Ronald McDonald House Charities® (RMHC®) has awarded The Carter Center $200,000 to support the Mental Health Program in Liberia. The funding will be used to train mental health care providers and to build supportive community environments that will benefit individuals suffering from mental illnesses and their families.

The Center’s work to train mental health professionals in Liberia is a prime example of the “train-the-trainer” style programs that RMHC supports via its Global Grants program. As part of its mental health initiative in Liberia, The Carter Center is working to create a sustainable mental health system in Liberia that will address a broad range of mental health conditions. The overarching goal over the five-year period is to improve functioning in people with mental illnesses in the most populous counties of Liberia, with specific targets of training 150 specialized nurses and physician assistants and 300 other mental health professionals, such as community mental health workers.

In addition to building a mental health work force, the Center also assists the Liberia Ministry of Health and Social Welfare by: collaborating on implementation of the national mental health plan; developing support models for family caregivers; promoting mental health advocacy; and working to reduce stigma and discrimination against people with mental illnesses.

Learn more about the Center’s mental health work in Liberia >
Learn more about RMHC >

Focusing Philanthropy was co-founded and is chaired by Larry Gilson, a former investment broker whose company handled more than $1.5 billion of equity capital from pension funds, insurance companies, college endowments, and high net worth individuals.

Part of the first class of Carter Center trainees in 2011, newly graduated and credentialed mental health clinician Quendi Appleton celebrates the beginning of her career helping people with mental illness in her country. Since the first class, The Carter Center has trained 39 local mental health clinicians, with an ultimate goal of 150 within the next few years. (Photo: Carter Center/P.Rohe)

Gilson says he and his colleagues wanted to find charities to support that could stand up to the same rigorous evaluations as the funds they had managed during their professional careers.

“We are all exposed to nonprofits tackling worthy causes, but which of them have substantial impact?”Gilson asked. “Which are institutionally credible? Which have shown the capacity to use additional donations effectively? Our goal is to make other conscientious donors aware of the opportunities we have winnowed through this extensive vetting.”

Focusing Philanthropy selected 14 U.S.-based and international organizations that work in three key areas: helping to build community infrastructure and resources, increasing self-sufficiency, or raising individual and community income.

The psychological impact of the long civil war in Liberia, which ended in 2003, has contributed to a mental health crisis. Less than 1 percent of Liberians have access to appropriate mental health services. In partnership with the Liberian government, The Carter Center aims to train 150 local, credentialed mental health clinicians, improve mental health policy, as well as conduct other activities to reduce stigma against mental illnesses.

“We are grateful for Focusing Philanthropy’s dedication to making a difference in lives of those with mental illnesses in Liberia,” said Rebecca Brookshire, senior associate director of development for health programs at The Carter Center.

Read the press release from Focusing Philanthropy highlighting The Carter Center >

Read the blog: Liberia’s First Mental Health Clinicians Deploy To Fight Disease, Build Hope >

Watch the PBS NewsHour segment on Liberia featuring Carter Center student Quendi Appleton: War-Torn Liberia Struggles to Care for Mentally Ill >

Listen to the National Public Radio’s “Tell Me More” interview with Dr. Janice Cooper: “Liberia Marks Milestone in Mental Illness Fight” >

A torrential rain began in Monrovia, Liberia, causing the power to flicker and the Internet to shut down, but Georgia Institute of Technology professor Dr. Ellen Zegura didn’t let the disruption stop the computer and software training session she was holding with Liberia’s first class of mental health clinicians.

Overcoming challenges is one of the foundations of Georgia Tech’s Computing for Good (C4G) initiative, through which students and faculty explore computing solutions for the world’s most urgent social problems.

“We’re all familiar with the impact of computing on things like business productivity in the developed world, but I think we are just starting to see the ways that technology can have impact on the developing world,” says Dr. Zegura, professor and chair of Georgia Tech’s School of Computer Science. “Our C4G work with The Carter Center in Liberia is a fantastic opportunity for us to take some theories of what might work in an extremely technologically limited setting and actually apply them on the ground.”

Since 2010, Georgia Tech has collaborated with the Carter Center’s Mental Health Program Liberia to provide the software and support that the Center and the Liberian government need to monitor the nation’s progress in building a sustainable mental health care system. The Carter Center’s five-year project in Liberia is training a cadre of local mental health clinicians and working to reduce stigma and discrimination against mental illnesses.

