The project

Stages

1. Reopening of the San Benito Menni Health Center

Closed in July 2014 due to the outbreak of Ebola, its reopening requires the construction of 3 new facilities:

• a triage station, which will determine whether or not patients show symptoms of Ebola and are classified.
• an isolation area for patients showing symptoms of Ebola.
• an incineration facility for waste materials from the isolation zone.

2. Implementation of psychosocial support programs for health personnel affected by Ebola and their family

From the experience gained in the Aita Menni Hospital regarding psychological support for victims of disasters or violence, a program of Liberian psychosocial community intervention will be held, aimed at both Ebola survivors and family members of those killed by the virus, as well as health professionals. The project will always be aimed at groups that can be classified as follows:

• Primary victims (those infected that have survived the disease) that face the potentially traumatic process of having had a near death experience and being feared by others (stigmatization and rejection).
• Secondary victims (relatives and partners of the deceased) face the need to mourn the loss, rejection by society (despite the assumed unfavorable prognosis for survival) and by their immediate family surroundings. All of this being due to the cultural impact of primitive beliefs about the disease (possession, spells, divine curses, evil spirits, etc.).

Context

The country has experienced two successive civil wars between 1989 and 1996 and between 1999 and 2003, with more than 200,000 dead and a reconciliation process that has not yet been completed. This has left a society traumatized by the violence suffered or inflicted and with a great need for psychological support.

Community Psychosocial Intervention Program

1. Community rooting
2. Evaluation of psychosocial needs
3. Training of Community Agents
4. Training programs for prevention (health and psycho-educational programs)
5. Support for the local network of psychiatric and psychological treatment

3. Implementation of an Assistance Unit

The Step Down Unit -the name given to the unit- will be a convalescence unit coordinated with the Grant Mental Health Hospital, the only mental hospital with 80 beds at its disposal, run by the Ministry of Health and funded and organized by the JFK Hospital.

The most common pathologies treated at the Grant Mental Health Hospital are:

1. Psychosis (47%, mainly schizophrenia, malaria-related organic psychosis, postpartum and drug abuse).
2. Epilepsy (23%).
3. Anxiety (18%).
4. Dementia (6%).
5. Post traumatic stress and depression (6%).

The average stay is no greater than 21 days.

The convalescence based “Step Down Unit” offers the following services:

• Effective residential mental health services for short stays in order to prevent relapse and assist drug users in their recovery from acute episodes of mental illness.
• To provide medication and medication management.
• To provide social work case management services for the assessment and organization of social issues that have an impact on the mental state of the person and their welfare.
• To offer rehabilitation services, including: skills training, self care and psycho-educational empowerment within the family.
• To provide links and references to Grant Mental Health Hospital and other hospitals and mental health centers.
• To provide extension services to get people back into the community.

Since the commissioning of this unit, and drawing on the experience brought by Aita Menni Hospital over its 115 year history in the management of patients with mental illness, we can say that the grouping of patients by pathology will lead to two sub-units/care units: the Mid-Term Stay Unit and the Intellectual Disability Unit.

Details of each sub-unit are given below:

1. Mid-Term Stay Unit, partnered with a Psychosocial Rehabilitation Service, structured in workshops (gardening, agriculture, sewing, hairdressing, craftsmanship, etc.) for patients with mental illness due to substance abuse. The Unit will have 10 beds, a day service center and workshops for occupational therapy that will provide resources for patients’ daily needs and for their interaction with their surroundings. This Unit would be associated with:

• Hospitals for patient referral.
• Mental Health Centers.
• The Red Cross.

Currently the predominant profile is that of a male, 30 to 35 years old and a drug user.

In addition, community psychosocial support will be provided to prevent social exclusion and promote the patient’s return to their surroundings.

2. Intellectual Disability Sub-Unit (mild to moderate mental handicap), with a 10 bed capacity, partnered with a structured Psychosocial Rehabilitation Service, made up of workshops, with the aim of acquiring skills in order for patients to be able to return to their surroundings

To attract patients, referrals from other health centers through pre-existing channels shall be made use of.

Procedures for collecting and filing patient data shall be used in accordance with Liberian Law and with the Aita Menni Hospital’s levels of quality.

Types of mental handicap:

• Mild mental disability (7% of the total population).
• Moderate mental disability (41% of the population).
• Severe mental disability (25% of the population)
• Heavy mental disability (5% of the population).
• Mental disability to an unspecified degree (22% of the population).

