Tiyatien Health is a Changemaker

Tiyatien Health, a winner in the Rethinking Mental Health competition, is treating the effects of decades of brutal war in Liberia by training non-doctor health workers and clinicians to work directly with citizens of one of the poorest countries on Earth. The founders are survivors of Liberia's civil war and people living with HIV/AIDS.

Tiyatien Health trained the first non-physicians to administer anti-retroviral therapy in Liberia,and provided the first-ever HIV/AIDS treatments in southeastern Liberia, the poorest corner of the country. Now it is expanding beyond providing public HIV/AIDS treatment to rural communities by working to reverse decades of untreated depression and epilepsy.

"The Changemakers prize comes at a critical point in our work as we ramp up services to meet overwhelming demand," said Dr. Pat Lee, Tiyatian Health’s director of chronic diseases.

"The $5,000 prize will go immediately to strengthen services, train community health workers, and lay down a foundation for rigorous evaluation and ongoing quality improvement of our program. More importantly, it will send a powerful message of hope to our patients and communities – that their future will be brighter than their troubled past, that the neglect and absent care they have always known can change, that they are no longer invisible.

"The visibility Changemakers has lent our work has already helped us strengthen partnerships with communities, experts, and government.  We are beginning to share lessons learned and build community with other projects entered in the competition. 

"We also anticipate the competition will raise the profile of community-driven solutions to mental health.  Often, communities such as ours are not included in shaping the very mental health policies and programs that affect them.  But they should be.

"We hope this prize will also bring welcome attention to the Liberian government’s bold and visionary National Mental Health Taskforce. With the connections generated through Changemakers, we hope more partners, donors and foundations will come forward to provide long-term financial support for the work of the Taskforce and its partners, including Tiyatien Health, to deliver mental healthcare to all Liberians."  

Tiyatien Health, which means "justice in health" in the Kwa dialect, is providing much-needed health services through an innovative, community-based strategy that gives care to some of Liberia's most vulnerable citizens, including former child soldiers, victims of sexual violence, and those living with the stigma of HIV/AIDS and mental illness. For example, up to five percent of the population suffers from epilepsy and some people with epilepsy fall into fires and are left to burn due to the common misconception that epileptic seizures are a contagious curse.

During the civil wars, combatants and civilians suffered physical and sexual violence. In the aftermath, many Liberians suffer from mental illness and social isolation. One survey found that 40 percent suffer from major depressive disorder and 44 percent from posttraumatic stress disorder.
Yet communities are unable to provide for those in need. There are fewer than 50 public physicians for its 3.5 million people. Without a healthy population, Liberia may fail to recover from decades of war and could sink back into turmoil and violence.

By employing community health workers, Tiyatien Health is providing jobs in a country where unemployment reaches 85 percent. It is the largest employer of the poor in the Tchien district. The community health workers provide an ideal solution to the triple threat of severe resource shortages, extreme deficits of trained health workers, and highly dispersed rural populations.

Tiyatien Health trains non-physician clinicians and community health workers to use innovative, simplified, evidence-based protocols to identify patients, lead group counseling sessions, directly observe medication when indicated, and monitor side effects. They visits patients' homes in the rural, heavily forested southeastern region of Liberia to provide education, counseling, medication, and support—educating the community about seeking early care, epilepsy, posttraumatic stress disorder, and depression—reducing the stigma for both HIV/AIDS and mental illness and addressing community disintegration.

This community-driven model now serves as the potential blueprint for a national effort to scale-up and decentralize HIV services across Liberia’s rural southeast region. Tiyatien Health also helped push Liberia's Ministry of Health to adopt the first national policy to address mental health issues in 2009.

The civil war in Liberia was one of Africa's most devastating conflicts. Warring factions recruited thousands of child soldiers who endured unimaginable conditions, abusing drugs, and committing—and falling victim to—gruesome acts of violence. The war claimed the lives of over 200,000 people, and thousands more fled to neighboring countries.

One such refugee was Weafus Quitoe, who fled on foot with his family to the Ivory Coast. Growing up in a refugee camp, Quitoe made a living by selling kerosene across the border to Liberians who stayed behind, crisscrossing military fronts. He returned to his home country after 15 years in exile, but was devastated by the growing population of young people struggling with AIDS without proper medicine, and women dying during childbirth because they couldn't afford hospital fees.

Recognizing the need for change, Quitoe partnered with Liberian-born physician Raj Panjabi to create Tiyatian Health as a community-run health system, serving some of the poorest in Liberia, and giving hope as the country rebuilds. In the process, he taught himself nursing skills, going from not knowing how to use the “on” button of a computer to learning email, budget management, and fundraising work.

"We are deeply grateful to Changemakers, and our many supporters, for giving a global voice to our Liberian partners," said Dr. Pat Lee, Tiyatian Health’s director of chronic diseases. "But Liberia is not the only country that faces a huge unmet burden of mental health.

“We hope Changemakers’ recognition will help generate debate and new thinking around strategies to meet this tremendous need in the areas where it is most neglected – particularly poor, post-war countries. We welcome the opportunity to partner with others who share our vision to build an innovative system that can deliver mental health and primary care for all."

Congratulations to Tiyatien Health for their great work and winning entry! Learn more about their efforts to provide care and reduce stigma in Liberia, and discover other mental health solutions submitted in the competition. Website: www.tiyatienhealth.org


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