All photos credit: P. Rohe
A computer services business in Monrovia, Liberia.

One of the world’s poorest nations, Liberia still is recovering from a brutal 14-year civil war that ended in 2003. Because millions of Liberians suffer from mental illnesses but have virtually nowhere to turn to receive cost-effective treatments, the Liberian government has made improving access to mental health services a priority. However, one of the major challenges of this effort has been for the Ministry of Health and Social Welfare to identify where the greatest areas of need are and how to most effectively use resources to address those needs.

“Georgia Tech really has helped The Carter Center and Liberia to leapfrog over technological challenges that would have delayed our ability to achieve our goals or diverted our limited funding from other important activities,” says Shelly Terrazas, assistant director for the Carter Center’s mental health project in Liberia, who is herself an alumnus of Georgia Tech. “Georgia Tech’s support has been invaluable as we seek to prevent unnecessary suffering among some of the world’s most vulnerable people.”

Dr. Zegura and her C4G team of undergraduate and graduate students spent months designing software that allows the Center and the Liberian government to anonymously track patient outcomes to evaluate the clinician training program and conduct health surveillance and monitoring. Her team also extensively researched computers, smartphones, and other devices to see which would be most appropriate for the country’s uncertain electricity supply and extremely humid and hot tropical climate.

Careful consideration was taken in how to design these computer-based patient evaluation tools so they could be used easily by the new mental health clinicians, many of whom had limited or no previous experience working with computers. In addition, understanding that many of the clinicians will work in very isolated and rural areas, Georgia Tech created an online tool for the clinicians to stay connected with one another, remotely support each other, and brainstorm options for difficult patient cases.

Georgia Institute of Technology School of Computer Science Chair Dr. Ellen Zegura spent hours training Liberia’s first class of 21 mental health clinicians to use specially designed software and custom Hewlett-Packard laptops to help The Carter Center and the Liberian government track progress in their efforts to build a sustainable mental health care system.

Not one to rest on her laurels, Dr. Zegura is busy planning the next step of the project now that the clinicians are deployed to the field and using the technology she and her team worked so hard to provide.

“I am excited about the next four years of this project and how Computing for Good can help The Carter Center and its partners not only do good, but also how we can contribute to a greater understanding of how these technologies can be used around the world,” says Dr. Zegura.

In August 2011, Dr. Zegura participated in the graduation ceremonies of the first class of Carter Center-trained Liberian mental health clinicians, handing each of the new graduates custom laptops provided by The Carter Center. Dr. Zegura plans to continue to work with The Carter Center to evaluate the use of these tools as the Center completes its mental health work in Liberia over the next four years.

All Photos: D. Hakes/The Carter Center
Liberians lined up to vote on a rainy morning in Monrovia on Tuesday, Oct. 11. Credible elections in 2011 are a key test of whether the country’s institutions are strong enough and its leaders are sufficiently committed to creating the conditions for an open and competitive process. This is the first election to be administered primarily by the National Elections Commission and the first to be held under Liberia’s 1986 constitution.

At the William Tubman High School in Monrovia, Liberians waited in line for several hours ahead of voting, which started at 8 a.m. There were 16 candidates for president, including Winston Tubman of the Congress for Democratic Change, Charles Brumskine of the Liberty Party, and current President Ellen Johnson Sirleaf of the Unity Party. If a single candidate does not receive a majority vote (50 percent plus one vote) on Oct. 11, a presidential runoff election will be held.

Voters were enthusiastic despite the rain, which varied from a drizzle to a  heavy downpour all morning in Monrovia.

Tape marks where voters will soon line up on Oct. 11 before polls opened.

Carter Center delegation leader General Dr. Yakubu Gowon and Field Office Director Alexander Bick inspect a stack of ballots before voting begins on Oct. 11.

A polling official looks up a voter’s ID card to be sure they are registered to vote in that location. Liberia’s National Elections Commission hired and trained  more than 27,000 poll workers for  4,457 polling places on election day.

Part of poll opening procedures by polling station staff includes sealing the empty ballot boxes.

Voting gets under way at the William Tubman High School.

