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Addressing Mental Health in Sierra Leone

Mental health in Sierra LeoneSierra Leone is a West African country bordered by the North Atlantic Ocean. It is an impoverished country with almost half of the working-age population involved in subsistence agriculture. Between 1991 and 2002, Sierra Leone was subject to a civil war that resulted in more than 50,000 deaths. Sierra Leone also experienced a harsh Ebola outbreak in 2014 that outclassed all others. Its citizens are still recovering from these events, which have resulted in years of physical and emotional pain. This has left hundreds of thousands of people plagued with mental health issues in Sierra Leone.

Mental Health in Sierra Leone

The World Health Organization approximates that 10 percent of Sierra Leone citizens are facing mental health problems. This number may be even higher when taking into account cases that have not been officially reported. “[D]aily hardships and misery can turn into what scientists call “toxic stress” and trigger or amplify mental health problems” as a result of living in extreme poverty. For a long time, there was a lack of political support for mental health in Sierra Leone.

Resources are a big problem when tackling the issue of mental health in Sierra Leone. There are only “two psychiatrists, two Clinical Psychologists and 19 Mental Health Nurses” in a country of seven million people. Furthermore, only four nurses are trained to work with children with mental health issues. Due to the absence of support, many citizens seek out help from the traditional healers available.

Many individuals and organizations are working together with the goal of improving mental health in Sierra Leone. Two organizations that have made significant efforts and progress in raising awareness or providing direct aid to mental health services are the Ministry of Health and Sanitation (MOHS) and the World Health Organization (WHO). Both WHO and MOHS have worked together on projects that have greatly improved support for mental health in Sierra Leone.

The Ministry of Health and Sanitation

Most of those infected or family to those infected during the Ebola virus disease (EVD) outbreak experienced trauma. Patients were often isolated from loved ones and surrounded by strangers. People had to cope with the death of family members and friends. Survivors of EVD beat the virus, but they still experienced toxic stress, depression, insomnia and anxiety. MOHS developed a plan for providing mental health services by improving community awareness, building demand for services and improving access to specialized healthcare workers at all levels of care.

The MOHS worked with the Advancing Partners program on a two-year project funded and managed by USAID’s Office of Population and Reproductive Health and implemented by JSI. In Sierra Leone specifically, MOHS’s framework is being used to aid Sierra Leone’s government with the implementation of health service in post-Ebola recovery. The program is improving mental health awareness in the community, training healthcare workers with the skills to provide high-quality care and reinforcing mental health governance.

So far, MOHS and Advancing Partners have created community healing dialogue (CHD) groups. The groups help communities by providing coping mechanisms, finding resources and offering support for those with psychosocial issues. These groups are placed in areas with a large amount of EVD survivors and trained mental health staff. The CHD groups have “reached almost 700 people in 40 communities across the six districts most affected by the Ebola outbreak (Bombali, Port Loko, Kailahun, Kenema, and Western Areas Rural and Urban).”

The World Health Organization

The World Health Organization is focused on training healthcare workers in Psychological First Aid and the identification of distress. WHO developed the mental health gap action programme (mhGAP) to train community health workers and medical doctors in Sierra Leone. This way, healthcare workers will be able to more easily identify mental disorders and discover treatment options. WHO wanted to create an approach that aims to support mid-level and higher level healthcare workers to provide better tailored services.

Sierra Leone was previously a country where mental health needs were not addressed. The country continues to be impoverished since a large part of its population is unemployed. It experienced devastating losses in its 11-year-long civil war and was further distressed by the severe Ebola outbreak in 2014. The country has a large amount of people still suffering from past issues. That suffering went untreated for a long time. However, organizations like the WHO and MOHS have made considerable progress in addressing the mental health in Sierra Leone.

– Jade Thompson
Photo: Flickr

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An App Joins the Fight Against Ebola in Congo

Ebola in the Democratic Republic of the CongoBoasting over 85 million people, Congo has struggled with political and social instability since the Belgian conquest in the early 20th century. To this day over 100 armed groups, including the Allied Democratic Forces, the Mai Mai and the Forces of the Liberation of Rwanda, are active in Congo. Against this backdrop of factionalism and violence quietly rages the second most deadly Ebola outbreak in history. Over 1,600 people have died. Despite these grim circumstances, a group of Congolese tech-savvy youth have developed an unlikely weapon against Ebola: an app they’ve called Lokole.

