Searching for Normal in the Wake of the Liberian War. Sharon Alane Abramowitz
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and that they were often implemented by poorly prepared local actors. But he hoped to “stay on for a while, to do what he could to help Liberia.”
In a 2006 interview, Jensen told me that he drew on his experience in Sierra Leone to identify several priority tasks for his six-month tenure. These included: completing a population-based mental health needs assessment; establishing a mental health and psychosocial coordination committee; commissioning a study of local attitudes to mental health; strengthening psychiatric services; establishing a pilot project showcasing community-based mental health; and developing a draft national mental health policy for Liberia. In postconflict transitions, these kinds of activities are carried out in government agencies across the spectrum and are vitally important. The performance of these tasks and the allocation of resources to them served to act as a “bookmark” for the emerging postconflict state bureaucracy, and the failure to implement these activities meant that the domain of care they represented might be left out of postreconstruction state bureaucracies altogether.
But problems arose. Having brought Jensen in, the WHO then refused to provide Jensen with a budget for mental health activities, transportation, any means of communication (like cellphones or short-wave radio), logistical support, or the permission to employ a research staff. His superiors made it clear that the WHO had no interest in financing or supporting mental health coordination at an operational level or for providing oversight for psychiatric care. According to expatriate officials from both organizations, no international aid funds had been allocated to support psychiatric care in Liberia. Thus, while the WHO engaged in supervising other aspects of the Liberian medical sector, like epidemic outbreaks, infectious disease programs, and vaccination campaigns, Jensen was unable to make substantial progress on mental health.
To make matters worse, Jensen’s newly designated Liberian partner, the psychiatrist Dr. Jarvis Brown, was uninterested in moving the mental health agenda forward. Dr. Brown held prestigious pedigrees in psychiatry and global health. After his undergraduate medical training at the University of Liberia, he went to London to study at the Institute of Psychiatry and at Bethlehem Royal Hospital, where he specialized in alcohol addiction. In 1984, when many educated Liberians were fleeing Liberia to escape political violence, he returned to Liberia to work at Katherine Mills at the invitation of JFK Hospital. In one of two extended interviews with me, Brown recalled that working in Liberia was difficult before the war. Salaries came late, most medical professionals had fled the country, and by 1989 he claims that he was the only doctor left. When the war broke out in 1990, Dr. Brown left Liberia to join his family in the United States.
During the war, Dr. Brown was recruited for a number of consultancies with the WHO and became a psychosocial counseling specialist for various UN HIV/AIDS programs. He was assigned to Malawi from 1990 to 1994, but from 1994 to 1996 Dr. Brown returned to Liberia at the request of the WHO and the United Nations Observer Mission in Liberia ([UNOMIL] the 1990s predecessor of UNMIL). As Liberia entered its first demobilization campaign (described earlier), the WHO intended to support a strong mental health and counseling component. Toward that end, the WHO supported the co-drafting of a guidance document for mental health in Liberia’s first DDRR process and sought the engagement of Dr. Brown, Dr. J. Oliver Duncan (a psychologist who died in 2006), and the aforementioned Dr. Grant in demobilization, substance abuse, and HIV/AIDS projects. Clashes erupted between Dr. Brown and Dr. Grant as each sought to be recognized as the Liberian psychiatrist. When war broke out again in 1996, Dr. Brown fled again to the United States, where he lived with his family while periodically consulting for the UNAIDS program over the next several years.
