How Mental Health Support Proved Critical Tanzania’S Marburg Outbreak Response

Washington Mushobozi, who was isolated in a Marburg Virus disease treatment facility, says he does not know if he could have coped with missing his mother's funeral had it not been for the warmth and kindness of the social workers who helped him through his grief.

“They are good people, God bless them,” he says of social health workers like Rebecca Gwambasa, the psychosocial expert who led the mental health psychosocial support (MHPSS) pillar during the response to the outbreak of Marburg Virus Disease in Kagera in March 2023.

“Mental health and psychosocial support colleagues visited us at the treatment centre, talked with us and helped us to connect with family. It helped a lot.” Dr Hagai Nkya, Marburg survivor

Prior to the confirmation of the outbreak, 89 health workers were quarantined after having contact with the first cases. Suspected cases were also isolated as efforts intensified to control exposure to the virus.

With support from the European Union, WHO in the African Region trained 72 social welfare officers from five of Tanzania's regions categorized as high risk for outbreaks, providing them with skills to address the mental health challenges associated with emergencies. This training coupled with the development of guidelines and structuring of mental health psychosocial support functions at central and subnational levels. Eight of these officers were deployed to Kagera, proving pivotal to the Marburg outbreak response.

A total of 48 people required treatment for outbreak-associated shock and depression, while psychological support was provided to 212 others who were isolated for 21 days, after coming in contact with people infected with the virus. In total, about 1400 people benefited from counselling services.

“Through this service, people got calmer and understood that their isolation was for the good of themselves and everyone.” Milton Buchwa, ward executive officer, Kanyangereko

Gwambasa stresses that being kept away from family and friends takes a heavy emotional toll on community members and health workers alike. Those in isolation are under severe stress, often unable to sleep properly, with any existing mental health issues further exacerbated.

“MHPSS colleagues visited us at the treatment centre, talked with us and helped us to connect with family. It helped a lot,” recalls Dr Hagai Nkya, a laboratory scientist who was among the health care workers isolated at the Bujunangoma Marburg treatment unit for the duration of the outbreak.

Mental health psychosocial support during health emergencies advanced rapidly during the COVID-19 pandemic, with greater efforts made to reinforce its criticality.

To support their work in Kagera, the training was cascaded to peers and to community members, including teachers, who became the eyes and ears of the response in communities.“We oriented teachers from schools that were near communities that had contacts or suspected cases. They helped us with the workload,” Gwambasa says.

Milton Buchwa, ward executive officer at Kanyangereko, where the outbreak hit, says he cannot stress enough the importance of mental health services in emergency situations.“Through this service, people got calmer and understood that their isolation was for the good of themselves and everyone. The experts also helped us identify people in need of mental health support who were previously unidentified,” he says.

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