Polling staff answer questions from Liberians in line to vote.

National, political party, and independent party observers in their designated seating area watch as a polling official checks the ID of a voter.

General Gowon watches a woman cast her ballot on Tuesday morning in Monrovia.

A polling staffer in Monrovia holds a woman’s infant as she casts her ballot, then inks the woman’s finger with indelible ink.

A woman votes in Paynesville.

Voters wait in line at Liberia University.

General Gowon addresses the media on election day morning, as others take shelter from the rain.

Carter Center intern Aliya Naim observes polling in Paynesville.

Polls closed at 6 p.m. on Oct. 11. At this Waterside polling station, the presiding officer cuts the seals off a ballot box to start the counting process, as a polling official holds a lantern so he can see.

Carter Center observers watch the counting process in Monrovia.

Read more about Liberia’s historic elections >

Torrential rains in Monrovia, Liberia, Friday morning did not deter dozens of family members and friends from arriving at the Tubman National Institute of Medical Arts hours before graduation ceremonies for the nation’s first mental health clinicians began. No one wanted to miss their loved one become part of their nation’s history and hope for a better future.

The 21 graduates, themselves, are primary care nurses, physician assistants, and nurse educators, a variety of ages, and hailing from hometowns across six counties.  Together, they labored through nearly six months of rigorous training, many late nights studying, and intense final exams, to receive the equivalent of a master’s degree in mental health care.

And so, at 3:30 p.m., during a ceremony attended by more than 200 guests, including high-ranking government officials, local and international media, and even, some of the students’ patients, the graduates received certificates recognizing their successful completion of the Carter Center-supported Post-Basic Mental Health Training Program.

“As these students return to their communities or begin to teach the next class of mental health clinicians, we know that they have the opportunity to truly impact the lives of millions of Liberians who would not otherwise have the chance to receive help for their mental illness,” said Dr. Janice Cooper, Carter Center Mental Health Program Liberia project lead. “We are unbelievably proud of these pioneers, who are making it possible for Liberia to build a healthier future for all.”

All photos: Carter Center/P. Rohe
Hailing from six counties in Liberia, the graduates are a variety of ages and are committed to integrating mental health into Liberia’s primary care system when they return to their positions at community health clinics, health care education institutions, and hospitals.

The graduation audience watches a special performance on myths about epilepsy—or “spell” as it is known in Liberia—from the Modia Drama Club, a long-time Carter Center partner in helping to spread public awareness messages on peace and now, mental health.

The graduation ceremonies were attended by Liberia Minister of Health and Social Welfare Dr. Walter Gwenigale, Dr. Bernice Dahn, chief medical officer and deputy minister for Health Services , and Seward Cooper, legal adviser to the president of Liberia, each of whom congratulated the graduates. They also, for the first time, announced their intentions to support new legislation for mental health care in Liberia to help protect people with mental illnesses from violations of their human rights.

Dr. Janice Cooper and Minister Gwenigale distributed the certificates to the graduates, who also received professional name badges to wear as part of their regular uniforms.

As a partner with The Carter Center, Dr. Ellen Zegura, of the Georgia Institute of Technology’s Computing for Good initiative, distributed laptops and custom software at the graduation ceremony to the new mental health clinicians to use during their practice. The laptops and software, provided by The Carter Center free to the graduates, will assist The Carter Center and the government of Liberia to monitor the impact of the program on patient care and mental health outcomes.

The graduates received news during the ceremony that they all passed their licensing exams and will receive higher wages in light of their new credentials.

“We know that people with even the most serious mental illnesses can contribute to their communities if they have access to appropriate mental health services,” said Carter Center Mental Health Program Director Dr. Thom  Bornemann. “During the next four years, the Post-Basic Mental Health Training Program will help ensure that more people than ever in Liberia will have that chance.”

Surprise Otto, 21, (right) first met physician assistant Klubo Mulba, 40, (left) during Mulba’s clinical rotation at JFK Hospital in Monrovia earlier this year. Through the mental health training program, Mulba and her fellow students had been visiting the hospital’s maternity ward, looking for any patients who may have had depression or anxiety. Mulba spotted Otto, 6 months pregnant at the time, sitting quietly alone in a corner. Mulba struck up a conversation and Otto explained that she had been having a difficult pregnancy and had many fears about her and her baby’s health that kept her from sleeping at night. Mulba and Otto began talk therapy sessions, which Otto said helped her a great deal. Now, safely delivered of a baby boy, James, Otto says, “I think Klubo is very good at her job. She helped me a lot when I was so sick and frightened. She made me have hope.”

