Looking back on the past (almost) two months
First of all, I want to acknowledge that I am very lucky to now be “en congé”.
Usually, we have our break after three months. My colleagues asked me why I was going on home leave already. I have always been answering that I literally begged msf/my supervisor to allow me to leave earlier as this would allow me to see the people who are most important in my life! I am very, very grateful.
When the leave was granted, I was able to make travel arrangements to go to Europe (just saying that I will pass through that nice airport again. Yes, the one with the nice food – more about that and my food fantasies later).
Travel plans were and are very uplifting! And I am not yet ready to let my mind go into the future thinking spiral that two weeks will also be over so quickly. Ah, the mind. Tell me how you experience your mind’s activities! My mind definitely goes into many directions at the same time and end up telling me opposing conclusions (and recommendations).
I had started to write down (kind of) daily what I had been doing at work because I am worried I will have to write the end of mission report and not be able to describe what I actually did. I think it is quite easy to get lost in the daily chaos, and I am glad in a way that I am not hired to do clinical work. Although that has always been my passion, I can see that I would not manage to do anything else. So many people who need support. I can’t remember if I had mentioned that my first task was to write a strategy document which I approached in my academic way. I admit I didn’t quite know how to do this so I tried to read everything I could find in the depth of my computer archives. I am the 4th person to use this computer and everybody had their own way of creating folders and saving documents. I think I did more of a scientific paper style with way too much information and too many pages. A Paris-based superior then luckily reduced it massively (and in a way saved me a lot of time) and I decided I will make it a bit longer again and sent it off just at the beginning of this week. My logic was while I am away, whoever has to read this document can read the document and when I am back, they will have evaluated it and maybe already made a decision about it. And then I can spent the remaining 3 ½ months putting it into action.
This action in a way has started already as my biggest goal is to build capacity in the “soutien psychosocial” team. We are going back to basics. And I also have to understand how my team understand what this psychosocial support is. They always talk about “santé mentale” to the patients and, just like in most places in the world, people hear “mental” and don’t follow through with the health thought but rather go into the illness idea. And that triggers fear and stigma. In the context, I work in it is not uncommon to have very terrible human rights abuses of people who live with a disability such as a chronic noncommunicable psychiatric disorder that is neither diagnosed nor treated. Just think of epilepsy. 50 million people globally have epilepsy, 80% of those are in low- and middle-income countries. If properly diagnosed and treated, 70% of them could live seizure-free but…. 75% of people living with epilepsy have no access to treatment. Sorry for info-dumping, I just looked at the WHO fact sheet https://www.who.int/news-room/fact-sheets/detail/epilepsy
Prevalence estimates often vary widely due to limited awareness of signs of the disorder and lack of access to diagnostic tools, especially when comparing urban and rural populations. African populations are most affected by epilepsy compared to other world regions, for both caused by underlying condition and no known cause).
Traditional explanatory models make their suffering worse. People and their families are stigmatized, excluded from communities, and patients often labelled to be possessed by a demon, cursed or bewitched. Epilepsy thus is a known phenomenon in communities, but tragically misunderstood! (In high-income countries it is much less visible as people have access to treatment and are therefore (hopefully) living their lives without experiencing seizures.)
Harmful traditional practices have been developed to treat the “possessed people” and drive the evil spirit out.
(And please don’t shake your head about the lack of understanding which leads to these practices. Access to knowledge is not as widely available as we might think, and knowledge does not lead to behavior or attitude change easily, either.)
There is a lot of work to do to increase knowledge, change perception and attitudes towards brain disorders amongst all, the general public, families, traditional and faith-based healers, religious and community leaders.
For those who want to read more: https://www.neurologyletters.com/article_189190.html
https://www.sciencedirect.com/science/article/abs/pii/S1525505020304364
and as this is not an open access paper, go visit our friends from sci-hub, they provide us with the full paper! #OpenScience
More info-dumping. You can skip the papers altogether. I just know that some of us are jumping on any lead to read some more and will click the links. Happy reading. I can’t ever stop myself to follow a link that I is in line with my current passion project.
Maybe I should work in science-communication.
