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TEDWomen 2017

Dixon Chibanda: Why I train grandmothers to treat depression

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Dixon Chibanda is one of 12 psychiatrists in Zimbabwe -- for a population of more than 16 million. Realizing that his country would never be able to scale traditional methods of treating those with mental health issues, Chibanda helped to develop a beautiful solution powered by a limitless resource: grandmothers. In this extraordinary, inspirational talk, learn more about the friendship bench program, which trains grandmothers in evidence-based talk therapy and brings care, and hope, to those in need.

- Psychiatrist
Dixon Chibanda is passionate about the human brain, how it influences our behavior and what we can do to make everybody happy. Full bio

On a warm August morning in Harare,
00:12
Farai,
00:16
a 24-year-old mother of two,
00:18
walks towards a park bench.
00:21
She looks miserable and dejected.
00:24
Now, on the park bench
sits an 82-year-old woman,
00:28
better known to the community
as Grandmother Jack.
00:33
Farai hands Grandmother Jack
an envelope from the clinic nurse.
00:39
Grandmother Jack invites Farai to sit down
00:47
as she opens the envelope and reads.
00:50
There's silence for three minutes
or so as she reads.
00:53
And after a long pause,
Grandmother Jack takes a deep breath,
00:58
looks at Farai and says,
01:02
"I'm here for you.
01:06
Would you like to share
your story with me?"
01:10
Farai begins,
01:13
her eyes swelling with tears.
01:15
She says, "Grandmother Jack,
01:19
I'm HIV-positive.
01:22
I've been living with HIV
for the past four years.
01:24
My husband left me a year ago.
01:28
I have two kids
01:30
under the age of five.
01:32
I'm unemployed.
01:34
I can hardly take care of my children."
01:35
Tears are now flowing down her face.
01:40
And in response,
Grandmother Jack moves closer,
01:43
puts her hand on Farai,
01:47
and says, "Farai, it's OK to cry.
01:49
You've been through a lot.
01:53
Would you like to share more with me?"
01:56
And Farai continues.
01:59
"In the last three weeks,
02:02
I have had recurrent thoughts
of killing myself,
02:04
taking my two children with me.
02:09
I can't take it anymore.
02:12
The clinic nurse sent me to see you."
02:15
There's an exchange between the two,
which lasts about 30 minutes.
02:20
And finally, Grandmother Jack says,
02:25
"Farai,
02:28
it seems to me that you have
all the symptoms of kufungisisa."
02:30
The word "kufungisisa"
opens up a floodgate of tears.
02:37
So, kufungisisa is the local
equivalent of depression
02:44
in my country.
02:48
It literally means
02:50
"thinking too much."
02:52
The World Health Organization estimates
02:56
that more than 300 million people
globally, today, suffer from depression,
02:59
or what in my country
we call kufungisisa.
03:05
And the World Health
Organization also tells us
03:08
that every 40 seconds,
03:12
someone somewhere in the world
commits suicide
03:15
because they are unhappy,
03:19
largely due to depression or kufungisisa.
03:21
And most of these deaths are occurring
in low- and middle-income countries.
03:24
In fact,
03:29
the World Health Organization
goes as far as to say
03:30
that when you look at the age group
between 15 to 29,
03:34
a leading cause of death
now is actually suicide.
03:38
But there are wider events
that lead to depression
03:43
and in some cases, suicide,
03:47
such as abuse,
03:49
conflict, violence,
03:51
isolation, loneliness --
03:53
the list is endless.
03:56
But one thing that we do know
03:59
is that depression can be treated
and suicides averted.
04:01
But the problem is
04:06
we just don't have enough psychiatrists
or psychologists in the world
04:07
to do the job.
04:11
In most low- and middle-income
countries, for instance,
04:12
the ratio of psychiatrists
to the population
04:15
is something like one for every
one and a half million people,
04:18
which literally means
that 90 percent of the people
04:22
needing mental health services
04:26
will not get it.
04:28
In my country,
04:30
there are 12 psychiatrists,
04:31
and I'm one of them,
04:34
for a population
of approximately 14 million.
04:36
Now, let me just put that into context.
04:40
One evening while I was at home,
04:43
I get a call from the ER,
04:46
or the emergency room,
04:48
from a city which is some
200 kilometers away
04:51
from where I live.
04:54
And the ER doctor says,
04:56
"One of your patients,
04:57
someone you treated four months ago,
04:59
has just taken an overdose,
05:01
and they are in the ER department.
05:03
Hemodynamically, they seem to be OK,
05:05
but they will need
neuropsychiatric evaluation."
05:07
Now, I obviously can't get into my car
in the middle of the night
05:11
and drive 200 kilometers.
05:14
So as best as we could,
05:16
over the phone with the ER doctor,
05:18
we come up with an assessment.
05:21
We ensure that suicidal
observations are in place.
05:24
We ensure that we start reviewing
the antidepressants
05:29
that this patient has been taking,
05:32
and we finally conclude
05:34
that as soon as Erica --
that was her name, 26-year-old --
05:37
as soon as Erica is ready
to be released from the ER,
05:40
she should come
directly to me with her mother,
05:44
and I will evaluate
05:47
and establish what can be done.
05:49
And we assumed that that would
take about a week.
05:51
A week passes.
05:54
Three weeks pass.
05:56
No Erica.
05:57
And one day I get a call
from Erica's mother,
05:59
and she says,
06:02
"Erica committed suicide three days ago.
06:04
She hanged herself from the mango tree
06:07
