NEW ERA 10 FEATURE 11 Friday, March 9 2018| NEW ERA Curbside counselling? These ‘friendship benches’ bring mental health closer to home Ranga Mberi Harare One in four Zimbabweans suffers from mental illness, but untrained female health workers are setting a new benchmark for the treatment of patients. The therapy room is a patch of waste ground, and the therapist’s couch a wooden bench under a tree. The therapist is an elderly Zimbabwean woman, in a long brown dress and headscarf. H e r p a t i e n t s c a l l h e r “Grandmother” when they come along to sit on her bench and discuss their feelings, their depression or other mental health issues. a poor suburb just south of Zimbabwe’s capital Harare, there are lots of grandmothers – trained who take turns on the park bench to hear stories. They listen to the battered wife who has attempted suicide twice, the man who hates women after he became infected with HIV, the unemployed single mother driven to despair by the struggle of raising four children. The benches are a safe place for people struggling with depression, which in the Shona language is called kufungisisa, “thinking too much”. It is a world away from conventional approaches to mental healthcare, but the Friendship Bench project has changed the lives of an estimated 27 000 Zimbabweans suffering from depression and other mental disorders. The grandmothers, all of whom are trained to improve a patient’s ability to cope with mental stress, listen and nod, offering only an occasional word of encouragement. One in four Zimbabweans suffers from some form of mental illness, but there are only 13 psychiatrists in a country of about 15.6 million, says the World Bank. A solution had to be found, and it came in the way of a bench and the tradition of respect for African matriarchs. Clinics screen their visitors for mental illness through a locally developed tool called the Shona Symptom Questionnaire. It has 14 questions, such as “Have you been struggling to sleep?” and “Have you been worrying too much?” Patients scoring above the cut-off level are referred to the friendship bench. Those who go less likely to have suicidal thoughts, according to Dixon Chibanda, cofounder of the scheme. we use an intervention which we call kuvhura pfungwa [opening of the mind]. They sit and talk about their problems. Through that process, the grandmothers enable Unconventional… Grandmothers working with the Friendship Bench project chat before counselling sessions begin. Photo: Cynthia R Matonhodze problem to focus on, and they help them through it,” he says. Through at least six one-on-one sessions with the health workers, the patients are encouraged to speak about their problems and their mental illness. Traditionally, elderly women play the role of counsellor for younger members of the community. On the bench, however, the grandmothers listen more, and lecture less. “We used to talk a lot, ‘Do this, do that’. But now we ask them to open up, open their minds and hearts,” says Sheba Khumalo, a grandmother. Chibanda says it is mostly we call kuvhura pfungwa [opening of the mind]. They sit and talk they help them through it.” women that visit the bench. “From our recent study, we found that 40% of those coming to the bench who show depression are victims of domestic violence. Whether that violence is caused by the economic situation is something that we have not looked at.” In conservative Zimbabwe, just getting people to open up about their mental health is a victory in itself, says Joyce Ncube, another of the grandmothers. “Many died just because they had nobody to tell their problems to,” she says, settling on to the wooden seat for a session with one of her patients. “When people keep things inside, their problems start.” Maria Makoni is a 49-year-old unemployed mother of three who began therapy earlier this year. “In our culture, you are ridiculed for speaking about your mental health,” says Makoni. She is tense, but lights up when she speaks about the grandmothers. talk to about my problems. When I speak to them, I feel like a load is lifted off my heart.” way to the friendship bench, she many with similar problems. Now she is volunteering to bring more to the bench. “I am ready to speak to as many people as I can.” For many Zimbabweans, poverty – more than 70% of people live below the poverty line – and unemployment are a source of despair. In such a deeply superstitious and religious society, mentally-ill people are sometimes seen as possessed; many are dragged to exorcism sessions at charismatic churches. Chibanda says such beliefs need not be a hurdle, provided the intervention is packaged well. “The term ‘opening of the mind’ does not sound medical at all. We have used those words to package why it’s acceptable.” The programme has had to pick its words carefully, as the grandmothers are meant to be more friends than doctors. The scheme was initially called “mental health bench” but nobody came. “The minute we changed it to friendship bench, it became acceptable, even though we are essentially providing the same thing,” says Chibanda. Researchers say the friendship bench may be a blueprint for mental healthcare in developing countries. In Zimbabwe, the programme will now be rolled out to 60 other clinics across the country. have in providing affordable care,” says Prosper Chonzi, director of health for the City of Harare. “We are glad to see it is being applied to other cities in the country.”
Friday, March 9 2018| NEW ERA 11 Nuusita Ashipala AMTA boss clears air on PPP with Fysal New Era journalist Nuusita Ashipala (NA) talked to Agro-Marketing and Trade Agency (AMTA)’s Managing Director Lungameni Lucas (LL) NA: How does Fysal’s collaborating with the Ongwediva Fresh Produce mandate to promote and develop locally grown produce at the expense of foreign produce? LL: increase the commission to AMTA NA: How is AMTA going to ensure that Namibian produce continues to enjoy an advantage in procurement, and receive prominent retail shelf space at Fysal retail shops? Currently, Fysal already markets and sells more than 60 percent of produce bought directly from South African farmers. How is AMTA going to facilitate the reduction in that percentage to favour Namibian produce, as dictated by the HDI? LL: situation is not likely to change any time soon due to required climatic LL: NA: How does AMTA rate the competition of Namibian produce compared to South African produce? Have the Namibian product reached a level where they can compete fairly with South African products? LL: Managing Director at AMTA, Lungameni Luca NA: Perhaps AMTA can also tell us the rationale behind the partnership with Fysal. LL: to come on board and assist other Pohamba asked AMTA to offer market-related prices to farmers, saying the current rates are too low. How does AMTA decide the rate offered to farmers? How do these rates compare to the market rates, such as the South African weekly fruit and vegetable prices. LL: Prices are negotiated with NA: Local farmers were previously reluctant to bring their produce to the hub because they were not paid on time. Has that been resolved? What is the current payment system? LL: NA: Apart from selling to individuals, including vendors who frequent the hub, how many Namibian retail chains and shops are currently supplied by AMTA’s hub? Are we able to have a geographical indication of where these retailers are? LL: NA: If possible can you give us an indication, in percentages, of how many tonnes of local produce AMTA supplies to Namibian retailers, vis-à-vis the imported produces, on an annual basis? LL: NA: How far is AMTA from rolling out a high-quality packaging system and grading of produce from local producers, which compete at the same level with South African produce, such as those that come aboard Fysal trucks? Ready for the market... Pohamba, Manager of Ongwediva Fresh Produce Business Hub Jacob Hamutenya, AMTA’s Managing Director Lungameni Lucas and the Governor of Oshikoto Region Henok Kankoshi tour the Ongwediva Fresh Produce Business Hub.