Seven out of the eight governments in the Sahel – the arid zone between the Sahara desert in North Africa and Sudan’s Savannas in the south – have taken the unprecedented step of declaring emergencies as 12 million people in the region are threatened by hunger.

Recurring droughts have destroyed most harvests in the Sahel. Credit: Kristin Palitza/IPS

“It’s a catastrophic year. The drought is severe. We need urgent intervention to prevent a famine,” warns Ahmed Weddady, national director in the Ministry of Water and Sanitation of Mauritania, the country with the world’s least amount of potable water, which suffered the worst harvest shortfall in the region. A third of its population already suffers severe food insecurity.

After a drought destroyed the majority of the harvest in the Sahel late last year, rural populations throughout the region have started to run out of food in early February. That’s a good six months before the next harvest is expected.

But the world’s rich nations, plagued by financial crises and having just spent millions of dollars in emergency aid during last year’s Somalia famine, have been slow to respond to the appeals. Barely half of the 650 million dollars needed by the United Nations (U.N.) alone have been pledged. Other aid agencies say they are equally short of funds.

The catch: the longer donors wait, the more lives will be lost and the more expensive it will be to help, says José Luis Fernandez, regional emergency coordinator of the Food and Agriculture Organization of the U.N. (FAO): “That’s the lesson we learnt in Somalia. We don’t have time to lose. We need to mobilise support now.”

It costs 10 to 20 times more to airlift food into an affected area than to ship it. Equally, it costs 80 dollars a day to treat a malnourished child, while it would cost only one dollar a day to prevent the child’s malnutrition if the money was invested in development programmes in advance.

The problem in the Sahel is that exactly such long-term development programmes are barely existent. The region suffers from cyclic droughts that have led to low resilience among the population. Even in a “normal” year, half of all children under five, the most vulnerable, suffer chronic malnutrition. That means the step to reaching a full-blown hunger crisis is small.

Climate change combined with population growth, acute poverty, poor access to basic services, changing migration patterns and weak governance, competition over scarce resources and conflict potential have intensified in a region where the majority is dependent on rain-fed agriculture and livestock for survival.

That is why development experts stress the fact that emergency aid can only help the Sahel in the short-term, while long-term, structural programmes are needed to assist the region in creating resilience to recurring droughts. “Such programmes should include investments in agricultural development, health and social protection services, water and sanitation as well as adaptation to climate change,” says Johannes Schoors, country director of international aid organisation CARE in Niger, where more and more people go hungry due to the drought.

Even if all the needed funds were pledged, providing humanitarian aid will be difficult and complex. The Sahel is a vast, sprawling region, with many villages in remote and inaccessible places, making it a logistical nightmare to distribute food and other supplies.

“Because people live very scattered, logistics are complicated and expensive. Distances to reach affected people are enormous, roads very bad and sometimes non-existent,” notes Schoors.

What makes the situation even worse is the recent upsurge of violence in the region. In January, fighting erupted between Mali’s army and nomadic Tuareg rebels seeking a sovereign homeland, while Nigeria experiences violence perpetrated by Islamist sect Boko Haram, combined with ongoing operations by a regional Al-Qaeda group, Al-Qaeda in the Maghreb.

According to the U.N. Children’s Fund (UNICEF), which tries to get life-saving aid to severely malnourished children in the region, first supply trucks have been prevented from reaching food insecure areas in Niger, which borders on northern Nigeria.

“It is becoming more and more difficult to reach people in need. We face similar difficulties in northern Mali. We foresee a period of great instability in the region,” worries UNICEF regional nutrition advisor for West and Central Africa Felicité Tchibindat.

The conflicts have caused many to flee their homes. At least 22,000 refugees had flooded into Mauritania, Burkina Faso and Niger by early February, crossing the border into the most food insecure areas in those countries.

“Having to deal with displaced people in areas where residents already suffer causes additional difficulties in reaching them with aid, as well as social tensions and conflict potential,” says Fernandez.

The quadruple burden of drought, structural problems, violence and refugees begs for a swift response, he adds. But for now, many aid agencies cannot scale up their efforts until they receive the necessary funds.

The incessant buzzing of mosquitoes was the first sign that there was something wrong. While Bernard Akumiah could clearly hear the small insects, there were none within his vicinity.