Fighting Ebola in Congo

Ebola is a virus that first causes fever, sore throat and muscle weakness and later progresses to vomiting, diarrhea as well as internal and external bleeding. Patients die due to dehydration and multiple organ failure. During the West African epidemic of 2014 to 2016, over 11,000 people died. During this epidemic, the investigational vaccine called rVSV-ZEBOV was used to fight the outbreak in Congo. However, it was used under the compassionate use clause because the vaccine had not been commercially licensed.

In addition, the Congolese Ministry of Health is seeking medical interventions through technological tools . Through collaboration with Internews and Kinshasa Digital, it organized a hackathon in March 2019, bringing 50 students in communications, medicine, journalism and computer science together. These students were sorted into teams of approximately seven.

Each team sought to answer the question: “How can Ebola response teams leverage new technologies to achieve their communication goals at the local, national and international level?” Thrown together for the first time, Emmanuel, Ursula, Aurore, Joel, David, Israël, and Maria worked for 24 hours. There, they came up with Lokole, the winning technology.

Introducing the Lokole App

Lokole is an Unstructured Supplementary Service Data (USSD) mobile application which “is designed to facilitate the real-time transmission of data and information between communities and the Ebola response teams,” despite poor internet connectivity in rural areas. This team of seven chose the name Lokole because a lokole is a traditional Congolese drum used to transmit messages over long distances. With this app, they hope to increase communication about the spread of Ebola in Congo.

USSD technology is a text-based communication system used by Global System for Mobile Communication (GSM) cellphones. Even though text-based communication might seem outdated with smartphones in the picture, smartphone use across Africa is at less than 35 percent. Plus, those with smartphones might not have access to data plans. As such, a real-time mobile to mobile communication platform based on USSD technology is inherently more inclusive, useful and cheaper.

The Lokole app allows community workers to note and document Ebola symptoms through questionnaires which are then relayed to Ebola response teams and the Ministry of Health. David Malaba, one of the app’s developers, says “Real-time management of information by the different components of the Ebola response will help detect and provide treatment to patients more quickly and deploy resources on the ground more swiftly, which will help lower Ebola mortality rates.”

While analog in comparison to smartphone technology, Lokole’s USSD platform offers the potential for real-time communication without having to invest in widespread expensive improvements in Congo’s internet connectivity infrastructure.

Changing the Future of Grassroots Healthcare

Since the virus’s discovery in 1976, Congo has had 10 documented Ebola outbreaks. Years of consistent violence has led to great mistrust of government and health authorities. Such widespread mistrust of health systems makes epidemics like Ebola even harder to combat.

However, Lokole empowers the everyday Congolese with the tools to fight Ebola. It is a democratic grassroots healthcare model. In fact, large-scale telemedicine platforms, such as BabylRwanda in Rwanda, are powered by similar USSD technology. This connects the average citizen with a nurse or physician in a matter of minutes.

The development of the Lokole app is exciting in its fight against Ebola in Congo, but the galvanization of local Congolese talent is a game-changer. Hackathons that bring disparate youth together to problem solve big and often overwhelming issues inspire others to pursue change. Lokole is just the beginning.

– Sarah Boyer
Photo: Flickr

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Causes of Poverty in Guinea

Causes of Poverty in Guinea

Guinea is a West African country known for its rich reserves of iron ore, gold, bauxite and other minerals. Despite the wealth these resources generate, Guinea is one of the poorest countries in the world.

Guinea has the highest per capita income on the continent of Africa, yet more than half of the population lives below the poverty line, with around 20 percent in extreme poverty. So where does this huge disparity come from?

The poverty statistics in Guinea are staggering, especially in rural areas. 55 percent of people live below the poverty line, and unemployment rates are very high. Hunger also poses a serious threat, with 17.5 percent of the population experiencing food insecurity, 230,000 children suffering from moderate acute malnutrition and 25.9 percent of the population experiencing chronic malnutrition.

Bearing all that in mind, what are the causes of poverty in Guinea?

