Psycho Social support for Ebola victims

by IsraAID
Psycho Social support for Ebola victims
Psycho Social support for Ebola victims
Psycho Social support for Ebola victims
Psycho Social support for Ebola victims
Psycho Social support for Ebola victims
Psycho Social support for Ebola victims
Psycho Social support for Ebola victims
Psycho Social support for Ebola victims
Psycho Social support for Ebola victims
Psycho Social support for Ebola victims
Psycho Social support for Ebola victims
Psycho Social support for Ebola victims
Psycho Social support for Ebola victims
Psycho Social support for Ebola victims
Psycho Social support for Ebola victims
Psycho Social support for Ebola victims
Psycho Social support for Ebola victims
Psycho Social support for Ebola victims
Psycho Social support for Ebola victims
Psycho Social support for Ebola victims
Community Event
Community Event

In spring 2014, the Ebola Virus Disease Epidemic (EVD) spread across West Africa into Sierra Leone. It killed over 3,500 individuals in Sierra Leone alone, and left about 3,500 survivors in its wake. Early emergent health consequences for survivors include joint pain, depression, anxiety, neurological symptoms, chronic pain, and ophthalmological issues. Throughout the epidemic and in its aftermath, survivors have been exposed to a multitude of risk factors that are known to trigger common mental health disorders such as trauma, post traumatic stress disorder (PTSD), anxiety and depression. These include exposure to life-threatening disease, bereavement, financial loss, lack of services, stigmatization, and isolation from support systems. In addition to the impact on survivors, children were left orphans, families lost breadwinners, and countless others were traumatized by their experiences, treating, collecting, and disposing of individuals and bodies. Survivors and frontline workers including medical professionals, burial teams, cemetery workers, and many others continue to face high levels of stigmatization within their communities.

Amidst the Ebola Virus Disease (EVD) outbreak, IsraAID’s mission in Sierra Leone launched in September 2014, when a preliminary needs assessment highlighted the gaps in mental health response being provided. Given their expertise in trauma and psychosocial support, IsraAID has subsequently offered a range of programming striving to mitigate the implications of EVD on stress, trauma, and social stigmatization and marginalization on survivors, frontline workers, and other communities impacted by the EVD epidemic. 

IsraAID has subsequently undertaken a range of projects working with international NGOs, local NGOs, and International Organizations. Since it’s launch IsraAID Sierra Leone has undertaken over a dozen projects. IsraAID’s efforts in Sierra Leone have and continue to respond to the emerging mental health and psychosocial needs of the Sierra Leonean people. To this end, during the third quarter of 2016, IsraAID implemented the ‘Ebola Heroes’ project recognize and share inspiring stories of different frontline workers and community members that were infected or affected by the EVD epidemic.

 Program Summary

The ‘Ebola Heroes’ project was undertaken over a four-month period.  In Kambia implementation was ten weeks while in Kailahun it was compressed into six weeks.

The Ebola Heroes project aimed to 1) support those impacted by EVD, 2) recognize and collect inspiring stories of survivors, frontline workers and community members 3) facilitate community dialogues on stigmatization and community rebuilding.  Through this multipronged approach the project strove to promote the resilience of participants, mitigate communal stigmatization and help memorialize stories of those who were crucial to curbing the spread of EVD. This goal was tackled through a multifaceted approach i) peer support sessions were provided in both the Kailahun and Kambia districts, trained social workers offered selected groups emotional support ii) over 245 interviews were collected from across the Kambia and Kailahun districts iii) community sensitizing events were held in each district capital bringing over 300 people a piece to discuss and reflect on EVD and stigma.

In its needs assessment, IsraAID identified four target groups for providing the peer narrative therapy support across Kambia and Kailahun town. These groups were identified based on the advice of a range of community stakeholders. These groups were as follows:

  • 40 high school students between the ages of 15 and 22 years;
  • 20 petty traders between the ages of 35 and 45 years;
  • 28 Ebola survivors and vulnerable youth engaged in farming, masonry, welding, etc. between the ages of 15 and 40 years; and
  • 25 caregivers between the ages of 31 and 43 years who are currently responsible for supporting orphans.

The Ebola Heroes project had three main components – 1) the collection of testimonies from over 245 EVD survivors and frontline workers to honour and memorialize their work; 2) the implementation of peer support groups in Kambia and Kailahun districts of Sierra Leone, 3) two community events held in each which featured the FreeTong Player theater troop.