Dr. Brown returned to Liberia in 1998 and continued his consulting work with UNAIDS, and opened several private businesses in Liberia, including (reportedly) a discothèque, an ice cream shop, a stationery store, and a private psychiatric practice. He did not speak much of his role in Liberia under the Taylor administration, but when the war ended, the MOHSW repeatedly invited Dr. Brown to become its national mental health advisor. According to Brown, he repeatedly turned down this request because the position carried no salary. Others, including deputy ministers at the MOHSW, WHO officials, and local community leaders, disputed that claim. Dr. Brown had accepted this position and was drawing a salary but was failing to fulfill his responsibilities. Other participants in postconflict mental health policy activities reported to me that as of 2008, Dr. Brown was drawing a salary of approximately US$40,000 per annum to act as a consultant on mental health to the WHO. (I attempted several times to obtain confirmation on this from the WHO and from Dr. Brown but received no response.) Thus, from 2004 to 2008, Dr. Brown held the titular role as the “head of mental health in Liberia,” but his businesses competed for his attention. As late as 2012, a senior USAID official confirmed that Dr. Brown was receiving a salary from the WHO, while Dr. Brown continued to publicly protest that he provided mental health–related work for little or no compensation.
Although the intricacies of Dr. Brown’s professional compensation and occupational history may seem to be a sideline, his stonewalling on matters of mental health led Jensen (and later the MOHSW, the WHO, the Mental Health and Psychosocial Coordination Committee [MHPCC], and humanitarian aid organizations) into an effective dead end for nearly five years. Without Dr. Brown’s engagement, Jensen’s work in Liberia was systemically discouraged and counteracted. In 2005 Jensen’s contract was not renewed, and he departed for Europe to await additional contracts and mandates from Liberia that never materialized.
Four of Jensen’s goals were, however, achieved during his time in Liberia. First, he worked with UNMIL to close the Holy Ghost Mental Home, a sham operation run by “Sister Sarah,” a madwoman with impressive political connections who ran the only mental health institution in Liberia at the end of the war. Sister Sarah’s strategy was to find psychotic people on Broad Street (a busy shopping thoroughfare in downtown Monrovia), offer them charity, and then manacle them and remove them to her “hospital.” At her hospital/ministry, patients were chained in abusive and unsanitary conditions, but Sister Sarah used her hospital as a means to obtain international charitable donations (see Jensen 2004a, 2004b). Jensen explained that without a national mental health policy, it was nearly impossible to persuade either the UNMIL police forces or the NTGL to rescue mentally ill patients suffering severe human rights abuses from a woman with an extensive corruption network. When UNMIL police finally took action, Sister Sarah was tipped off by a contact in government and managed to escape with all but two of her wards, and her operation was driven underground, but continued to thrive.
Second, Jensen and Immanuel Ballah, Grant Hospital’s chief psychiatric nurse, recruited the German medical NGO Cap Anamur to take over, repair, and reopen the E. S. Grant Mental Health Hospital in the national capital, which had fallen into decline after Dr. Grant’s death. Though Grant Hospital, like other emergency medical organizations, often had trouble maintaining consistent supplies of psychiatric medication,4 it was able to ensure the presence of an expatriate psychiatric nurse, and it worked hard to stock generic psychiatric medications, antibiotics, and malaria medications from the WHO’s essential medicines list. Thus Grant Hospital, under Cap Anamur, became the go-to resource for any NGO with a psychiatric case, anywhere in the country. Cap Anamur and MDM, a provider of outpatient psychiatric care, became the sole providers of psychiatric treatment in Liberia, and financially supported their psychiatric services through private charitable donations rather than waiting for nonexistent international humanitarian grants.
Third, Jensen organized the MHPCC. Founded around the failed “Greenfields Project,” an attempt to create a dedicated space at JFK Hospital for outpatient psychiatric care and referral, the MHPCC soon assumed an important “ownership role” for mental health and psychosocial visibility in national health policy. In principle, the MHPCC was founded in an attempt to institutionalize mental health and psychosocial coordination in conformity with emerging standards (IASC 2007) and to compensate for the lack of mental health coordination within the UN cluster rubric and within the MOHSW. It was, in effect, a “shadow cluster,” voluntarily organized by constituent NGOs and UN partners, the MOHSW, and Liberian organizations like the newly founded Liberian Social Work Association. Under the auspices of the MHPCC, NGOs offering mental health and psychosocial services were to meet monthly to coordinate mental health and psychosocial activities, to lobby government and international organizations, and to establish standards for the licensing and professionalization of