Treating More than Diarrhea

During the course of my work with SEWA Rural, a community health organization in rural Gujarat, India, I often wondered how mental health concerns would ever gain traction in a climate where community members suffered, and sometimes died from, such common ailments as diarrhea or anemia. Those with mental health problems (whether diagnosed or not), were considered “hopeless”, and as a result, did not receive the medical attention they deserved.

In the case of individuals suffering from depression, their family members would often dismiss their behaviour as erratic, or if the condition worsened, would use derogatory terms such as “ganda/gandi” (crazy in Gujarati) to characterize them. In one particular instance, a young girl who had recently undergone a painful pregnancy and premature delivery suddenly withdrew, and simply stopped speaking, even refusing, at times, to breastfeed her baby. In response, her family lapsed into denial, and insisted that she was faking her condition. Upon our first visit, it became apparent that the girl was suffering from postpartum depression, and needed love and attention in order to overcome her depression. After repeated visits, one-sided conversations, and hand-cooked meals, she reluctantly smiled and uttered her first few words – “Don’t go…”

Unfortunately, India is no haven for individuals suffering from mental conditions. Neither is the preconception that depression afflicts only Western countries a correct one. As explained in the NYTimes article entitled, “Psychotheraphy for All: An Experiment” (thank you to Sepia Mutiny for referring us to this article):

In India, as in much of the developing world, depression and anxiety are rarely diagnosed or treated…As a result, most Indians with mental illness go untreated, especially in poor and rural areas. “There is a huge treatment gap for people with depression,” said Dr. Vikram Patel of the London School of Hygiene and Tropical Medicine, the psychiatrist who began the Siolim project. “In most places in the developing world, 80 percent to 90 percent of people with severe depression don’t receive adequate treatment.”

Researchers say that even in places with very poor people, the ailments require urgent attention. Severe depression can be as disabling as physical diseases like malaria, the researchers say, and can have serious economic effects. If a subsistence farmer is so depressed that he cannot get out of bed, neither he nor his children are likely to eat.

In response to India’s relative dearth of psychiatrists, Dr. Vikram Patel, founder of Sangath, is experimenting with a revolutionary concept – treating individuals with depression not through psychiatrists, but trained “health professionals” or “health counselors”, who, for the most part, employ “low-tech strategies”, and simply listen to their patients during the course of therapy:

The clinic is at the forefront of a program that has the potential to transform mental health treatment in the developing world. Instead of doctors, the program trains laypeople to identify and treat depression and anxiety and sends them to six community health clinics in Goa, in western India…If the research, which will finish in 2010, reports positive results, donors and governments are more likely to try it elsewhere in India and the world, Dr. Patel said, adding: “This is the most important question in psychiatry. How do we scale up treatments to a population in a low-resource setting?”

The program is straightforward – five days a week, “health assistants” screen patients for symptoms of depression (alarmingly, they have found that 1 our of 3 patients that visit their Goa clinic exhibit signs of depression), and if the patient is deemed a potential candidate for therapy, they are referred to the “health counselor.” Because mental health conditions are stigmatized, counselors refrain from using terms such as “mental illness” or “depression”.

Out of the more than 2,000 patients that have been treated to date, Dr. Patel has found that the strategy that works the best is relatively simple: listening. As expressed by one of the clinic’s doctors, “I feel like I’m doing something, just giving them time to ventilate,” she said. “They can tell their problems, they can share their feelings.” The realization is a humbling one, as it brings us back to the fundamentals of being human. Whether it is a Goan woman in Dr. Patel’s clinic, or a young girl in Kharia, Gujarat, their needs are the same – having someone that cares enough to simply listen.

For more information regarding the pioneering work Sangath is doing with respect to mental health, specifically with children, go here.