How did we even get here? Lack of knowledge leads to scientifically false explanatory models, leads to stigma, leads to harmful treatment attempts which don’t work and make people suffer. Which is all terrible in and by itself. (I could go on another tangent here with depression. Most people link depression to a cause…like “I have lost my job and then I got depressed”. It makes sense that it is causally linked in people’s understanding because it has a time line to it… why then do other people who have not lost their job develop depression? Or what about those people who have lost their job and do not develop depression? You see how complicated it becomes when we try to find simple explanations for very complex topics.)
I have two more hours before being taken to the airport. I am in N’Djamena, 4 of us left the project in Adré yesterday. A bit of a bumpy flight over a still very, very dry landscape. People were telling me confidently that the rainy season will come, just a bit later than usual. But… Overall rain amounts probably vary and the cropping season will be shortened (#agronomy). There are people who read this who can explain this all better than me.
Back to my work experience so far.
Two months! I have grown used to how things are done. I managed to get a situational report in that was most likely as expected. (A few fights with excel and automated analysis forms here and there included). I have written up work plans and have given a presentation/mini workshop to the midwives who were engaged and shared their experiences. I couldn’t tell them enough how important their role is in perinatal mental health. And how the mental health of a new mom is impacting on the child’s future outcomes (long-term!).
We have done some serious work on data collection, understanding why we collect data, how to collect data so that they are reliable, questionnaires: why and how we use them well? And then always and for probably all my time in Adré, how to support patients. At the moment, we are doing a lot of “problem talking”, a very common effect of supporters who don’t have much therapeutic skills to draw from.
I have to work on changing some attitudes because of course we get feedback from some patients that they felt good being asked about their story and that they had someone who listened. My guess is that these people are actually quite resilient and can use the story-telling to verbally process and rewrite their own story.
Not so good for those who actually suffer from PTSD and need trauma-informed therapy approaches.
I get frustrated with the limits of task-shifting approaches. Task-shifting means to train non-professionals to do a specific task while supervising them. In mental health….? I am not completely convinced (after years at Friendship Bench). What even is one specific task in mental health? Can someone tell me? It is always complex to interact with another person and every person is different. And we are different on different days.
In our last supervision session, we filmed each other doing a role play and then watched and discussed. And the room always has 36-38 degrees, a fan is blowing, and I feel like I am melting. #HeatResilience (which I seem to have developed a bit of)
Have I said already that I have found out that having one job is calmer and maybe better than having several jobs? I don’t think I had the opportunity to realize it during the past 20 years.
Just want to state that I love being in contact with the projects out there and enjoy working with you all #FBAthensOhio #HealTogetHER #AbriDuSoutien #Banquillo and #Vietnam.
I have seen some hectic stuff in the past two months. Violent behavior, risky behavior, abused animals, abused people. And beautiful warm smiles, people talking to me in Arabic and when they noticed I can’t follow even more words in Arabic would follow and lots of laughter. I engaged with kids on the pediatric ward who fear our white vests (#chaleco), we have no common language, some finally smiled back at me and waved when I walked away. Some stayed solemn and just observed what I was doing, playing peek-a-boo for example. This mostly happened in the nutrition ward where the children just have no energy yet to engage much in play.
(Oh, did I tell you with all the aid cuts, WPF has had to reduce food distribution already, and we WILL see more malnourished children. It is fact. And a question of time.)
Emotionally, I have been all over. Content and utterly miserable (asking myself what I am doing?). Feeling in community with the colleagues and other times absolutely lonely and forgotten and misunderstood.
My French has been improving, I still have sometimes total breakdowns and don’t understand a word … (granted we have a lot of different accents and dialects in our team). Very soft voices and a fan blowing in my ear makes me not hear… So I sometimes have to turn off the fan which then makes us all melt… Communication is more important then, I decide.
I have also started to rely less on AI translations and am just happily writing along (isn’t spell check great?)
And I have done this too: listening to a podcast in another language, someone speaks to me, and I answer in the podcast language. Something in my brain is not adapting quickly enough. Looking at a stunned face makes me realize that I did something unexpected.
This is the longest post ever. Thanks for reading. And thanks for sending messages. You are all very kind!
And overall, I am ok. And will eat cheese sandwiches in Germany. #Käsebrot (there are no dairy products in Adré, except the powdered milk)
And strawberries… and raspberries and cherries and did I mention cheese sandwiches? And tofu!
PS: couldn’t be bothered to proofread. If chaos, please ignore and continue reading.
Thank you!
