Each new CVT center goes through stages of growth and learning in its early years. This has been the case for the CVT Ethiopia team in Gambella, where a new center was established three years ago and clients began coming for individual and group counseling sessions. A large portion of CVT’s early work is always spent getting the word out to the community that trauma causes symptoms that many people may be experiencing, and that CVT is there to help. For CVT Gambella, working with the South Sudanese community in the Nguenyyiel refugee camp, these early stages were going very successfully and clients were finding healing. Then, the COVID-19 pandemic arrived in early 2020, causing the team to need to quickly change modalities and structure in order to keep people as safe as possible from the coronavirus while continuing to take care of clients who were in difficult circumstances.

Wahba Hassanein, Ph.D., psychotherapist/trainer, said, “When COVID started in 2020, we had two priorities: begin new protocols for working remotely, and prepare crisis interventions for clients.” The team moved quickly to begin an ethical closure process, as clients were in the process of meeting in group sessions, which under normal circumstances run a course of ten weeks. The team knew it would no longer work to meet in person, so with the clinical advisor the team determined a way to close the groups in just a few weeks. “This meant working more intensively with the clients over that time,” Wahba said. “This was early in the pandemic. After that we worked remotely.”

The process for working remotely required a new structure and training for all the incentive workers in the camp, as well as the psychosocial counselors (PSCs) who provided care. Remote work meant that dedicated phones were needed along with communication channels among the counselors and clinical supervisors. So, training in new protocols was conducted and incentive workers were equipped with the new supplies they needed: masks, phones, SIM cards and credit for phone service.

The team prioritized the need for urgent care. “As part of crisis intervention, we needed to move quickly,” Wahba said. “In urgent cases, such as situations where a person was suicidal, we ensured that an incentive worker was able to access a CVT supervisor quickly, to discuss the case and engage in clinical supervision.”

The team also established a pathway to refer urgent cases where medical care was needed or an individual needed to be admitted to a clinic.

“We also began new protocols with our staff, doing training with staff on self-care, stress management and anxiety,” said Wahba. This kind of training caught on and the team began to get requests for training from international partners (IPs). “As we got requests from our partners for this kind of help, we conducted trainings regionally and nationally,” Wahba said.

The team also knew that outreach in the community would be very important. Incentive workers and PSCs shared messages about CVT’s care as well as about COVID and how to keep themselves and their families safe, and they published the CVT crisis phone number all over the camp. Wahba noted, “We also made sure that community leaders had our number and would make phone calls for people who needed to contact us.”

“One thing that helped was that we used a storybook for psychoeducation sessions after COVID,” said Sandra Githaiga, clinical program director, CVT Ethiopia. These sessions are conducted to help people learn about trauma and the symptoms it causes. Psychoeducation is one of the key tools to help people understand that CVT’s mental health counseling can help them feel better, and a storybook helps with this process because engages people with limited literacy and it traces the experience of an individual who went through violent conflict and had to flee to the camp, where she began to be affected by that past trauma. The story helps people understand what those impacts look like, including symptoms of depression or post-traumatic stress disorder (PTSD). In the book, she goes to CVT and begins to feel better and engage with the community again.

“We use a storybook for these sessions because it is lighter,” Wahba said. “An artist named Ambassajer Welday created the images for us, to help bring the story to life. And stories are especially important with our clients, many of whom are from South Sudan, a community in which storytelling is part of the culture – it’s how values are taught, how pride is taught – so it’s more effective to use a story to educate about trauma and how to get better.”

Sandra noted that psychoeducation sessions were modified for the pandemic, saying “As a COVID measure, we do all our psychoeducation in the open air, and we give masks and use physical distance.” And the team is now working on new storybooks, with different stories to correspond to different people who come to CVT for care.

Today, the team is able to meet in person with clients again, but using strict protocols for use of masks and physical distancing, as well as a new reception desk where clients are screened for symptoms, temperatures are taken, and masks are handed out to all clients. And the team is currently working on expanding to a second zone within the camp. The plans have been drawn up and the construction will begin in the near future.

The CVT Gambella team has come to be recognized and very respected by the international partners. “Partners know we have much expertise here on the ground and we have an effective structure,” Wahba said. “We are known to use a solid code of ethics.” Sandra noted that there is heavy focus within the IP and NGO community on facing trauma. “We are specialized in what we do, so CVT has gained a lot of recognition,” she said.

The staff have become very knowledgeable and feel committed to their work. “Mental health care is not well known here,” Wahba said. “For staff to speak to the community about mental health, it’s important that each person feels knowledgeable and believes that mental health care makes a difference.”

Even through the difficult times of the pandemic, staff have continued to move forward in the community, talk to clients about mental health, and provide healing. Clients come for therapy and they begin to find their place in the world once again.