The organization of the peer support groups was based on ‘narrative therapy practice’, which allows individuals to build resilience through sharing their stories and learning from the experiences of others. This model focused on the possibility of conversation and collaboration. To this end, the weekly modules included:

  1. Sharing traumatic experiences and practicing externalization: sharing stories to build trust and practice distancing one’s self from one’s pain.
  2. Building trust: establish ground rules for a safe space and undertake community trust building efforts.
  3. Tree of life: what roots us and how do we grow? reflection on past, present and future.
  4. Ebola and the community: reflection on stigma and methods to respond and re-integrate into communities.
  5. Anger management: how are we responding to our pain and what might be best practices and tools for responding better to it?
  6. Dream affirmation: developing goals and action plans to achieve them. Focusing on believing in a future that is better.
  7. Inner strength and resilience: boost confidence through promoting self recognition of resilience and inner strength. Reflection on personal capacity to overcome adversity.
  8. My purpose and toolbox: reflection on personal growth, tools developed and ways for integrating lessons to promote personal health.
  9. Sustainability measures were incorporated in the design of the project from its commencement to ensure that the project could have longevity. Beneficiaries were selected and grouped by common characteristics / attributes that would provide a reason for them to continue meeting even after the project had ended. For instance, the caregivers group in Kailahun district comprised of members of the Child Welfare Committee (CWC), that meet regularly at the Ministry of Social Welfare office in Kailahun town. Similarly, other target groups in Kambia were convened under the auspices of an umbrella organization – Community Association for the Welfare of Children (CAWEC) in Kambia. The Ebola Heroes project identified beneficiaries with the assistance of the CWC and CAWEC, so that the members of these organizations are now equipped with better skills and tools to continue supporting each other through peer groups.

Sustainability measures were incorporated in the design of the project from its commencement to ensure that the project could have longevity. Beneficiaries were selected and grouped by common characteristics / attributes that would provide a reason for them to continue meeting even after the project had ended. For instance, the caregivers group in Kailahun district comprised of members of the Child Welfare Committee (CWC), that meet regularly at the Ministry of Social Welfare office in Kailahun town. Similarly, other target groups in Kambia were convened under the auspices of an umbrella organization – Community Association for the Welfare of Children (CAWEC) in Kambia. The Ebola Heroes project identified beneficiaries with the assistance of the CWC and CAWEC, so that the members of these organizations are now equipped with better skills and tools to continue supporting each other through peer groups. 

A new survey instrument tool was piloted to begin to examine, and eventually quantify, the relationship between the participant's experience with group narrative therapy and an increased sense of empowerment.

 

This is a One Group Pre-Post Test Design. The instrument adopted used Linkert-based scales to measure changes in:

 

  1. Personal Agency: Optimistic self-belief to cope with difficult demands in life; i.e. the belief that one's actions are responsible for successful outcomes (perceived); and
  2. Mastery of Environment: One’s personal ability to choose or create contexts suitable to one’s personal needs and values.

 

The scales correspond to the main objectives of group narrative therapy – inner strength and resiliency, the recovery of personal agency, and are based on the individual’s perception of self.

The three main positive outcomes of the Ebola heroes project were:

  1. Reduction of Stigmatization:Engaging in peer group sessions helped the participants build their inner strength and resilience to overcome the stigma they faced in their communities. The community event, which was the culmination of the project served as an eye opener for community members to end stigmatization against survivors and frontline workers.

 

  1. Awareness and Education: Most participants learned a lot through the messages delivered during the various activities. For example, the ‘red and black’ game taught them to practice cooperation within the community and how it could help build efficiency.

 

The Freetong Players’ act during the community event highlighted some of the humiliation that frontline workers and survivors were faced with during the Ebola crisis. This sent a message to community members that survivors and frontline workers should not be condemned, but recognized for their roles and reintegrated into their community.

 

  1. Restore Hope and Confidence: As a result of the EVD epidemic, and the consequent stigmatization, many participants were suffering from low self-esteem and feelings of inferiority. The facilitators were able to restore hope and raise confidence levels amongst the participants, especially through the sharing of stories and personal accounts.

Quotes From M&E Tools

Question: Could Ebola Heroes have provided you with additional support during session what do you think would have been the most helpful?

  • “The peer group helped us to understand ourselves even better.’’
  • “Teenage pregnancy is one of topics that I had learnt more about on how to sensitize my peer group in school and in my community.’’

Question: What did you like best about the peer group? What about the peer group would you change?

  • “I like the tree of life exercise.”
  • “In the peer group session we had a lot of interaction and the tree of life taught us about our family background.”

Question: Is there anything else you would like to share with us about your experience participating in this peer group?

