President Ellen Johnson-Sirleaf and her Cabinet have planned a visit to our center in Zwedru.  The President's visit falls on the momentous 3rd anniversary commemorating the launch of our HIV Equity Initiative -- the first program to provide treatment to people with AIDS in southeastern Liberia.  Community leaders like Philip Collins, the second patient in our HIV Equity Initiative and now TH's poverty reduction officer, will give speeches to the President about the farm and support group he has started.  And leaders of our women's empowerment program, Zwedru Women United for Change, will share a photovoice documentary film they created about the life of rural Liberian women in Zwedru.  Stay tuned to our blog and the President's Executive Mansion website for more details.

Tiyatien Health has won the grand prize in a global competition seeking “the best solutions to improve mental health in communities around the world.” Sponsored by Ashoka Foundation’s Changemakers and the Robert Wood Johnson Foundation, the “Rethinking Mental Health: Improving Community Wellbeing” competition drew over 340 submissions from 42 countries.

Selected for its “vision, impact and unique approach”, Tiyatien Health’s winning Changemaker submission -- a project dubbed “Rebuilding Hope after War” -- partners with the Liberian Ministry of Health to employ local residents as community health workers who team-up with mid-level clinicians to treat depression and epilepsy. TH trains non-physician clinicians in simplified, evidence-based protocols. Community health workers (CHWs) lead group counseling sessions and identify, monitor, and support patients on treatment. The Rebuilding Hope initiative serves over 100 patients at Tubman Hospital in Zwedru, Liberia.

“The CHWs provide an ideal solution to Liberia’s triple threat of severe resource shortages, extreme deficits of trained health workers, and highly dispersed rural populations,” said Dr. Pat Lee, a Harvard-based physician and Director of Tiyatien’s Chronic Disease programs. “We will rigorously evaluate this mental health program as an effective solution for Liberia and a model for other rural, post-conflict settings.”

TH’s community-based strategy works to provide high-quality primary health care and promote job creation among the poor in rural Liberia. “Our model is effective because it is highly participatory”, said Gideon Tenty, a former Liberian war refugee and community mental health leader at Tiyatien Health. “Our programs are directly designed by the people served by them in collaboration with public health experts.”

“The Changemakers prize offers hope to Liberians suffering from the silent burden of depression and other mental health disorders,” said Dr. Amisha Raja, a VA-based expert in psychological treatment of war victims and co-founder of Tiyatien Health. In 2008, a landmark national study of 1666 households that Dr. Raja and TH helped organize uncovered that over 40% of Liberian adults suffer from depression and post-traumatic stress disorder.

“Three years ago, Ministry of Health leaders declared the lack of mental health services an emergency,” said Dr. Raj Panjabi, a Liberian-born, Harvard-trained physician and Executive Director at Tiyatien Health. “By bringing international recognition to this work, the Ashoka Changemakers prize honors the bold commitment of the Liberian government’s Mental Health Taskforce and its many partners who seek to close the mental health treatment gap.”

Tiyatien Health will receive $5000 and its work will be highlighted on the Ashoka Foundation’s website, Changemakers.com, “where innovators, investors, and supporters come together to help refine and scale up the impact of the newest, best ideas for social change.

TH's Rural Women's Initiative gathers after completing, "A Life in Zwedru", the documentary PhotoVoice Film.

Liberia elected President Ellen Johnson Sirleaf Africa’s first woman president.  And, in Zwedru, the fight for women's rights continues.  Here, there is a still a common saying: “women can’t cut stick and walk across it too.” It signifies a belief that women are only capable of a limited supportive role in society, not one with decision- making power.  In our last bi-annual update, we described how 18 women rallied this summer to challenge this unjust conventional wisdom by launching a Rural Women’s Initiative, called “Zwedru Women United for Change”.  This summer the group, led by Agatha, produced a moving Photovoice documentary film narrating the lives of rural women in Zwedru.  

Since then, Agatha and TH’s women’s committee have set out to establish a women’s resource and advocacy center.  They initially plan to train 100 women in social advocacy and economic skills.  Their first skills training project is on a roll.  In September, Agatha and the women just secured a contract from a local primary school to sew 100 uniforms for the poorest children, who otherwise would be unable to attend school.  Agatha and the women will use the income to buy their own sewing machines and train more women in sewing.   

They plan to find a home for their projects by constructing a women’s center, for which they have just secured a land donation.  Please write to info@tiyatienhealth.org or visit http://www.tiyatienhealth.org/donate to get involved or support the Women United for Change. 

