April 5-11, 2025
Saturday, April 5, 2025
From Atlanta to Newark to Brussels to Freetown, I arrived in Monrovia, Liberia, for The Carter Center’s Mental Health Program Review. I left Atlanta with Karmen, and we were united with Kashef, Eve, Toni, and Iliana in the Brussels Airport’s Sunrise Lounge.
Sunday, April 6, 2025
As is my custom, I tried and failed to sleep on the flights. We all arrived at the Roberts International Airport around 8:00 PM on Sunday, April 6. A representative from Immigration and Customs whisked us all to the VIP holding room, complete with a gilded bathroom.
As our passports were taken and processed, we met with our Senior Country Representative, Benedict Dossen, and my Protocol Officer, Carnetta Hoff, from the Ministry of Foreign Affairs. The Ministry assigned me a security detail, who led our team, via our able and fearless driver Peter, to the Mamba Point Hotel in Monrovia.
The shower was hot and the bed was comfy. RON
Monday, April 7, 2025
On Monday, we awoke, had breakfast at the hotel, and visited The Carter Center office in Monrovia. We met in Ben’s office, made introductions, and then Ben took us to the B.W. Payne Elementary School on Benson Street. A first-grade girl welcomed me to her school with a bouquet of flowers, and then the principal of the school was overjoyed to announce to me and The Carter Center staff that their school is the first in the country with a nurse on campus with mental health training, which was provided through the work of The Carter Center. We then toured the school, its clinic, and the mental health room. We were then treated to a play written and performed by students from 2nd to 6th grade. Through their performance, the students taught me that with just one mental health professional on site, the entire school was able to focus on building trust with one another, and the students were able to replace bullying and ostracizing with empathy and understanding. Their skit was ultimately about how young school-age children were being taught de-escalation and conflict resolution techniques. This allowed students to better work together, better understand each other, and focus on their education.
I later learned that for schools with these types of resources, fights and expulsions have reduced from 4-6 per month to less than 1 per quarter. There are now 8 schools in-country with mental health services on site, and now 9000 students are growing up with support that was simply impossible just a few years ago. My final lesson from the school was that students were able to bring their mental health learnings home, and these young students were able to identify and help some of their older siblings, and even some of their parents. I did a few interviews in the courtyard, and returned to The Carter Center office.
Separated by Lunch at La Kora, Ben, Dr. Ijaz, Eve, Iliana, Toni, and I had meetings back at The Carter Center office. The first was with the in-country Carter Center staff, where we had the opportunity to elevate and congratulate the staff on their incredible work in building Liberia’s mental health system correctly, from scratch, over the past 15 years.
The second meeting was with local mental health clinicians: nurses who have obtained their mental health professional certification, a UN-approved standard recognized by their national nursing board. The dozen or so people in the room represented the 368 mental health practitioners who have graduated from the Carter Center’s mental health nursing program. This discussion was much more lively, as the mental health practitioners shared their successes, hopes, dreams, and challenges that they face in operating in-country. This meeting turned into a town hall, with an airing of grievances. After a lively discussion, I summarized their main challenges into the following three points:
- Liberia has not streamlined the importation of psychotropic medication. These medications are expensive and mostly donated by the Liberian diaspora in the United States. The last container of medication that arrived in port was ruined because it stood on the docks in the hot Liberian sun, waiting for import tariffs to be paid and warehousing to be set up.
- Mental health practitioners have not yet been integrated into the national health system. Currently, when a medical facility recognizes that its system could be improved with mental health training, willing nurses leave their facility for 6 months to receive their mental health certification. When they graduate and receive their certification from the nursing board, they return to their clinic and resume the role they left, with the added case load of mental health work in their clinic. Nobody returns to sole mental health work, which means that no mental health professionals are available for doctor referral. In short, nurses leave one job to get trained, and come back to two jobs, which leads to understandable gripe number 3:
- The Civil Service of Liberia has not integrated a single mental health professional; nobody who gets their certification gets a pay bump for their certification. This means that every single person with a current mental health certification is doing it out of necessity and passion. This is great, but obviously not sustainable.
