First Results Coming In

It's been 3 months since we launched the Sankofa Project.
We followed-up with our first 46 graduates and documented clinically significant reduction in severity of trauma, depression symptoms, and in disability levels.

We will continue following up our participants, and release a comprehensive data report for the first 100 participants by December 2017.

Thank you to all of our supporters for making this project possible!
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Project Launch Field Update from Region 1: Liberia, West Africa

         PROJECT LAUNCH FIELD UPDATE FROM REGION 1: LIBERIA, WEST AFRICA

 
        Since 2003, Liberians have been coping with the aftermath of a 14-year civil war, of which, Post-Traumatic Stress Disorder (PTSD) is still a concerning outcome. A representative national survey indicated that 44% of the total Liberian population presented PTSD symptoms 5 years after the end of the war [1]. Moreover, another study noted that those particularly in specific geographical locations where violent conflicts took place, presented PTSD even twenty years after the conflict [2]. The recent Ebola outbreak in the region exposed this population to a new perceived life threat. Witnessing the severely ill, exposure to deceased bodies, and quarantine procedures were strong triggers for a population with already high incidence of PTSD, propagating new fear behaviors [3], and expected to contribute to a rise in mental disorders [4]. The World Health Organization (WHO) declared Liberia Ebola free on January 3, 2016. Since then, most relief programs gradually left the country. Based on the chronic and debilitating characteristics of PTSD, it was expected that levels of trauma would rise further among communities affected by both emergencies.

The First Target Region

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On June 3rd, 2017, we launched our new trauma relief program, the Sankofa Project, in the Banjor region, one of the most impacted by the Ebola Virus Disease (EVD) outbreak. With the invitation of Mr. Wolabah Yekeku, the community chief, we were guided to the Pinyonkosa village with a list of EVD survivors to commence the outreach.

Recruitment, Assessments, and Preliminary Diagnoses

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     Utilizing the DSM-5 diagnostic criteria for PTSD and Major Depressive Disorder (MDD), the first round of interviews to enroll participants yielded concerning results. In total, 88% of our interviewees qualified for a preliminary diagnosis of PTSD (PCL-5 Criteria including severity of symptoms averaging at 43.3), while 68% also qualified for MDD (PHQ-9 scores > 10). Moreover, 42% presented suicidal ideation. Only 5% diagnosed for MDD without PTSD.

      We also noted that every person interviewed, including the few who did not meet either diagnostic criteria, were highly symptomatic under the DSM-5 PTSD Cluster D, which recognizes negative mood and cognition as a new group of symptoms not previously included in the DSM-IV. Symptoms in cluster D have been widely observed in traumatized individuals with histories of repeated exposure to traumatic experiences, whom are also often diagnosed under “Disorder of Stress Not Otherwise Specified” (DESNOS), and commonly referred to as cases of “complex” trauma, rather than acute PTSD.

      Due to limited resources, we were unable to collect information on further conditions such as anaemia, alcohol, drug use and psychosis for MDD-related symptoms, as recommended by the WHO's Interim Guidance Clinical Care for Survivors of EVD by the WHO (2016). The high incidence of PTSD symptomatology presented among this community may be residual and accentuated from the war period. Among all participants that met that diagnostic criteria for PTSD, 39% also reported surviving severe physical violence during the war, and yet, all of them listed EVD as the "worst stressful event" in their lives (in which the provisional diagnosis is based on).
      Without pre-Ebola mental health assessments, it is difficult to understand how war-related trauma was triggered or worsened due to EVD. It is also premature to suggest that such percentages are representative of all communities impacted by EVD. These initial numbers are a very small but concerning indication of the severe long-term impact of consecutive humanitarian emergencies in mental health.

Group Allocation and Participant Response to Clinical Tasks

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      Participants were allocated to groups based on severity of symptoms. During the first session, the biggest challenge was to motivate participation. We presented the program as as opportunity for individuals to learn techniques which they could utilize to alleviate stress and increase well-being to the body and mind whenever needed. We refrained from speaking about trauma, war, or Ebola to avoid re-traumatization. The stressful event was only briefly noted during the screening process. To learn more about our clinical curriculum, click here. We focus on ANS stabilization, cognitive and interpersonal domains without addressing the traumatic narrative.
     Many felt shy or laughed when asked to try new tasks, such as vocalization, guided imagery and breath work. We empowered them with the choice not to do any task they did not feel comfortable with. Two out of ten group members who completed all exercises shared with the rest of the group a deep sense of wellbeing, further triggering curiosity among others. Despite low participation, everyone returned the following day for session 2 and completed all tasks. By the end of day, 5 out of 10 shared significant relief of somatic symptoms (head, neck, chest, and stomach pain reduced). We will be monitoring symptom improvement at intervention completion, 1, 6 and 12 months. The first set of data will be available in the first week of July here on our website.