  • “My experience participating in this peer group session is concerning the tree of life. It helped me to know more about my root which talks of where I originated from, ground, fruit, leaves, trunk etc.’’
  • “I would also like for this group to continue because it serves as a way of helping me to forget about my problems whenever I am among my colleagues.’’
  • “At first, I thought this program was a waste of time but now I realize that I can now quickly think of ways to solve difficult situations that I undergo daily because we are not the cause of the problem but rather we are the solutions.”
  • “I have learnt a lot of strategies on how to handle conflict during the sessions, for example I now know that it is better to work together rather than fighting each other to succeed.”   

Thank you to all the donors who helped make 'Ebola Heroes' such a success. 

Community Group
Community Group
Community Outreach Event
Community Outreach Event
Community Theater
Community Theater
Personal Interview
Personal Interview
School Girls Theraputic Group
School Girls Theraputic Group
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Ebola Heroes Community Event
Ebola Heroes Community Event

IsraAID’s mission in Sierra Leone started in September 2014 amidst the Ebola Virus Disease (EVD) outbreak, where a preliminary needs assessment highlighted the gaps in the mental health and psychosocial support response being provided. Given our expertise in trauma and psychosocial support, IsraAID has subsequently offered a range of programming striving to mitigate the implications of EVD on stress, trauma, social stigmatization and marginalization on survivors, frontline workers, and other communities impacted by the EVD epidemic. 

Through the provision of these projects, IsraAID SL recognized the need to support and empower frontline workers including medical personnel, burial teams, survivors, and a myriad of other individuals who were integral in curbing the spread of Ebola.  One therapeutic program launched was Ebola Heroes, which had a multilayered approach, striving to 1) collect narratives of those involved in the EVD response, 2) offer support to individuals who continue to face stigmatization, isolation, and other impacts from the response 3) provide community events to combat stigmatization and celebrate the strength of Sierra Leones communities.

The ultimate goal of the Ebola Heroes project is to mitigate the psychosocial impact of Ebola Virus Disease on affected populations, emphasizing survivors and service providers.

In this phase of the project, IsraAID SL is focusing on strengthening the local existing mental health and psychosocial support (MHPSS) structures through capacity-building at the community level, by developing peer-based support networks. IsraAID SL is working to rebuild and strengthen the capacity of the communities themselves rather than creating dependency on support from the outside. The main outcomes achieved thus far are: 

  • Development of eight peer support groups that have met for a total of 16 sessions and were structured to promote sustainability and continuation after the cessation of involvement by the facilitating field officers.
  • To date we have an archive of over 400 oral testimonies and portrait photography of survivors, burial team members, hotline operators, nurses, doctors, and citizens who volunteered to share their experiences. These testimonies are the foundation of the Ebola Museum and Education Center being constructed on the campus of Njala University in Moyamba district.
  • Organization of a community events including dramatization of experiences, music and contributions from participants of the peer support groups have been held in each community, Kailahun and Kambia.

After completing the first phase of the program in Sierra Leone's Western Area, IsraAID has expanded the project into the eastern and northern provinces respectively. On April 24th, 2016, Ebola Heroes initiated this phase in Kailahun and Kambia Districts. IsraAID’s field officers have been meeting with four peer support groups in Kambia Town and three in the Kailahun Town.

These groups are composed of high school students, caregivers for orphans, Ebola survivors, and community volunteers. Each group is composed of 20 participants meeting for two hours each gathering. During each session the field officer’s facilitated the group, guiding them through psychosocial activities and discussions using narrative practice technique.

 In mid-May we hosted our first community event in Kailahun in partnership with the Ministry of Social Welfare and the theater troupe Freetong Players International. The event included a dramatization of people's stories of heroism in the face of the epidemic, distribution of educational material regarding the effect of stigmatization on the community and had over 500 people in attendance. Through this event, the community had the opportunity to share their experiences during the epidemic and reflect on lingering stigmatization and fears.

Margaret's Story

In our Ebola survivors group in Kailahun, we heard Margaret’s story. Margaret, a 32-year-old woman, is originally from the village of Koindu in the east of Kailahun District. She lost six members of her family to EVD including her mother, elder sister, her two children and two nieces and nephews. It was her sister who first contracted the virus and later infected their mother, then the children of the house and finally Margaret herself. After surviving the disease and enduring the loss of her family, Margaret moved to Kailahun township because the memories of her family in Koindu we too much for her to bear. She now lives in Kailahun and works as a trader in the market. After recounting her story, the group thanked her for the show of fortitude and courage. They further complimented her for her resilience in sharing such loss with the group. Since the beginning of the sessions, Margaret has begun to open up to the group and express more positive emotions and opinions about her situation.