I told the nursing team that I would bring these concerns to their senior leadership, but that I was only here for one week, and I would only have one meeting. I told them to do three things: organize, organize, organize. Liberia has the most passionate and dedicated team of mental health practitioners in all of Africa, and we don’t want these gains to be lost. I congratulated the team on the incredible progress that they have made, and that 15 years ago, we couldn’t even imagine these problems. These are good problems to have.
After meeting individually with the nursing team and taking photographs, we returned to the Mamba Point Hotel, where I was recognized on the street by a local who introduced himself as Plato. He thanked me profusely for all of the work of my grandparents, and he recounted the time when he learned that President Carter first came to Liberia to end their second Civil War. He told me that when he heard the news, he felt that war was already over. That thought bounced in my head as I went up the hill, grabbed dinner, worked on my speech, and crashed. RON
Tuesday, April 8, 2025
The morning came early, and the coffee was strong. Our SCR Ben Dossen opened the Carter Center’s Program Review: Mental Health System Strengthening Through Workforce Development. I delivered my speech congratulating the work of The Carter Center and the work of the Liberian people in integrating their mental health system into their health system. I acknowledged the work that remains, but reminded everyone that the challenges discussed are the challenges of statecraft and nation-building. I urged everyone to look away from their spreadsheets and to-do lists and take a holistic view of the work they have accomplished. Representatives from former President Ellen Johnson Sirleaf, First Lady Kartumu Boakai, and Health Minister Dr. Kpoto issued welcoming remarks. Then, the Minister of Mental Health, Dr. Moses Ziah, presented the work he is doing to integrate mental health services into the Liberian government.
At lunchtime, my detail whisked me, Kashef, Eve, and Ben to the Liberian executive mansion where we met with President Boakai and his cabinet. In his executive office and in front of his cabinet, I congratulated him and the Liberian people on the incredible work they have done in elevating mental health. I told him that Liberia is now the model on-continent about how to grow a mental health program from scratch in Africa. I then brought the top three issues from the nursing team to His Excellency. President Boakai remarked to me about his great relationship with Jimmy and Rosalynn, and sent his condolences to me and my family. He was happy to see me continue the work; I told him that this was my first trip to Liberia, and that Liberia was my first Carter Center trip without my grandparents. I told the President I have flown the nest, and he thought it was funny.
President Boakai then told me that while Liberia has made strides in mental health, he has declared a national emergency against substance abuse, and wanted me to know that his priorities lie there. I responded that Rosalynn always saw mental health and substance abuse as two sides of the same coin–If people in a mental health crisis can’t find help the right way, they will find help the wrong way. He considered the point and said, “True”. He then agreed to address my three issues as top priorities, and assured us that he and his cabinet would set up a meeting with the Minister of Health.
We thanked the President and his cabinet for their time and took photos. I asked the President to send my best to the First Lady, and left the Executive Mansion to return to The Carter Center program review. The topics of for the rest of the day included a presentation of the mental health clinicians on how they are institutionalizing their workforce development programs in-country, where we formally handed over the Mental Health Clinicians Compendium to the Liberian Ministry of Health, and a panel on Policy, Law, and Financing, which included the formal presentation of the Financing Assessment Report and the Mental Health Regulations to Ministry of Health. The presentation concluded with a performance from Smiling Faces International, which is a group of young artists and performers who communicate their generation’s mental health challenges through song, poetry, art, and plays.
We concluded the meeting, and the Atlanta-based team gathered to look in the small shops at the base of the hotel, and then attempted to go to dinner at a favorite Mediterranean restaurant called Sajj. When we arrived at its previously known location, we found the building leveled, with not even a shell of a building standing. After driving around twice trying to see if we had missed a turn, my security detail and our driver, Peter, found from the locals that Sajj had moved, and we proceeded to the dead end of an alley near a soccer field. Kashef and Eve seemed disheartened until the wall at the end of our alley opened, and we found a space on the beachfront that was very much under construction. This construction was, indeed, the new Sajj, and Kashef ordered the left and right sides of the menu. We implored Miss Huff to join us for dinner, and we watched the sun set over the Atlantic. After ordering table appetizers, meals, and drinks for five, the waitress informed us that the credit card processor was inoperable. We scrounged for $130 to cover the bill and headed back to the Mamba Point Hotel to end an eventful day. RON
Wednesday, April 9, 2025
Day Two of the Carter Center Program Review started with a presentation on integrating mental health services into other systems of government, including law enforcement, data systems, and future integration projects. Law enforcement reported that over 1500 officers have been trained in mental health awareness, to divert people in mental health crises to clinicians for help instead of prisons that further exacerbate the crisis. After the presentation, Immigration Officer Jeffrey Morris met with me separately, and he identified that his main challenge as an officer is a lack of information dissemination amongst the entire Liberian police force. Although we handed over the Crisis Intervention Training Manual to the Liberian police force, he asked The Carter Center to develop a pocket guide that will fit in the front pocket of the law enforcement uniform to help them understand the Dos and Don’ts. I thought that was a great idea.