The "Vu sound" is a simple Somatic Experiencing (SE) technique in which participants are asked to sustain the sound "VU" while exhaling. The sound creates a pleasant vibration in the stomach, sending cues of safety to the brainstem (a part of the brain that controls vital autonomic body functions) and assists in the stabilisation of the autonomic nervous system (ANS) disregulated by traumatic experiences.

Resonant Breathing is another simple technique that regulates Heart Rate Variability (HRV), further promoting stabilization of the Autonomic Nervous System and alleviating somatic reactions of trauma.
 
Community Health Worker (CHW) Training and Response to Curriculum
Our Liberian staff, experienced in working with traumatized communities, required two hours of training to adapt to the new curriculum format and a meeting for feedback after leading the first group session. We estimate that CHWs without former experience will require two full days of training - one theory, and one practical. Our upcoming implementation in region 2 (Uganda), commencing in July 2017, will provide us a more accurate estimate of training times for non-experienced community workers.

Intervention Application (App) Platform
During the first two weeks, we focused only on clinical challenges, accuracy, and safety of our participants. In the upcoming weeks, we are also beginning to field test all core features of our App prototype v1.0. Our Innovation Director is in Liberia to closely supervise and improve the functionality of the tool according to the needs of our Liberian staff, and limitations of the regions we are targeting. 

Community Response (Non-Participants)
After learning about the Sankofa Project, a group of young adults in the community requested Second Chance to provide training so they can volunteer to help lead groups instead of joining one. As they accurately stated, our staff was too small to meet the demand for services in the community. We are taking note of CHW training interest and look forward to running training sessions when funding permits.

Sankofa Blue Group #11.                                                                        

Sankofa Blue Group #11.                                                                        

We would like to thank and acknowledge all of our supporters and partners for making this project possible. We will continue to share monthly updates from the field so that you can follow how your donation is making a difference. If you haven't donated yet, please consider supporting us today. We stretch every donation to create sustainable impact. 

Footnotes
[1] Johnson et al., 2008
[2] Galea et al, 2010
[3] Chan, 2014
[4] Shultz, Baingana and Neria, 2015

We respect our participant's confidentiality. All images are posted with consent.

Sankofa Flying Higher. Thank you Bono for the Support!

Special thanks to Bono for believing in our work and supporting us by wearing our yellow Sankofa Project bracelet during the 2017 U2 Joshua Tree Tour. He's been a great source of inspiration and encouragement for Second Chance over the years.

If you would also like to wear one, you can get yours online as soon as next month when we launch the project. For only $10, you will receive a pack of 10 bracelets and sponsor a full trauma relief program in a post-war region in Africa, for a group of 10 participants during our field implementation phase in 2017-2018.  

Stay tuned for more details!

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Sankofa mHealth Innovation Brings PTSD Support to War-Impacted Communities

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Monrovia. 3 May 2017 – Second Chance Africa and Code Innovation announce our partnership on the Sankofa project to create a mobile application of an innovative clinical curriculum that helps people recover from trauma in war-impacted communities.

     The mHealth curriculum pioneered by Second Chance Africa will be used by the organization’s cohort of mental health facilitators, half of whom are graduates of the program. Since 2008, they have reached more than 7,000 war-impacted Africans on a shoestring, crowdfunded budget. Participants in one of their clinical outreach projects report a 65% reduction in the debilitating symptoms of trauma like intrusive memories, hyper-arousal, and avoidant behavior, a difference that allows them to return to a more stable life in their families and communities.

    Post-traumatic stress disorder (PTSD), complex trauma and extreme stress are common outcomes of war and debilitate a person’s ability to function in society. In West Africa, the recent Ebola outbreak worsened existing war-related PTSD, compounding long-lasting community mental health issues that remain unattended. In post-conflict areas, trauma often becomes a silent epidemic and while some people get better with time, many do not.

    In some areas, rates of PTSD diagnosis are close to 100% based on the nature and severity of events, and trauma symptoms have been documented in refugee groups decades after traumatic exposure. PTSD may heighten the risk for poverty, aggravating the consequences of war and conflict.