-Raj Panjabi, Co-Founder at Tiyatien Health; Harvard Medical School

Philip (center back) and the HIV/AIDS patient support group at clearing their new farm

Last November, Philip, the second AIDS patient to ever receive care in Tiyatien Health’s (TH) HIV clinic, rose from a bench under a tree’s shade to give a rousing speech at TH’s annual retreat.  Philip called for a renewed focus on “improving the living conditions of we, the poor.”  At the moment, he announced that he would form a support group for people like him, who are living with AIDS, to make that change.  

In one year, Philip has organized with 32 other patients, primarily women with AIDS, to start the region’s only HIV/AIDS patient support group.  The support group’s first project was to reduce hunger and poverty by starting a cassava and peanut farm.  They managed to get land donated and TH, in partnership with the United Nations, gave them hoes and axes.  

As of July they needed just a final $43 to launch their farm.  Eager to start before the rains end, the support group refused to wait for aid from the outside.  Rather, they set out to raise funds on their own.  They first collected small dues from their members, and then lending the growing pool of cash to support individual members for various projects -- asking for a small interest on return.  Last year, a Nobal Peace Prize was awarded to Muhammad Yunus, the man who championed this so-called “microcredit” approach.  It’s a credit to Philip and the HIV/AIDS patient support group that they arrived at this idea on their own!  

Since July, Philip and the support group surpassed their fundraising goal -- collecting over $65 to launch the farm!  As you can see above they have already begun to plant cassava crop in their farm.  The group is now asking TH to raise another $200 in micro-loans to buy peanut seeds.  

Email us at info@tiyatienhealth.org or visit http://www.tiyatienhealth.org/donate if you would like to support or get more involved with TH’s poverty reduction work. 

p.s. - We’re also proud to report TH just hired Philip as our anti-poverty officer.  We hope in this new position he will continue to be an inspiration to others living in poverty.

-Raj Panjabi, Co-Founder at Tiyatien Health; Harvard Medical School

Tiyatien Health (TH) Bi-Annual Update
August 2009

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Dear Friends of Liberia,

The United Nations Mission in Liberia featured the work of TH’s new women’s committee, Zwedru Women United for Change, and their Photovoice documentary in its July 29th edition.  See the “Recent News” column at http://www.tiyatienhealth.org/women to listen to the segment.

As always, please help us spread the word.  In this radio program about Photovoice, 18 rural Liberian women in Zwedru organize a powerful photo-audio documentary to “elicit an authentic narrative” describing their life struggles, triumphs and hopes.  Photovoice is an example of how TH fights against poverty and disease through our community-based programs in Zwedru and its surrounding forest communities in southeastern Liberia.  After the UN radio program aired, Women United for Change members Agatha Toure and Janet Jedo, along with Photovoice co-organizers, Danielle Alkov and Julia Fleming from Harvard Medical School, were invited by the Liberia’s special UN advisor on gender to present a film about Photovoice to senior officials at the Liberian Ministry of Gender and Development in Monrovia.  TH plans to share the Photovoice documentary at exhibits at various venues in the United States and Liberia.  If you or your group would be interested in holding a viewing of the Photovoice exhibit please contact Julia or Danielle at julia_fleming@hms.harvard.edu or danielle_alkov@hms.harvard.edu    

Our health programs, too, are on the move.  This spring, the HIV Equity Initiative (HEI) enrolled its 300th patient at Zwedru’s Tubman Hospital.  Designed by AIDS-affected women and organized as a joint project of TH and the Liberian government, HEI was the first program to introduce life-saving HIV (or antiretroviral) treatment at a rural public hospital in Liberia.  HEI deploys a comprehensive, home-based approach to HIV care focused on delivering quality healthcare and poverty reduction through job creation, agricultural support, and small-business training.  Led by Liberians Dr. Valentine Sawyerr, TH’s medical co-director and Othello Davis, our clinical supervisor, HEI is helping revolutionize access to HIV care at rural health centers.   

In January 2009, TH assisted the National Tuberculosis Program in collaboration with the Clinton Foundation and Partners in Health, to diagnose the first patients with multi-drug resistant tuberculosis (MDR-TB) at the government’s Tuberculosis referral hospital in Monrovia.  A disease of poverty, tuberculosis kills over 2 million people a year globally.  MDR-TB is a difficult form of TB that fails to respond to first-line drugs.  TH supported the National Tuberculosis program’s successful application to the WHO’s Green Light Committee to procure an initial batch of second-line drugs to treat patients with MDR-TB.  Led by Dr. Kerry Dierberg, TH’s medical co-director, TH is working with the National Tuberculosis program to develop a formal partnership to provide technical assistance to Liberia’s MDR-TB and tuberculosis response.  