We also had a presentation from a young man named Archie Pitah, who became addicted to drugs and was thrown out of his home by his father after Archie started hawking his dad’s possessions to get money to feed the monster. Archie was homeless with a depressed immune system from the street drugs he was on, and he caught tuberculosis from his living conditions. He found his way to a tuberculosis clinic that had integrated mental health services on campus, and the tuberculosis clinicians stayed on top of him until he finished his course of TB medication. The clinic then spent months working with him on the mental health issues that drove him to addiction, and helped him get off the street drugs. He has repaired most of the relationships he has ruptured through his addiction, save the one with his father, which he said was painful. But he is now traveling in Montserrado County as a mental health ambassador.
My ceremonial presentation of handing off the School-Based Behavioral Health Materials and the Crisis Intervention Training Manuals was superseded by President Boakai, who made good on his promise to have me meet with the Minister of Health in her boardroom. Eve took over that job as Ben, Kashef, and I went to the Ministry of Health to meet with Minister Dr. Louise Kpoto. I brought her the same three challenges that I brought to the President. Dr. Kpoto was very gracious and congratulatory of me continuing the work of my grandparents, and she informed me that the issue of psychotropic drug importation is resolved. She is now working to integrate psychotropic medication into the supply chain so that these medications are available at local pharmacies instead of just the two main hospitals. Kashef and I were very pleased to hear the news, and once verified, I will be able to bring this news to the Liberian diaspora in the United States so they can be assured that their next shipment of medication won’t go to waste.
Dr. Kpoto continued, stating that the issue of mental health professional pay would be addressed in the next budget. She also said that integrating mental health practitioners is in the works with the Minister of Mental Health, Dr. Moses Ziah, a passionate mental health advocate. In fact, she keeps reminding Dr. Ziah that the Ministry of Health does more than mental health, and I responded that Dr. Ziah is doing a great job! We entered Dr. Kpoto’s office, took photos, and returned to The Carter Center Program Review.
Back at Mamba Point Hotel, Dr. Ziah gave a live presentation of the mental health dashboard, an online tool for all Liberians to manage the mental health needs of the country. It’s a big ask and a remarkable feat, and as a software project manager in a former life, the requirements and results were truly astounding. On one web portal: a Liberan citizen in need of mental health care can select their symptoms and find a facility or practitioner close to their current location, a Liberian clinic can update their capabilities and availability to manage case load, a Liberian patient can select a pharmacy near their location to pick up their prescribed medications, the Ministry of Health can manage their stock of medication and move needed medication to counties or districts where the demand outstrips supply, the Liberian pharmacists can manage medication by expiration date to ensure that valuable medication is used before it expires nationwide, and Liberian data analysts can track mental health service availablity and utilization, and analyze trends across the nation. The session concluded with the national launch of the dashboard. Next was a quick Q&A where the audience wanted more from The Carter Center, especially an initiative to help combat substance abuse. Kashef said no, and I took the question as my opportunity to tell the room that I had visited the President, and recounted our exchange on that question. Satisfied enough, we concluded the Program Review and prepared for the Iseye.
