By Mohamed Makmid Kamara
In the last week, I have been on self-isolation at home in Accra. I decided to self-isolate after I returned from Conakry for a week-long work trip. I returned to Accra just before borders were shut and flights were cancelled. I feel very lucky. It was such a relief to be back in Accra, safely. But I don’t feel relieved.
To say I have not been scared during this isolation period would be telling a lie. My anxiety level increased. My patience reduced. My suspicious hormones were gravely imbalanced. I almost always became weary of my sneeze and cough, something that should ordinarily be normal. I no longer trust the constant use of my hand. This is particularly difficult for me because I have Erb’s Palsy, a paralysis of the arm caused by injury to the upper group of the arm's main nerves. I have had this condition on my right hand since birth. So these past few days, anytime I read the news, I get anxious. The lack of certainty regarding when this will all be done has also not helped. So I keep reading the news and WhatsApp messages, even though I keep telling myself to stop.
But I also feel lucky, at least I can read the news. At least I can access multiple news channels and platforms. At least I can discern between the fake, the real and the bizarre. There are thousands of others who are not so fortunate; Thousands of people with disability and mental health conditions in Sierra Leone. People like my aunt Felicia and my cousin Steve (not their real names), who both have a mental health condition and physical disability respectively. So this article is to draw the government’s attention to one observable problem in the ongoing national efforts to prevent an outbreak of Covid-19 in Sierra Leone, which, sadly, has entered our country.
In my daily readings and interactions with messages from Sierra Leone, I noticed how little consideration or regard is being given to people with mental health and disability during this Covid-19 pandemic. The public health messaging I have seen from many agencies seems to be targeted mostly at the “able-bodied” segments of the population. It is neither inclusive of, nor accessible to the majority of persons with disability and mental health conditions across the country. This, in my view, risks leaving behind a lot of people such as my cousin and my aunt.
Research has shown that in public health emergencies and crises such as the one we are confronted with, the needs of people with mental health and disability conditions are disproportionately affected because they can easily be neglected, often forgotten. They most times struggle to access information and services. To prove my concern, I went to the Sierra Leone government-approved site online for messaging around Covid-19. I browsed through the various pieces of advice and warnings to see whether customised messages have been produced for persons with disability and mental health conditions. I found none. But I was not particularly surprised.
There is arguably little data about persons with disabilities in Sierra Leone. Several statistics and figures are being bandied around. But according to the Sierra Leone Population and Housing Census Thematic Reports on Disability, there are 93,129 persons with varying forms of disability in the country. This represents 1.3 per cent of the country’s total population, according to the report. Disability Africa estimates there are about 50,000 young people with disability in Freetown alone. This is a significant number for a small country like ours. It means we have 93,000+ people we need to get to first before the virus gets to them. We cannot afford to leave them behind in our response. And one way to carry them along (no pun intended) is to embark on mass inclusive public health communications.
Inclusive public health communication is an approach to communication in which information and its understanding are made accessible to everyone. This includes people with a learning disability, autistic spectrum disorders, dementia, stroke, cancer, visual impairment, people who are deaf or blind or who have a dual sensory impairment, as well as those who have cerebral palsy and mental illness. This is particularly important for contexts such as Sierra Leone where evidence indicates that people with disability and mental health condition face high levels of discrimination.
In their 2019 Human Rights report, the US State Department noted that even though the law prohibits discrimination against people with physical, intellectual, sensory, mental and other forms of disabilities or impairments, “The government did not effectively implement the law and programs to provide access to buildings, information, and communications.” The report further claims that “there was considerable discrimination against persons with mental disabilities. The vast majority of persons with mental disabilities received no treatment or public services.” Such indictments should worry us as a nation. It should also shame us. Importantly, it should embarrass us into action, now that we have an opportunity.
We have an opportunity which many countries could only wish for. Let us not squander it. One such opportunity is to ensure that images of people with disabilities are incorporated into promotional or educational materials where appropriate. The reason for this is to mitigate against the stigma and marginalisation that often accompany health epidemics such as this. There is no evidence to suggest that people with mental health or physical disability conditions are prone to contracting the coronavirus. However, there is evidence to suggest that pandemics like this could increase stress and anxiety for persons with disabilities and mental health, particularly for those already with pre-existing mental health conditions.
Another important step is for the government to include people with mental health and disability conditions during Covid-19 in crisis planning meetings and discussions. The table seems already crowded, but the voices are incomplete. There ought to be space for this segment of the population. Luckily, there is a National Commission for Persons with Disability (NCPD) in Sierra Leone. I hold no brief for the Commission, but I think this is an opportunity to get them involved. The Emergency Operations Centre (EOC) and the relevant ministries overseeing the government’s preparedness – now readiness – plans should ensure the NCPD and other credible disabled groups participate in planning discussions. Their involvement is crucial as only persons with disability will be best placed to identify and offset specific risks from government mitigation and containment measures, such as social distancing or ultimate lockdown. Their inclusion, both in communications and planning, will also help guarantee eventual access to essential services and care.
Additionally, the government has an opportunity to develop mitigating measures to ameliorate the disproportionate economic impact any future Covid-19 outbreak will have on persons with disability and mental health conditions. According to one study on disability in and around urban areas in Sierra Leone, 69 per cent of working age persons with disability, report having no income at all. Twenty-eight (28) per cent of disabled people live in households which report having no income at all. This compares to 20 per cent of non-disabled households. Such statistics ought to be enough for government to work with businesses, retailers, healthcare service providers, etc. as well as community organisations to ensure special provisions are put in place to support people with mental health and disabilities to access basic necessities such as food, medicines and medical supplies, water and sanitation as the crisis hits.
Finally, I would like to urge the government to ensure that systems are put in place to support the potential mental health and other consequences of Covid-19. I am not familiar with any measures that were set up for providing psychosocial support to those directly affected by Ebola and the wider population, post-Ebola. Worryingly, the current approach does not trigger optimism. My brief enquiry indicates that no such measures are currently being considered for during or post COVID-19 psychosocial trauma. I would, therefore, suggest, that these measures be considered to ensure that persons with disability such as my auntie Felicia and cousin Steve, are treated as a distinct group when public health inequity issues are discussed. And, importantly, to guarantee that we leave no one behind in our collective efforts to keep the coronavirus out of Sierra Leone.
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