div> <div class="field-wrapper field field-node--field-caption field-name-field-caption field-type-string-long field-label-hidden"> <div class="field-items"> <div class="field-item">Dr. Bailor Barrie (left), strategic advisor for PIH in Sierra Leone, and Gbessay Safa of Sierra Leone&#039;s Ministry of Health conduct a “training of the trainers”—preparing 42 countrywide health officials to train contact tracers—in Freetown, Sierra Leone, in late April. Contact tracing is a public health staple used effectively to fight Ebola in Sierra Leone, and now to combat COVID-19 in Massachusetts. </div> </div> </div> <div class="field-wrapper field field-node--field-photo-credit field-name-field-photo-credit field-type-string-long field-label-hidden"> <div class="field-items"> <div class="field-item">Jon Lascher / PIH</div> </div> </div> <div class="field-wrapper body field field-node--body field-name-body field-type-text-with-summary field-label-hidden"> <div class="field-items"> <div class="field-item"><p><span><span><span>While home to some of the best hospitals and medical schools in the U.S., Massachusetts was one of the hardest-hit U.S. states early in the COVID-19 pandemic. In looking to stop the virus’ spread, state leaders turned to world experts—and found significant help from <strong><a href="https://www.pih.org/country/sierra-leone">Sierra Leone</a></strong>.</span></span></span></p> <p><span><span><span>Seeing how the West African nation and its <strong><a href="https://www.pih.org/programs/ebola">Ebola</a></strong> response in 2014-16 are informing Massachusetts’ response to COVID-19 requires a step back, to early this spring. </span></span></span></p> <p><span><span><span>As Massachusetts became one of the first states hit by COVID-19, the rapid spread of the virus presented an enormous challenge for the state’s world-class Department of Public Health. Recognizing the gap in Massachusetts’ prevention strategy—with 20 percent of cases requiring hospitalization, but the other 80 percent spreading in communities—Gov. Charlie Baker announced that the state would join with Partners In Health, drawing on PIH’s decades of experience fighting Ebola and other outbreaks. To stop community-based transmission, the state and PIH established the <strong><a href="https://www.pih.org/ma-response">Massachusetts Community Tracing Collaborative</a></strong> (CTC)—the first large-scale coronavirus contact tracing program in the U.S.</span></span></span></p> <figure role="group" class="align-right"> <img alt="Gov. Charlie Baker and Dr. Joia Mukherjee at the State House" data-entity-type="file" data-entity-uuid="ff7e0555-e8b9-4b28-ab88-6736ea1ecff6" src="/sites/default/files/inline-images/USA_0420_MassCTC_JQualls_02_crop.JPG" width="450" height="522" loading="lazy" /> <figcaption>Dr. Joia Mukherjee, chief medical officer for PIH, speaks at the April 3 launch of the Massachusetts Community Tracing Collaborative, while Gov. Charlie Baker looks on, at the State House in Boston. (Joshua Qualls / Governor's Press Office)</figcaption> </figure> <p><span><span><span>Following an <strong><a href="https://www.pih.org/article/pih-partners-mass-governors-office-covid-19-response">April 3 launch</a></strong> at the State House, PIH would rapidly hire and train more than 1,500 people, to support the state and its 351 local health departments in a broad scaling-up of case investigation and contact tracing. New CTC staff members began calling everyone who had tested positive for the virus, gathering details about people with whom they had been in close contact, and then calling those contacts to ensure they knew about their exposure and could quarantine safely.</span></span></span></p> <p><span><span><span>The partnership between PIH, the Commonwealth, and local health departments introduced many Americans to contact tracing, a tried-and-true practice for public health practitioners. For PIH, contact tracing is foundational to placing equity at the center of an epidemic response, by ensuring that people who cannot quarantine safely get the material support to do so, and by directly engaging the community in response efforts.