Aminata's Story

In our high school girls group in Kambia, we heard the story of Aminata, a 19-year-old student. Aminata had attended the Kollenten Secondary School in Kambia before Ebola came to Sierra Leone. With the Ebola outbreak in 2014, her life was changed forever. Her father volunteered to work as a hygienist in one of the treatment centers as a source of income for the family. He contracted Ebola at the center. One day he felt ill and was taken to the treatment center where he tested positive. The family was quarantined for 21 days, and within the quarantined period, her mother, elder brother and sister showed signs of the virus and eventually died along with her father. Aminata's mother and father left behind four children, and her elder brother and sister who died also left behind four children.  Aminata is now the primary caregiver for all eight children and struggles to maintain them while also attending high school. She is enrolled in a tailoring training program hoping that this skill will enable her to generate income. In the evenings, her siblings ask many questions about those that have died. It is difficult for her to cope with the responsibility, and thus she often tells them that their parents are only away on a trip. She is very overwhelmed with her new role and finds no time to take care of herself. She has expressed thanks for the support group. It has helped her cope emotionally with the stress and sadness she constantly feels in her current circumstances.

These two stories are just a couple of the dozens of harrowing stories that we have collected from Kambia and Kailahun. The discipline of narrative practice teaches that through the sharing of stories, one begins the process of healing and building resilience from trauma.  Through undertaking these interviews and recording the stories, IsraAID SL strives to simultaneously provide therapeutic support to individuals and communities through narrative practice and memorialize their experiences for perpetuity.

All testimonies and portraits, in addition to the Ebola Museum, are uploaded to a website for the wider world community to engage and learn from Sierra Leone's experience.

http://ebolaheroes.com/

Community Members Watching the Freetong Players
Community Members Watching the Freetong Players
Community Sensitization Event
Community Sensitization Event
Stigma Reduction Event
Stigma Reduction Event
Theatrical Representation of Ebola Heroes
Theatrical Representation of Ebola Heroes
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IsraAID began its mission in Sierra Leone in September 2014 in response to the deadly outbreak of Ebola Virus Disease (EVD). A preliminary needs assessment highlighted gaps in the psychosocial response to EVD, the vast majority of national and international resources having been dedicated to emergency medical interventions. EVD impacts not only those infected by the disease, but their families and communities, as well as the front-line service providers; the effects are not solely medical but have wider implications for stress, trauma and social stigmatisation and marginalisation.

 

IsraAID has positioned itself, with the overwhelming support of the OFL, national and international actors as the leading agency for MHPSS, PSS training and support, bringing in expatriate expertise in a wide range of specialisations including psychotherapy, psychology, social work, child trauma, art therapy, movement therapy and group facilitation experts.

As Sierra Leone moved toward recovery and post Ebola projects IsraAID IsraAID developed projects in the mental health and psychosocial support sector focusing to the issues of those who had been marginalized such as frontline workers. Additionally, a pilot internship programme with students from the school of Social work at Fourah Bay College in alternative therapies and group facilitation is ongoing. All of our programming is designed in-line with the approved PFA guidebook promoted by MSWGCA with a view to strengthening governmental initiatives and promoting local capacity building. All of the knowledge and experience IsraAID brings to Sierra Leone has allowed us to be part of the development of important protocols and documents including the Survivor Service Packages and the MHPSS Strategy.

 

IsraAID Sierra Leone engaged 175 Ebola frontline workers, including nurses, community mobilisers, 117 operators, burial teams, cemetery workers, hygienists, health promoters, and social workers in 7 communities across Western Area District. On the 2nd of December 2015, we concluded the ‘Ebola Heores’ project with the final stigma reduction event in the community of Calabatown in Western Area, Sierra Leone. This event capped off 4 months of narrative therapy interviews with Ebola frontline workers, in which we collected stories of trauma, discrimination, and ostracisation, and 4 weeks of educational stigma-reduction activities in communities with large numbers of frontline workers.

The high levels of attendance and engagement during the community events are a testament to their success in educating people about Ebola, thereby reducing stigma against survivors and frontline workers. It must be noted however that these benefits are limited to those who attended the events, and the lack of deeper engagement has lead to the conception of a second phase more focused on community engagement and healing.