Bernard Akumiah said that government needs to recognise mental illness as a legitimate health concern. Credit: Jamila Akweley Okertchiri/IPS

The buzzing of mosquitoes eventually turned into voices coming from nearby rooms. The voices sounded as though they were in French, a language neither Akumiah nor his brother, with whom he lived, could speak.

The year was 1982 and the experience of hearing mosquitoes that did not exist was the first sign Akumiah, then a young man with his whole life ahead of him, had schizophrenia. The mental disorder, which can now be treated with the right combination of antipsychotic drugs, is characterised by paranoid delusions and auditory hallucinations that are often paired with social dysfunction and anxiety.

But Akumiah’s diagnosis changed his life. Like many others with schizophrenia, he has been a victim of stigma.

“At first I had a lot of family support, they would even bring me food so I didn’t eat the food prepared at the hospital but when I was discharged, somewhere along the line, there was something like discrimination,” Akumiah said.

Stigma is a major impairment to mental health treatment in Ghana. The country is expected to pass a new Mental Health Bill by the end of March that could greatly improve mental health services if it is properly enforced.

Now 59-years-old, Akumiah has managed to control his illness by taking powerful antipsychotic medication every day. He is a volunteer with the Mental Health Society of Ghana and dedicates much of his free time to reducing the stigma associated with mental illness in the country.

He remains one of the lucky Ghanaians who are able to live normal lives with a severe mental illness.

He said the government needs to recognise mental illness as a legitimate health concern. “When you fall sick your family rejects you,” Akumiah said. “So who should take care of you? The government must accept and embrace people with mental illness with their whole heart and not by word alone but by deed.”

It is estimated that 98 percent of Ghanaians with mental illnesses never receive treatment. There are only three mental health facilities in the country, all located in the more populated south. In the poorer north there are no mental health services at all. There are more than 24 million people in Ghana but only 12 psychiatrists.

Ghana spends about one percent of its annual healthcare budget on mental health. Mental health practitioners estimate that as much as 10 percent of the population suffers from a mental illness of some kind. Dr. Akwasi Osei, director of the Accra Psychiatric Hospital, the largest facility of its kind in Ghana, has said that at least seven percent of Ghana’s total healthcare budget should be set aside for mental health.

“Our system for mental healthcare is quite poor,” said Osei.

Accra Psychiatric Hospital currently has 800 patients but only 500 beds. In the men’s ward patients are strewn about the floor of an open courtyard. Most are in a groggy state, thanks to their medication, and ask for better food or for a way out. Some said they get visits from family members but many others have been abandoned by their kin.

Osei said mental illness is not a priority in Ghana because of the stigma associated with it. That stigma manifests itself in three ways: against the condition itself, the patient and the mental health practitioner.

“The main thing is fear of the unknown,” said Osei. “People don’t know exactly what mental illness is and what causes it. And we are credulous beings. We want to believe. And if you want to believe and you don’t understand then you find superstition. Superstition becomes an antidote to ignorance, so we turn to associate superstition with mental illness.”

That superstition is most evident in the prayer camps scattered around Ghana. People with mental illnesses are often chained in the camps as preachers pray for their miraculous recovery.

But Ghana’s mental health practitioners and advocates believe the country’s new Mental Health Bill could help end the stigma against mental illness and allow for better treatment across the country.

The Mental Health Bill was first put before Parliament in 2006. It has gone through its first and second readings and is now at the committee stage. Humphrey Kofie, executive secretary of the Mental Health Society of Ghana, said the country’s health committee has assured him the bill will be passed by the end of March 2012.

Kofie said the bill would help protect the human rights of people who suffer from a mental illness. People who are known to be mentally ill in Ghana, for instance, are often prevented from voting during elections. Kofie said the Mental Health Bill would put an end to that kind of discrimination.

Osei said the new bill would be one of the most progressive pieces of legislation of its kind in Africa. “Healthcare will be community oriented instead of institutionalised, a mental health board and a trust to collect funds for mental healthcare will be established, it will provide enforcement power to end rights abuse and department for public education to further reduce stigma and train as well as monitor traditional healers,” he said.

The bill would also provide additional funding for mental healthcare in Ghana. There are no numbers for additional funding yet.

But Kofie said the law would need the proper legislative instruments to be put into practice.

Ghana’s Disability Rights Bill, passed in 2006, has still not been enforced. The country’s institutions are still largely inaccessible to people who have physical disabilities. Kofie has feared that the situation could be similar for the Mental Health Bill.