Disparities Between Rural and Urban Areas
There is a significantly higher occurrence of poverty in rural areas compared to urban areas. Many Guineans rely on agriculture and do not receive help from any national safety net program; therefore, when frequent floods and natural disasters hit, rural areas are especially devastated. Approximately 63 percent of the rural population is poor, and a huge discrepancy exists between the availability of services like healthcare and education between rural and urban areas.

Influx of Refugees
Another factor contributing to the poverty in Guinea is the significant influx of refugees from Liberia and Sierra Leone into Guinea due to political instability in those countries. These refugees put a strain on the already struggling economy and contribute to political instability that deters investors from helping Guinea.

Insecurity Due to Ebola
Another one of the causes of poverty in Guinea was the 2014 outbreak of Ebola that ravaged Guinea and neighboring countries. The Ebola outbreak continues to have an economic impact, as certain trading restrictions curb economic activities. Ebola has affected almost a million people in Guinea, and many communities require rebuilding that will require a lot of time and money.

Domestic Corruption
Rampant corruption among government officials helps explain why such a rich country has such high poverty rates. Senior government officials have accumulated huge personal fortunes from the oil boom. A money laundering investigation revealed systemic corruption in the government. The government invests heavily in sketchy infrastructure projects that have inflated prices and little social value, at the cost of the well-being of their citizens. To put it into perspective, the government of Guinea spends US$80 out of every US$100 in its budget on construction projects, but only dedicates US$2-3 to health and education. Thus, the citizens continue to suffer from illiteracy and poor health and have no way to escape poverty.

Despite the concerning causes of poverty in Guinea, some aid is coming to the poor. For example, the World Food Programme has a number of programs dedicated to assisting those in Guinea. The World Food Programme is helping by providing emergency support for communities affected by Ebola, food assistance and nutrition, resilience building, school meals and support for local farmers. Although the plight of the poor in Guinea is concerning, efforts by organizations like the World Food Programme can alleviate some of the suffering.

– Lauren McBride

Photo: Flickr

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Recovering Education in Sierra Leone After Ebola

Education in Sierra Leone

As of this year, Sierra Leone is an Ebola-free country. However, thousands of lives were lost during the epidemic, and while it may be over, the effects of the disease are still crippling the country, especially economically.

During the epidemic, schools were shut down to prevent further spread of the disease. These closures stalled the learning of almost 1.8 million children. For nine months, the youth of Sierra Leone were not only living in fear of Ebola but also of falling behind in their studies.

With the loss of “181 teachers and 945 students,” according to UNICEF, it was difficult for Sierra Leone to reopen schools again in 2015. Education in Sierra Leone had been on the rise since the end of the country’s civil war in 2002. The Ebola epidemic cracked that stable foundation and led to “an accelerated curriculum to shorten the duration of academic years” to make up for what school-aged children had missed.

Due to the increase of poverty in Sierra Leone, education has been put on the back burner for many families. Many children are now reliant on other family members to care for them, which means they are now less likely to finish their education.

Beginning in 2015, the charity Street Child has been working hard to recover education in Sierra Leone. They have found that 12,000 children no longer have an adult to support them because of Ebola. The CEO of Street Child, Tom Dannatt, said, “…unless we help families out of poverty, their children remain out of school. It is likely that their life prospects will be bleak as a result.”

Street Child runs a program called Livelihoods Programme, which supports the businesses of poor families that cannot afford school for the children they’re responsible for. The program provides grants to start small businesses. Training programs are also available along with these grants.

Another organization, Dubai Cares, started Education in Emergencies: Evidence for Action (3EA), a program focused specifically on recovering education in Sierra Leone. The goal of the program is to “improve teaching methodologies, ways to monitor and mentor staff, and reinforcing teaching styles that improve classroom performance.” 3EA encourages a positive learning environment and fitting the lessons to accommodate each student.

The Livelihoods Programme and Education in Emergencies: Evidence for Action have so far proven to be successful approaches to improving the education system in Sierra Leone. Both have allowed a greater number of children to go back to school, despite the country’s serious poverty. The future generation of Sierra Leone is not going to remain a victim of the Ebola epidemic, thanks to help from charitable organizations and knowledgeable people.

