Short Observation on Facilitating the PIPA Program in the Northern Part of Ethiopia
Ephrem Woldeyesus 
Here is the experience of one of the trained facilitators, Ephrem Woldeyesus, who used the PIPA Program for an intervention in northern Ethopia, 2024.
The war in Northern Ethiopia has had a devastating impact on different sections of society in the Amhara, Tigray, and Afar regions. The conflict has caused widespread human suffering, economic disruption, and social instability. The war has had profound and devastating effects on the all the three regions, impacting almost every aspect of life. Many individuals, especially children and women, have experienced significant mental health challenges due to the violence and displacement.
For two years, Tigray in northern Ethiopia was wracked by a brutal civil war that claimed more than hundreds of thousands and left 2.7 million people internally displaced. During the fighting, rape was used as a weapon of war, and one in 10 women and girls of reproductive age experienced physical, psychological and sexual violence. Women in Tigray witnessed several causalities and were exposed to heaps of violence because of the deadly conflict in the Northern part of Ethiopia. Women were powerless but exposed to both physical and psychological adverse effects of the war.
We have partnered with the prominent five international partners to implement a psychological first aid and mental health and psychosocial services in the community. During the past two years, I have led nine short and mid-term projects in Tigray, Amhara and Afar regions by preparing problem statements, desk review, proposals, implementation plan, coordination, and facilitating group sessions. Our intervention techniques include an early mental health and psychosocial service using a trauma-informed approach and contextualized trauma-healing group sessions for women and youth. The Trauma-informed care program opened doors for women participants to discuss their shared trauma during the conflict and find ways to heal from it in a collective manner using evidence-based and well-designed community circles that engage participants safely and inclusively and finally thrive.
Five of these projects included a two-day integration of PIPA program tools and this decision was made after rigorous training on PIPA program and certification for more than 4 members of our team members. We conducted 4 days of psychoeducation and psychological first aid in emergency settings followed by PIPA program sessions. The participants were mostly with only primary or secondary school education background who were vulnerable during the civil war. The PIPA program tools were very practical and cost-effective for low-economic setting and early intervention in emergency setting where participants opened and became vulnerable and responded to the tools. It worked well because it helped participants start processing their most traumatic events during the war and built up their resilience and coping strategies in a very unstable environment. We have observed a significant decrement in SUD during the first afternoon and participants were comfortable to use the tools as most of the activities didn’t demand to talk about the traumatic events rather to process by oneself. Most participants wanted more than a psychoeducation tools and PIPA program was a right fit to provide them with the necessary stabilizing and processing tools. The exercises helped the participants to discover hope and positive values even in most difficult seasons of life especially on paper-based drawing exercises. Participants mentioned that helped them to discover their resources and build their resilience.
Pre and post assessment shows that participants have showed significant difference to PCL tests from the first pre-assessment and post assessment conducted within 3 months’ time. Finally, I would love to see the implementation of PIPA program across all the three regions and even beyond in Ethiopia as this is practical, very cost-effective and can be done with ToT and in a group setting. Integrating more alternative ways to the PIPA activities for people with physical disability can help reach more communities. I strongly believe that such tools can be very helpful and practical in post-war and post-conflict areas and settings.
Two quotes from the sessions are below;
“I was dependent on Tramadol, and I decided to stop. I believe that I can handle life’s challenges without trying to numb the pain. My past few days changed my thought process.”, Participant 1
“I am more comfortable in doing the exercises as most activities require me not just to talk rather to deal with my fear by myself. I want to do these exercises more even after the completion of this program”,
Participant 2
Ephrem Woldeyesus, MHPSS Expert