“The future is the legislative instrument,” he said.

Excerpt:

European leaders have mapped out a bold agenda ahead of the Rio summit, vowing to transform development aid, help provide renewable electricity to the world’s neediest people, and bulk up the United Nations environment body.

The European Union’s ‘Agenda for Change’ proposal calls for pumping foreign aid into sustainable growth and energy access, while European Union officials have also floated the idea of transforming the U.N. Environmental Programme into an agency with expanded influence and greater power to promote research and development.

Janez Poto?nik, the EU environment commissioner, on Tuesday reaffirmed the 27-nation block’s pledge to provide the equivalent of 0.7 percent of gross national income (GNI) for aid to the world’s poorest countries, while urging that there be a focus on sustainable growth.

“The potential for investment and gains are massive compared to official development assistance,” he said in a speech. “But at the same time the poorest countries need help, to make this promise good.

“That is why the European Union intends to fully meet our commitments to the poorest countries and will meet the Millennium Development Goal of 0.7 (percent) in 2015.”

Meanwhile, Development Commissioner Andris Piebalgs was expected on Wednesday to offer fresh support to U.N. Secretary-General Ban Ki-moon’s energy-access initiative.

“Through the promotion of our technology and expertise combined with a targeted use of our aid funding, we will aim to increase access to modern energy services for the world’s poorest,” Piebalgs said on the eve of an address at the European Parliament.

The pledges reflect officials’ hopes that the EU can be a catalyst in turning the UN Conference on Sustainable Development into a ground-breaking shift towards low-carbon, resource-efficient economic growth after disappointments at recent climate and development summits. The conference is to take place Jun. 20-22 in Rio de Janeiro, 20 years after the Brazilian city hosted the first ‘Earth Summit’.

“We are trying to work hard to ensure that we will obtain concrete results,” Poto?nik said, adding that “a day will not pass by in the coming months where the Rio outcome will not be discussed in our contacts with international partners.”

EU officials cite Europe’s commitments to cut greenhouse gas emissions, boost the use of renewable energy and improve energy efficiency as a way to tackle climate change while transforming economies and creating jobs.

Poto?nik also said it was a European priority to give the Nairobi-based UNEP more influence and resources.

But the European Commission, the EU’s executive, faces tall hurdles if it is to achieve some of these goals.

Many EU countries are economically stagnant and face rising unemployment. At a summit on Jan. 30, EU leaders pledged to create more jobs and spur growth to address a continent-wide malaise and sovereign debt problems that have forced EU leaders to ask for help from China and other countries with deep cash reserves.

EU leaders have traditionally seen overseas aid as an extension of their ‘soft power’, agreeing in 2002 to provide annual development aid equivalent to 0.51 percent of GNI by 2010, and 0.7 percent by 2015 for the 15 richest EU nations.

Yet there are doubts about whether the EU can really live up to its aid commitments.

A 2011 study by the CONCORD coalition of advocacy organisations said that despite the 54 billion euros (71.5 billion dollars) in aid provided by the EU in 2010, only nine of the bloc’s 27 countries kept or exceeded their promises on aid in 2010. The overall rate is 0.43 percent of GNI. The CONCORD group warns that at current levels of spending, aid will barely move beyond that, to 0.45 percent, by 2015.

“To succeed, Rio will need to put more money on the table to fund the move towards an economy based on sustainable development,” Felix Dodds, executive director of the London-based Stakeholder Forum said Tuesday at a development conference organised by the European Economic and Social Committee, an EU body.

Dodds, whose organisation promotes sustainable development, suggests ways in addition to development aid to create greener growth: a tax on financial transactions – backed by the European Commission but opposed by Britain and Ireland – and shifting the estimated 4.7 trillion dollars held by global sovereign wealth funds into green investments.

Dodds said the consequences of inaction are high. Referring to the EU’s aid commitment, he said: “If they do not do that, then seriously we are in danger of losing any trust with developing countries.”

With vehicles and donkey carts packed with their belongings, Somalis are returning, four years after they fled, to their partially standing, bullet-scarred and mortar-shelled neighbourhoods in former Al-Shabaab controlled areas of Mogadishu.

A Somali youngster walks past a ruined building in Hodon district in Mogadishu. Credit: Abdurrahman Warsameh/IPS.

