26 Jan 2025 Estefanía Ibáñez, volunteer psychiatrist: “Liberian culture has great values that we in the West have lost”.

Estefanía Ibáñez Martínez is a Spanish psychiatrist who spent the last quarter of 2024 working as a volunteer in the Mental Health Unit of the Saint Benedict Menni Centre in Monrovia. She studied medicine at the University of Alcalá de Henares (Madrid), and subsequently trained in the specialty of psychiatry. Since she finished university in 2019, she is working as an adult psychiatrist at the mental health center of Arganda del Rey (Madrid). She also does psychiatry shifts at the Southeast Hospital. As we did previously with other volunteers such as Cristina Bressel and Enrique González, we chatted with her about her time at our center and her experience in Liberia.

Why did you want to volunteer and what made you want to go to Liberia and to our center?

Ever since I was a child, I have had a sensitivity to those who suffer. That’s why I started studying medicine and then psychiatry. My father, a nurse in an acute psychiatric ward, often said to me “They are the last ones of the last ones” and somehow this awakened in me the impulse to go and help them.

In this context of “the last ones of the last ones” I have always had a sensitivity towards Africa, but I did not have the opportunity to come until two years ago, when thanks to a meeting with a family from Madrid who have a house in Liberia, I had my first experience in the country. While I was in Liberia on one of my previous trips to the country, we came to visit the center of the Sisters Hospitallers: that is how I got to know the center.

This experience strongly awakened in me the desire to return the following year and I finally decided that I wanted to go deeper for a longer period, so I applied for an international cooperation permit in my job and I was able to come for three months.

Have you ever been to an African country before?

No. Liberia is the first African country I have visited.

What were your feelings when you first arrived in Monrovia and downtown?

The first time I was in Monrovia I remember feeling a bit overwhelmed by the chaos of driving around the city. However, I recognize that after three trips to the country, it no longer generates the same impact on me as it did at the beginning.

In this city I love the spaces of nature, the small rural communities, the life that develops in the street, the markets etc… I recognize that this generates an attraction for me compared to the life so often locked up in the houses that is lived in the West. And of course, the affection of the people, even if they do not know you.

The center awakens amazement upon entering, for the beauty of its gardens, the truth is that it is like a haven of peace in the midst of the chaos of traffic and the streets of Monrovia.

What have been your tasks at the center?

My tasks at the center have been the psychiatric follow-up of the patients admitted to the unit, with whom I have been able not only to have consultations but also to live in the environment of the center, which favors a more comprehensive knowledge of how they are. We have had individual consultations with the patients, sometimes in the presence of Dr. Harris (the center’s referral psychiatrist) and other times in the company of the nursing and/or social work staff (who helped me to understand the local dialect). I have supported in the choice of the different psychopharmacological and diagnostic treatments and I have done some small training sessions with the nursing staff.

I have also participated in group activities with nursing and social work. I have really enjoyed the therapeutic walks every Wednesday with the patients. We have done weekly consultations and home visits. I have done individual outpatient follow-up with patients. I have also helped in the design of the individual treatment plan for each patient and in the restructuring of some of the activities of the unit, looking for a better clinical intervention.

In addition, I have participated in all the team meetings and have been integrated from the beginning as part of the team, collaborating also in some meetings with other mental health centers and participating in various days such as the International Mental Health Day that was celebrated unifying all the professionals involved in this field in Monrovia.

What similarities and differences would you establish between the approach to mental health in our center and in the places where you have worked?

The treatment approach is similar to the one we have in Spain, following a comprehensive model that takes into account the biological and psychosocial part of the patients. In this sense it is similar, with psychiatric consultations and group activities, inviting families to participate in the recovery process. There is no psychologist available, which makes that aspect a bit more complex to address.

Thanks to the support of the Sisters Hospitallers center in Mondragon, we have a significant part of the psychopharmaceuticals that we have in the West and that in many cases are not available in other medical centers in Liberia. This allows us to treat patients with drugs with a better profile and better tolerance.

The biggest difference is the limited access to medical tests and treatments, which sometimes influences the better use of treatments (for example, in bipolar disorder, which requires tests that we cannot do there) and to better diagnose the medical comorbidities of patients (for example, it is very expensive to do a thyroid profile).

