The Psychological, Social and Economic Impact of Depression

 November 6, 2017 Written by Ishmael Sallieu Koroma and Amélie van den Brink

In 2014 Ebola struck the three West African states of Guinea, Sierra Leone and Liberia and claimed over 14,000 lives. This calamity has left an indelible mark on the psychological, social and economic life of ordinary citizens. Psychologically, it has left many people, especially Ebola survivors, with Post Traumatic Stress Disorder (PTSD).

One of the main symptoms of PTSD is depression. Depression occurs when a person feels intense helplessness, worthlessness and sadness. The symptoms are usually feelings of debilitating fatigue, guilt, not being able to concentrate or sleeping well, having little or no interest in things that were once enjoyable (i.e. a hobby, eating, seeing friends, etc.), having recurring thoughts of death or suicide, as well as experiencing significant weight loss or weight gain. These feelings have a devastating impact on a person’s daily functioning. But even on a national level, the impact on a country’s economy is damaging – due to the total number of days, months and sometimes even years a person is not optimally productive, or often even completely unable to work. The crippling effects of depression can start at a very young age and continue into adulthood, and even into old age.

According to the World Health Organisation (WHO), depression is a significant contributor to the global burden of disease and affects people in all communities across the world. Today, depression is estimated to affect 350 million people worldwide. The World Mental Health Survey conducted in 2012 in seventeen countries found that on average about 1 in 20 people reported having an episode of depression in the previous year. The suicide rate was estimated at 804,000 globally. A recent World Health Assembly has called on WHO and its member states to take action to curb this scourge. These statistics are frightening, but we should remember that depression is a disease that can be treated. People have come out of this terrible disease and can resume normal lives.

These global statistics include Sierra Leone, a country whose population is estimated at seven million. Although the figures on suicide in Sierra Leone are non-existent, it is feared that the number of people suffering from depression as a result of the recent Ebola epidemic in 2014-2015 has made people, including the 4 million Ebola survivors. In Sierra Leone, around 5,115 persons are confirmed to have survived Ebola according to the National Ebola Response Centre. Many of these survivors are prone to taking their own lives for many reasons, including high levels of stigmatization and lack of access to psychosocial support.

Depression among survivors in particular is rampant and there is a weak mental health infrastructure that can help them. The WHO estimated in 2015 that there were about 450,000 Sierra Leoneans suffering from depression, although this number is an underestimate of the current situation because it does not take in to account the number of depressed in the aftermath of the Ebola tragedy. These numbers do however, show that the mental health status of the country is serious.

To date, the Kissy National Referral Psychiatric Hospital is the only Psychiatric Hospital in the country trying to respond to this silent epidemic. But even with a maximum 250 beds, the hospital is clearly unable to accommodate all patients in need of help. Compounding this is the lack of well-trained mental health experts. Sierra Leone currently has only one Mental Medical Health Consultant, Dr. Edward Nahim, who together with international partners like WHO, UNICEF and others, is training nurses to take up the daunting task as mental health counsellors.

The Government should be applauded for taking up the lead in its ongoing initiatives since the country was declared Ebola free. In June 2016, the Ministry of Social Welfare, Gender and Children’s Affairs and the United Nations Development Programme (UNDP) signed an annual work plan with a budget of US $1.4 million for the social rehabilitation and payment to Ebola survivors. The program has made strides in providing psychosocial counselling services and improving their livelihoods. These laudable efforts are still just a drop in the ocean.

In reality, many survivors have yet to benefit from the stipends or from the home care packages that were once promised to them in the aftermath. Human rights organizations and civil society groups believe the Government is dragging its feet in implementing the plan, and leaving survivors to fight their own battles. Many survivors echo this belief, saying that their voices have been side-lined. However, it is precisely their stories that can provide direction into how to better help them. Some of the survivors include people who worked in Ebola Treatment Centres, who selflessly put themselves in danger’s way to stem the disease.

One such survivor is Abbas Kamara, a 31 year old, living in the Goderich Community. He became infected with the virus while working at the Lakka Emergency Ebola Treatment Centre in the western part of Freetown.

He recounts:

“I was working in the Ebola Treatment Centre at Lakka, when I was diagnosed with the virus. I was tested initially as negative and the following week another diagnosis was done and it was positive. It was frustrating for me as I have already felt Ebola whilst I was looking after Ebola patient in the treatment centre and I have seen how Ebola survivors were dying. It was very frustrating for me as I have seen how devastated this dreadful disease ravaged the country.”

As a survivor, Abbas still suffers from what has now been termed, “Post Ebola Syndrome” (PES) which includes a host of symptoms, including in his case, having urinary problems. His problem is so significant that it has prevented him from  worshipping at the Mosque and spending carefree times with his friends.

“I sometimes become depressed and stressed,” he said as tears fill his eyes. He went further to say that when he thinks about his past life and how life was for him he becomes saddened by his present situation.

Matthew Junior Fofanah, 26, is another Ebola survivor living in the Mabella Community slum in Freetown. He said he contracted the disease in his community through contact with his brothers and sisters. He now lives with the complications of PES. Not only does he live in poor conditions, he now sits idle and frustrated on many days. He no longer has the strength to complete his daily routines due to his  debilitating pain in his back and joints. Most of all, he worries about his eyesight. On most days, he says he cannot work when it is sunny or hot. Furthermore, he says the government has not done anything to help him with his eyesight problem. Moreover, he is in a constant battle with his medical bills from trips made to the Eye Clinic based on the East End of Freetown. He said that even though he has been going to the Clinic he has not fully recovered and will need more treatments. He hopes to go overseas some day to have proper medical care.

