If you ask Margaret Ballah to describe a typical day at work, she will tell you that there is no such thing. Every day Ballah rises at dawn, dons her crisp white uniform and shiny mental health clinician badge and walks several miles to Gbarzon Health Center in rural Grand Gedeh County, southeastern Liberia.
By the time she arrives, she finds dozens of patients who have lined up in the early hours of the morning to receive medical attention. Some of these patients are refugees from the conflict in Cote d'Ivoire, which borders the area where she lives. Others are patients whose illnesses started during Liberia's own long civil war, which left hundreds of thousands dead and still more raped, mutilated, or traumatized.
Margaret Ballah (right), shown with her proud husband and children following a special ceremony held in August 2011, is one of 39 credentialed mental health clinicians in Liberia trained by The Carter Center in partnership with the Liberian Government. (Photo: P.Rohe/The Carter Center)
Ballah has her work cut out for her. She is one of the only credentialed mental health care providers for these patients in Grand Gedeh County, an area almost the size of Jamaica.
Caring for others comes naturally to Ballah, who at age 10 became the primary caregiver for her younger siblings. But these early challenges never stopped Ballah from pursuing her dream to become a nurse and treat patients with mental illness.
"During a psychiatry course in nursing school, my instructor asked if any of the students would like to become mental health nurses," says Ballah, whose bright eyes and ready laugh puts many patients at ease. "But no one raised their hand. No one wanted to work with 'crazy people.' I thought to myself that someone had to care for people with these illnesses, and I wanted to be that person."
Yet, at the time, there was no mental health specialty for nurses at Tubman National Institute of Medical Arts in Monrovia or anyplace else in Liberia. The entire nation only had one practicing psychiatrist and one psychiatric hospital with 80 beds.
With jobs being scarce throughout Liberia, Ballah had no choice but to accept an offer at Gbarzon Health Center, a primary care clinic nearly 250 miles away (or 12 hours by bus) from her husband and children in Monrovia.
A few years later, in early 2011, a friend called her and told her about a new mental health program The Carter Center was starting that would train mental health clinicians in Monrovia. The program was free for students. Ballah saw it as an answer to her prayers and applied right away.
Ballah's employers promised to retain her position while she took the six-month leave of absence she needed to complete the program. In between late night study sessions and visits to clinical sites like jails, primary care clinics, and hospitals, Ballah also got to spend time with her family.
She especially is proud of her efforts to convince her husband – currently a nursing student – to pursue a mental health career, sharing with him her class notes and case studies from the Post-Basic Mental Health Training Program.
In August 2011, during a special ceremony on the grounds of her old nursing school, Ballah's family witnessed her graduation alongside 20 of her classmates as these clinicians became pioneers in their country to improve mental health.
"The steely determination that brought Margaret from teen motherhood and the many obstacles she faced to a leader in mental health in our country is combined with a rare gift to instantly calm and empathize," says Dr. Janice Cooper, country representative for the Liberia Mental Health Initiative. "But, we can't take credit for any of that. Our program provides the content and vehicle to help Liberians help each other. Everything else comes from our students and their families."
As Ballah continues her hard work in her community, she will be joined by dozens of other Liberian mental health clinicians. So far, in partnership with the Liberian government, The Carter Center has trained 39 mental health clinicians, who currently serve 8 out of 15 Liberian counties, with more to come.
The Center also works to help the Liberia Ministry of Health and Social Welfare to implement its national mental health policy as well as defeat stigma against mental illnesses in local communities.
"I feel I am able to see so much more of the patient's true health issues now than before," she says. "Before when a patient wasn't sleeping, we would prescribe a sleeping medication, or if someone wasn't eating, we thought it was malnutrition. Now, I am much more able to see if these conditions are caused by mental illness and treat them appropriately."
The separation from her family remains difficult, but Ballah says she is proud of her work and what she has been able to accomplish. She has plans to go on the local radio soon to raise awareness about mental illness and dispel common myths that these diseases can be contagious or caused by witchcraft.
"I want to help people with mental health problems feel empowered to get treatment and be well enough to do things they could never do before," she says. "I want people to know you can still have a life if you have mental illness."
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