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View on Disability: Soothing Ebola’s mental scars

Copyright: Samuel Aranda/Panos

Speed read

  • The social and emotional impacts of the Ebola crisis are ‘unusually cruel’

  • But non-specialists can help support those affected using a recently adapted WHO guide

  • The guide includes direct experience and insight from Ebola workers in the field

The number of Ebola cases is roughly doubling every three weeks. With families being torn apart and thousands of children already orphaned and abandoned due to the stigma associated with the disease, UNICEF’s regional director for West and Central Africa Manuel Fontaine has called for both traditional and new ways to provide psychosocial support. According to UN News Centre, this will include training 400 new mental health workers in Liberia. [1]

But there are also ways that non-specialists, including volunteer health workers, can provide emotional support for Ebola-affected families, WHO consultant Leslie Snider tells me.

Snider helped produce and adapt a Psychological First Aid (PFA) guide and training for workers and volunteers in partnership with World Vision International, UNICEF, and CBM, a development organisation for people with disabilities. The guide, first released in 2011, is used in low and middle income countries to help people who have recently experienced a traumatic event. It has now been adapted to deal with the extremely stressful events surrounding the Ebola crisis.

“Our usual ways of caring for and comforting people in distress are radically changed with Ebola.”

 Leslie Snider, WHO


Snider tells me that the “unusually cruel” social and emotional impacts of Ebola are at the heart of suffering and spread of infection. It is incredibly difficult that loved ones and healt workers cannot provide comfort and support for the sick through physical affection or delivering homemade food due to quarantine procedures.

“Our usual ways of caring for and comforting people in distress are radically changed with Ebola,” Snider says. If a patient dies, the family can’t touch the body, and sometimes they can't even see it. This is why it was essential to adapt the guidelines for PFA to include how to help victims cope with grief and recent loss by confronting the fear, isolation and stigma associated with the disease. [2]

Health workers “have been training in PFA since the start of the Ebola crisis. It empowers people at all levels to know what to say and do to help people, and to stay safe,” she says.

The 2001 PFA guide was peer reviewed by 60 international experts, particularly from low and middle income countries, and is available in several languages [3].The recent adaptation for the Ebola crisis incorporates direct experience and insight from workers in the field. 

Snider says PFA is not equivalent to professional counselling. Instead it is about providing emotional and practical support, communicating sensitive information effectively, and building trust within Ebola-affected communities. PFA emphasises ‘the three ‘Ls’: look, listen and link. First, see whether anyone requires urgent care or is having a severe reaction to stress. Next, listen to them and try to calm them down, without providing false reassurance. Finally, inform them about what help is available and connect them to their loved ones and social services.

“You see a ten-year-old child at the treatment centre, alone and frightened. What are the implications? This is where the three ‘L’s are used.”

The guide aims to stop people affected by the disease from becoming isolated — perhaps through the deaths of family members or perhaps because of communities’ fear of associating with those affected by the virus.

Snider says mental health experts are particularly concerned about how such isolation could affect abandoned children.
Aamna Mohdin is a freelance journalist in London. @aamnamohdin


[1] UN News Centre In West Africa, UN launches strengthened response as Ebola shatters lives, orphans children (UN, 30 September 2014)

[2] Psychological first aid during Ebola virus disease outbreaks (WHO, 2014)
[3] Psychological first aid: Guide for field workers (WHO, 2011) 
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