With much of the Somali capital now under the control of government forces backed by African Union troops, most of the city’s residents have returned to their ruined homes after the surprise withdrawal of the extremists in August. Despite security incidents in the city, a semblance of normalcy has returned here.

Residents have now begun the slow process of rebuilding their homes and their lives. While most have been weary of returning to former Al-Shabaab controlled areas, a brave few have dared to return to their ruined neighborhoods intent on a new beginning. There are, however, no official figures of how many people have returned to date.

Many have had to endure years of hardship in squalid conditions in makeshift shelters on the outskirts of the city.

Maryan Guled, a mother of five, has lived with her husband and children in the Elasha camp on the outskirts of Mogadishu since 2008.

The family has now returned to their neighbourhood in Hodan district where they used to live in a villa in the midst of a close-knit community. However, their home was completely gutted during the three- year conflict for control of the city.

Her family had been forced to flee their home after Guled’s sister was killed when a stray bullet entered their home.

“Things began to fall apart when all of a sudden our neighbourhood became the target of blanket bombing and shooting back in 2008. My sister and many of my neighbours, who we were very close to, died in front of my eyes. We had to flee with our lives with nothing else,” said Guled as she swept the yard of her ruined villa.

Guled says the family does not know how they will pay for the repairs.

The Somali Transitional Federal Government, which is bankrolled by the United Nations and donor countries, has been unable to financially assist people rebuild their homes. And aid agencies remain busy helping those displaced by the famine to return to their homes in southern Somalia.

But security challenges persist for the returnees. Hundreds of unexploded bombs, planted by Al- Shabaab to prevent Somali government forces and African Union peacekeepers from taking control of these areas, remain scattered throughout the areas vacated by the Islamist rebels.

Somali government officials have warned returning residents of the presence of the explosives, which have so far claimed the lives of a number of people and injured dozens more.

Returnees to the city have also complained that under-paid Somali government soldiers have been a security threat. They have been accused of murder, rape, looting and robbery.

The government imposed a state of emergency in former Islamist-occupied areas, while the military has court martialed a number of soldiers after they were convicted of rape and looting.

Some were sentenced to death for murdering civilians, while others were given jail sentences for petty crimes. In recent weeks the incidences of crime have decreased.

But schools and markets are slowing reopening in Mogadishu, while the local government is repairing the main street in the heart of the city. Street lighting in some districts has been repaired, streets have been cleaned and garbage collected.

However, most services remain largely non-existent as only private companies supply running water and electricity to residents. Hospitals in Islamist-vacated areas have been destroyed and remain closed.

Dahir Kulmiye and his family of five returned to their partially destroyed home in Hodon soon after the rebels fled the city in August.

He says that water and electricity has been a major problem for the returnees, but local companies are trying their best to kick-start services.

The state utility company was destroyed during the country’s two-decade civil war. So small, local and privately run companies provide services for those who can afford them.

“Lack of a clean water supply is another big problem for us since we returned here a month ago. The power company has restored electricity in many homes and we expect to get it in our home soon,” Kulmiye told IPS.

He added that his children had to attend a school far from their home because the nearby one remained closed, as it required major repairs.

Mohamed Hallane says his family wants to live in their home again. It is situated in Hawlwadag district in the south of Mogadishu, an area that was once an Al-Shabaab stronghold. But Hallane’s home was hit by mortar shells and is in need of major repairs before he can move back.

“I checked on my home. The areas are secure but almost every home in our neighborhood has been hit by shells, and bullets scars are everywhere,” Hallane told IPS.

As returnees work at rebuilding their lives, they have also found time to enjoy life. Residents in the capital have, for the first time, started visiting the city’s beaches to relax as the security in the capital gradually improves. Hundreds of residents flocked to Mogadishu’s Lido Beach over the Christmas weekend.

Schools are beginning to re-open slowly in areas of capital Mogadishu that were until recently controlled by the militant Islamic group al-Shabaab. But an estimated 80 percent of students have not yet returned.

Girls at most schools in Somalia are ordered to wear an Islamic dress. Credit: Shafi’i Mohyaddin Abokar/IPS.

The government is moving also to create a unified syllabus for all schools. Al-Shabaab controlled schools had been running a separate Islamic curriculum.

Eleven of Mogadishu’s 16 districts were under the control of the Al-Qaeda linked militants before their August withdrawal from the capital. Only 20 of the 78 existing schools in these districts have opened since September, but they are mainly empty as families slowly return to the capital.

