Stories From the Field:

SIERRA LEONE

Mental Illness in Sierra Leone

Rachel Ross, MD, PhD, a third year resident at the MGH McLean Adult Psychiatry Residency Program, was granted a Center for Global Health Travel Award to spend two weeks in Sierra Leone working with Wellbody Alliance.

I work with a small NGO in Sierra Leone that a friend of mine started when we were in medical school. When it began, Wellbody Alliance was meant to serve as a mobile clinic to provide health care to amputees who could not travel the distance required to obtain care at the local hospital. In the six years since its inception, Wellbody Alliance has grown into a standing clinic with laboratory testing and a pharmacy on site and sees hundreds of patients per week. It continues to provide free, often at home care to patients physically affected by the recent civil war, as well as to those with HIV, TB, pregnant women, and more recently, those with mental illness.

Since first going to work with the clinic when I was in medical school, I have been interested in helping treat non-communicable chronic diseases. At that time, hypertension and diabetes were my focus. Now, as a psychiatry resident, I realize much of the work I was doing then can be transposed to helping the clinic deal with mental illness. The purpose of my trip this past year, my first time back to Sierra Leone since 2010, was to canvas the mental health needs of our patient population and figure out how to treat them in a sustainable manner.

This task was made difficult by the lack of understanding of the terms used to describe the illnesses, and by the fact that much of the time, mental illness is not even characterized as a treatable disease. There is minimal medication available in country, and in general, patients and their families will seek help far from the medical establishment, believing mental illness to be outside the realm of what is seen in the clinic. This is a belief held by the medical practitioners as well, and most are scared to treat patients with mental illness.

As a result, I spent much of my time educating our clinic staff and trying to come up with reasonable protocols to help them feel more comfortable diagnosing and treating the patients who do seek their help. I was also able to spend time with patients, and found it interesting to see how psychopathology can be so unique to a certain culture, yet some things remain the same across continents. The patients who I was able to convince to try medication came back to the clinic for follow-up with real improvement in their symptoms, which was incredibly gratifying. Thus far, they have continued to come to the clinic for treatment, though there have been times when the clinic does not have the necessary medications.

My goal in the coming year is to continue what I’ve started in Sierra Leone. To that end, I will be working with a research group at Harvard School of Public Health to better define the terms used to describe mental illness in the patients’ local language. I will use the results of that to write protocols for the clinic staff to use to evaluate and treat those who come to seek help from our clinic. I hope to procure some more medication in order to ensure that those patients who do present to the clinic are able to get the medications that will help them. Finally, I plan to go back this year, both to ensure that the work moves forward, and to continue to work on improving the treatment of the population of mentally ill individuals in Sierra Leone.