Five IsraAID Field Officers, all graduating social work students who previously interned with the organisation, conducted narrative therapy interviews with 175 Ebola frontline workers. They were given a set of pre-determined questions to administer to participants, and they were trained and supervised by technical advisors from IsraAID. They were also given a short photography course and access to a professional camera in order to capture portraits of the participants to be printed as tokens for the participants to keep. The interviews were conducted in the workplaces of the participating forntline workers e.g. cemeteries and hospitals. The Field Officers initially contacted frontline workers through their contacts as prominent members of their own communities in Western Area. As this became unsustainable, particularly because many frontline workers needed permission from their organisation before participating, the Project Manager made contacts with high-level management to organise further interviews.

One of the Field Officers shared his experience:
"When doing Narrative Therapeutic Interviews with frontline workers it was challenging on one hand and encouraging on the other hand. During our interview with the frontline workers that we were opportune to interview we came to the realization that most of them were traumatize because of the stigmatization that they were facing on a daily bases. As a result of that some of them were blaming themselves for all what they were going through. As field officers during our Narrative therapeutic interviews with them we tried to validate their experience and made them to realize their heroic deeds even though it was not an easy task. Also during our community events we were able to sensitize the community people about the impact of stigmatization on the frontline workers and the importance of acceptance and inclusion. During the events we made a clear explanation of the deadly sacrifices made by the frontline workers; also that the frontline workers are not responsible for the outbreak so they should not be stigmatize against. Most people who participated in the event noted that they were not aware of the efforts that these frontline workers have made in eliminating the virus from the country but now that they are aware they sure to accept them in their community. Finally, some of the frontline workers that we interviewed called and appreciated our services and explained that the techniques that we used were helpful to them whenever they get stress."

 

During the process of interviewing the frontline workers the IsraAID team laid the groundwork for community events which would consist of a short play highlighting the stories and experiences of the frontline workers in their communities, which would be based on actual interviews. In order to organise the community events, the Project Manager, along with the lead Field Officers and representatives from the Freetong Players theatre troupe, visited 9 communities in Western Area with high numbers of frontline workers living and working in them to do a mapping. We met with community leaders, including Chiefs, counsellors, and Youth Chairmen, and introduced IsraAID and the Ebola Heroes project. All of the leaders were enthusiastic to participate, but we ultimately decided on 7 communities based on the existence of a vibrant, central meeting area in which we could conduct the events. We also scouted locations for the events, settling on open fields and market places rather than community centres because they were more inclusive and likely to attract a larger and more diverse crowd of people. In order to truly engage the community it was important to go to them where they would commonly gather.

One story of an interview with a nurse is as follows:

"I am Nurse by qualification. During the Ebola outbreak I was one of the 36 Nurses trained by Red Cross to go to the field and fight against the outbreak. After the training only six of us went to the field to do the work, the thirty did not agree to go. I was first posted in Kailahun District where I was working with the late Doctor Khan. My family abandon me for accepting to go to Kailahun district. But with all the family and community stigmatization I  received I never decline from being a working Nurse, I took an oath. When the Ebola situation become worst I was transferred to Kenema hospital that was hosting the highest amount of patient, where I was made the welfare Nurse of the hospital. During my work in the hospital I contacted the virus, which made me to be laid off and sent for treatment by Red Cross. I was totally barred from returning home by my husband, family and other community members. Fortunately for me, I got healed and return to work at the hospital. By the end of 2014 I was transferred to Kono District hospital where I worked for some time and finally transferred to Freetown Hasting Treatment Center but as a nurse for the Ebola quarantine home."

 

The events took place in 7 communities in Western Area, including Eastern Police, Rokel, Waterloo, Godridge, Kissy, Wellington, and Calabatown. They went for approximately 4 hours, including initial music to attract crowds, song and dance performances with a message about loving each other and national pride by Freetong Players, a skit aimed at reducing stigma developed in partnership with IsraAID and Freetong, and a question and answer session facilitated by the Field Officers. All of the events can be described as a success, with crowds of over 100 people in attendance, and high levels of audience participation and engagement as observed by the Field Officers and the Project Manager. All of the questions and comments from community members at the conclusion of the events were positive towards the role of frontntline workers in the fight against Ebola, and reinforced the need for community cohesion. Many community members recognized the need to reintegrate and include those who had been pushed out and were willing to openly say they had not done enough to include them.

Here is an account of one community event where a frontline worker attended as told by an IsraAID Field Officer. During our community event in Rokel for frontline workers, one participant who was working as a Community sensitization volunteer was impressed with our program. When given the opportunity to share his experience “he noted that he is really amazed with the Ebola Heroes Community Event” he explained to the public the challenges he had gone through as a frontline worker who was doing community sensitization work. According to him there were times when he was chased, stone and even driven away from his community. He was very happy and pleased with the program and noted in his final statement that “this are the types of programs he is expecting the government to embark on”. The program focus was mainly on community acceptance and inclusion of frontline workers who have been stigmatize against.

