In Pictures

‘Toxic stress’: Addressing mental health needs in Sierra Leone

Inaccessible health services and spiritual beliefs drive those in need to the shrines of 45,000 traditional healers.

Kroo Bay is a slum in Sierra Leone’s capital Freetown. Roughly 7.000 people live on the densly populated 50 acres wide expanse with no electricity, running water or sewage system. Harsh living conditi — Kroo Bay is a slum in Sierra Leone's capital Freetown. Roughly 7,000 people live on the densely populated 50-acre area with no access to electricity, running water or sewage system. Harsh living conditions like these often lead to child neglect, violent abuse or sexual exploitation. [Olivia Acland/Al Jazeera]

Freetown, Sierra Leone – Sierra Leone witnessed a decade-long civil war and the worst Ebola outbreak ever, leaving hundreds of thousands traumatised in one of the world’s poorest countries.

The World Health Organization (WHO) estimates that 10 percent of the country’s population of seven million has mental health problems. Due to an unknown number of unreported cases, the reach of depression, psychosis or post-traumatic stress disorder (PTSD) is likely to be higher.

Psychological help for these disorders is hardly available as there are only two practising psychiatrists in the country.

With more than half the population living in extreme poverty, daily hardships and misery can turn into what scientists call “toxic stress” and trigger or amplify mental health problems.

For children growing up in adversity, this “toxic stress” can have damaging effects on learning, behaviour and health throughout their life.

Inaccessible health services and spiritual beliefs drive those in need to the shrines of 45,000 traditional healers.

For a long time, there was a lack of political will to change the situation.

But now, individuals, activists, medical professionals and NGOs are coming together to help the country come out of the dire situation.

This project has been funded by the European Journalism Center (EJC) via the Global Health Journalism Grant Programme for Germany.

Nonetheless people are trying hard getting on in the toughest of circumstances. — Despite the difficult conditions, people are getting on with their lives in the toughest of circumstances. [Olivia Acland/Al Jazeera]

Destitution, hunger, violence, loss of a caregiver, emotional neglect and social isolation are what scientists call “daily stressors“. If they occur constantly they can turn into “toxis stress“. Cons — For children growing up in adversity, this 'toxic stress' can have damaging effects on learning, behaviour and health throughout their life. [Olivia Acland/Al Jazeera]

The NGO „We Yone Child“ (Krio for „Our Own Children“) has built a school of wood and corrugated iron for 200 pupils from this neighborhood. — A school by an NGO We Yone Child (Our Own Children) for 200 children was built with wood and corrugated iron. [Olivia Acland/Al Jazeera]

Its founder Santigie Bayo Dumbuya knows what it‘s like to grow up in adversity. He was twelve when rebels forced him to fight in the civil war. After the war, going back to school helped him to overco — The school's founder, Santigie Bayo Dumbuya, was 12 when rebels forced him to fight in the civil war. After the war, going back to school helped him overcome his trauma. 'The people here don't see education as a necessity,' says Dumbuya. 'But it's the only way out.' [Olivia Acland/Al Jazeera]

When Ebola hit the country in 2014 it was still recovering from the war. In the following 18 months roughly 8,700 people got infected, nearly half of them died. Thousands of kids were orphaned by the — The Ebola outbreak hit the country in 2014. In the following 18 months, roughly 8,700 people were infected, nearly half of them died. Thousands of kids were orphaned. [Olivia Acland/Al Jazeera]

Health service are almost inaccesible for those who suffer, medication hardly availbale. As a result, patients in the country’s only psychiatric hospital are still being chained. “The situation is qui — Health services are almost inaccessible and medication is hardly available. Until recently, patients in the country's only psychiatric hospital were still being chained. 'We need a necessary political commitment to strengthen the mental health system and the health system in general,' says Stephen Sevalie, one of the only two psychiatrists practising in the country. 'There is huge overlap between mental health and physical diseases. People with mental illnesses die about 20 to 25 years earlier than other people in the same environment. That cannot be ignored.' [Olivia Acland/Al Jazeera]

Inaccessible health services and spiritual beliefs drive those in need into the shrines of 45.000 traditional healers. Their role is ambivalent. In a country without comprehensive health care they are — Inaccessible health services and spiritual beliefs drive those in need into the shrines of 45,000 traditional healers. Their role is ambivalent. In a country without comprehensive healthcare, they are the go-to people for everyday problems. [Olivia Acland/Al Jazeera]

Healer David Conteh mixes pastes and tinctures out of powders, roots and leafs – to drive away evil spirits, as he explains. — Healer David Conteh mixes pastes and tinctures out of powders, roots and leaves to drive away evil spirits, he says. [Olivia Acland/Al Jazeera]

Mocked as “craze man“ in Sierra Leone’s lingua franca Krio (a country-wide spoken English-based creole) mentally ill outcasts roam the city. In the case of Ibrahim, his family brought him to healer Co — Mocked as 'crazy' men, mentally ill outcasts roam the city. In the case of Ibrahim, his family brought him to healer Conteh. As Conteh explains, Ibrahim used to be a teacher until the day his girlfriend's father cursed him. [Olivia Acland/Al Jazeera]

Rebecca Esliker, director and only employee at the institute for psychology at the university of Makeni in central Sierra Leone, critizises the healers. In her research she speaks of a “medical war th — Rebecca Esliker, director and only employee at the Institute for Psychology at the University of Makeni in central Sierra Leone, criticised the healers. In her research, she speaks of a 'medical war the country is currently fighting' between modern medicine and what she calls myths and beliefs. 'They [healers] beat them [the patients] mercilessly because they say that's the way to get rid of the devil.' [Olivia Acland/Al Jazeera]

Mary Kargbo works in the Mental Health Department at Koidu Community Hospital. She is one of 21 mental health nurses that were trained and sent to the 14 districts to provide basic treatment. It‘s on — Mary Kargbo works in the Mental Health Department at Koidu Community Hospital. She is one of the 21 mental health nurses that were trained and sent to 14 districts to provide basic treatment. [Olivia Acland/Al Jazeera]