Zanzibar is an island off the East coast of Tanzania. It is a popular holiday destination due to its beautiful beaches. People may have heard of Zanzibar as a holiday destination, but they may not realise that it is a poor country with the average wage being less than a dollar a day, there is often no electricity, that people still die of cholera.
Like Mid Wales there are areas of Zanzibar that are sparsely populated and a long way from the major town, Zanzibar City. Like Wales the mental health services in Zanzibar are concentrated in the big towns, and the people who live in the rural parts of the island find it difficult to access services. People in the community are very poor and often face long journeys and struggle to afford the Daladala (bus) fare to attend clinics even though it is typically 30 pence.
ZAMHS stands for Zanzibar Mental Health Shamba. Shamba is the Swahili word for countryside. ZAMHS is a small NGO that aims to support people with mental health problems in the rural areas of Zanzibar.
We are working with Community Mental Health services in Zanzibar to pay for fuel for transport to far flung areas and medicines to be able to give to those with Mental Health or Neurological problems who cannot afford to pay for them. Some of these “patients ” are children some adults. Many have epilepsy as a result of childhood malaria.
Working with people with mental health problems in Zanzibar throws our own views on mental illness into perspective. In Zanzibar people often believe that illness is caused by evil spirits, and consult a witch doctor rather than a psychiatrist.
Despite this the outcomes for people with Schizophrenia in Zanzibar are better than for people in the West, and we have to ask ourselves why it is that despite vastly greater resources available to us we have worse results
In other cultures people do not experience mental health problems the same way that we do in the West, and this throws open the question of whether our Western view of mental health problems is specific to our own culture, and whether applying a Western model of psychiatry is the most useful approach. Our partners in Zanzibar invite the local witch doctors to training events to teach them which symptoms to look out for in people they should refer to mental health services, and which symptoms they can safely deal with.