As Ebola fades, a mental-health crisis is coming in its wake. At the height of the outbreak, West African countries that had no more than a roomful of doctors and too few nurses threw thousands of ordinary people — taxi drivers, accountants and college students among them — onto the front lines.
Now, many of the Ebola fighters are battling their own, quieter afflictions. Alcoholism, depression and drug addiction are raging, health officials say, in countries that have very few psychiatrists.
Their ranks include Anthony Dingay, a 30-year-old former child soldier who signed up in 2014 to bury the bodies of Ebola victims in coastal Liberia’s chest-high grass and mud. Three months into the job, he helped inter a body bag containing his two-year-old daughter Kumba.
These days, like hundreds of other so-called burial boys, he no longer spends his days dressed in hazmat clothing, removing the dead from their homes. His $350 monthly paycheck for the dangerous assignment no longer comes.
Instead, Mr Dingay sleeps in a church, screams in his sleep and worries he might be somehow responsible for his daughter’s death. By day, he sells sand and sometimes pawns his clothes to buy cheap rum and Italian White, as heroin is called here. He left home, he says, to give his family some relief.
“They didn’t tell us at the end of this job, you people will get crazy,” said Matthew Kruah, a companion in his daily drinking and drug abuse, who buried his father during his own time on the graveyard crews.
Ebola killed about 11,000 West Africans, but it also left survivors to grieve in an area with very few mental-health professionals, and where few can afford to see one in any case. Liberia has just one psychiatrist for a population of 4-million, according to the health ministry. Sierra Leone, home to 7-million, also has only one. The mental-health wing of the Liberian health ministry has just two staffers on payroll.
It is an unsettling postscript to an epidemic that, for all its horrors, was meant to leave behind an army of newly trained health workers. Instead, large numbers of that crew are too shaken to work. “They all lost somebody close to them,” said Janice Cooper, project lead for the nonprofit Carter Center’s mental-health programme in Liberia, which is looking to put hospital staff through basic mental-health crash courses.
Even before Ebola, Liberia and Sierra Leone numbered among the world’s most traumatised nations, both recovering from civil war. Fourteen years of conflict in Liberia left 250,000 dead and many survivors homeless. A 2011 study in Liberia’s Nimba County found 40% of its 500,000 people exhibited symptoms of post-traumatic stress disorder.
Many fought in the war as child soldiers, including Dingay and Kruah. The two left school early, leaving them barely literate.
When work burying Ebola victims became available, the two saw it as possibly their only chance to secure a salaried job. They frittered away the money as quickly as it came.
“We were thinking, after this job, we can die, too,” said Dingay. “So we just spend the money.”
A year later, Kruah finds it difficult to eat or focus. Dingay said he could not shake the image of his daughter in the days before she died. Neighbours, repulsed by the unusual, macabre trade they plied, have turned “burial boys” into an insult.
“That’s that burial team,” teased a man pushing a wheelbarrow past the porch where they spent a recent afternoon.” Go away!” one of the burial men shot back.
Liberia — its economy wrecked, its government broke and its people exhausted — can hardly attend to these wounds. Virtually no clinic in the country stocks antidepressants. Liberia’s only mental-health pharmacist, Joseph Quoi, has never found a reliable source, so he often runs out. “Mental health has fallen by the wayside,” he said.
There are just 72 hospital beds in Liberia reserved for mental-health patients. About 160 hospital staff have psychosocial training, such as how to spot problems like post-traumatic stress disorder. As the hospital system collapsed there last year, half turned to roles that did not require those skills. Many are probably traumatised as well.
“This is just abnormal,” said Angie Tarr-Nyakoon, the director of the government’s mental-health unit. “How are we going to handle it?”
The answer, for many Liberians: self-medication with alcohol and heroin. The government has no capacity to treat addiction. There are only 15 beds for addicts in a country where bars frequently start selling beer and liquor before noon.
From August 2014 to the following March, Dingay and Kruah spent days lumbering into the homes of neighbours they knew, to lift their remains up from the blood, sweat and vomit in which they died. Sometime after burying their 50th body in the September heat, they began drinking after work.
Soon they were drinking before work, too. Often, they were drunk, they said, while they put on their elaborate, head-to-toe biohazard suits — a meticulous process, in which a single slip-up can allow the Ebola virus to penetrate. Dingay wondered if he missed a step and somehow carried the virus home. In October, his daughter died. “Some people started saying I’m playing with this virus so I’m the one that gave it to her,” he said. “I dream about her. When I’m sitting, eating, I can picture her face.”
A few months later, the two men traded their homes for the churchyard. The pastor tries to cure them with daily prayer. That is about the only place for them to go, their burial-team supervisor, John Johnson, said.
“I really want to see them doing better,” said Johnson, who acknowledged his own problems: “If I don’t drink, I will have some kind of sleepless night.”