Our programmes in Ebola-affected countries

It has now over a year since the Ebola outbreak started in Guinea. CBM partner organisations in Guinea and Sierra Leone – 2 of the 3 most affected countries – were forced initially to scale down their routine activities like community eye care, cataract operations, and community mental health care.  The regional post-graduate ophthalmology course that we support in Guinea (DESSO) had to be put on hold. The loss of local staff either from Ebola or due to difficulties in travel, and the reduction in clients coming for services has led to a risk of insolvency of institutions, among other negative effects. By extension, tens of thousands of people who depended on them for health and other social services are no longer getting the services they require resulting in greater disability and deeper poverty.

To help the partners in Sierra weather the storm during the outbreak, CBM is providing financial support aimed at organisational strengthening, as well as supporting health education activities carried out by the partner organisations in their catchment areas thereby guaranteeing their sustainability and the resilience of the communities they serve.

Additionally, CBM is working with a grass-roots organisation in Sierra Leone to reduce the vulnerability of persons with disabilities and their families in Sierra Leone to Ebola through awareness raising strategies.

A final component targets persons with psychosocial disabilities as a result of Ebola in Sierra Leone by providing psychological and social support in close collaboration with the WHO, UNICEF and other agencies. This activity is being carried out through an existing CBM-supported Mental Health programme and involves adaptation of WHO training materials on psychological first aid and training of health workers to effectively provide psychosocial support to individuals and population groups in need.

Dr Julian Eaton, Psychiatrist and CBM Mental Health Advisor for West Africa, tells us more about the mental health programme and its role in responding to psychosocial needs of the population in Sierra Leone.

Our activities in Sierra Leone since the Ebola outbreak started

“When the Ebola crisis began in March 2014, our programmes in Sierra Leone were affected. Due to the rapid spread of this disease, there were significant travel bans imposed, bans on public gatherings, closure of schools, reduction in the use of hospitals by people etc. Routine cataracts and surgeries came to a standstill and routine programmes started collapsing.

We needed to continue supporting our existing partners as there was no income flowing in due to lack of day-to-day expenses of operations and surgeries etc. Business services started collapsing due to the lack of finances and there was a massive gap between what was existing and what was needed by the people.

CBM’s first response to the outbreak was to redirect our efforts as much as we could, within the framework of our programme, to support the mental health and psychosocial response to the outbreak.” 

CBM projects in Sierra Leone

“The ‘Enabling Access to Mental Health’ Programme (EAMH) supported by CBM has been active for the past four years in Sierra Leone. Addressing the consequences of mental health is an important part of standard Ebola response. Today, this programme focuses more on the specific mental needs of people affected by this disease. It provides mental health facilities to families of Ebola victims, children who are now orphans, health workers who are under a huge amount of stress and survivors who are marginalised by their families and communities.

The programme has dedicated three blocks to:

• Block 1, Capacity Building: support the 21 mental health nurses trained by the EAMH programme in the districts, so they can provide services for those who are suffering the consequences of the outbreak. Other efforts, like the provision of trainers and specialists to prepare teams of other organisations (such as child protection) are also being made.
   
• Block 2, Advocacy: The EAMH has also established the Mental Health Coalition that brings together stakeholders to advocate for the inclusion of mental health in the government’s agenda. The Mental Health Coalition has been engaging from the beginning of the outbreak with the response pillars of both, the Ministry of Health and the Ministry of Social Welfare, to ensure that the mental health component of the outbreak is not neglected and that local actors are taken into consideration. The Coalition, being one of the main actors in this area, works in close collaboration with WHO, UNICEF, and the other NGOs.
   
• Block 3, Awareness: Radio programmes and support to the other blocks are being provided, to raise awareness about the psychosocial consequences of the outbreak, and to fight stigma and discrimination.

To address the massive increase in needs CBM has also added more resources to scale up support for psychosocial disability. We have collaborated closely with the WHO to write a standard manual for psychosocial first aid (both in English and in French). This manual is currently being used by national governments, WHO and other international and local NGOs in Sierra Leone, Nigeria, Mali, Guinea, Togo and Liberia. 

In Sierra Leone the Mental Health programme has been the strongest programme supporting services outside psychiatric hospitals. It has deployed nurses who are the main referral for people doing counseling.” 

Building Resilience for persons with disabilities during the Ebola Crisis

“Another project has begun to ensure the resilience of persons with disabilities to the outbreak. CBM has liaised with our local partners in Sierra Leone to adapt all official messages from the WHO, UNICEF and the government, to ensure they are accessible for people with disabilities.

We are adopting a participatory approach in this project – our partners are conducting training sessions for Organisations for Persons with Disabilities (DPOs), who in turn train communities in the villages.

We have involved key organisations in this project – specialist schools for hearing impairment, amputee groups etc. so that persons with disabilities can have a say in how they want messages to be transmitted to them. Our collaborating local partner organisations have also identified other DPOs and are organising workshops.

Disaster Risk Reduction and preparedness in Nigeria and Togo

“We are strengthening capacities of Mental Health workers to provide mental health support in crisis situations."

Dr. Julian Eaton concludes “All these projects are strongly focused in working through our local partners, capacitating them, working in collaboration and therefore, assuring sustainability and continuation after the Ebola crisis period.”

Beyond the realm of mental health, CBM is supporting existing partners involved in eye health in Sierra Leone, to sustain their programmes and to reduce the vulnerability of their target group to Ebola. The partners have had to scale down their eye health activities in their catchment areas thereby depriving communities of much needed eye health service. A person who is blind is doubly vulnerable compared to able-bodied members of society due to the fact that they require support in their daily living as a result of an inaccessible environment. A key strategy Ebola health workers are promoting is the “don’t touch rule” to reduce the spread of infection. Such a rule, to a person who is blind completely immobilises them and elevates their risk of infection to Ebola.

In this context, CBM eye health partners aim to: increase the knowledge of their staff and traditional leaders regarding Ebola to enable them to effectively sensitize communities in the catchment area; and to work with DPOs to reach out to persons with disabilities especially persons who are blind.

The current Ebola epidemic has overloaded and stressed health infrastructure in the affected countries; the number of health care workers – already insufficient before the outbreak - has gone down even further as many health workers became infected and lost the fight. Social stigma towards survivors of Ebola and their families has increased thus worsening distress and isolation. Family and social ties have been severed; cultural practices have been over-turned; and livelihoods have been severely strained.

In future, the affected countries, and the international community will have to engage at a much wider scale to re-establish the socio-cultural, economic, and political systems, which Ebola has severely shaken. This will be a critical and indispensable step if the affected countries are to overcome future public health challenges like the current one.

In the coming months, CBM will participate, with other development agencies and the governments of the three affected countries, in a major conference looking at lessons learnt in mental health and psychosocial support from the outbreak, and how we can work together to rebuild mental health services.