Read the press release >

My early morning walks serve as vivid reminders of why I am here. Along my route, children in freshly starched uniforms make their way to school signaling the hope of a recovering nation. Near the nightspots on Carey Street, daylight reveals young men languishing, many lacking jobs, and nearly all having some residue of trauma resulting from the civil war. It’s a trauma that lingers close to the surface and is sparked by the smallest of disagreements.

Today, as the country struggles to heal and reconcile, memories of the war haunt Liberians daily: a woman may get in a taxi in Monrovia driven by a man who raped her; a teenager in Bong County may live next door to a family he harmed as a conscripted child soldier.

Compounding this problem, there are few places for people in Liberia to go to receive counseling or other services to help them deal with the deep and unresolved trauma, anger, or grief they feel.

Carter Center Photo: J. Cooper
The first class of mental health clinicians visits Grant Hospital, the nation’s only psychiatric hospital, and meets with the nursing supervisor.

After my walk, I joined the Carter Center’s first class of 21 Liberian health care professionals. When I arrived, they were all busy taking last minute notes or discussing relevant case studies. The next day, they will go on clinical rotation at Liberia’s sole psychiatric hospital, Grant Hospital, one of five clinical sites. The bags under their eyes and the flurry of activity led me to believe most had been up late studying, again.

Gathered from across the country, these men and women were selected from among dozens of physician assistants and nurses to receive free training to become the first cadre of qualified Liberian mental health clinicians. Their teachers are experts from Liberia and around the world, and their curriculum was developed specifically for the Liberian context, modeled after lessons learned from the Center’s Ethiopia Public Health Training Initiative.

Many of these students have years—even decades—of experience working in villages and cities in Liberia, and after they graduate in August, they will participate in innovative work to integrate mental health care into basic primary care services in their local communities, sometimes in places where no primary care existed before. They are passionate about serving their country, but they also are sobered by the challenges.

Carter Center Photo: J. Cooper
The Carter Center’s first class of 21 Liberian health care professionals gather from across the country, selected from among dozens of physician assistants and nurses to receive this free training.

When training is complete, these professionals will return to communities where the lack of adequate psychotropic drugs, laboratory facilities, and even transportation pose significant challenges. However, these students are committed to overcoming these challenges. And in the coming months, their work will be bolstered by additional classes of professionals graduating and being deployed into the field, eventually expanding access to mental health care to 70 percent of the population.

So, as I set out each morning, traveling by many reminders of our nation’s difficult past, I’ve come to think of my steps toward these students as steps toward Liberia’s bright future.

Learn more about the Carter Center’s efforts to help Liberia build a sustainable mental health care system >

Many Liberians suffer from trauma, depression, and other mental health issues following more than a decade of civil conflict. With only one psychiatrist in the entire country, and just a handful of nurses with mental health training, treating those who suffer from mental illnesses has been almost impossible. Jane Bigham, assistant program coordinator for the Carter Center’s Mental Health Program, recently traveled to the West African country. Below, she reflects on her journey and what a new Carter Center mental health initiative will mean for the people of Liberia.

I recently traveled to Monrovia, Liberia, to work on the Carter Center’s Liberia Mental Health Initiative—our first international project to improve access to mental health care. The initiative will assist the Liberia Ministry of Health and Social Welfare to implement the national mental health plan, a set of priorities and goals established by the Liberian government to improve access to mental health services in the country. Among other activities, The Carter Center will help create training systems for mental health professionals, such as nurses; develop support systems for family caregivers; and work to reduce stigma and discrimination against people with mental illnesses.

Photo credit: The Carter Center/M. Benckert
Jane Bigham and the team depart the Carter Center offices on U.N. Drive in Monrovia.

