After losing both her parents to Ebola, Liberian nurse Salome Karwah recovered from the virus herself. Protected by her new immunity, she returned to work to care for countless other victims. Time Magazine recognized her as a 2014 Person of the Year for her compassion and tirelessness. In February of this year, Nurse Karwah was rushed to the hospital with seizures following a cesarean delivery of her son. Her garish symptoms frightened the hospital staff that knew she had survived Ebola. They would not touch her. They let her die without treatment.
That is what stigma looks like.
Even after being declared free of Ebola, many survivors found themselves alone, as the International Federation of Red Cross and Red Crescent Societies reported. A chilling new normal replaced the terror and death in the isolation wards: rejection by family, friends, and neighbors, even by their places of worship. Employers fired them. Customers abandoned them. There was no carrying on with the lives they knew before Ebola. There was only more loss.
Ebola’s yield of mass casualties devastated the natural coping abilities of many who were left to carry on. Whole communities struggled. After watching loved ones suffer severe headaches and pain, hemorrhagic bleeding, diarrhea, vomiting, and fever, and taken away to hospitals, never to be seen again, their nightmarish memories have outlived the epidemic.
For those who kept their hearts open, there have been orphaned children to raise and bereaved husbands, daughters, siblings, and friends to heal. Heroes have emerged.
Ebola by no means is the only disease to tear apart the social fabric. Young mothers of Zika-affected babies have faced desertion by their husbands. People with HIV have faced cruel ostracism and discrimination. Chinese businesses were unnecessarily boycotted during SARS. TB, plague, and leprosy, all have leaked psychosocial sequelae throughout human history—pulsing terror, depression, anxiety, post-traumatic stress, and heart-crushing abandonment and isolation.
There is very little data available about how best to serve individuals and communities that have survived Ebola or other large-scale epidemics. But there is shocking evidence from the World Health Organization on depressive illness overall. According to the latest estimates from WHO, depression is the leading cause of ill health and disability worldwide with more than 300 million people affected, and the numbers are rising. WHO’s “Depression: Let’s Talk” campaign calls on countries to strengthen their approaches to mental health, and to treat it with the “urgency that it deserves.”
Mental illness has inextricable links to poverty and communicable diseases such as AIDS, tuberculosis, and malaria, yet little attention has been paid to mental health services in resource-constrained countries. The health systems of Ebola-affected West Africa were already makeshift and lacking mental health services. At one point, Liberia and Sierra Leone each had only one practicing psychiatrist and a bare smattering of trained mental health nurses and paraprofessionals to diagnose and treat mental disorders.
Psychosocial response mechanisms support resiliency in people and their nations, in both times of crisis and stability, helping people move forward together. As countries and the global community engage in preparedness planning for health emergencies, mental health must not be a sidebar, but a primary focus.
Many people with mental illness do not seek help. They and their loved ones suffer the effects of psychosis, depression, and alcohol and drug use, or the PTSD of Ebola without the support of qualified professionals. Integrating psychosocial services as a mainstay of health systems and continuum of care will raise awareness of mental illness, reduce stigma for people with mental disorders, and improve detection and treatment. Everyone will be stronger for it.
Since the emergency ended in West Africa, local, national, and international governments and partners have been seeking ways to provide comprehensive mental health strategies to people and communities that survived Ebola. In 2015, for example, The Carter Center kicked off its initiative, “Supporting Psychosocial Health and Resilience in Liberia,” which is funded by Japan through the Japanese Social Development Fund, administered by the World Bank. The International Medical Corps continues to support Ebola recovery and provide guidance on strengthening mental health capacity.
With the help of local NGOs and health officials, Ebola survivors themselves have formed support groups to buoy one another and to hold healing dialogues with communities. They reach out in an attempt to banish fear and rebuild understanding, connection. The circle of healing may be infinitesimally widening, but grief and loss, dread and shame, anger and trauma reverberate. Nurse Karwah died from the blows of neglect, by people not yet healed.
By Ashley Arabasadi and Jo Ellen Warner