With a population of around 4 million inhabitants, an estimated 10,000 people may suffer from severe mental disability and 2,000 of them from heavy mental disability.

In addition, psychosocial community support will be provided to prevent social exclusion and promote the patient’s return to their surroundings.

4. Outpatient care for patients with mental and behavioral disorders

The Ministry of Health and Social Affairs runs a program called “Wellness Centers”, which was expected to create a network of mental health centers, one for each of the 15 state counties, with the ability to serve the mentally ill and the possibility of having 4 beds for the hospitalization of acute cases. Of these 15 centers, only one remains in operation, the Phebe Hospital. The Grand Gedeh and Sinoe centers, which should be up and running from 2012, are still not operational.

The San Benito Menni Health Center will join the “Wellness Centers” network, and will be able to handle between 1,000 and 3,000 specific mental health patients a year, referred from other health centers in the Montserrado County.

5. Training programs

This is a key element for progress, development, the mutual transfer of knowledge and the future sustainability of the project. We can distinguish three levels:

• Specific personnel training for the units that are to be created. The collaborative project involves the training of doctors (psychiatrists), psychologists, nurses, physiotherapists and nursing assistants in the management of these patients.

• Collaboration agreements with universities and training centers and training for students of medicine, psychology and nursing: M. Dogliotti Medical College (University of Liberia – Faculty of Medicine), Mother Patern School of Health Sciences (Stella Maris Polytechnic – University School of Nursing and Physiotherapy) and Cuttinton University (nursing assistants and occupational therapists).

• Training for health professionals in the health field by conducting training sessions.

At the next level, this being a more advanced stage, one should consider the possibility of sending the best professionals abroad, in order for them to see how other healthcare environments are run. These experiences have a dual purpose; first to get to know different realities (cultural, human resources and technical) and, on the other hand, to generate the desire to help and work with those Western professionals who receive, accompany and work with them.

The fact that the project is supported by the experience and knowledge brought by the Aita Menni Hospital guarantees seriousness in its implementation. Aita Menni currently features specific units for the treatment of all types of patients, combining psychiatric and psychological aspects, pioneering the combination of work systems and the understanding of people and mental illness from a multidisciplinary perspective.

Beneficiaries

WE ARE LIKE YOU aims to help the following social groups:

Residents of the Benedict Menni Health Center area

The violent outbreak of Ebola in the spring of 2014 forced the closure of the center in July. Even though the country was declared free of Ebola a year later, new outbreaks cannot be ruled out, which means that it is necessary to build three new facilities to ensure the safety of those attending the Health Center’s consultations:

• • • A triage station, which will determine whether patients show symptoms of Ebola and are then classified.
    • A care center for those patients showing symptoms of Ebola.
    • An incineration facility.

Mentally ill patients discharged from Grant Hospital

The project includes the implementation of a Convalescence Unit to provide a place of welcome and care for:

• • • Stable patients, whose families need time to organize and adapt their environment.
    • Patients who relapse after a critical event in their surroundings, such as job loss by the member who provides most of the resources needed for the survival of the family unit.

Patients requiring psychological and social support programs

• • • People suffering from post-traumatic stress as a result of being victims, perpetrators and witnesses of extreme violence during the 14 years of civil war.
    • Victims of a social context that stigmatizes illness, both in the case of Ebola and of mental illness: Ebola survivors, relatives of victims, the mentally ill, etc.
    • Workers and health workers who have cared for patients infected with Ebola, who need help combating phobias, social rejection, feelings of guilt, etc.

Patients with mental and behavioral disorders that require outpatient care

A network of outpatient centers exists that takes part in the “Wellness Center Program”, promoted by the Ministry of Health and Social Welfare in the 15 counties of the country. However, since this network is incomplete and Montserrado County, where Monrovia is located, has a large population, we believe that the Sisters Hospitallers center can take part in the outpatient care of patients with mental and behavioral disorders.

Patients with dual diagnosis (substance abuse and mental illness)

There are some programs that address these problems, including one from the Liberian Red Cross focused on women that are victims of extreme violence and drug abuse. The program includes various types of workshops to provide women with skills that will help them find a job or start a small business.

The Medium-stay Unit, covered by the project, can accommodate dual diagnosis groups that do not fit into existing programs, as well as cases referred by health centers.

Mentally handicapped patients

Mental disability is the great enigma of statistics and reports on mental health in Liberia.

With a population of 4.4 million inhabitants, an estimated 10,000 people suffer from severe mental disability and some 2,000 from heavy mental disability.

Often, our social environment rejects and stigmatizes these patients.