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.
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.