– Mackenzie Fielder

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New Ebola Vaccine Heads to the Congo

Ebola Vaccine
On Monday, May 29 the government of the Democratic Republic of the Congo approved the use of a new Ebola vaccine to address the current outbreak in the northeastern region of the country. According to Reuters, a Medecins Sans Frontieres (Doctors Without Borders) team arrived the same day to validate the protocol with technical teams. Since the beginning of the outbreak in April, the Congo has seen around 19 cases of the Ebola virus, including suspected and probable cases. There have been four deaths reported since the beginning of the outbreak.

The vaccine, rVSV-ZEBOV, has been in development since the 1990s. NPR notes that in the 2000s the Ebola vaccine was not produced due to a lack of funding. It was first tested in Guinea in 2015 in collaboration with the World Health Organization (WHO), Guinea’s Ministry of Health, Medecins Sans Frontieres and the Norwegian Institute of Public Health. In the trial, the vaccine completely protected all 5,837 people it was administered to, with some participants feeling side effects of the vaccine. According to the WHO, “no Ebola cases were recorded 10 or more days after vaccination.” The efficacy of the Ebola vaccine is approximately 70 to 100 percent, although this will likely decrease as more people are vaccinated.

Despite the trial conducted by WHO, the vaccine has not yet been approved by the WHO or the Federal Drug Administration. According to NPR, this approval will likely happen in 2018. Development of the vaccine was largely made possible by funding from the WHO and the Global Alliance for Vaccines and Immunization (GAVI). GAVI provided $5 million in funding to allow for the production of the vaccine by the pharmaceutical company Merck. There are currently 300,000 doses available. Merck will submit the Ebola vaccine for approval by the WHO by the end of 2017.

The efficacy of the Ebola vaccine is so high that it will likely be effective at halting the outbreak in the Congo, thanks to the combined efforts of multiple parties like GAVI and the WHO. The development of rVSV-ZEBOV is a much-needed game-changer in the continued battle against the Ebola virus.

– Anika Lanser

Photo: Flickr

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Progress Toward Eradicating Ebola


Eradicating Ebola is the global community’s next step in ensuring worldwide health. The disease is rare but extremely contagious, and causes internal and external bleeding as well as a severe fever. As soon as the virus enters the body, it weakens the immune system by attacking immune cells. In time, it causes blood vessels to carry less blood, which results in organ failure and eventual death.

Also known as Ebola hemorrhagic fever or Ebola virus, the disease is spread through direct contact with bodily fluids or objects that have been contaminated by bodily fluids, such as medical needles. It can also be contracted through contact with infected animals, specifically bats and primates.

There have been a number of Ebola cases internationally but the disease has mainly remained in regions of West Africa. The disease originated in 1976 in the Democratic Republic of the Congo, but it was Guinea, Liberia, and Sierra Leone that witnessed the largest Ebola epidemic in 2014 through 2016. An estimated 28,616 people contracted the disease and this resulted in 11,310 deaths.

Fortunately, the presence of Ebola has been contained since the outbreak. In 2015, researchers from the World Health Organization began testing a vaccine in Guinea, which returned with a 100 percent success rate. This vaccine was developed through a “ring vaccination” approach. The approach separated patients and their immediate contacts from the general public.

The vaccination report was released in December 2016. As Marie-Paule Kieny, lead author of the report, states: “While these compelling results come too late for those who lost their lives during West Africa’s Ebola epidemic, they show that when the next Ebola outbreak hits, we will not be defenseless.” Although the vaccine demonstrates progress in eradicating Ebola, it is in need of additional safety research before it can be formally licensed.

Another development in eliminating Ebola comes from a group of Canadian researchers. The group administered a drug known as Interferon Beta-1a to patients infected with Ebola. The drug, which is used to treat hepatitis B and C, had surprisingly effective results. “After 21 days, 67 percent of the Interferon-treated Ebola patients were still alive, compared to just 19 percent of the others,” reports Tom Blackwell from The National Post.

Although more research must be conducted regarding Interferon Beta-1a, findings look promising. The vaccine also demonstrates significant progress in eradicating Ebola, a disease that is now destined to become an element of the past.

– Gigi DeLorenzo

Photo: Flickr

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Top Three Diseases in Guinea

Diseases in Guinea
Although experts thought Ebola had been eliminated in Guinea, there have been fears of the disease coming back after a few cases were documented in the past two years. People are still skeptical after the largest Ebola outbreak in March 2014 even though experts have claimed that the outbreak ended at the end of 2015. However, with the country still lacking in health resources, diseases in Guinea, which could otherwise be preventable and treatable in another developed nation, are rapidly distributed. Here are the top three diseases in Guinea.

