Stories From the Field:

LIBERIA

Global Health Psychiatry in Liberia

Dr. Oriana Vesga-Lopez, a fourth year resident in Mass General Hospital’s Psychiatry Department, traveled to Liberia in December 2012 to conduct in-depth interviews of war-affected adults.

Between 1989 and 2003, Liberia experienced a brutal civil war, which earned international reputation for the widespread human rights violations, massive displacement, dissemination of sexual violence, and the indiscriminate use of child soldiers. Despite these insights, mental health has not been addressed in a meaningful way since the end of the war, there is currently one psychiatrist for a population of 3.7 million, and there is virtually no other access to mental health services in the country.

I had the opportunity to travel to Monrovia, Liberia, funded by a travel grant from the Massachusetts General Hospital Center for Global Health. As a fourth year resident in Psychiatry, I was interested in gaining a better understanding of the psychological impact of the civil conflict on a sample of war-affected adult Liberians living in Monrovia. To this end, I conducted in-depth interviews of males and females at a local community site.

I was saddened to hear the wide array of traumatic experiences that individuals in the community had been subject to. Forced displacement, separation from family, loss of loved ones, severe poverty and hunger, and extreme physical and sexual violence, were some of the events that became a daily reality for the vast majority of the population. It was hard to imagine that anyone could have survived after going through that. Contrary to what I expected, I observed that most of the individuals in the sample population had consciously decided to let go of the past, to be grateful for the opportunity of being alive, and to remain optimistic about the future. In the middle of widespread poverty, difficult access to education, high rates of unemployment, and lack of basic needs, young adult males and females were striving every day to get their dreams back. It was not surprising to hear that faith, family and access to education, had become the pillars that were holding these lives together.

A lot remains to be done. The development and delivery of effective prevention and treatment interventions is essential to the long-term health outcomes of this population. In the meantime, ongoing funding and support of physicians in training, like myself, is of the outmost importance to address some of the current gaps in access to health care in post-conflict societies. I am grateful for the opportunity to work in this setting, and look forward to my next travel.