Somalia was the hardest hit by the drought in the Horn of Africa with the United Nations (U.N.) declaring famine in parts of southern Somalia.

Sadeq Salaad, from the non-governmental organisation Formal Private Educational Network in Somalia (FPENS), told IPS that 78 schools in north and northeastern parts of the capital were closed because of the daily armed confrontations between Al-Shabaab and forces loyal to the government in those areas since mid-2009.

“According to our statistics only 20 schools in these war-ravaged areas have reopened and that is because of the small number of families which have returned to their homes in the city since August,” he said.

In Somalia, most schools are managed by the FPENS, as the Somali Transitional Federal Government has yet to gain control over them after years of war in this East African nation.

FPENS has been managing schools here since the country fell into anarchy in 1991 with the outbreak of the Somali Civil War. During that time there had been no central government control over the country.

“Another big problem is that so many schools were destroyed by the wars and they need to be rebuilt. There are some schools that were reopened but are partly destroyed,” Sadeq told IPS by telephone.

Boondheere district in the northeastern part of the capital is a former Al-Shabaab controlled area. Twelve schools here were closed during the militant group’s three-year siege of Mogadishu.

Mujama Umul Qura, which is said to be the largest school in this district with a capacity for 6,000 students, became the first school in the area to open its doors in October. But only a few students are enrolled here.

“At least 20 percent of our 6,000 students are currently here. We hope that all students will restart their education by January,” the school’s principal Sheik Hassan Mohamed Ahmed told IPS.

The International Islamic Relief Organization runs Mujama Umul Qura and the school curriculum differs from that of other schools in this area. It is a common occurrence in Somalia.

Somali Education Minister Ahmed Aideed Ibrahim told IPS that his ministry is currently attempting to combine the different curriculums being taught at Somali schools into one unified syllabus.

“We are in consultations with experts from the former Somali Education Ministry and we are discussing ways to unite the different curriculums used in the country. We hope to reach our target within the next eight months and we are very hopeful that the country’s former curriculum will once again be in place,” he said.

While students and parents say they are happy with the opening of some of the schools in the capital, most homes in the former Al-Shabaab controlled districts are in need of major repairs, and residents say this is one of the main reasons why more families are yet to return to the capital.

Hasna Abdulkader Farah, a mother of five, said that two of her sons would have graduated from high school on January 2011 if the country’s ongoing conflict had not affected their education.

“I am praying to Allah to punish Al-Shabaab in his hell, because they caused many problems for us. Praise be to Allah now we are safe and my children have returned to school,” Hasna told IPS.

Many other children in Somalia suffered a worse fate, as they were easy targets for militant recruitment.

Ibrahim told IPS that a large number of Somali children of school-going age have been used as combatants in country’s long-running conflict. He said that a lack of education was the main cause for the increasing number of child soldiers in this war-ravaged country.

Ibrahim said that his ministry is planning to build colleges and boarding schools for orphans and children from poor families in an attempt to prevent them from being recruited by militant groups.

“The Somali government is giving particular consideration to this sector, because lack of education has lead thousands of children to be very vulnerable to warmongers who have been monopolising them as warriors for the past two decades,” Ibrahim told IPS.

In the past, education was free in Somalia but Ibrahim could not say if his ministry would be able to continue with this.

Mohamed Abdullahi, the chairman of Somali Students’ Union (SSU), told IPS that the organisation welcomed the reestablishment of education in the capital.

“If there is no education it means we have no bright future, because when education is growing, the civilisation also grows. So the SSU is very much jubilant at the restart of education in the war-devastated parts of Mogadishu,” he said.

He called on the Somali government and the U.N. Educational Scientific and Cultural Organization to help rebuild the destroyed schools.

Excerpt:

Elizabeth Zainab Kargbo was a successful young woman, eight months pregnant and working in Sierra Leone’s civil service, when she had her first seizure.

Elizabeth Zainab Kargbo suffers from epileptic seizures. Suffers in Sierra Leone are often undiagnosed and unaware that their condition is treatable. Credit: Jessica McDiarmid/IPS

No one knew what it was. She lost her job and the baby, and as the attacks kept coming, most of her friends, neighbours and family stayed away.

“When I get the attack and drop down, people are so afraid of me, they run,” says Kargbo.

