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More than half the population of Mozambique live on less than a dollar a day. Life expectancy for men is 50 years – 52 years for women. Against this background, it’s hard to imagine the challenge of working for mental health, in a country of twenty million people – and nine psychiatrists.
Dr dos Santos, a clinical psychologist from Mozambique, will be sharing her country's experience in the symposium Depression: Addressing the Global Burden.
She is well aware of the task she faces. When she graduated from the Polytechnic University in Maputo in 2003, it was the only university in the country which taught clinical psychology. She didn’t even intend to take the course – she arrived to do architecture, only to find that all the architecture places were already taken. She’s never looked back.
One of the biggest problems she faces is lack of solid information. Only one international paper* has been published to date on mental health in Mozambique, and it was only in 2011 that the first scientific journal on mental health - Revista Psique - was published there. In Dr dos Santos’s own experience, common problems range from schizophrenia & other psychoses, to drug addiction – drug addicts are treated at psychiatric hospital as in patients.
Stigma is rife. Dr Dos Santos says, “I saw a young man with schizophrenia, he was an excellent professional but was discharged from his last job because someone discovered he had schizophrenia. There is stigma in communities, in the work place, even in some families, who hide their relatives as they don’t want people to know they have ‘spirits.’”
A common belief is that mental illnesses - especially psychosis - stem from possession by spirits. This means that it's usual for her patients to see traditional healers first, not accessing her services until much later, if at all. For this, as for other challenges, Mozambique's Ministry of Health has come up with a novel solution.
“Traditional healers are organised into a kind of association,” she says. “We’ve a traditional medicine institute at the Ministry of Health, and Ministry of Health employees liaise with the association, do advocacy etc – the idea is that people can see traditional healers but also please go to the health facilities - in other words, we can share our patients.” However, she acknowledges it’s going to take time. A traditional healer is more likely to be local, and free – it’s hard for mainstream health services to compete.
Creative solutions extend to training mental health workers. Mozambique is now training what Dr dos Santos calls psychiatric technicians - undergraduate health professionals with 30 months' intensive training in psychiatry. They are allowed to prescribe psychotropic drugs, and act as psychiatrists all over the country under the supervision of a regional psychiatrist.
Resources remain scarce, and problems of funding – and access to medicines – are not ones with magical solutions. A key issue for Dr dos Santos is having a legal framework to work with. There’s no law covering mental health in Mozambique, and while the Ministry of Health's Mental Health Department is trying to get one passed, the process is frustratingly slow. Getting a law approved would be “a dream,” she says. “It will give families an instrument to fight for their relatives. We only have one family member’s organisation here. They do a lot, but it’s not enough. They need a more powerful voice for change.”
Palmira Fortunato dos Santos will be sharing Mozambique’s experiences with mental health on a panel: “Depression: addressing the Global Burden” as part of the Grand Challenge of Global Health NCD Season.
* Professor Vikram Patel, published internationally in PubMed
Page last modified on 11 apr 14 10:03