But did Liberia say Thank You? Iseye, pronounced ee-suh, indeed means Thank You, and the Liberian team hosted a massive party at Club Montserrado. I arrived wearing my new shirt from my new personal shopper, Rosaline. The Chief of Staff joined me from the First Lady’s Office, and we had a great conversation about leadership and writing, as he tortures entertains himself by publishing two books a year. Dinner was served, and Jerry, also called Catfish, took the stage and explained some Liberian cultural history. In his culture, males on your father’s side of the family are all referred to as fathers, and males on your mother’s side of the family are all referred to as uncles. To be a nephew is to never be without, as your uncles are responsible for your happiness and success. There, I gained an uncle in Catfish, and I was bestowed the Liberian name of Tarnue Kollie, pronounced Tanu Quallie, which means Jason’s Assistant Deputy Town Owner. I was given a princely shirt with the honor, and I accepted my obligation to deliver Liberian gifts to the real Tarnue, Jason. Tarnue Kollie then recorded a message to the First Lady, shut down the dance floor with The Cupid Shuffle, and then headed back to Mamba Point. RON
Thursday, April 10, 2025
With the program review completed, I filled my Thursday with field trips. I put on jeans and packed my suit, caffeinated, and headed to the TB Annex. Liberia is a heavily TB-burdened country, with instances in the 380 cases per 100,000 range. (America is around 9 per 100,000) Tuberculosis is a horribly stigmatized disease where people who get it are often ostracized from their communities, homes, and families. Within Liberia, there is a prevailing belief that tuberculosis is untreatable. Thankfully, this is no longer true. However, TB has an added stigma that it disproportionately affects people who are immunocompromised from AIDS, street drug use, or alcoholism. Therefore, a TB diagnosis is often accompanied by a heavy mental health toll, with anxiety and depression as almost guaranteed. The TB Annex has now incorporated mental health counseling in every interaction with a new TB patient, and they have instituted an aggressive follow-up routine where nurses will call patients and caregivers to make sure they take their medication. Nurses will even go into communities and ghettos themselves to find patients they have lost contact with. The TB clinic has a high success rate of delivering full-course treatments, with the one major caveat that people suffering from starvation often cannot tolerate the medication because it makes them even hungrier. It’s heartbreaking, but Liberia is making incredible strides.
My next stop was to the JFK hospital, which proudly displays a poetically weathered and torn USAID logo emblazoned with the words “From the American People”. I felt so much shame that I could hardly look at it. But I was there, and I met with the nurses and doctor who ran the tuberculosis clinic out of the hospital. I visited the lab and met the technician who clears or readmits all TB patients out of the hospital. I thought it was incredible that the only real tools you need to send someone back into their community, their family home, and their partner’s bed are a functional microscope and a practiced eye.
I took photos with the team and headed back to The Carter Center to swap my jeans for a suit, and Ben, Eve, Soyia, Ron, and I headed next door to meet the former President and first woman President of an African nation, Madam Ellen Johnson Sirleaf. Her compound was beautifully manicured. We were greeted by her chief of staff and led to her garden gazebo. We exchanged pleasantries, and Madam Sirleaf came out of her house to join us. She was incredibly gracious that we had arrived, and she offered her condolences on the loss of my grandparents. I thanked her for her leadership and expressed how incredibly jealous Sarah was to miss meeting her. Ben and I gave her an update on all 15 years of mental health development in Liberia, every bit of which started with her administration. She was overjoyed to learn that Liberia now had 368 trained mental health clinicians and eight clinical psychologists. We told her about the work of reducing the stigma of mental illness within the tuberculosis community, and she remarked that it is just what she and Rosalynn wanted to work on. We then told her of our plans to export the Liberian model of home-growing a successful and sustainable mental health program to other African nations, including Liberia’s neighbor, Sierra Leone. She was very pleased to learn that Liberia leads the continent.
Madam Sirleaf then informed us about the work that she is doing in elevating women leaders in Africa, and we learned that her organization is supporting prominent women in 19 different African nations. She also told us that she is continuing the work of elevating and supporting women leaders through her work at The Elders, who remain fully committed to gender equality around the globe.
Madam Sirleaf then told us that she is coming to America soon, twice–once to Atlanta to visit her grandson’s graduation in Columbus, and again to Los Angeles to speak at the American Psychiatric Association. Eve and I implored her to let us host her at The Carter Center, and I thanked her for hosting us at her beautiful home this afternoon. We left Madam Sirleaf’s compound and skipped right past The Carter Center office on our way to lunch at Terra Cotta, where I arrived supremely overdressed. I canceled my pre-order of chicken for a real Liberian meal of collard greens, hot peppers, anysorta meat, and rice, and it was delicious. Refeuled, we headed to UMU to visit their new campus. They have just moved into a new building with brand new paint on the walls, and they showed me the classrooms that they are building. The school president then presented me with the curriculum that Emory University helped them build, and they have made the curriculum available to any university in the country that wants to build a mental health graduate program. Finally, they unveiled a proposal to name the school the Rosalynn Carter Graduate School for Mental Health, which would be proudly displayed on the main thoroughfare in Montserrado County. It’s an incredible honor that I told them I would take back to the family.