TH’s focus on HIV and tuberculosis is integrated with our broader approach to strengthen rural health systems.  With only 50 doctors post-war, Liberia faces one of the worst shortages in clinic staffing in the world.  Since 2006, TH has been supporting Tubman Hospital, a 75-bed regional health center serving over 300,000 people in forest communities,  through employing and training clinical staff to deliver Liberia’s Basic Package of Health services, such as women’s and child healthcare..  This week, on-call for Tubman Hospital, Dr. Sawyerr performed yet another midnight emergency cesarean section saving a mother who would have otherwise died unnecessarily in childbirth.  And, as you read this, community health workers from TH and the Ministry of Health are conducting a masssive malaria prevention campaign in Grand Gedeh County southeastern Liberia – distributing 8000 bednets to keep malaria, a chief cause of child mortality, away from children in the region.  These services for women and children are critical in rural Liberia, where mothers and their children suffer one of the highest death rates in the world.

Beyond directly caring for the sick, TH advances its dual mission to tackle the root cause of disease – poverty.  Our livelihoods officer, Neewray Gaye, continues to help patients and families access small business training, food packages and agricultural tools through TH’s social and economic rights program.  Over 200 patients and their communities have participated in the program.  Several of our patients, having lived all their life in forests or as war refugees, are now employed as community health leaders.  TH’s approach to poverty reduction aims to respond to the structural risk factors that predisposed the country to violent conflict while identifying opportunities for reconciliation and peace building. 

In April, TH welcomed 6 new members to its advisory board, including Dr. Paul Farmer, Partners in Health Co-Founder and the subject of Tracy Kidder’s biography, “Mountains Beyond Mountains”; Dr. Joia Mukherjee of Partners in Health and Harvard Medical School; Liberian MacArthur Foundation Fellow, Dr. Lisa Cooper, and Physicians for Human Rights co-founder Dr. Robert Lawrence, both of Johns Hopkins University; Dr. Peter Ehrenkranz, Medical Director of the Clinton Foundation’s HIV/AIDS Initiative in Liberia; and Edward Cardoza, founder of Still Harbor.  TH is fortunate to have the counsel of these advisors, who have long been friends and advisors to TH’s leaders.  

TH continues to share its experience through broader advocacy.  TH Co-Founder, Weafus Quitoe was invited by the UN Refugee Agency to share presentations about HEI’s work with other community-based organizations at a regional summit in Dakar, Senegal.  Co-Founder and Liberian-born Dr. Raj Panjabi gave a seminar on TH’s approach to colleagues at Partners in Health and Harvard Medical School.  This followed a keynote presentation by Raj at the 15th annual Partners In Health symposium last October at Sanders Theatre at Harvard University.  Dr. Amisha Raja and Ben Grant contributed served on Liberia’s new National Mental Health Committee, which created Liberia’s first National Mental Health Policy this summer.  Finally, TH has launched a new website, developed by Peter Luckow, and opened a new office in Liberia’s capital Monrovia.  TH’s Monrovia office, located at the Edwin J Barclay Building on Johnson and Carey streets, is led by Bernard Togba and Ben Grant and aims to represent TH among the Liberian government and other international partners based in Liberia.  To arrange a visit with our Monrovia-based team, please email Bernard at btogba@tiyatienhealth.org 

Looking to the future, TH plans several exciting projects.  In September, Amisha and our new Director of Chronic Diseases, Dr. Pat Lee, jointly affiliated with Harvard Medical School and Partners in Health, will work with TH’s Liberian team to strengthen care for seizures and depression.  The work on depression builds off TH’s work on a groundbreaking national study which found that over 40% of Liberians suffer from depression, with people caught in the country’s civil war at higher risk.  TH also plans to work with the Liberian government towards building a model community health center in Zwedru, integrating our innovative services in health, poverty reduction and reconciliation.  

TH is currently working to support these initiatives through a semi-annual fundraising campaign.  Our goal is to raise $50,000 by August 31st and to date we’ve raised nearly $35,000.  If we could interest you in making a campaign pledge, please let us know.  Or click “Donate Now” on our website at http://www.tiyatienhealth.org/donate 

Friends, eighteen years ago, when we escaped Liberia’s civil war with our families, we felt an overwhelming sense of despair and panic.  Today, we see our Liberia on the rise.  After war, the country is poised for tremendous progress – focused on equal opportunity, greater health, and less poverty.  We worked with friends to start TH to prove Liberia’s often unrecognized rural communities can lead this effort.

Together we have the power to accomplish the extraordinary. 

 In solidarity,

 Raj Panjabi & Weafus Quitoe 

Co-Founders

Tiyatien Health

http://www.justiceinhealth.org