</span></span></span></p> <p><span><span><span>Lessons from Sierra Leone became vital as PIH, the state, and local health departments worked to scale and launch the Massachusetts collaborative. Sierra Leone’s use of compassionate, community-based contact tracing to halt history’s worst Ebola outbreak has provided inspiration for Massachusetts’ COVID-19 efforts—and, now, for efforts by a growing list of other U.S. states and jurisdictions. </span></span></span></p> <p><span><span><span>“We looked at our notes and were specifically referencing Sierra Leone,” said Dr. Joia Mukherjee, PIH’s chief medical officer and a leader of the organization’s U.S. COVID-19 response. “<span><span>Contact tracing is something that allowed Sierra Leone to do well in the fight against Ebola. We need to take those lessons about tracing every contact and to think of strategies that will allow the most vulnerable to survive, while also enacting other public health measures.”</span></span></span></span></span></p> <p><span><span><span>At the April announcement with Gov. Baker, Mukherjee talked about Tonkolili, a remote Sierra Leone district that was home to the country’s last person infected with Ebola. She recalled how teams checked every single person who entered the district.  </span></span></span></p> <p><span><span><span>“Everyone would get out of the car, be screened, temperature written down, cell phone numbers recorded. Every single contact was traced,” she said. “If they can do this in a place like Tonkolili, how can we say it is too late in the Commonwealth?</span></span></span></p> <blockquote> <p><span><span><span>“You cannot do control of infection without social support, solidarity, and protection for the vulnerable. Those public health principles we've all learned together in places like Sierra Leone should be at the forefront today,” Mukherjee continued. “That model going from, as we say, Tonkolili to Tewksbury [Massachusetts].”</span></span></span></p> </blockquote> <figure role="group"> <img alt="PIH staff visit the home of Ebola survivors in Sierra Leone, in 2014" data-entity-type="file" data-entity-uuid="e9a6a8d9-4cca-41da-9014-62cd13c8be73" src="/sites/default/files/inline-images/SierraLeone_1014_Survivors_rrollins_05_web.JPG" width="938" height="420" loading="lazy" /> <figcaption>PIH staff visit a home of Ebola survivors in Freetown, Sierra Leone, in 2014, as part of contact tracing efforts to provide social support and make sure the people are remaining safe and healthy. (Rebecca Rollins / PIH)</figcaption> </figure> <h2><span><span><span><strong>Contact Tracing During Ebola </strong></span></span></span></h2> <p><span><span><span>Contact tracing proved essential to ending the historic Ebola outbreak that killed thousands of people in West Africa from 2014 to 2016. </span></span></span></p> <p><span><span><span>“It was very helpful,” said Gbessay Safa, Sierra Leone’s national coordinator for contact tracing. “We were able to contact every person who’d come into contact with a probable or confirmed case [of Ebola], and follow up with them for 21 days. That prevented the spread of the disease in many ways, and prevented new hot spots.”</span></span></span></p> <p><span><span><span>The country’s Ebola contact tracing program relied on a force of 2,250 community contact tracers, working alongside community health workers. Their joint efforts aimed to not only identify cases and notify contacts of their exposure, but also ensure people’s ability to safely, comfortably quarantine—a tricky endeavor throughout Sierra Leone, where a majority of families living on the margins can’t afford to lose a day, let alone two weeks, of work outside the home.</span></span></span></p> <p><span><span><span> “In Kono and Port Loko, PIH used community health workers to go to homes to actually see and understand the real needs of families,” said Dr. Bailor Barrie, who helped design Sierra Leone’s national contact tracing program and is currently a strategic advisor for PIH-Sierra Leone. </span></span></span></p> <p><span><span><span>Meals were a top priority among quarantining households; PIH partnered with other organizations focused on hunger prevention to advocate for families’ needs.</span></span></span></p> <p><span><span><span>“In Kono, we had a family whose breadwinner got Ebola and was taken to a treatment center,” Barrie recalled. “It was painful for them; his wife and four kids had no other means. But our community health worker flagged that, and we helped a partner organization distribute their food support accordingly.</span></span></span></p> <blockquote> <p><span><span><span>“We know—the evidence proves it—that when you connect social support and contact tracing, it works very well,” he said. “That is the humane way to treat people.”