    “Approximately 17.6 million people are currently impacted by war and conflict across East, West and Central Africa,” says Second Chance Africa founder and Executive Director Jana V. Pinto. “Yet despite the clear need, trauma relief is not yet a humanitarian priority, as current efforts are expensive and there is no evidence base available to guide treatment choice. We urgently need more scientific research to develop best practices around trauma relief interventions in war-impacted communities.”

   “While it may seem secondary to investments in maternal health or child survival, research has shown that communities with a high prevalence of trauma struggle to progress economically,” says Elie Calhoun, Director of Code Innovation. “Trauma becomes a piece of the poverty trap and needs to be addressed before war-impacted communities can make lasting social and economic progress.”

   “The Sankofa mHealth app is designed as a tool for civilians and community health workers to lead local trauma relief groups independently and without prior training or experience,” says Calhoun “The 10-hour protocol directly addresses major PTSD symptoms without one-on-one psychotherapy or drug interventions. Digitizing this model on a free mobile app makes the approach accessible to health systems and organizations all over the world. It is a truly game-changing model.”

   “Although feature phone handsets still significantly outnumber smart phones in Africa, we expect to see a gradual shift to smartphones as they become increasingly available and affordable. Because the Sankofa mobile app is designed to be used by one facilitator working with many groups over time, the program model leverages what is still a relatively rare technology to harness its impact.”

   Field testing of the digital tool will begin in June in Northern Uganda with South Sudanese refugees fleeing current conflict, and in Monrovia, Liberia with a core team of Second Chance Africa facilitators who have been with the organization since its inception in the Buduburam Refugee Camp in Ghana in 2008. As early recipients of the intervention, the facilitators are a testament to the transformative potential of the Second Chance Africa model and have dedicated themselves to ensuring that others in their country receive the same life-changing services.

   The Sankofa digital tool will help them and other heroes in the battle against trauma to reach more people and help more people impacted by war regain their lives.

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Sankofa is crowdfunding to cover its program costs: https://www.razoo.com/story/Sankofa2017

For more information about the Sankofa project, visit http://secondchanceafrica.org/sankofa

Second Chance Africa
After six years delivering hands-on clinical services, Second Chance Africa’s team of scientists and health workers now focus on rigorous research and development of innovative, scalable and culturally-adapted intervention tools to advance trauma relief for African communities impacted by war. For more information, visit http://www.secondchanceafrica.org.

Code Innovation’s team of ICT4D experts specialize in helping high-impact development solutions go to scale. Our projects have been supported by UNICEF, the UK Department for International Development and major philanthropic foundations. For more information, visit http://www.codeinnovation.com.

For more information, contact:

Jana V. Pinto, Executive Director, Second Chance Africa, jana@secondchanceafrica.org
Elie Calhoun, Director of Operations, Code Innovation, elie@codeinnovation.com

World Health Day 2017 in Liberia

A World Health Day event organized by the World Health Organization (WHO) took place at the E. S. Grant Mental Health Hospital, the only mental health hospital in the republic of Liberia. The hospital received a generous donation from WHO, including mattresses, bedsheets, sanitizers, garbage disposal cans, toiletry, etc. We joined representatives of local and international NGOs, alongside government agencies and ministries to discuss this year's theme: "Depression: Let's Talk."

Did you know? Approximately half of people with post-traumatic stress disorder (PTSD) also suffer from Major Depressive Disorder (MDD). At Second Chance, we make sure the treatment curriculums we evaluate for PTSD in Africa also addresses MDD. We are here to guide and equip other NGOs working in post-war settings to make the best evidence-based treatment choices.

Support us to continue improving the quality of mental health services for communities impacted by war. Every dollar counts.
Thank you for your support!

Liberian Mental Health Policy Launching

Last week, Second Chance Africa participated in the mental health policy launching program at the E. S. Grant Mental Health Hospital, in Paynesville, Monrovia. This policy is a fundamental step forward to protect the rights of individuals struggling with psychiatric disorders in Liberia, to promote safe treatment options, and to reduce stigma among many other benefits for the local population. Congratulations Liberia and the dedicated staff at the Ministry of Health who worked very hard all these years to make this possible! We look forward to continue working alongside the government to implement the bill in urban and rural communities across the country.

Leadership and Advocacy Training in Nigeria

Our Liberian staff completed a two-week mental health leadership and advocacy training Nigeria. Thank you to the Liberian Ministry of Health for promoting this great opportunity for our team!