We left UMU and we bee-lined to The Carter Center so I could retrieve my jeans, and Eve and I went shopping in the booths by the United States embassy. Though everybody was willing to deal, I resisted the urge to buy any of the impressively endowed statuettes, if only for lack of suitcase space.
Money was otherwise exchanged for goods, and we proceeded to Club D’Calabash for dinner with The Carter Center Atlanta and Liberia-based staff. As I exited the car, my protocol officer, Miss Huff, presented me with a gift of a Liberian shirt, which I promptly donned, and I went to hang out with the staff to celebrate a project well done. Goat soup was mixed with rice. We all went back to the hotel, and I commenced the task of packing all of my clothes and gifts into my suitcases. Even though I brought an empty bag, my luggage was straining at the zippers. I got everything as good as it was going to be, and I attempted once again to sleep. RON
Friday, April 11, 2025
On my last day in Liberia, I awoke to the sound of a torrential downpour, and the rain kept me in bed for an extra minute or three. I was due downstairs to shoot some b-roll on the streets of Monrovia, and I was somehow enticed to buy my children something that made noise.
After filming and coffee, I met up with Miss Huff, and we were escorted to Ben’s house. After driving for more than 45 minutes, Eve and I agreed that Ben lived too far away from The Carter Center office. But then we pulled into his compound and discovered why. Ben’s house is beautiful, and it backs up to a lagoon that forms his kayaking course during the rainy season. The weather was so nice that I sat outside and enjoyed the view while the rest of The Carter Center team sat around Ben’s dining table and closed out their session for the day. Food was brought in, and I finally tried fufu.
Though I had not finished my writing, the team had finished with theirs, and we all said our final goodbyes and went to the beachside to empty Club Beer bottles and watch the sunset. I was well protected, and about 30 minutes before departure, I ordered the quickest food on the menu before we had to leave.
After an hour, we told the establishment that we would need to give up and head to the airport, and the staff chased us down with our chicken shwarma as we chased the sun. Eve, Megan, and I packed into the Land Rover and headed up the 2-kilometer gravel driveway to the road. When we finally hit the pavement, we all noticed it was odd that the ride didn’t improve. A quick inspection found that the left rear tire had departed this world, and a scramble was afoot. I grabbed my flashlight as our fearless driver, Peter, began the process of freeing the spare, and a couple of dudes from a ditched truck across the street ran over with a leaking but functional bottle jack. Quick teamwork, good lighting, and a well-earned cool panic changed the tire in a time that wouldn’t embarrass a shade-tree racing team. I thanked our pit crew via Andrew Jackson, and away we went.
Despite the many assurances that the beach wasn’t far from the airport, I began checking the clock more often as our drive time approached the 1-hour mark. We arrived at the chaos that is Roberts International Airport, and I checked my bags and showed every single employee my passport. My reputation preceded my arrival at Passport Control, and the officer at the counter recognized me and told me that he had just read the article about my meeting with President Boakai. I told him I had a great time in Liberia, he stamped what he needed to stamp, and then I turned around and handed my passport to the employee sitting 3 feet away. I then put my bags through the airport’s lone baggage scanner, showed the remaining five employees my passport, and finally headed up the escalator as my airplane’s arrival from Sierra Leone was announced to all interested parties–every single person in the airport. I found a chair outside Terminal 2, numbered out of tradition, though they all lead to the same hallway, and said goodbye to Africa. A quick 6-hour flight, 7-hour layover, 8-hour flight, 4-hour layover, 2-hour flight, and a 45-minute MARTA ride will hopefully take me back to my own bed. But for now, the lounge in Brussels is nice, and I enjoyed watching the staff scold my couchmate into returning his stash of stolen Leffe.
One Response
Sounds like a great trip. Liberia will break your heart sometimes.8