Closing the mental health treatment gap through the collaboration of traditional and Western medicine in Liberia

ABSTRACT

Liberians have experienced significant psychological trauma following fourteen years of violent civil war and the 2014–2015 Ebola epidemic, but there are only two psychiatrists for the entire population. However, many traditional healers commonly treat mental health-related illnesses throughout the country. This paper examines the potential for collaboration between traditional and Western medicine to close the mental health treatment gap in Liberia. We conducted 35 semi-structured qualitative interviews with Liberian traditional healers and utilizers of traditional medicine asking questions about common health problems, treatments, beliefs, and personal preferences. Participants discussed cultural attitudes, beliefs, and structural factors that may influence collaboration between traditional and Western medicine. Healers expressed willingness to collaborate in order to strengthen their skills, though realized Western physicians were hesitant to collaborate. Additionally, Liberians believed in both medical traditions, though preferred Western medicine. Finally, structural factors such as geographic distance and financial barriers made traditional medicine more accessible than Western medicine. Traditional healers and utilizers support collaboration as evidenced by their perceptions of cultural attitudes, beliefs, and structural factors within the Liberian context. With Liberia’s overwhelming mental illness burden, a collaboration between traditional healers and Western medicine physicians offers a solution to the treatment gap in Liberian mental health care.

KEYWORDS:

• Traditional medicine
• Liberia
• mental health
• collaboration
• treatment gap

Acknowledgements

We would like to thank the Liberian traditional healers and utilizers of traditional medicine who participated in these interviews without whom this work would not have been possible. We would also like to thank Mosaka Fallah, PhD, Arthur Payne, Veronique Diandy, Edward Brown, Saffa Howard, Boima Pusah, Jeremiah Menyongai, Jr, and the team at Christ Jubilee International Ministries for their assistance with the transcription of the qualitative interviews.

Disclosure statement

No potential conflict of interest was reported by the authors.

Notes on contributors

Augusta Herman, MPH graduated from Boston University School of Public Health with a Masters of Public Health in Social & Behavioural Sciences and Global Health in 2017.

Dr. Samuel Pullen is the Chair for the Department of Psychiatry and Behavioural Health at St. Luke’s Health System in Boise, Idaho.

Brittany Lange, MPH is studying for her Doctor of Philosophy in Social Intervention at the University of Oxford and received her Masters in Public Health from the Yale School of Public Health.

Dr. Nicole Christian-Brathwaite is a child-adolescent psychiatrist and Medical Director at Riverside Community Care in Dedham, Massachusetts. She received her MD from the University of Pittsburgh School of Medicine.

Melissa Ulloa, MA, LCAT-LP is an Art Therapist at Bonding Links Clinic at the Coalition for Hispanic Family Services. She graduated from the Steinhardt School of Culture, Education, and Human Development, New York University, in New York City.

Michael Kempeh is a medical student studying at the A.M. Dogliotti Medical College at the University of Liberia in Monrovia, Liberia.

Dyujay Karnga is a medical student studying at the A.M. Dogliotti Medical College at the University of Liberia in Monrovia, Liberia.

Dorothy Johnson is an author and researcher, having worked for Liberia’s Population Division of the Ministry of Planning and Economic Affairs and the Liberian Demographic and Health Survey. She has a Master of Arts in Demography/Population Statistics from Georgetown University in Washington, D.C.

Dr. Benjamin Harris is an Associate Professor of Psychiatry and the Chairman of the Department of Psychiatry at A.M. Dogliotti Medical College at the University of Liberia in Monrovia, Liberia.

Dr. David Henderson is the Chair of the Department of Psychiatry at the Boston University School of Medicine and Chief of Psychiatry at Boston Medical Center.

Dr. Christina Borba is an Assistant Professor in Psychiatry at the Boston University School of Medicine and the Director of Research for Boston Medical Center, Department of Psychiatry.

ORCID

Augusta R. Herman http://orcid.org/0000-0001-7057-2248

Additional information

Funding

This research was supported by funding from the Massachusetts General Hospital Chester M. Pierce, MD Division of Global Psychiatry. The last author is additionally supported by the National Institute of Mental Health [grant number K01MH100428].