Society

In Zimbabwe, Where Grandma Steps In For Missing Shrinks

In the absence of qualified staff, grandmothers from the Friendship Benches program offer free listening and advice to patients suffering from depression.

A Friendship Bench session in progress
A Friendship Bench session in progress
Elsa Dorey iQ and Klervi Le Cozic iQ

HARARE — In Shona, there is no word for depression. So, to talk about it, "we say "kufungisisa," which means ‘thinking too much,"" says Esilida, 73, while waiting for her next patient on a wooden bench in the clinic of Glen Norah, an impoverished suburb in Zimbabwe"s capital Harare. "I explain to them how to take care of themselves," she says in a rocky and breathless voice, examining visitors that come and go.

All sorts of miseries are unloaded onto her bench: Domestic violence, lack of money, fear of being rejected because of AIDS, unemployment. "If my patient has several problems, we approach them together, one by one, until we've solved them all." Esilida is among the first grandmothers in her neighborhood to get involved in the Friendship Bench program. These old women, present in most of Harare's clinics, offer free listening and advice in a country with only 14 psychiatrists.

I didn't set up the project to look good. I did it because it was necessary

Dixon Chibanda is one of them. He is behind the project that has been present in most of the capital's suburbs since 2006. At that time, Zimbabwe's few psychiatrists left the country in the middle of an economic crisis. While he was carrying out his a masters degree in public health, Chibanda realized there was a high level of mental health disorders, such as depression and anxiety, in working-class neighborhoods. He decided to act and enlisted the help of Harare's public health department. Symbolic help, that is to say, because no funding, doctors, nurses or buildings were granted. "I was offered to work with 14 volunteer grandmothers who were already health advisers in the Mbare neighborhood. I didn't set up the project to look good. I did it because it was necessary."

Mental health guards

This morning, it is Jane's third appointment with Esilida. She discovered the Friendship Bench initiative when she was picking up her AIDS medication at the clinic. After the death of her husband, she found herself penniless and Esilida suggested they sit down. "I cried again and again. The counselor told me: ‘You will die, I will die too. You have to think about your children, take your medication every day, and eat the right food.""

Even if the language they use may be a bit too direct sometimes, the grandmothers know what they're doing. Themselves neighborhood's residents, the grannies know very well the living conditions of their patients — because they live in the same conditions. True guards for mental health, these social workers help ward off depression before it settles in and causes severe mental health problems.

In 2016, more than 85,000 people sat down on a friendship bench. This approach, more social than psychiatric, can be summarized in three concepts. "‘Kusimudzira," to lift your spirit, ‘kusimbisa," to strengthen your mind, and ‘kusimbisisa" to strengthen it even more," said Esilida, pointing to the words on the yellow loincloth that she has around her body.

Every Wednesday, former Friendship Bench patients gather in a speaking circle that combines moral support and financial help. As they sing and listen to each other, participants also learn to crochet bags they can later sell.

"Here, we hold hands rather than the mind," Esilida says with a smile. Jane uses the money to buy wholesale products at the market, and then resells them on the roadside. This way she can send her son to college.

Talking to someone who empathizes is very powerful.

Little by little, the project has spread across the country, all the way to the rural zones, where it has represented a wake-up call on the issue of mental health. In Ngomahuru, the second biggest psychiatric hospital in Zimbabwe does not have a single psychiatrist. This former leprosarium is not suitable for patients suffering from mental health disorders. "We have to improvise," says Parirenyatwa Maramba, the hospital director, pointing to the isolation cell, an empty room closed by bars: "The walls are supposed to be padded, the furniture fixed to the floor or to the wall, the room near the nurses' office ... Here, it is quite the opposite." A few days ago, a patient suffering from depression committed suicide.

Dr Maramba saw the Friendship Bench project as an opportunity to overcome the shortcomings of this place that can accommodate "180 patients instead of 300 because of a lack of staff." "Only 16 of us, out of 53 doctors, have been introduced to psychiatry, but none of us is a psychiatrist, psychologist, or occupational therapist," says the doctor, who dreams of being able to detect and treat mental diseases before they become more acute.