  1. Malaria. According to the Center for Diseases Control, 10 percent of deaths in Guinea are caused by malaria. In 2015, tens of thousands of malaria cases went untreated. Because of the ebola outbreak, people avoided health clinics for fear of being sent to an isolated Ebola treatment center. People might have died from malaria more than Ebola, and the entire population is at risk for malaria. To try to control this disease, the President’s Malaria Initiative distributes insecticide-treated nets (ITNS), supports malaria diagnostics as well as treatments at health facilities.
  2. HIV/AIDS. AIDS plagues so many parts of Africa, and Guinea is no exception. Four percent of deaths are caused by HIV or AIDS, and almost 7,000 children are living with HIV. AIDS has been considered a death sentence since only 27 percent are receiving antiretroviral medication. Hopefully, treatment will come to more people. The countries of Ethiopia, Ghana, Malawi, Namibia and Tanzania have been receiving antiretroviral treatment programs from the Global Fund since 2010.
  3. Lower Respiratory Infections. Currently, lower respiratory tract infections are the leading cause of death among children under the age of five. Forty-two percent of these deaths occur in Africa, and the infections can cause pneumonia, influenza and bronchitis.

Guinea has one of the poorest populations in West Africa. Little of its people have access to good healthcare. Diseases in Guinea can be curable and treatable if organizations continue to provide healthcare to treat these diseases.

– Emma Majewski

Photo: Flickr

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The Coalition for Epidemic Preparedness Innovations

Preparedness Innovations
When the Ebola virus broke out in 2014, the world was ill-prepared to respond. In all, there were more than 15,000 confirmed cases and 11,000 deaths. Although the outbreak was concentrated in West Africa, a handful of cases reached the United States and Europe. With the rise of globalization and intercontinental travel, the next epidemic could easily become a pandemic.

To combat this danger, a multinational coalition is needed. The formation of such a group — the Coalition for Epidemic Preparedness Innovations (CEPI) — was announced at the World Economic Forum in Davos earlier this year.

The Coalition for Epidemic Preparedness Innovations is backed by the governments of Norway, India, Japan and Germany. These countries are partnering with the Bill and Melinda Gates Foundation and the Wellcome Trust to invest in vaccines to prevent diseases that have the potential to cause the next great epidemic.

Given the cost-efficiency of immunization programs, the development of vaccines is an effective component of epidemic preparation. With an initial fund of $460 million, CEPI will be well worth the investment. Guinea, Liberia and Sierra Lione lost approximately $1.6 billion in GDP in 2015 alone. A worldwide pandemic would be drastically more costly; the World Bank estimates a flu pandemic would cost $3 trillion globally.

The Coalition for Epidemic Preparedness Innovations will initially focus on three viruses: MERS-CoV, Lassa and Nipah. These viruses are among the diseases identified by the World Health Organization that warrant prioritization. For each virus, CEPI hopes to develop at least two vaccines. This head start is critical, as vaccine development is a long, arduous process. On average, a vaccine takes about 10 years to reach the market, and epidemics take far less time to spread.

Although CEPI is a major step in the right direction, a more comprehensive strategy is necessary to control a potential pandemic. As shown by the Ebola outbreak, a global surveillance system is needed. In addition, vaccines cannot prevent all cases of disease; treatment development is also needed. The current members of CEPI have demonstrated admirable initiative in showing the world that everyone is a stakeholder concerning global health.

– Rebecca Yu

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Jim Yong Kim Re-elected as World Bank Group President

World Bank Group President
On September 24, 2016, it was announced that World Bank Group’s President Jim Yong Kim had been selected for a second term. Starting July 2017, Kim will continue leading The World Bank’s ongoing efforts to alleviate global poverty.

Founded in 1944, The World Bank began as an institution facilitating post-war reconstruction and development. At that time, The World Bank took on infrastructure projects to physically rebuild communities. Today, however, the organization has expanded its work to include myriad social projects.