A major component of Ebola Heroes was to provide an outlet for the frontline workers to share their stories but also to listen. They are a group that has been largely marginalized by their communities and their voices were not being heard. They were not being noticed or recognized for their heroism during the fight against Ebola. In order to recognize them IsraAID provided each participant with a portrait taken of them, which was printed as a postcard along with a quote from their interview. These postcards were distributed to them as keepsakes to remember the vital role they played in the fight against Ebola.

The stories collected through the narrative interviews were recorded, transcribed into English, and edited for publication. They will be uploaded onto the Ebola Heroes website, which will act as an online archive for academics, journalists, and other interested parties. As agreed upon in the consent forms, each story will be uploaded along with a portrait of the participant and an audio recording of the interview. The stories and photos will also be given to the National Ebola Museum housed at Njala University.

There were many lessons to be learned from the first phase of the Ebola Heroes project. The first phase of the project and its outcomes have helped to inform the development of a second phase which will be community based.

The continuation of this project would benefit from further empowerment of the Field Officers. Rather than projects being designed in a top down manner, the Field Officers are perhaps in the best position to design projects as they are integrated in the cultural context in which we are working, and have the tools to better address the needs of the community. It is important to have a Project Manager to coordinate the inevitable bureaucratic and organisational issues, but the professional aspect of the project can, with supervision, be designed and undertaken by the Field Officers.

One valuable piece of advice for future community events is to host them in fields and market places rather than community centres. During the community mapping process, it became evident that community centres are seen as elite and exclusive places where many average members of the community would not feel comfortable venturing. If the aim of an event is to reach as many people as possible in the community and ensure a diverse audience, the best locations are fields and market places with high foot traffic. It is also important to visit the location at the time of day you hope to have the event to make sure it is crowded at that time, because crowds fluctuate at different times from community to community. 

Finally it is imperative to include the community in the entire process. Through the community events it became evident that the community had its own story and healing that it needed to do. At each event it became more and more evident that the communities wanted to be engaged in this process and wanted their voices to be heard as well. They had also suffered tremendously.

 For more information please visit www.ebolaheroes.com

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Ebola Heroes Report Fall 2015:

Ebola Heroes works to collect and share the stories of frontline workers in the Ebola response in order to inspire, educate, and mobilise communities to eradicate stigma.

Burial teams, cemetery workers, 117 hotline operators, social workers, community mobilisers, security personnel, hygienists, nurses, and doctors have been on the frontlines of the battle to end Ebola in Sierra Leone.

Their work can be traumatising. One burial team worker described the personal impact of his work:

We have once collected a dead body at Dr. Bash hospital which has been in that place for eleven days. It took a week to forget and I will never forget that scene as it was really frightened. I will never forget what I have seen.  Sometime when I go to sleep I have nightmares. This work is not really easy.

Despite the immense trauma many frontline workers experienced while providing essential services during the Ebola response, they have received little to no support or recognition from the government.

Many frontline workers also face violence and stigma in their communities, born mostly out of fear and misinformation. The same burial team worker described his experience in his community:

Before I took up this work the community was united and respect was reciprocal. But now there are some people who do not appreciate what I do and when I move they call me Ebola, sing slogans at me because of the work I do. They do not appreciate thinking I am doing a bad job. Most people don’t appreciate us in the community, they stigmatise us. I was once driven from where I was unless I had to seek refuge at my uncle’s place who accepted me. This work we do has a lot of stigmatisation.

 

Ebola Heroes works to address the trauma of frontline workers and the stigma surrounding their work in a number of ways. This includes:

  1. Addressing the trauma experienced by frontline workers through therapeutic narrative interviews conducted by IsraAID Field Officers. Our Field Officers are local social work students who have also received extensive training from IsraAID.
  2. Creating an online archive of the photos and stories collected as a testament to the role of frontline workers in an important part of Sierra Leone’s history.
  3. Building bridges of trust between frontline service providers and their communities through art exhibitions and theatre performances. We have partnered with the Freetong Players, Sierra Leone’s celebrated acting troupe and social activists. They use music and theatre to educate communities and facilitate dialogue.

 

We have completed 140 interviews in the two districts that make up Western Area, with 60 to go to reach our target. To achieve this, we initiated partnerships with a number of government and non-governmental organisations. Utilising contacts from these organisations, our Field Officers have collected the stories of burial team workers, cemetery workers, social workers, 117 Hotline workers, hygienists, orphanage workers, health promoters, nurses, and doctors.