To optimize skills, the medical team has kept the essential parts of Chibanda's project: Caring and watching out for peers. Based on the domino effect, the psychiatrist trained the caregivers to detect mental disorders, so that in turn they transmit their new know-how to about 20 non-specialized nurses in remote clinics. "We administer these pills against headaches or to sleep without looking to understand the origins of the disorder," explains the chief nurse in the hospital. "If their disorders were detected earlier, some patients would not have to be hospitalized."

Once trained, the rural nurses will pass the baton to community workers dispersed in each village, so they can get closer to even to those who live in the most remote areas. This chain includes teachers who "deal with teenagers, whose suicides are increasing," says Dr. Maramba: "Young people have so many challenges, at school, at home, with undesired pregnancies, with strained relationships... It's a very fragile age group, that needs the help of the Friendship Bench."

In Ngomahuru, the Friendship Bench project is expanding and is gradually changing. Soon, wooden benches, a school room, the steps of a dispensary, or the shade of a mango tree will become places of listening. The idea remains the same. "They provide a space for the sick," explains Chibanda. Talking to someone who listens and empathizes with you is very powerful. Everyone needs it."


Research for this article was supported by the European Journalism Centre's Global Health Journalism Grant Program for France.

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Coronavirus

Where Lockdowns For LGBTQ Meant Moving Back In With Homophobic Relatives

The confinement experience could turn brutal for those forced to live with relatives who would not tolerate a member of the family living their sexual orientation openly as a young adult. Here are stories from urban and rural India.

At a Rainbow pride walk in Kolkata, India

Sreemanti Sengupta

Abhijith had been working as a radio jockey in the southern Indian city of Thiruvananthapuram when the COVID-19 pandemic hit in March, 2020. When the government imposed a nationwide lockdown, Abhijith returned to the rural Pathanamthitta district , where his parents live with an extended family, including uncles, cousins and grandparents.

Eighteen months later, he recalled that the experience was "unbearable" because he had to live with homophobic relatives. "Apart from the frequent reference to my sexual 'abnormality', they took me to a guruji to 'cure' me," Abhijith recalled. "He gave me something to eat, which made me throw up. The guru assured me that I was throwing up whatever 'demon' was possessing me and 'making' me gay."


Early in 2021, Abhijith travelled back to Thiruvananthapuram, where he found support from the members of the queer collective.

Inspired by their work, he also decided to work towards uplifting the queer community. "I wish no one else goes through the mental trauma I have endured," said Abhijit.

Abhijith's story of mental distress arising from family abuse turns out to be all too common among members of India's LGBTQ+ community, many of whom were trapped in their homes and removed from peer support groups during the pandemic.

Oppressive home situations

As India continues to reel from a pandemic that has claimed more lives (235,524) in three months of the second wave (April-June 2021) than in the one year before that (162,960 deaths in March 2020-March 2021), the LGBTQ community has faced myriad problems. Sexual minorities have historically suffered from mainstream prejudice and the pandemic has aggravated socio-economic inequalities, instigated family and institutionalized abuse, apart from limiting access to essential care. This has resulted in acute mental distress which has overwhelmed queer support infrastructure across the country.

Speaking to queer collective representatives across India, I learned that the heightened levels of distress in the community was due to longstanding factors that were triggered under lockdown conditions. Family members who are intolerant of marginalized sexual identities, often tagging their orientation as a "disorder" or "just a phase", have always featured among the main perpetrators of subtle and overt forms of violence towards queer, trans and homosexual people.

Calls from lesbians and trans men to prevent forced marriages during lockdowns.

Sappho For Equality, a Kolkata-based feminist organization that works for the rights of sexually marginalized women and trans men, recorded a similar trend. Early in the first wave, the organization realized that the existing helpline number was getting overwhelmed with distress calls. It added a second helpline number. The comparative figures indicate a 13-fold jump in numbers: from 290 calls in April 2019-March 20 to 3,940 calls in April 2020-May 2021.

"Most of the calls we have been getting from lesbians and trans men are urgent appeals to prevent forced marriages during lockdowns," said Shreosi, a Sappho member and peer support provider. "If they happen to resist, they are either evicted or forced to flee home. But where to house them? There aren't so many shelters, and ours is at full capacity."