</span></span></span></p> </blockquote> <h2><span><span><span><strong>On to Massachusetts</strong></span></span></span></h2> <p><span><span><span>Protection for the vulnerable is a cornerstone of the Massachusetts Community Tracing Collaborative.</span></span></span></p> <p><span><span><span>CTC contact tracers not only inform people of their exposure to COVID-19, but also advise them on how to safely isolate, seek care, and obtain social services. Care resource coordinators then connect vulnerable patients and their families with local organizations that assist with needs like food, shelter, and mental health care.</span></span></span></p> <p><span><span><span><img alt="Care resource coordinators connect patients to social services " data-entity-type="file" data-entity-uuid="5704bf77-48a9-4bda-8244-a3f6bdb99692" src="/sites/default/files/inline-images/pih%20ctc%20call%202_1.jpg" class="align-left" width="280" height="400" loading="lazy" />“A lot of inequalities in social services are becoming glaringly obvious through this work,” said <strong><a href="https://www.pih.org/article/qa-michelle-baum-care-resource-coordinator-pih-massachusetts">Michelle Baum, a care resource coordinator</a></strong>. “People who are quarantining themselves might need food urgently, for example, or diapers or baby formula. Or rent money if they’re not able to work, or cleaning supplies if they’re sharing a space with someone who’s confirmed to have COVID-19. </span></span></span></p> <p><span><span><span>“They call the CTC saying, ‘We’re going to leave the house’ because of these needs. And then contact tracers are able to say: ‘Hold on, a care resource coordinator is going to call you.’”</span></span></span></p> <p><span><span><span>By the end of June in Massachusetts, contact tracers were reporting a median of two contacts per case (excluding people with zero contacts)—a low rate that speaks to the effectiveness of social distancing and pandemic response efforts led by the state’s Department of Public Health and local health departments. Relaxing such measures will inevitably increase transmission, especially among the majority of cases that are minor or asymptomatic and are “<span>silently and unknowingly spreading the disease,” in Mukherjee’s words. </span></span></span></span></p> <blockquote> <p><span><span><span><span>“We want to shine a light on that,” Mukherjee said. “A light with love and compassion, that can reach out to people and humanely let them know that they are at risk and help them to isolate themselves.”</span></span></span></span></p> </blockquote> <h2><span><span><span><strong>Back to Sierra Leone</strong></span></span></span></h2> <p><span><span><span>As a trusted government partner in Sierra Leone, PIH immediately began helping coordinate the country’s national response to COVID-19, which has now spread to all of the country’s 16 districts, including Kono, where PIH has worked for years to strengthen the overall health system.</span></span></span></p> <p><span><span><span>Contact tracing has been a primary focus of the response, with Sierra Leone President Julius Maada Bio asking PIH to apply lessons from Massachusetts to Sierra Leone.</span></span></span></p> <p><span><span><span>In so doing, Sierra Leoneans are using lessons from their own country and history.</span></span></span></p> <p><span><span><span>Barrie coordinated with Safa and other government partners on a national contact tracing plan for COVID-19. Subsequently, PIH trained 1,540 contact tracers across Sierra Leone’s population of 7 million—a similar set up to the 1,900 contact tracers who cared for Massachusetts’ same-sized population at the height of cases in the state. </span></span></span></p> <p><span><span><span>Currently, 110 contact tracers are assigned to each district in Sierra Leone, and PIH is providing specialized accompaniment to all 16 of those district efforts.</span></span></span></p> <figure role="group"> <img alt="Kono District, Sierra Leone" data-entity-type="file" data-entity-uuid="13c7c959-4fbd-4f76-8062-08fc12e263dd" src="/sites/default/files/inline-images/SL_TonkTewks_KonoScenic_web.JPG" width="938" height="625" loading="lazy" /> <figcaption>PIH has helped train more than 1,500 contact tracers in Sierra Leone, to support COVID-19 patients and response efforts across the country, including in Kono District, shown here. (Courtesy of PIH Sierra Leone)</figcaption> </figure> <p><span><span><span>“What <span>PIH will be able to do is coordinate surveillance in the country, because surveillance is very important in terms of disease outbreaks,” Barrie said. “If we strengthen the surveillance system, we’ll be able to get ahead of the curve.”