in the family garden."
06:12
Now, almost like a knee-jerk reaction,
06:16
I couldn't help but ask,
06:19
"But why didn't you come
to Harare, where I live?
06:21
We had agreed that as soon
as you're released from the ER,
06:25
you will come to me."
06:28
Her response was brief.
06:30
"We didn't have the 15 dollars bus fare
06:34
to come to Harare."
06:37
Now, suicide is not an unusual event
06:40
in the world of mental health.
06:44
But there was something
about Erica's death
06:47
that struck me at the core
of my very being.
06:49
That statement from Erica's mother:
06:54
"We didn't have 15 dollars bus fare
to come to you,"
06:57
made me realize
07:03
that it just wasn't going to work,
07:05
me expecting people to come to me.
07:07
And I got into this state
of soul-searching,
07:10
trying to really discover my role
07:14
as a psychiatrist in Africa.
07:18
And after considerable consultation
and soul-searching,
07:21
talking to colleagues, friends and family,
07:25
it suddenly dawned on me
07:28
that actually, one the most reliable
resources we have in Africa
07:31
are grandmothers.
07:36
Yes, grandmothers.
07:39
And I thought,
07:41
grandmothers are in every community.
07:43
There are hundreds of them.
07:46
And --
07:48
(Laughter)
07:49
And they don't leave their communities
in search of greener pastures.
07:50
(Laughter)
07:55
See, the only time they leave
07:57
is when they go to a greener
pasture called heaven.
07:59
(Laughter)
08:01
So I thought, how about
training grandmothers
08:02
in evidence-based talk therapy,
08:06
which they can deliver on a bench?
08:09
Empower them with the skills to listen,
08:13
to show empathy,
08:16
all of that rooted
in cognitive behavioral therapy;
08:19
empower them with the skills
to provide behavior activation,
08:22
activity scheduling;
08:27
and support them using digital technology.
08:28
You know, mobile phone technology.
08:33
Pretty much everyone in Africa
has a mobile phone today.
08:35
So in 2006,
08:38
I started my first group
08:40
of grandmothers.
08:44
(Applause)
08:45
Thank you.
08:49
(Applause)
08:50
Today, there are hundreds of grandmothers
08:53
who are working
in more than 70 communities.
08:56
And in the last year alone,
09:00
more than 30,000 people received treatment
09:03
on the Friendship Bench
09:08
from a grandmother
in a community in Zimbabwe.
09:09
(Applause)
09:13
And recently, we published this work
that is done by these grandmothers
09:21
in the Journal of the American
Medical Association.
09:26
And --
09:29
(Applause)
09:30
And our results show
that six months after receiving treatment
09:32
from a grandmother,
09:38
people were still symptom-free:
09:40
no depression,
09:42
suicidal ideation completely reduced.
09:44
In fact, our results --
this was a clinical trial --
09:47
in fact, this clinical trial showed
09:50
that grandmothers were more effective
at treating depression
09:52
than doctors and --
09:56
(Laughter)
09:57
(Applause)
09:58
And so,
10:06
we're now working towards
expanding this program.
10:08
There are more than 600 million people
currently aged above 65 in the world.
10:14
And by the year 2050,
10:21
there will be 1.5 billion people
aged 65 and above.
10:23
Imagine if we could create
a global network of grandmothers
10:29
in every major city in the world,
10:35
who are trained
in evidence-based talk therapy,
10:39
supported through digital platforms,
10:44
networked.
10:46
And they will make a difference
in communities.
10:48
They will reduce the treatment gap
10:53
for mental, neurological
and substance-use disorders.
10:55
Finally,
11:00
this is a file photograph
of Grandmother Jack.
11:01
So, Farai had six sessions on the bench
with Grandmother Jack.
11:05
Today, Farai is employed.
11:12
She has her two children at school.
11:14
And as for Grandmother Jack,
11:18
one morning in February, we expected her
to see her 257th client on the bench.
11:20
She didn't show up.
11:28
She had gone to a greener
pasture called heaven.
11:31
But I believe that Grandmother Jack,
11:34
from up there,
11:37
she's cheering on
all the other grandmothers --
11:39
the increasing number of grandmothers
who are making a difference
11:42
in the lives of thousands of people.
11:46
And I'm sure she's in awe
11:50
when she realizes that something
that she helped to pioneer
11:52
is now spreading to other countries,
11:57
like Malawi,
12:00
the island of Zanzibar
12:01
and coming closer to home
here in the Unites States
12:02
in the city of New York.
12:06
May her soul rest in peace.
12:09
Thank you.
12:12
(Applause)
12:13
(Cheering)
12:16
(Applause)
12:18

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About the speaker:

Dixon Chibanda - Psychiatrist
Dixon Chibanda is passionate about the human brain, how it influences our behavior and what we can do to make everybody happy.

Why you should listen

Dixon Chibanda is the director of the African Mental Health Research Initiative (AMARI). He's based in Zimbabwe, where he works on the Friendship Bench program, a cognitive behavioral therapy–based approach to kufungisisa, the local term for depression, literally translated into “thinking too much.” At the Friendship Bench, patients receive individual problem-solving therapy from a specifically trained lay health worker.

Chibanda is passionate about connecting with ordinary people in ways that improve their lives using simple but effective programs that can be carried out by non-specialists or professionals. He likes to think outside the box as he explores ways of helping people with conditions such as depression, PTSD and ADHD.

More profile about the speaker
Dixon Chibanda | Speaker | TED.com