“They say, ‘Oh, don’t touch her, don’t touch her, it will spread.’ So sometimes when I drop down, I have damages to my face.”

Kargbo has epilepsy, a neurological condition that afflicts an estimated 60,000 to 100,000 people in this West African country of just over six million. Most are never diagnosed and only about 2,500 of them receive medical treatment. Sufferers here are often isolated, driven from their communities, and unaware that what they have is a highly treatable medical condition.

After Kargbo began experiencing seizures, her mother took her to a traditional healer. She was taken into a room and told to remove her clothes – and made to promise that she would not tell anyone what happened.

She wanted to get better, so she promised not to tell, took off her clothes and was molested.

Despite her promise, Kargbo told her mother. That was the end of traditional healers, she says with a smile.

Max Bangura, the coordinator and founder of the Epilepsy Association of Sierra Leone, has heard dozens of stories like Kargbo’s.

Seizures are often attributed to witchcraft, curses or demonic possession, says Bangura, whose association provides counselling and treatment to epilepsy patients and runs a small vocational training programme.

There is widespread belief that it is contagious, which further isolates people with epilepsy. Bangura says even those who have gone to medical centres for treatment have been referred to traditional healers because medical staff weren’t aware of the symptoms of epilepsy.

People with epilepsy are often driven from schools, jobs, homes, and subjected to traditional treatments that, he says, are “tantamount to torture” – cuts, burning, inhaling or drinking potions. One of the association’s members survived drinking two litres of kerosene. Girls and young women are subjected to sexual assault as a purported “cure,” says Bangura.

Treatment with phenobarbital, an anti-epileptic drug, costs 10,000 Leones (about two dollars) per month in Sierra Leone and is up to 70 percent effective in controlling epilepsy. But few people access it – and many cannot afford it.

“People do not come out. People do not want to be identified as having epilepsy,” says Bangura. “The stigma attached to the disease makes people not go to health centres because they don’t want anyone to know.”

The challenges of treating epilepsy in Sierra Leone are daunting. The country’s fledgling healthcare system struggles to cope with far more common — and deadly — afflictions such as malaria, diarrhoea and respiratory infections with little infrastructure and few professional health staff. It is one condition competing with many others in a system painfully short of resources.

Dr. Radcliffe Durodami Lisk, the only neurologist in a nation of about six million, runs the Epilepsy Project, which works with Bangura’s association to provide care throughout the country.

Funded by a British charity, the project runs three clinics in Freetown and one in Bo, the country’s second-largest city, which operate out of government hospitals. Workers travel to other areas of the country each month to disperse medication and provide care.

Sierra Leoneans have higher rates of epilepsy than most Western countries, due to risk factors such as meningitis, traumatic births and cerebral malaria.

Many patients cannot afford drugs, even at a cost of two dollars a month, says Lisk.

“It would be great if we could provide free treatment because most of these patients cannot work – no one will hire them,” says Lisk. “We end up giving quite a few patients free medication and trying to absorb the cost.”

But the biggest challenge, says Lisk, is convincing people to come forward and access treatment.

“They do not believe it’s a medical illness,” he says. “They don’t even think of going to see a doctor because as far as they are concerned, this is a demon or witchcraft.”

On a narrow lane behind a mosque in eastern Freetown, a handful of students lean over sewing machines under an awning that juts out from a partially finished building. The epilepsy association’s headquarters doubles as Bangura’s family home, and a vocational training centre, dubbed “The Love Institute” for about 20 people with epilepsy.

Here, people with epilepsy learn trades and are offered counselling, support and treatment. Bangura has been running the association for 11 years with funds from donations and membership contributions.

Chernor Dumbuya was carrying a basket of cooking items home from the market in Freetown, Sierra Leone, for his mother the first time he had a seizure. Thirteen at the time, Dumbuya dropped his load and fell to the ground with froth coming from his mouth. Everyone ran away.

The attacks kept coming, and no one knew what was causing them. Neighbours and friends were afraid of him.

“They all went far away,” says Dumbuya, who is now 28. “They all stayed away.”

Since starting treatment, he has had almost no attacks, and was the first graduate of the association’s three-year training programme, finishing in 2007 and carrying on to work as a tailor.

After years of living in isolation, Kargbo began taking classes here a year ago and the association connected her with treatment. She gets the money to pay for her medication from her church.

“If you expose (your illness), you get help.”

Excerpt: