Throughout the world people with mental health problems suffer from stigmatization and discrimination. Much of this is due to ignorance about the causes and treatment of mental health problems. Many cultures believe that people who hear voices are possessed by spirits so people do not get treatment for their problems.
Psychiatric services in mid Wales have a lot in common with Zanzibar, they are rural areas where the main services are concentrated in cities that are many miles away from people who live in rural are, transport is expensive and to travel anywhere by public transport takes a long time so accessing services is difficult unless they are provided locally.
Both Wales and Zanzibar have their own government but are ultimately governed by the laws of a country of which they are part, in Wales the Welsh Assembly is overseen by the UK Government in Westminster, and in Zanzibar the Revolutionary Government of Zanzibar is overseen y the Tanzanian Government of John Magafuli. This means that in both cases the staff have to obey 2 masters.
Zanzibar is an archipelago, and has 2 main islands. Unguja is the main island that we usually refer to as Zanzibar, where all the tourists go, and where the main hospital is. The second largest island, Pemba, is only slightly smaller and has about one third of the population of Zanzibar, about 400,000 people. They do not get equitable care for mental health problems compared to the people of Unguja, and part of the project is a scoping visit to Pemba to find out what services exist there, and how we can support the existing services to provide more equitable care to the people of Pemba.
This project aims to reduce the stigma of mental health in Zanzibar and Wales. We will work with the Zanzibar Ministry of Heath and the Zanzibar Psychiatric Association to provide health education to people in clinics in the rural areas of Zanzibar. We will also provide training for volunteers and health staff in rural clinics in Zanzibar.
We will use information and experience gained in Zanzibar to provide presentations of health and voluntary organisations in Wales to gain a wider perspective on mental health issues by focussing on cross cultural psychiatry.
ZAMHS is an organisation that exists to support the provision of equitable health care in Zanzibar and raise issues of cross cultural psychiatry in Wales.
ZAMHS supports the provision of mental health clinics in rural Zanzibar as people in rural areas are often too poor to afford the bus fares to Kidongo Chekundu Hospital (KCH) in Zanzibar City, so go without treatment and medication. Many people with mental health and neurological problems seek treatment from Traditional Healers (witch doctors) instead of getting help from conventional medicine.
ZAMHS supports the provision of services in the rural areas of Zanzibar by providing a motorbike, fuel and medication so staff can travel to rural villages to provide clinics. As a result of this there are now more clinics in rural Zanzibar than before ZAMHS started. ZAMHS and the Ministry of Health are working with traditional healers to educate them on when they have to refer patients to KCH for treatment. ZAMHS also works with the Zanzibar Psychiatric Association (ZPA) to provide support for people with mental health problems. This includes providing tools and equipment for people with mental health problems to set up in small businesses and support themselves.
In Wales ZAMHS has provided poster displays, presentations and discussions at public events, presentations to local mental health team and health organisations and to the psychology department at the University of Bangor. Research shows that people with psychotic disorders recover more quickly in Zanzibar than in the UK, and people experience depression, PTSD and eating disorders in a different way, and looking at how other cultures experience mental health problems is useful in reflecting on our own practice. (A WHO report commented that the more money a country spent on mental health the worse the outcomes were)
In Zanzibar neurological disorders are included in mental health issues, there is a high incidence of neurological problems due to cerebral malaria in childhood. Many people think that epilepsy and psychosis are caused by possession by spirits and treat them with infusions of roots and/or spells, which have no effect so the children do not get proper treatment and are unable to go to school.
Both the Ministry of Health and ZPA have produced proposals to provide health education in the rural areas of Zanzibar but do not have the funding to carry it out.
This project is to provide the equipment, staffing and transport to enable the highly skilled staff in Zanzibar to arrange health education session for the general public, for volunteers, for teachers and for health staff to enable them to understand better the issues surrounding the treatment of depression, anxiety and psychosis. Traditional Healers will also be involved to train them to recognise when a person cannot be helped by traditional means and must be referred to the Mental Health Team, for instance those people suffering from epilepsy or psychosis.
Part of the project will be through public media such as radio and TV broadcasts. Enabling the Mental health team to broadcast on Radio issues around Mental Health will educate especially the young and encourage them to come to the clinics to get help.
The project will be supporting knowledge and skills sharing between health institutions in Wales and Africa for mutual learning and benefit. Some of the teaching materials used in Zanzibar will come from Wales, experiences of mental health treatment in Zanzibar will be used with mental health workers and the general public to raise awareness of mental health issues and their treatment in Wales.