 Another Ebola survivor is Adama Kamara, a 29 year old female who also resides in the Mabella Community. She lost all her family members, including her husband, to the deadly virus in 2014. Before she contracted the disease, Adama was a very busy and successful business woman. She took care of all her family affairs, including paying for her children’s school fees, house rent, among others. Like Junior Fofanah, Adama also does not have the strength that she once possessed before she was diagnosed. She says that since her discharge from Medicines Sans Frontieres Belgium’s Ebola Treatment Centre in Kingtom, she has suffered from multiple symptoms of the disease. Her eyes are constantly itchy and her muscles – especially in her legs – are always painful, making it impossible for her to walk long distances. Moreover, she said that economic hardships and difficulties have made her life unbearable. She can no longer find finances to cover her medical bills. Also, she says that since her discharge she has only received very minimal support from the Government in the form of a stipend. This stipend however, is not the same as was promised by the government in their so-called “National Ebola  Recovery  Strategy For Sierra Leone” which was supposed to cut across all sectors, including support for the most vulnerable and affected individuals—namely Ebola survivors, orphans, widows and widowers, construction of interim care centres and homes. Moreover, there was also a promise to reintegrate Ebola survivors and related health workers, including burial teams, back into their communities.

However, Adama said that with all these promises, she has only received a take home package of a foam mattress and a pillow. The promise she said has also yet to be materialize complaining that only a few of other Ebola Survivors have enjoyed the lion’s share because they have the political connections ,and good relations with the Ministry of Social Welfare and Children’s Affairs (MSWGCA).

Adama is one of many people suffering from PES across the country. Many of the survivors continue to suffer from eye problems, muscle aches and problems urinating. Most of them cannot afford to pay for necessary medical treatment. Some may need to travel overseas in order to receive appropriate care before they can fully recover. Almost all of the survivors interviewed said the government needs to be doing more, especially in terms of their health and living condition as most of them cannot afford to pay for their children’s school fees, housing and other basic necessities.

Much, if not all of the support, is being done by international NGOs. The Don Bosco Fambul International, a charitable Non-Governmental Organisation with offices in over 130 countries around the world helping children and vulnerable groups, for example has been helping Ebola Survivors by establishing an interim care centre in Lungi. Since 2014 they have helped to rehabilitate them and reintegrate them back to the society. In an interview with Assistant Director, Thomas Bojohn said that they have been helping the EVD survivors In all aspects—from educational support, food support to psychosocial support. “In our interim care centre we rehabilitated over fifty EVD survivors and we have given them a facelift to their lives and livelihood. On a monthly basis, we are giving them counselling services, health, psychosocial support and food. We have even assigned Social workers to check on them regularly. From 2015, to present we are still following up with them as we have a three -year plan for Ebola Survivors that will last until  March 2018 when we will phase out their programme,” said Mr. Bojohn.

After Don Bosco leaves, the question remains: who will check on Ebola survivors’ general wellbeing? Who will make sure that the millions of international funding that was promised to them will be administered? In the words of Mr. Bojohn, “We are worried now that the [post Ebola project]t is coming to an end. We are planning ways of creating a livelihood for them, such as micro finance, agriculture, among other initiatives.”

 In the face of many serious but costly needs, it is tempting to sweep such problems under the rug. But it is almost a foregone conclusion that if not much is done right now to help Ebola survivors, it will inevitably lead to many more problems in the future. In a country, where unemployment is rife, Ebola survivors are more vulnerable than other groups. They have been traumatized and continue to face many barriers, causing even more stress to their overall lives. Experts in the field of psychology and mental health studies have noted that there will be an increase in the number of mental illness, especially among Ebola survivors. They say that the government should prioritize the needs and aspirations of the Ebola survivors, continue to provide them with psychosocial and counselling services to help them cope, and help them reintegrate back into their societies.

While the future may be distant, the government must be willing to provide the necessary resources they had promised the survivors in its post Ebola Recovery Drive/Initiatives.  It has a huge role to play in making sure that the provision of basic social amenities, education about post-Ebola depression, and psychosocial support are implemented, reinforced and monitored.  If more is not done, the repercussions could be even more than damaging than the Ebola epidemic itself.

This article was co-produced by Ishmael Sallieu Koroma and Amélie van den Brink.

 Ishmael Sallieu Koroma is a print journalist, a social commentator in Sierra Leone, with over five years experience working in both print and broadcast media.

Amélie van den Brink is currently enrolled in a Research Masters degree in African Studies at Leiden University, the Netherlands, and is conducting research on disability advocacy in Sierra Leone. She is also an Art Psychotherapist and Consultant from the Netherlands. She obtained her Master’s degree from New York University in Art Therapy and has worked in both the public and private sectors of mental health as well as in education. She provides psychosocial support and training for children and their communities affected by natural and manmade disasters around the world. In private practice, she specializes in treating children and adolescents with special needs and incorporates evidence-based trauma interventions with at risk-youth.