</span></span></span></span></p> <p><span><span><span><span>The government has also been providing food to all quarantining households. In Kono District in particular, social support is a robust part of stopping COVID-19.</span></span></span></span></p> <p><span><span><span><span>When the country’s borders closed at the end of March, Kono was hosting an influx of Sierra Leonean families needing to immediately quarantine after returning from Guinea. PIH provided food and housing to allow them to do so.</span></span></span></span></p> <p><span><span><span><span>Subsequently, the organization hired additional community health staff charged with educating households about the virus and linking patients and families with the resources they need to effectively quarantine. And when the district confirmed its first cases of COVID-19 on May 21, PIH began putting together social support referral plans and packages, which include soap and laundry detergent, food, and money for cellphone cards.</span></span></span></span></p> <h2><span><span><span><span>New Challenges for COVID-19</span></span></span></span></h2> <p><span><span><span><span>Yet as the pandemic begins to take hold in Sierra Leone and cases rise in Kono, limited funding threatens to stifle relief. There are now more than 50 cases in Kono, and more than 1,400 nationally—numbers that pale in comparison to Massachusetts’ more than 108,000 cases, but that likely reflect the challenges of widespread testing and, relatedly, of widespread social support.</span></span></span></span></p> <p><span><span><span><span>“The key difference between the Ebola outbreak and the COVID outbreak is resources,” Barrie said. “Now we have the structures functionally in place, but resources to support them are lacking. This means that countries like Sierra Leone, all across Africa, are often unable to implement social support fully alongside contact tracing.” </span></span></span></span></p> <figure role="group"> <img alt="Bailor Barrie, strategic advisor for PIH in Sierra Leone" data-entity-type="file" data-entity-uuid="40214757-91bb-4e43-939d-1edeee1cd50d" src="/sites/default/files/inline-images/SL_BailorBarrie_web.JPG" width="938" height="625" loading="lazy" /> <figcaption>Dr. Bailor Barrie, strategic advisor for PIH in Sierra Leone, says that while resources are lacking in the country's fight against COVID-19, he is confident that Sierra Leone will overcome the pandemic, as it did Ebola in 2016. (Courtesy of PIH-Sierra Leone)</figcaption> </figure> <p><span><span><span><span>Nonetheless, he added, “we’re doing a good job in Kono linking the two. We have budgeted to give around 500 households support; I’m cautiously optimistic we won’t get to that number.”</span></span></span></span></p> <p><span><span><span><span>And while there’s a long road ahead, Barrie indicated he expects Sierra Leone eventually to see a similar sight to Tonkolili, where the last Ebola patient was identified four years ago—the country’s last COVID-19 patient, safely tested and quarantined.  </span></span></span></span></p> <blockquote> <p><span><span><span><span>“These are difficult times,” Barrie said. “But I’m sure we’ll all fight it together and overcome it.”</span></span></span></span></p> </blockquote> </div> </div> </div> <div class="field-wrapper field field-node--field-programs field-name-field-programs field-type-entity-reference field-label-above"> <div class="field-label">Programs</div> <div class="field-items"> <div class="field-item"><a href="/programs/community-health-workers" hreflang="en">Community Health Workers</a></div> <div class="field-item"><a href="/programs/ebola" hreflang="en">Ebola</a></div> </div> </div> <div class="field-wrapper field field-node--field-taxonomy-tags field-name-field-taxonomy-tags field-type-entity-reference field-label-above"> <div class="field-label">Related Categories</div> <div class="field-items"> <div class="field-item"><a href="/advocacy" hreflang="en">Advocacy</a></div> <div class="field-item"><a href="/build-systems" hreflang="en">Build Systems</a></div> <div class="field-item"><a href="/tag/community-health-workers" hreflang="en">Community Health Workers</a></div> <div class="field-item"><a href="/tag/covid" hreflang="en">Covid-19</a></div> <div class="field-item"><a