Now, the multifaceted institution is comprised of economists, experts in public policy, social scientists and sector experts and has a portfolio of projects in agriculture, health, education and other areas of the social sector. Although reconstruction is still a focus, the group’s overlying goal is to reduce global poverty through sustainable and inclusive global prosperity.

When Jim Yong Kim, a South Korean-American physician and anthropologist, was originally elected to the presidency in 2012, The World Bank had set two bold goals: to eradicate global poverty by 2030 and to promote shared prosperity by boosting the income growth of the bottom 40 percent of the population in every developing country.

During his first term, Kim brought more structure, accountability and focus to The World Bank with clearer policies and targets, and efforts to meet those targets have been successful. Some of his greatest accomplishments came from dispersing the bank’s power and reallocating large amounts of its resources to combating climate change, addressing the Syrian refugee crisis and undertaking other initiatives that have not traditionally been within The World Bank’s scope.

He also gained much praise for his leadership in the Ebola outbreak, during which he allocated $400 million to combat the deadly virus in West Africa. Additionally, he implored the rest of the international community to invest in containing Ebola, even criticizing the World Health Organization (WHO) for its lax response.

The World Bank Group president also made a number of allies during his term, according to Africa News. When he voiced his intention to run for a second term, he gained endorsements from many countries, including South Korea, the Netherlands, Kenya, Rwanda, Togo and others.

Recognized worldwide for his invaluable experience and accomplishments prior to his election in 2012, Kim worked as an advisor to the director-general of WHO. He later rose to the position of director in WHO’s renowned HIV/AIDS department.

As he finishes his first term and looks forward to his second, one of Kim’s main focuses is making more progress toward the goal of eradicating global poverty by 2030.

-Alex Fidler

Photo: Flickr

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Diagnostic Methods Build the Foundation of Outbreak Control

Diagnostic Methods Build the Foundation of Outbreak Control
Disease outbreaks are frequently portrayed by the news and other media as two-step occurrences: disease strikes, then people die. What’s left untold are the in-between moments that are crucial to outbreak investigation and disease outbreak control. Disease testing, the essential step of the diagnostic process, is one of the most useful tools in stabilizing disease outbreaks and preventing them from worsening.

The case of Ebola in Liberia provides an example of how breakthrough disease-testing methods can save thousands of lives. Jude Senguku, one of the leading physicians who treated Ebola patients in Liberia, told BBC that misinformation, panic and misdiagnosis kept people from seeking help at the onset of symptoms.

People knew very little about the deadly disease and feared being sent to Ebola isolation units. Public health workers needed better diagnostic methods to screen people for Ebola in order to obtain medical evidence that would support or invalidate a diagnosis.

For Monrovia’s Redemption Hospital, the solution came in the form of GeneXpert, a machine that rapidly tests for Ebola and provides results within 90 minutes.

At the beginning of the Ebola outbreak in 2014, there were 50 licensed doctors for a population of 4.3 million. To provide each symptomatic person a one-on-one doctor visit was both unfeasible and impractical. During and after the outbreak, GeneXpert allowed health care workers, including volunteers with limited medical training, to accurately test patients for the presence of the Ebola virus and direct them to care in time to receive life-saving treatment.

Senguku says that since 2014, GeneXpert was “very critical” in reducing Ebola scares and restoring Monrovia’s confidence in their doctors.

The technology uses a process called DNA amplification, which tests a human specimen — cheek cells, saliva, etc. — for the disease’s specific DNA sequence. In contrast to other diagnostic methods, the technology can identify extremely low amounts of viral DNA as well as drug-resistant strains, which makes it incredibly sensitive and accurate. The machine, which is used for multiple tests, costs about $17,000. The test cartridge, which is used in every test per person, costs a mere $10.

One of the technology’s most valuable features is its usability. The health care worker administering the test does not need to be trained to identify a specific disease. Rather, they simply need to know how to operate the machine. Moreover, because of its low dependence on electricity, GeneXpert is an ideal diagnostic tool for regions with limited access to power.

The diagnostic process plays a critical role in outbreak control, stabilizing population health and providing a sense of security to an affected community. Events like the Ebola outbreak of 2014 serve as examples of how improved diagnostic methods are helping health care workers deliver faster and more efficient care under strenuous circumstances.

– Jessica Levitan

Photo: Flickr

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