This was my first visit to Africa, and I was somewhat nervous, but very excited. During my flight from the United States, I had my first encounter with the impact of the Liberian civil war. I sat next to Nathan, an older gentleman and self-described “military man,” who served in Liberia in 1996 as a member of the Ghanaian peacekeeping force. He described his time there as the hardest peace-keeping mission of his service; he encountered many child and adolescent soldiers who had experienced severe cuts and scrapes, amputations, and scars. Recalling his experience brought tears to Nathan’s eyes.

Photo credit: The Carter Center/M. Benckert
Liberia is rebuilding its roads and infrastructure, but must also improve its collective mental health.

I couldn’t fathom the level of anguish and emotional turmoil that the people in Liberia experienced because of the war. And once I arrived, I saw firsthand the immense challenges facing the country. After 14 years of brutal civil conflict, the physical wounds remain visible and the emotional trauma lies close to the surface for many.

During my stay in Monrovia, I heard many accounts of how people with mental illnesses often are feared and discriminated against, underscoring the importance of the mental health work we were preparing to do.

A young man named Guzt, from Bong County, told me about a woman in her early 40s who suddenly started hearing voices and went to her church to seek help. She was assumed to have a mental health problem and was held against her will in the church, chained at the ankle. Two days later, she died. Guzt suspected the woman did not have a mental illness, but rather cerebral malaria—a common health problem in Liberia that might have been treatable if she had been given access to adequate medical care. Unfortunately, people with severe psychological disorders often are “treated” through starvation, neglect, or restraint with chains, due to myths about the causes and treatments for mental illnesses and the desperate lack of mental health services.

Photo credit: The Carter Center/M. Benckert
Dr. Janice Cooper (left), with The Carter Center, and Marion Subah, with Rebuilding Basic Health Services, participate in a mental health workshop co-hosted by The Carter Center and Liberia’s Ministry of Health and Social Welfare.

Although many such challenges exist, mental health is a high priority for the Liberian government and its Ministry of Health and Social Welfare. The government’s National Mental Health Policy and Strategic Plan for Implementation will address the need for mental health care professionals as well as challenge negative attitudes and misconceptions associated with mental illness.

Photo credit: The Carter Center/ J. Bigham
Many Liberians suffer from trauma, depression, and other mental health issues following more than a decade of civil conflict. Through its first international project, The Carter Center’s Mental Health Program will assist the Liberia Ministry of Health and Social Welfare to improve access to mental health services in the country.

Despite all the suffering I saw or heard about, I believe the people of Liberia are a testament to human resilience and resolve. I left Monrovia hopeful about what Liberia and The Carter Center can accomplish together to address mental health issues associated with the recent conflict as well as create ongoing mental health services.

The country can and has, in part, rebuilt its roads and infrastructure. But to fully recover from the horrors and devastation of war, it also must heal its collective mind and improve its mental health.

Links:
Carter Center Mental Health Program

Listen to the full story here: http://www.theworld.org/2010/08/03/liberia-land-disputes-laura-cunial/

The Carter Center has worked since 2006 with the Ministry of Justice and the Ministry of Internal Affairs to strengthen formal systems of justice, educate citizens on their rights, and to strengthen indigenous dispute resolution capacity in ways consistent with the law.

Read more about the Carter Center’s work in Liberia.

In an AllAfrica.com article about the event, NTC Chairman Chief Zazan Kawah said “he was particularly impressed with the cordial working relationship between the council and the Carter Center over the past few years,” describing the working atmosphere as rewarding. He also said he was pleased with the manner in which Hummel and the Carter Center’s staff engaged with them and that it was “now time for the traditional people to appreciate the Center for its numerous contributions made in Liberia’s peace-building process, as well as the many assistance rendered the country’s justice system aimed at strengthening the rule of law.”

Carter Center Country Representative John Hummel receives a farewell gift from National Traditional Council Chairman Chief Zanzan Kawar. Photos by Pewee Flomoku/The Carter Center.

The Carter Center has worked since 2006 with the Ministry of Justice and the Ministry of Internal Affairs to strengthen formal systems of justice, educate citizens on their rights, and to strengthen indigenous dispute resolution capacity in ways consistent with the law. Read more about our efforts: www.cartercenter.org/liberia

<

Carter Center staff and members of the National Traditional Council in front of the organization’s headquarters in Monrovia, Liberia.

Read more about the Center’s work in Liberia.