href="/tag/human-rights-and-justice" hreflang="en">Human Rights and Justice</a></div> <div class="field-item"><a href="/mental-health-psychosocial-support" hreflang="en">Mental Health &amp; Psychosocial Support</a></div> <div class="field-item"><a href="/tag/add-term-0" hreflang="en">United States</a></div> </div> </div> Tue, 07 Jul 2020 19:12:41 +0000 mlawrence 7578 at https://www.pih.org PIH Liberia, Government Partners Establish New COVID-19 Center https://www.pih.org/article/pih-liberia-government-partners-establish-new-covid-19-center <span class="field-wrapper">PIH Liberia, Government Partners Establish New COVID-19 Center </span> <span class="field-wrapper"><span lang="" about="/user/366" typeof="schema:Person" property="schema:name" datatype="">mlawrence</span></span> <span class="field-wrapper">Fri, 06/05/2020 - 14:43</span> <div class="field-wrapper field field-node--field-photo field-name-field-photo field-type-image field-label-hidden"> <div class="field-items"> <div class="field-item"> <picture> <source srcset="/sites/default/files/styles/article_xlarge/public/2020-06/Liberia_0520_CovidCenter_Setup_McLaughlin_web.webp?itok=WT2-EbCA 1x" media="all and (min-width: 1200px)" type="image/webp"/> <source srcset="/sites/default/files/styles/article_large/public/2020-06/Liberia_0520_CovidCenter_Setup_McLaughlin_web.webp?itok=LvoawNF- 1x" media="all and (min-width: 900px) and (max-width: 1199px)" type="image/webp"/> <source srcset="/sites/default/files/styles/article_xmedium/public/2020-06/Liberia_0520_CovidCenter_Setup_McLaughlin_web.webp?itok=2rBkaEto 1x" media="all and (min-width: 640px) and (max-width: 899px)" type="image/webp"/> <source srcset="/sites/default/files/styles/article_medium/public/2020-06/Liberia_0520_CovidCenter_Setup_McLaughlin_web.webp?itok=n1Z5ikVT 1x" media="all and (min-width: 450px) and (max-width: 639px)" type="image/webp"/> <source srcset="/sites/default/files/styles/article_mobile/public/2020-06/Liberia_0520_CovidCenter_Setup_McLaughlin_web.webp?itok=Rgmk30zQ 1x" type="image/webp"/> <source srcset="/sites/default/files/styles/article_xlarge/public/2020-06/Liberia_0520_CovidCenter_Setup_McLaughlin_web.jpg?itok=WT2-EbCA 1x" media="all and (min-width: 1200px)" type="image/jpeg"/> <source srcset="/sites/default/files/styles/article_large/public/2020-06/Liberia_0520_CovidCenter_Setup_McLaughlin_web.jpg?itok=LvoawNF- 1x" media="all and (min-width: 900px) and (max-width: 1199px)" type="image/jpeg"/> <source srcset="/sites/default/files/styles/article_xmedium/public/2020-06/Liberia_0520_CovidCenter_Setup_McLaughlin_web.jpg?itok=2rBkaEto 1x" media="all and (min-width: 640px) and (max-width: 899px)" type="image/jpeg"/> <source srcset="/sites/default/files/styles/article_medium/public/2020-06/Liberia_0520_CovidCenter_Setup_McLaughlin_web.jpg?itok=n1Z5ikVT 1x" media="all and (min-width: 450px) and (max-width: 639px)" type="image/jpeg"/> <source srcset="/sites/default/files/styles/article_mobile/public/2020-06/Liberia_0520_CovidCenter_Setup_McLaughlin_web.jpg?itok=Rgmk30zQ 1x" type="image/jpeg"/> <img src="/sites/default/files/styles/article_xlarge/public/2020-06/Liberia_0520_CovidCenter_Setup_McLaughlin_web.jpg?itok=WT2-EbCA" alt="PIH Liberia and government partners set up a COVID-19 quarantine center in Harper" typeof="foaf:Image" /> </picture> </div> </div> </div> <div class="field-wrapper field field-node--field-caption field-name-field-caption field-type-string-long field-label-hidden"> <div class="field-items"> <div class="field-item">PIH Liberia staff set up beds and isolation areas for the new quarantine center at Cape Palmas High School in the city of Harper, in Liberia&#039;s Maryland County. Set up and operation of the center is a collaboration between PIH and Liberia’s Ministry of Health, National Public Health Institute, and Maryland County Health Team.</div> </div> </div> <div class="field-wrapper field field-node--field-photo-credit field-name-field-photo-credit field-type-string-long field-label-hidden"> <div class="field-items"> <div class="field-item">Photo by Amy McLaughlin/PIH</div> </div> </div> <div class="field-wrapper body field field-node--body field-name-body field-type-text-with-summary field-label-hidden"> <div class="field-items"> <div class="field-item"><p><span><span><span><span><span><span><span>In collaboration with Liberia’s Ministry of Health, National Public Health Institute, and Maryland County Health Team,</span></span></span></span><span><span><span> Partners In Health Liberia is operating a 26-bed quarantine center in the coastal city of Harper, supporting the government’s COVID-19 response across Maryland County in Liberia’s <span>southeast.