We are in the process of rolling out 7 community events in the Western Area in partnership with the Freetong Players. We have finalised the locations of each event. They will take place in densely populated areas that were particularly affected by Ebola. In an effort to create a sense of ownership, we will meet with the community leaders in each area to seek formal approval for the events. We hope to work with these leaders, including councillors, youth chairmen, and religious leaders, to finalise dates and publicise the event in the community.

An image of a community event that took place during the pilot event in Aberdeen Freetown. 

We are also currently processing the completed interviews for publication in our online archive. As well as creating an archive, we will print a portrait for each participant to have as a keepsake.

In the coming months, we will roll out the narrative interviews and community events in the remaining 12 districts of Sierra Leone. Monitoring and evaluation will largely be through qualitative indicators, generated through focus groups.

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E-Health 117 Hotline Operators Self-Care Sessions

IsraAID has been providing the hotline operators of the 117 self-care sessions on a weekly basis. The sessions afford the operators the opportunity to let loose and air their grievances in a safe space. The sessions have focused on a range of topics including coping skills, anger management, trauma and grief, etc... This program is run by both IsraAID specialists and our social work student interns. By providing the students with the opportunity to plan and facilitate sessions we are helping to build their capacity to take on such programs in the future.

An observation as written by one of our social work interns about the work being done at the 117 Ebola response hotline, " like doctors and nurses 117 operator are also vulnerable and are faced with immense challenges from the public. In spite of their job, they also remained subject to verbal abuses and are looked low upon... IsraAID provides emotional self-care sessions to enable them to release the tension and stress from their daily work."

I solely depend on IsraAID support here at 117 because it gives me the inner most peace that I need. I used to come to work stress[ed] and easily get irritated either by my colleagues or the calls I received. But the sessions have enable[d] to cope and deal with the things that stressed me in the past. I also get lots of fun and learn from our different stories, because I thought I was the only one in this. 

At the height of the EVD crisis with the hotline operating 24/7 IsraAID provided self-care to 120 operators a week. With the decreasing number cases there has been a commensurate downsizing of the hotline staff. This has caused a great degree of consternation and distress for those who are losing their livelihoods and who feel shunted aside. The self-care sessions have been instrumental in allowing those operators to process their experience, in promoting agency through advocacy by and for the operators and in celebrating the enormous contribution of 117 operators in the frontline battle against Ebola.

Concern Worldwide CAPS and Burial Teams

IsraAID in partnership with local NGO CAPS (Community Association for Psychological Support) provided self-care sessions for 168 members of the Concern burial teams operating the EVD hotspots of Western Area Rural and Urban districts.

Th program for the self-care sessions was developed jointly by IsraAID professional PSS specialist and the CAPS counsellors, prviously trained by the Centre for Victims of torture. The program included 12 weeks of self-care sessions, provided on one of the weekly days off for the 14 burial teams. Topics covered in the sessions included; coping skills, stigma, trust, and team-building. Sessions were carried out in an interactive and experiential manner, using examples provided by participants in order to illustrate and illuminate the points the facilitators wished to drive home. Music, movement, story-telling and art were also incorporated into the sessions, allowing participants to express themselves in a wide variety of ways and thus ensuring an appropriate outlet for each participant.

While the sessions were run by CAPS counsellors, supervision for the counsellors was provided by IsraAID specialist to ensure quality control, adherence to the program and ensure durable ssolutions via local capacity-building. In addition to general oversight of the program and reguular interaction with both participants and counsellors at the IsraAID training venue, CAPS counsellors were provided with peer supervision and professional supervision on a weekly basis by a dedicated IsraAID staff member. Programmatic challenges and adjustments were thus easy to implement in an organic fashion ensuring that best practices were employed and lessons learned were incorporated in later sessions.

The overall attendance rate of 97% throughout the sessions is testament to the value attributed by participants to the sessions. Whereas, initially, participants were somewhat reticent and reluctant to actively participate in sessions, by the close of the program, most of the participants had to be reigned in, as their overwhelming enthusiasm was noticeable.

In the baseline stress assessment carried out in February 2015, all 168 burial team members showed elevated to extremely elevated levels of stress on both the PROQOL scale as well as on a locally-validated instrument. The midline assessment showed a significant drop in stress levels across the board, reducing the range of stress from extremely high to moderately high, in part due to concerns about staff downsizing and the probable loss of livelihoods entailed therein. An end-line survey is in progress, we expect to see even lower levels of stress in this planned survey, particularly given the fact that Concern, following up upon IsraAID and CAPS' recommendation, has decided to provide transitional programming and employment for the burial teams.