Shreosi says that the nature of distress calls has also changed. "Earlier people would call in for long-term help, such as professional mental health support. But during the pandemic, it has changed to immediate requests to rescue from oppressive home situations. Often, they will speak in whispers so that the parents can't hear."

Lack of spaces

Like many of his fellow queer community members, life for Sumit P., a 30-year-old gay man from Mumbai, has taken a turn for the worse. The lockdown has led to the loss of safe spaces and prolonged residence at home.

"It has been a really difficult time since the beginning of the lockdown. I am suffering from a lot of mental stress since I cannot freely express myself at home. Even while making a call, I have to check my surroundings to see if anybody is there. If I try to go out, my family demands an explanation. I feel suffocated," he said.

The pandemic has forced some queer people to come out

Sumit is also dealing with a risk that has hit the community harder than others – unemployment and income shortage. He's opened a cafe with two other queer friends, which is now running into losses. For others, pandemic-induced job losses have forced queer persons from all over the country to return to their home states and move in with their families who've turned abusive during this long period of confinement.

Lockdowns force coming out

According to Kolkata-based physician, filmmaker and gay rights activist Tirthankar Guha Thakurata, the pandemic has forced some queer people to come out, succumbing to rising discomfort and pressure exerted by homophobic families.

"In most cases, family relations sour when a person reveals their identity. But many do not flee home. They find a breathing space or 'space out' in their workspaces. In the absence of these spaces, mental problems rose significantly," he said.

Not being able to express themselves freely in front of parents who are hostile, intolerant and often address transgender persons by their deadname or misgender them has created situations of severe distress, suicidal thoughts and self-harm.

Psychiatrist and queer feminist activist Ranjita Biswas (she/they) cites an incident. A gender-nonconforming person died under suspicious circumstances just days after leaving their peer group and going home to their birth parents. The final rites were performed with them dressed in bangles and a saree.

"When a member of our community asked their mother why she chose a saree for someone who had worn androgynous clothes all their life, she plainly said it was natural because after all, the deceased 'was her daughter,'" Biswas recalls.

The Indian queer mental health support infrastructure, already compromised with historical prejudice, is now struggling

David Talukdar/ZUMA

"Correctional" therapy

In India, queer people's access to professional mental healthcare has been "very limited," according to community members such as Ankan Biswas, India's first transgender lawyer who has been working with the Human Rights Law Network in West Bengal.

"A large majority of the psychiatrists still consider homosexuality as a disorder and practice 'correctional therapy'. It's only around the big cities that some queer-friendly psychiatrists can be found," Biswas said. "The pandemic has further widened the inequalities in access to mental health support for India's LGBTQ community."

Biswas is spending anxious days fielding an overwhelming amount of calls and rescue requests from queer members trapped in their homes, undergoing mental, verbal and even physical torture. "We don't have the space, I just tell them to wait and bear it a little longer," he said.

Medical care is dismal

Anuradha Krishnan's story, though not involving birth family, outlines how the lack of physical support spaces have affected India's queer population. Abandoned by her birth family when she came out to them as a trans woman in 2017, Anuradha Krishnan (she/they), founder of Queerythm in Kerala who is studying dentistry, had to move into an accommodation with four other persons.

Isolation triggered my depression

"I am used to talking and hanging around with friends. Isolation triggered my depression and I had to seek psychiatric help." Living in cramped quarters did not help with quarantine requirements and all of them tested positive during the first wave.

What is deeply worrying is that the Indian queer mental health support infrastructure, already compromised with historical prejudice, is now struggling, placing more and more pressure on queer collectives and peer support groups whose resources are wearing thin.

During the 10 months of the first wave of the pandemic in India in 2020, Y'all, a queer collective based in Manipur, received about 1,000 distress calls on their helpline number from LGBTQ+ individuals. In May 2021 alone, they received 450 such calls (including texts and WhatsApp messages) indicating a telling escalation in the number of queer people seeking help during the second wave.

As India's queer-friendly mental health support infrastructure continues to be tested, Y'all founder, Sadam Hanjabam, a gay man, says, "Honestly, we are struggling to handle such a large number of calls, it is so overwhelming. We are also dealing with our own anxieties. We are burning out."

Sreemanti Sengupta is a freelance writer, poet, and media studies lecturer based in Kolkata.

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