ccording to the World Health Organization, over 300 million people around the world suffer from depression. Zimbabweans, like other people all over the world, experience depression as well. With few resources at their disposal, the mental health crisis in the area is an uphill battle.
“WHEN IT COMES TO MENTAL HEALTH, WE ARE ALL DEVELOPING COUNTRIES.” Shekhar Saxena, Director of Mental Health and Substance Abuse, World Health Organization
Depression is the highest cause of suicides, leading to an estimated 800,000 suicides per year, and most of these suicides occur in developing countries. Although nobody knows the exact number of people living with depression in Zimbabwe, Dr. Dixon Chibanda believes the number to be quite high.
Dr. Chibanda is an associate professor of psychiatry at the University of Zimbabwe and the London School of Hygiene and Tropical Medicine.
He was inspired to be a psychiatrist when one of his classmates in a medical school committed suicide.
Dr. Chibanda is also the director of the African Mental Health Research Initiative and one of the twelve psychiatrists in the country. Zimbabwe has a population of about 17 million. Statistics like this are quite common in Sub-Saharan Africa, and Dr. Chibanda says that some countries don’t even have a single psychiatrist.
“AT THE MOMENT (IN ZIMBABWE), WE HAVE 15 PSYCHIATRISTS. SO ITS ESSENTIALLY A RATIO OF ONE PSYCHIATRIST TO JUST OVER A MILLION PEOPLE”.
A Revolutionary Project Against the Mental Health Crisis
Dr. Chibanda states:
“MORE THAN 10% OF THE TOTAL DISEASE BURDEN IN LOW AND MIDDLE-INCOME COUNTRIES IS DUE TO MENTAL HEALTH DISORDERS, YET THESE RECEIVE LESS THAN 1% OF MANY OF THESE COUNTRIES’ HEALTH BUDGETS”.
Dr. Chibanda tells the story of his inspiration to find a solution to the heartbreaking problem when one of his former patients succeeded in committing suicide. One evening, Chibanda received a phone call from a doctor in the emergency room. Apparently, one of his former patients, a 26-year-old woman named Erica, had attempted suicide. The doctor said he needed the assistance of Dr. Dixon to ensure she didn’t try it again.
Although Erica was about 160km away from Dr. Chibanda, he and her mother made arrangements over the telephone. They were to come to him as soon as she was discharged from the hospital so that he could review her treatment plan.
After these arrangements were made, three weeks went by without a word from Erica. Eventually, Dr. Dixon received a call from Erica’s mother. She had called to inform him that Erica had committed suicide three days earlier. Upon questioning her, he found out that they couldn’t come to him in Harare because they didn’t have the $15 transport fare.
According to the doctor, he was shaken to the core by the unfortunate incident. He knew that a lot of people died due to a lack of funds. Even at that, he was haunted by the death of Erica for years.
“I’VE LOST QUITE A NUMBER OF PATIENTS THROUGH SUICIDE, ITS NORMAL. BUT WITH ERICA, I FELT LIKE I DIDN’T DO EVERYTHING I COULD”.
The Friendship Bench — At the Feet of a Grandmother
While deliberating on possible solutions to the problem, he arrived at a very unusual one — grandmothers. Ever since 2006, Dr. Chibanda and his team have trained over 500 grandmothers in talk therapy, which is done for free in about 80 communities in Zimbabwe. In the year 2017 alone, the project helped over 300,000 people. The grandmothers deliver help from benches outside local health clinics.
The methods have been studied, and subsequently expanded to other countries, including Malawi. Dr. Chibanda believes strongly that the program can act as a model to any city, state, or country that wants affordable, effective, and accessible mental health services for its citizens and residents.
Chibanda was the only psychiatrist in his country that worked in the public health sector, and his supervisors told him that they had no resources to give to him. All the nurses had their hands full treating HIV patients, and there were no rooms to spare. The only thing they could do was give him fourteen grandmothers and access to space outside the hospital.
Instead of giving up, Dr. Dixon came up with the idea that would eventually birth The Friendship Bench. Despite his numerous doubts about the plan, he began to train the grandmothers. He tried to teach them with Western techniques at first. Eventually, the grandmothers suggested that it would be easier to reach and impact people if they used cultural concepts that the people were familiar with.
By 2009, Dr. Dixon and his team of grandmothers were beyond certain that The Friendship Bench was a success, both in terms of reducing the suicide rate and increasing the quality of life of the patients. This was a good thing, but Chibanda knew that he needed scientific proof if he wanted The Friendship Bench to be imitated globally.
Proving The Fight Worthy
In the year 2016, in collaboration with colleagues from the UK and Zimbabwe, the doctor published the results of a controlled trial of the program’s adequacy in the Journal of the American Medical Association. The researchers split 600 people into two groups. After six months, it was discovered that the group handled by the grandmothers had visibly lower signs of depression compared to the other group that underwent the traditional treatment.
The project has expanded to many countries since then. In the course of the expansion, Dr. Chibanda and his team found out that not only does the idea work exceptionally across cultures, but grandmothers aren’t the only ones that can give effective counsel.
In New York City, the counselors are the most diverse. They include individuals of all ages and races, some of which are members of the LGBTQ community. Some of the counselors have been through tragedies and dealt with addictions themselves, which gives them an idea of what the patients are going through. In Zanzibar, younger men and women are more popular as counselors. The Friendship Bench in Malawi uses elderly counselors of both genders.
Even though there are a lot more psychiatrists in New York City than there are in Zimbabwe, the ratio of doctors to residents — about 1 to 6,000 — is still an issue. This is especially true when it comes to providing access to health care for the less privileged. Therefore, the Friendship Bench is a lot more than a solution for developing and under-developed countries; it is a solution that all countries can gain from.