</span> </span></span></span></span></span></span></p> <p><span><span><span><span><span><span>The center will accommodate people who have traveled from high-risk areas, along with those who have potentially contacted someone positive for COVID-19, or exhibit symptoms including a cough, fever, sore throat, or difficulty breathing. </span></span></span></span></span></span></p> <p><span><span><span><span><span><span>In addition to the 26 isolated beds, the center is equipped with hand-washing stations, water tanks, gender-friendly washrooms, blood pressure equipment, oxygen saturation machines, medical thermometers, and more. PIH is operating the center <span>alongside national and county partners,</span> supporting their efforts to identify COVID-19 cases and minimize spread of the viral disease. </span></span></span></span></span></span></p> <p><span><span><span><span><span><span><span><span>“A well-equipped and dignified Precautionary Observation Center is an essential part of community-based infectious disease management and prevention,” said Dr. Maxo Luma, executive director of PIH Liberia. “Using this space, we are able to quarantine COVID-19 contacts to keep our communities safe, while ensuring those exposed to COVID-19 receive the medical attention and psychosocial support they need.”</span></span></span></span></span></span></span></span></p> <figure role="group"> <img alt="Melvin Tamba of PIH Liberia sorts supplies for the quarantine center" data-entity-type="file" data-entity-uuid="742639db-e548-4b1f-828e-de3b24e7ddcb" src="/sites/default/files/inline-images/Liberia_0520_CovidCenter_MelvinSupplies_PIH_web.jpeg" width="938" height="469" loading="lazy" /> <figcaption>Melvin Tamba, clinical mentor coordinator for PIH Liberia, sorts supplies for the new quarantine center in Harper. (Photo courtesy of PIH Liberia)</figcaption> </figure> <p><span><span><span><span><span><span><span>Clinicians at PIH-supported Pleebo Health Center, north of Harper, reported their first confirmed case of COVID-19 in April. </span></span></span></span><span><span><span>Shortly after, PIH and the c<span>ounty health team</span> set up the quarantine center at Harper’s Cape Palmas High School, which the national government had designated for use in the country’s COVID-19 response.  </span></span></span></span></span></span></p> <p><span><span><span><span><span><span><span>Managing cases at the center is a joint effort between PIH Liberia and the county health team, with PIH clinicians and mental health staff providing care and social support alongside technical support from the county team. </span></span></span></span></span></span></span></p> <p><span><span><span><span><span><span>Clinicians at the center had monitored <span>21 </span>patients <span>total </span>as of June 1 for COVID-19 symptoms, regularly checking their temperature, blood pressure and oxygen levels, while sending samples for testing in Monrovia, Liberia’s capital. <span>By the end of May, Clinicians had designated a group of 17 patients as stable and ready to be discharged</span>, enabling them to safely return to their families and communities. </span></span></span></span></span></span></p> <p><span><span><span><span><span><span><span>As of June 1,</span></span></span></span><span><span><span> the confirmed case from April remained Pleebo’s only positive case. Four people who had traveled into Liberia were under observation at Pleebo Health Center as of that date. </span></span></span></span></span></span></p> <figure role="group" class="align-left"> <img alt="Melvin Tamba prepares mosquito nets for the center" data-entity-type="file" data-entity-uuid="68f2887b-4647-468b-9d1d-042e1ff9c458" src="/sites/default/files/inline-images/Liberia_0520_CovidCenter_MelvinNets_PIH_crop.jpeg" width="450" height="596" loading="lazy" /> <figcaption>Melvin Tamba of PIH Liberia sorts mosquito nets for the COVID-19 quarantine center in Harper. (Courtesy of PIH Liberia)</figcaption> </figure> <p><span><span><span><span><span><span>Melvin Tamba, clinical mentor coordinator for PIH Liberia, said it took the team a week to set up the quarantine center in Harper, with help from volunteers. But the group also faced initial public sentiment against using the school for COVID-19 care, because of concerns about infection risks.  </span></span></span></span></span></span></p> <p><span><span><span><span><span><span>The county health team and local authorities addressed those concerns with a public awareness campaign about the health protocols implemented to prevent spread of the virus among the public.</span></span></span></span></span></span></p> <p><span><span><span><span><span><span>“In order to prepare the quarantine center within a week, PIH, the county health team and volunteers from the Red Cross and Integrated Development Youth cleaned and disinfected the center before setting up,” Tamba said. </span></span></span></span></span></span></p> <p><span><span><span><span><span><span>The group partitioned a block of six classrooms into safe, isolated spaces of about six beds per room, to limit exposure and safely provide hygiene and infection control supplies for each patient.</span></span></span></span></span></span></p> <p><span><span><span><span><span><span>The group also set up hand-washing stations with clean water and soap at every entrance and exit, to limit the spread of the virus and help patients safely meet health protocols and social distancing measures. </span></span></span></span></span></span></p> <p><span><span><span><span><span><span>The center is staffed 24 hours a day by medical clinicians, psychosocial clinicians, and security personnel, who work in shifts to check vital signs, monitor new patients and give care when necessary. Two custodial workers also are on duty, cleaning all surfaces and washrooms to ensure patients’ safety. </span></span></span></span></span></span></p> <figure role="group" class="align-right"> <img alt="Dr. Francis Ketah, Liberia chief medical officer, opens the center in Harper" data-entity-type="file" data-entity-uuid="31ead5c7-7b3b-405f-bcfc-61d2a8f08670" src="/sites/default/files/inline-images/Liberia_0520_CovidCenter_CMO_McLaughlin_crop.jpg" width="450" height="630" loading="lazy" /> <figcaption>Dr. Francis Ketah, Liberia's chief medical officer, formally opens the quarantine center in Harper. (Photo by Amy McLaughlin / PIH) </figcaption> </figure> <p><span><span><span><span><span><span>Dr. Francis Ketah, Liberia’s national chief medical officer, received keys to the quarantine center on behalf of the county health team, at a ceremony marking its opening. Ketah expressed his appreciation for PIH’s continuous work to strengthen the country’s health system, and for its leadership role in fighting COVID-19 in Maryland County. Also at the opening ceremony were PIH Liberia staff, leadership of PIH-supported J.J. Dossen Hospital and of Tubman University, local authorities, and community leaders. </span></span></span></span></span></span></p> <p><span><span><span><span><span><span>Isaac Dolo, senior clinical mentor for PIH-Liberia, emphasized that the quarantine center will offer psychosocial support to patients, as well as medical care. </span></span></span></span></span></span></p> <p><span><span><span><span><span><span>“We seek to give the utmost care, including psychological counseling, and the unit will keep people from high-risk zones and situations under close observation, until they clearly manifest symptoms or are safely discharged, in order to ensure public safety,” Dolo said.</span></span></span></span></span></span></p> </div> </div> </div> <div class="field-wrapper field field-node--field-programs field-name-field-programs field-type-entity-reference field-label-above"> <div class="field-label">Programs</div> <div class="field-items"> <div class="field-item"><a href="/programs/mental-health" hreflang="en">Mental Health</a></div> </div> </div> <div class="field-wrapper field field-node--field-taxonomy-tags field-name-field-taxonomy-tags field-type-entity-reference field-label-above"> <div class="field-label">Related Categories</div> <div class="field-items"> <div class="field-item"><a href="/tag/covid" hreflang="en">Covid-19</a></div> <div class="field-item"><a href="/food-water-housing" hreflang="en">Food, Water, Housing</a></div> <div class="field-item"><a href="/tag/human-rights-and-justice" hreflang="en">Human Rights and Justice</a></div> <div class="field-item"><a href="/infrastructure-improvements" hreflang="en">Infrastructure Improvements</a></div> <div class="field-item"><a href="/mental-health-psychosocial-support" hreflang="en">Mental Health &amp; Psychosocial Support</a></div> </div> </div> Fri, 05 Jun 2020 18:43:28 +0000 mlawrence 7361 at https://www.pih.org