How that works? Conteh walks over to a shed where a young man cowers on the door step. His name is Ibrahim and he used to be a teacher up to the day his girlfriend’s father cursed him, Conteh explains. He calls upon Ibrahim to stand up. A strenuous effort for the young man. Finally Ibrahim gets on his feet, standing crooked with a small bag of white powder and a spoon in his left hand. His right hand clutches his trouser waistband which is about to slip. “He made good progress, since he came to us”, Conteh says and tells Ibrahim to walk over. His patient roars. At one point, the healer is at the end of his tether. “Bring me the cane!”, he yells at one of his helpers.
The role of traditional healers in Sierra Leone is ambivalent. In a country without comprehensive health care they are the go to people for everyday problems. Cleansing ceremonies and other rituals are deep-rooted in the national cultural heritage. Same goes for the treatment of mental problems.
Until today there is the widespread believe that mental health problems are caused by witchcraft or demons as punishment for misconduct in the past. The local people call it „noto ospitul sik” – an illness that cannot be cured in a hospital due to its transcendental provenance.
Fighting a Medical War
“Providing mental health care in this country is a challenge, due to the beliefs of people”, says Rebecca Esliker, director and only employee at the institute for psychology at the university of Makeni in central Sierra Leone. “I wouldn’t want to blame them. The only thing they know are those traditional healers.”
The dainty lady, who looks far younger than her 58 years, bears little sympathy for the healers. In her research she speaks of a “medical war the country is currently fighting” between modern medicine and what she calls myths and beliefs. “Most of the time they are making it worse”, Esliker blusters. “They might be able to stabilize someone with mild conditions but not the severe ones.”
Esliker, who was born in Sierra Leone and went to university in Ireland and the United States, holds a long list of accusations against the healers’ treatment: financial exploitation of families, who vainly hope for curation of their mentally ill relatives; irresponsible use of psychotropic medication mixed with their herbs without knowing anything about dosages and side effects; finally: violence. “When they take someone to the traditional healer, especially these severe psychotic cases, they will flog them almost on a daily basis”, Esliker recalls experiences with her patients. “They beat them mercilessly because they say that’s the way to get rid of the devil.”
Since she came back to her home country three years ago, Esliker is lobbying to put mental health on the political agenda. She is part of the Mental Health Coalition (MHC) that worked on rewriting the national legislation with the telling name “Lunacy Act” from 1902. The MHC achieved a directorate for noncommunicable disease and mental health was established within the Ministry of Health. Besides, 21 mental health nurses were trained and sent to the districts to provide basic treatment and Esliker started a clinical counselling course for PAC (physician assistant - certified). “When we started with the course we had two students”, Esliker says and with a trace of pride adds: “This year I got six. So, it’s slowly getting better.”
Despite the little progress made, mental health still is not a priority for the government. In a strategic paper published by the ministry of health for the years to come mental health is not even mentioned once. A mistake, Esliker says: “Without mental health there is no health.”
To help as many patients as possible the MHC decided to include the controversial Traditional Healer’s Union in their efforts. Healers are now trained to detect severe cases and refer them to a hospital with a mental health unit - in theory. At the “Mortalman Garage”, on whose wall the word “crazy” is written next to painting of a chained man, bush doctor David Conteh assures the hospital had given up on Ibrahim and referred the patient to him. Their alleged diagnosis: noto ospitul sik.
Disclaimer: This project has been funded by the European Journalism Center (EJC) via ist Global Health Journalism Grant Programme for Germany.
Betancourt (2008): High Hopes, Grim Reality: Reintegration and the Education of Former Child Soldiers in Sierra Leone. In: Comp Educ Rev.
Betancourt (2010a): Past horrors, present struggles: The role of stigma in the association between war experiences and psychosocial adjustment among former child soldiers in Sierra Leone. In: Soc Sci Med.
Betancourt (2010b): Sierra Leone's Former Child Soldiers: A Follow-up Study of Psychosocial Adjustment and Community Reintegration. In: Child Dev.
Betancourt (2013): Post-traumatic stress symptoms among former child soldiers in Sierra Leone: follow-up study. In: The British Journal of Psychiatry.
Betancourt (2014): School Persistence in the Wake of War: Wartime Experiences, Reintegration Supports, and Dropout in Sierra Leone. In: Florida State University Libraries.
Betancourt (2015): Youth mental health after civil war: the importance of daily stressors. In: The British Journal of Psychiatry.
Betancourt (2016a): Associations between Mental Health and Ebola-Related Health Behaviors: A Regionally Representative Cross-sectional Survey in Postconflict Sierra Leone. In: PLOS Medicine.
Betancourt (2016b): Youth and Resilience in Postconflict Settings: An Intervention for War-Affected Youth in Sierra Leone.
Betancourt (2017): Coping and mental health outcomes among Sierra Leonean war-affected youth: Results from a longitudinal study. In: Development and Psychopathology.
Betancourt (2019): Stigma and Acceptance of Sierra Leone's Child Soldiers: A Prospective Longitudinal Study of Adult Mental Health and Social Functioning. In: Journal of the American Academy of Child & Adolescent Psychiatry.
Bulanda; Jalloh (2017): A needs assessment for school social workers in Sierra Leone. In: International Social Work.
de Jong (2000): The trauma of war in Sierra Leone. In: The Lancet.
Edoka (2016): Free health care for under-fives, expectant and recent mothers? Evaluating the impact of Sierra Leone’s free health care initiative. In: Health Economics Review.
Esliker (2015): Mental Health in Sierra Leone: Beliefs, Myths and Truth. In: University of Makeni.
Healy (2016): Did we learn the right lessons from Ebola? In: New Internationalist, 2016. Online verfügbar unter https://newint.org/features/2016/06/01/after-ebola-keynote.
Kamara (2017): Mental health care during the Ebola virus disease outbreak in Sierra Leone. In: Bull World Health Organ.
Keefe (2016): Young guns. In: New Yorker, 2016.
Ministry of Health and Sanitation (2016): NATIONAL HEALTH PROMOTION STRATEGY OF SIERRA LEONE (2017–2021).
OSullivan: Childhood Disability in Burkina Faso and Sierra Leone: In: M. MacLachlan and L. Swartz (eds.), Disability & International Development: Towards Inclusive Global Health,
Sevalie (2018): Mental health in Africa. In: The Lancet. Online verfügbar unter https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(18)30303-6/fulltext.
Shonkoff (2012): The Lifelong Effects of Early Childhood Adversity and Toxic Stress. In: Pediatrics.
Song (2013 (2011)): Who Cares for Former Child Soldiers? Mental Health Systems of Care in Sierra Leone. In: Community Ment Health J.
UNDP (2017): Analysis of the Causal and Trigger Factors of the August 2017 Landslide in Freetown: towards a Sustainable Landslide Risk Management in Sierra Leone.
Wessels (2010): Sealing the Past, Facing the Future. In: Girlhood Studies.
WHO (2012): WHO proMIND: Profiles on Mental Health in Development.
WHO (2017): Improving access to mental health services in Sierra Leone. Online verfügbar unter http://www.afro.who.int/news/improving-access-mental-health-services-sierra-leone.
Worldbank (2016): As Liberia and Sierra Leone recover from civil wars. Online verfügbar unter http://www.worldbank.org/en/news/feature/2016/04/11/as-liberia-sierra-leone-recover-from-civil-wars-and-ebola-demand-for-mental-health-services-surges.
Yoder (2016): Child mental health in Sierra Leone: a survey and exploratory qualitative study (Daten vor Ebola). In: International Journal of Mental Health Systems.