On the other hand, I really liked the usefulness of music in therapy and I think it is something that helps a lot and that in Spain we do not take advantage of. I also find it very interesting that all the patients who have been admitted, upon discharge, enter the outpatient follow-up program, but also periodic home visits.

What do you think of the center, its professionals and activities?

The center is located in an emblematic space, with a huge garden, surrounded by nature, which I think is a privileged place for the patients’ recovery. It is a safe environment, and also there are only female patients, which favors greater security among them.

The facilities are very adequate compared to other health centers in Liberia.

The team of professionals is charming and treats the patients with appreciation and affection. There is a family atmosphere and I felt very welcome. It is true that it is necessary to continue to provide them with training in mental health since most of the nurses and assistants have not had the opportunity to deepen their knowledge of the psychiatric approach to the patient before their arrival at the center.

The group activities are interesting: baking, sewing, music, health education, psychoeducation, walking, etc., although I see that the patients need to be motivated more to achieve greater involvement and participation, especially of the most deteriorated patients.

I also see that it is necessary to promote individualized follow-up of each patient, with individual consultations.

There is a very interesting program to help start a small business after discharge, with supervision, but it was just starting to be implemented when I finished my stay.

What skills, knowledge or experiences have you been able to add to your personal or professional background during your stay?

It has been very enriching, without a doubt. Liberian culture has great values that we in the West have lost, such as the capacity for acceptance, knowing how to live the events of life with simplicity, respecting the rhythms of life, living in the present, not controlling, living in relationship with God, etc. I see how Liberian people live with a serenity and confidence in the day to day that allows them to live with less anxiety than Europe.

On a professional level, it has certainly helped me to see the influence of our European culture in the complication and development of certain psychiatric disorders (anxious-depressive syndromes, personality disorders, etc.) that in Africa practically do not exist or are handled in a simpler way. On the other hand, I have been able to confirm how other serious mental disorders such as schizophrenia remain constant in both cultures, with certain nuances.

I have learned to manage these pathologies with fewer medical resources, less variety of medication or older drugs that I was not used to using. Also to treat pathologies such as epilepsy, which I do not usually treat directly in Spain and here are treated by the psychiatrist, so I have also learned in this aspect.

What difficulties have you encountered in your work?

The main difficulties have been that, on the one hand, I had never worked with the economic factor in mind, and in Liberia health care is not free, which has limited my medical intervention. On the other hand, another difficulty has been that sometimes we have had different treatment criteria because in Liberia they tend to put the treatments much slower than what we do here. The fact that there are few specialized mental health personnel has also limited some of the interventions that we have wanted to implement. Finally, language, of course, is a major limitation, but thanks to the nurses who have translated from colloquial English to British English I have been able to communicate acceptably with the patients.

Was there anything that caught your attention during your stay?

First of all, I have been impressed by the fact that the Liberian patients we have had admitted, despite having similar symptoms to those suffered by patients admitted to Spanish units, in general have a much more cooperative attitude, greatly facilitating compliance with the rules of the unit. The patients are much more accepting of admission and have an affable attitude towards the staff. I think this has to do with the culture and living conditions of the patients, which are usually much worse at home than during admission, where they have the possibility of daily showers, sleeping in a bed, eating three times a day, etc.

I was also impressed by the strong belief of the population in the influence of spirits in the appearance of physical and mental illnesses, often resorting to what they call “country medicin”, which are the healers and shamans, delaying, sometimes for years, the arrival at medical centers.

On the other hand, I have been very touched by the working conditions in Liberia, where salaries are so low that, even working full time, many workers cannot afford basic expenses such as paying school fees for their children. This has caused me concern about the possibility of the country gradually emerging from the level of poverty in which it is immersed, since the first step for that is education and health care, which in Liberia are restricted only to the population that can afford it.

Would you recommend other professionals to volunteer at our center?

Of course I would recommend it. I think it is a safe and adapted way to start volunteering in an African country.

Would you like to do it again?

I would love to do it again. The three months have flown by for me. I hope to be able to continue collaborating in the development of this Unit.

Beyond the work part, I am very grateful to all the staff who are part of the center who have treated me with great esteem and service, from security workers, admission, hospital sisters, the driver, etc.. They have provided me with everything I have needed during this time (home, food, transportation, access to the sacraments and prayer spaces, etc.), and it has undoubtedly been a very special few months in my life.