BY PHYLLIS MBANJE
Words tumbled out of her mouth, jumbled up and filled with raw emotion but the older woman sitting across from her on a wooden bench nodded encouragingly.
Jamia recounted the horrific torture at the hands of her husband, whom she said beat her up, burnt her backside with cigarette stubs and pulled her hair out without flinching.
She also provided gory details of how he raped her repeatedly even though he had sores from an STI dotted all over his manhood and how he poured boiling water on her legs for wearing a “short” skirt.
Finally, she was done. Exhausted from the pent up emotions she sat back and breathed. At only 23, abuse had aged her and she now looked older than her 54-year-old mother.
Her four-year-old daughter looked on and occasionally patted her hand as if to reassure her. She was not sure who had made her mother cry. She helplessly looked at “grandmother” sitting opposite her mother.
Jamia is part of the successful story of the Friendship Bench concept, a home grown idea aimed at providing mental therapy by lay counsellors.
The brain child of Dixon Chibanda, who is one of the only 14 psychiatrists servicing Zimbabwe’s 14 million population, the concept is meant to bridge the gap created by the lack of enough personnel for psychiatry services.
After realising that the country will not be able to scale traditional methods of treating those with mental health issues, Chibanda was instrumental in the development of an alternative method using a limitless resource — grandmothers.
The Friendship Bench programme is powered by grandmothers trained in evidence-based talk therapy and brings care, and hope, to those in need.
“The concept came up after an initial survey, which showed a very high rate of common mental disorders, which include (depression, anxiety disorders and psychological trauma) after Operation Murambatsvina,” Chibanda said.
He was also spurred on when a young girl scheduled for a session with him committed suicide.
“One evening, while I was at home, I got a call from the emergency room, the doctor said, ‘one of your patients, someone you treated four months ago, has just taken an overdose, and they are in the ER department. Hemodynamically, they seem to be fine, but they will need neuropsychiatric evaluation’,” Chibanda said.
Because it was in the middle of the night and the girl was 200km away, Chibanda could not travel and together with the attending doctor, came up with an assessment over the phone.
“We ensured that suicidal observations were in place and that we start reviewing the antidepressants that this patient had been taking, and we finally concluded that as soon as Erica —that was her name — is ready to be released from the ER, she should come directly to me with her mother, and I will evaluate and establish what can be done,” he recalled painfully.
But Erica never showed up. Three weeks passed. No Erica.
“And one day, I get a call from Erica’s mother, and she says, ‘Erica committed suicide three days ago’. Now, almost like a knee-jerk reaction, I couldn’t help but ask, ‘But why didn’t you come to Harare where I live? We had agreed that as soon as you’re released from the ER, you will come to me.’ Her response was brief. ‘We didn’t have the $15 bus fare to come to Harare’,” Chibanda said.
Although the need for an intervention in mental therapy is evident, there is no space in the health facilities to provide therapy.
Through an interactive process and discussions with the grandmothers and other professional colleagues, the idea of delivering therapy on a bench using grandmothers gradually began to form in Chibanda’s head.
“So far, we have trained just over 300 grandmothers in Zimbabwe. We are about to start training in Masvingo, Shurugwi and Zanzibar and outside Zimbabwe we recently facilitated the start of the programme (Friendship Bench) in Malawi and New York City. We are preparing to train in Liberia in July 2018. So in all we are looking at training over a 1000 benchers before the end of the year,” Chibanda said
There are not enough psychiatrists and psychologists to address the huge treatment gap for these conditions. The Friendship Bench programme, therefore, seeks to use community resources such as trained grandmothers, who are supported by clinicians to help thousands of people in communities.
Young people are mostly at risk as they battle many challenges including peer pressure.
The World Health Organisation (WHO) says the leading cause of death now for people between 15 and 29 is suicide.
Mental illness is almost taboo in Zimbabwe and is associated with witchcraft. This prevents many from seeking treatment on time.
“Most people with mental illness go to traditional healers, churches or prophets because this is, as far as I am concerned, is the readily available platform in the community. It’s a low hanging fruit,” Chibanda said.
The psychiatrist said there was need to make evidence based interventions more readily available at community level so that people can have easy access to such approaches. Currently anybody with a mental illness is told to go to the psychiatric hospital.
“Imagine if people could have access to care right within their communities, but care that works and is based on empirical evidence. This is what the Friendship Bench is trying to build. Our purpose is to create community platforms for interaction, communication to enhance mental wellbeing and improve quality of life locally and beyond,” Chibanda explained.
Ninety percent of those needing care for depression just don’t access it in Zimbabwe and the rest of Africa.
Local studies show rates of 33% for post-natal depression in Zimbabwe. Just after delivery over 30% of mothers experience post-natal depression and they are told to snap out of it, and yet they need help and by taking mental health to the community there is a chance to reach out to a lot more of these women and treat their depression.
WHO estimates that more than 300 million people globally suffer from depression and every 40 seconds, someone commits suicide because of it.