 

Ebola Heroes

"Ebola Heroes" is a community empowerment documentation project aiming to share inspiring stories of different service providers on the frontline of the Ebola response.

We invited individuals from the different response groups such as: burial teams, 117 hotline operators, Observation Interim Care Centers (OICC) staff, Ebola Treatment Center (ETC) doctors and nurses, Mental Health nurses, Social workers and mobilizers, Police and Ebola survivors to join this initiative.

We took a still photo of each of them and a video interview. The pilot group consisted of 20 frontline workers. While efforts are underway to compile and complete the final video of all the interviews on the ground here in Sierra Leone we had a small community event to display the photos and have the group speak about their experience of sharing their story. Each participant receive their still shot and a t-shirt that said "I am and Ebola Hero" in Krio.

As this project progresses IsraAID plans to get more participants' stories and to have larger community events as well as involve the Office of the First Lady and the Ministry of Social Welfare.

 

Mental Health Nurses

In February IsraAID provided each of the 20 mental health nurses with a smart phone with the EbolaCare application, designed by both IsraAID and JourneyApps. The mental health nurses are newly qualified and are in desperate need of support. IsraAID provided the EbolaCare application to augment their own assessment tools. The EbolaCare application consists of a stress assessment and the PROQOL. The nurses were provided with a two hour training on the phone along with an explanation of the two assessment tools.

Enabling Access for Mental Health Sierra Leone has provided follow up training for each of the nurses on an as needed basis with support from IsraAID and JourneyApps. The application does not require internet connection to operate but in order to collect the data online the nurses will need to have an internet connection. As there is little internet connectivity in the outlying districts where they are located we have received very little data to date. When the nurses return to Freetown for a refresher training we will receive the data and report on what we have found.

The nurses have been very pleased to receive the support from IsraAID and are so thankful to have any help they can get. One nurse upon receiving the phone mentioned that the application would help her not have to second guess herself and would be an excellent tool.

CRS Caritas Training of Trainers Group Work with EVD Affected Children, Supervision/Observations

IsraAID implemented a two week training of trainers (TOT) in three districts, Western Area Rural, Port Loko and Bombali. The training provided community volunteers with skills to run groups with children affected by the EVD outbreak. The trainings and supervisions have been co-facilitated by the IsraAID specialists and our social work interns who have proved to be an invaluable resource. As expressed by one student "Even though there are many challenges we are facing with our supervision work there are also some rewards. The first reward is that facilitators believe that for every session they held with the children they realize improvement in their skills. Another reward is that the facilitators find the activities in the training manual useful and applicable to the children. Finally the children are appreciating this services alot."  IsrAID developed a comprehensive training manual that included reframed theoretical concepts in a practical hands on multidisciplinary activity toolbox for facilitation of children's groups. The first week focused on facilitating games and activities based on five core themes: inner peace and security, stigma, social connection, safety and grief and trauma. The second week focused on different therapeutic modalities including song, dance, the use of movement, art, story-telling and the incorporation of our partner produced video clips on each of the five themes. The volunteers also received extensive training on facilitation skills for group work with children. 

After the two week TOT IsraAID has been providing ongoing support to the community volunteers by way of field observations and supervision. An IsraAID specialist meets with the community volunteers on a weekly basis in all three districts to discuss issues and concerns as well as reinforce the tools and skills acquired over the course of the training. IsraAID has also served as an advocate and liaison for the volunteers in the field and the implementing partner, ensuring that transport stipends and materials are delivered and maintaining good communication between the field and headquarters.

IsraAID developed, translated into Krio and validated, a behavioral checklist for the groups as a means of identifying children in need of further referrals- other agencies are interested in using this M&E tool. At the end of each session with the children, volunteers fill out the checklist allowing us to track macro trends without violating confidentiality protocols. At the end of the 10 week sessions we should be able to chart the overall progress in terms of positive versus negative behaviors. This tool is also used as a spring board for conversation and deepening understanding during supervision sessions.

The geographic scope and logistical constraints involved in this project have allowed us to grow as an organization, to extend our sphere of operations and further define IsraAID as the primordial PSS agency operating in Sierra Leone. A further series of trainings and supervisions is in development for Bo district to be carried out in the next six months. 

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Organization Information

IsraAID

Location: Tel Aviv, Merkaz - Israel
Website:
Facebook: Facebook Page
Twitter: @IsraAID
Project Leader:
Navonel (Voni) Glick
Deputy Director / COO
Be'er Sheva, Be'er Sheva Israel

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