Bridging the gap: A mental health supervisor in South Sudan

10 Oct 2022
msf

My day starts with the to-do list. It’s always long because my job spans a lot of roles.

Our mental health service has existed for less than a year, but we’ve worked hard to make sure we’re reaching patients across the MSF hospital here in Lankien, a town in quite a remote area of South Sudan. Our patients include people with HIV and tuberculosis, survivors of sexual violence, malnourished children and their family members who are facing long stays in hospital and people who are started on medication to help with specific mental health disorders.

As the mental health supervisor, I plan mental health activities, coordinate the psychosocial support activities, supervise the counsellors, and also provide counselling myself. But I started my career doing something very different…

The start

My first role in the humanitarian field was in logistics. I was working in Akobo County, where I’m from, and it was really practical work – supporting projects like emergency food distribution and education provision.

Working in those kinds of humanitarian projects is where I really started to be aware of the mental health gap.

The gap

People in South Sudan have lived through decades of war. There was the war with Sudan before independence: 22 years of conflict. Then after independence, when people were just starting to live in a new atmosphere of tranquillity, we went into a crisis again: civil war broke out in 2013.

This crisis forced millions of people to leave their homes and livelihoods, trying to escape the fighting. Millions became refugees in neighbouring countries, often having to survive in very tough conditions. Although a national peace agreement has been signed in 2018, within local communities we also have intercommunal tensions, which means many people are still caught up in a cycle of violence. All this has an impact.

We know that rates of mental health disorders increase during emergencies, but mental health services are generally allocated only low levels of funding or resources. This limits their ability to reach the people most in need, or to provide high-quality care. Meanwhile, mental health disorders attract severe levels of stigma in South Sudan, which discourages people from accessing what help does exist. The result is that many people here are living with mental health problems, but the care they need is either unavailable, inaccessible or inadequately supervised.  

The dream

When I was working as a logistician, I could see that there was an issue with mental health, but I didn’t know how I could help.

I talked about it with Kieran, the area manager from my logistics job, and a good friend. He’s originally from the UK, and he told me that he’d done his first degree in psychology. That conversation was a turning point. As he talked about his studies, something clicked. I saw what I needed to do to achieve my dream. I had to keep my plan to myself for a few years. It wasn’t until 2017 that I was able to travel to Ethiopia to sit for the university entrance exam. In 2021 I graduated with a bachelor’s degree in psychology.

Throughout my studies, I kept my focus on mental health. I did a lot of internships, and even before I graduated, I found a job as a Mental Health and Psychosocial Support Officer, working in a refugee camp in Ethiopia. Many of the people living in the camp were from South Sudan, and had crossed the border to escape the conflict at home. My job was eventually cut short due to the COVID-19 lockdown, but I learned a lot. I knew I was on the right path.  

We know that rates of mental health disorders increase during emergencies, but mental health services are generally allocated only low levels of funding or resources. This limits their ability to reach the people most in need, or to provide high quality care.

msf
Ngueny Deng Pal
Mental Health Specialist

Making a difference in my community

After I returned to South Sudan, I saw the Mental Health Supervisor job advertised with MSF. Lankien is in Jonglei State, in the neighbouring county where I grew up. MSF has been providing physical health services here for many years, but when I was hired last year, I was one of the founding members of the mental health team.

Currently, I supervise six counsellors and we’re hoping to recruit one more. We’re all from the local community. This means we speak the same language as our clients, we understand the culture, and so we can build really good therapeutic relationships. It’s rewarding. I feel like we’re really making a positive change for people here.

Challenges

There are definitely some challenges too. Before clients meet us they may not believe we can help, and we have to use all our counselling skills to build up that trust.

We also hear a lot of difficult stories. Vicarious trauma is a real risk in this line of work, so during the counselling process you have to look after yourself: we always try to debrief as a team and to leave those experiences in the counselling room. At home I might do some breathing exercises or read a book to make sure I’m taking care of my own mental health.

Looking ahead

My favourite aspect of the job is working in our multi-disciplinary team, where we work hand-in-hand with our medical colleagues to consider a patient’s health in a really holistic way.

Any patient can have a mental health need, even if that’s not what originally brought them to the hospital. My ambition is to make sure each and every one of them has the option of that support.