Imagine living in a country recently emerging from a 14-year civil war that resulted in the deaths of 250,000 of its people and the displacement of an additional 1 million – with just one psychiatrist to care for 3.7 million survivors. Liberia saw the end of armed conflict in 2003 and has since experienced an influx of international support to develop sorely needed medical services. Elizabeth Levey, MD, and Oriana Vesga-Lopez, MD – both fourth year residents in the MGH McLean Adult Psychiatry Residency Program working with the Chester M. Pierce, MD Division of Global Psychiatry – have twice traveled to Liberia’s capital of Monrovia to help guide the development of mental health services in the war-torn country.
Their work began more than a year ago, as the two analyzed data from a community needs assessment conducted by David Henderson, MD, director of the MGH Division of Global Psychiatry, who serves as the pair’s mentor. Levey and Vesga-Lopez say mental health is an oft-overlooked component of global health, where communicable disease tends to be the primary focus. However, underlying mental illness can disrupt the care a patient receives for a communicable disease, so understanding culturally relevant ways of addressing mental illness can boost other health indicators as well. “We are trying to get a sense of how the population in Liberia experiences both well-being and distress,” says Vesga-Lopez.
Levey and Vesga-Lopez hope to qualitatively describe the perceptions of mental illness and mental health in the adolescent and university-aged adult populations. Through interviews that detail the physical, psychological and psychosocial problems and symptoms experienced by these groups, Levey and Vesga-Lopez also learned about the ways they recovered from illness and what that meant to them.
INTERNATIONAL OUTREACH:Levey, far left, and Vesga-Lopez, center
“Despite the amount of traumatic experiences they were exposed to, I was quite surprised to see how resilient the population has been and how they have been able to recover without any significant interventions in terms of mental health,” Vesga-Lopez says.
As part of their study, Levey looked at how 13- to 18-year-old Liberians deal with mental illness. Her preliminary findings show that a person’s sense of community – who they live with, what their daily life is like, who they turn to for support and their familial responsibilities – has a profound effect on their ability to cope with past traumatic experiences.
These findings also can shape the way that care is delivered here at the MGH and in surrounding communities. “We see so many people who live in very different worlds, very different environments, very different cultures from each other, and thinking about their interactions with their community, in addition to their medications, can prove very valuable,” says Levey.
Adds Vesga-Lopez, “I had this idea that, if you’re going to do work internationally, you’re bringing something to them. It was striking for me to see how much we could learn from a different culture. It goes both ways.”
Global Psychiatry hosts dinner series: The Chester M. Pierce, MD Division of Global Psychiatry will continue its Global Psychiatry Dinner series on April 22 at 6 pm in the Trustees Room with speaker Greg Fricchione, MD, associate chief of Psychiatry. These monthly events are open to all. For more information or to register, email email@example.com.
Read more articles from the 04/05/13 Hotline issue.