Kathleen tells...
Visiting colleagues
On our way to Korongwe, an overgrown village at the foot of the Usambara Mountains, we cycle along a sign of the 'Bagamoyo Mental health clinic'. I like to visit my Tanzanian colleagues, but I don't see a phone number. No website. Can we make it to just knock on the door of the centre?
Life is up to the daredevils, so we turn into the dirty dirt road next to the sign until we reach a brown gate, which is wide open. A four year old boy is waiting for us. Nowhere to be found a sign with the name of the hospital. In the doorway a young woman appears with a bright red coloured shawl around her. We hesitantly ask: 'Is this the mental health clinic? Yes, it is! Karibuni', it sounds. Welcome.
The woman points to a fresh green building next to her own house. We park our bicycles along a front garden full of tropical plants. On the terrace in front of the centre some men with a deep wrinkled face and long robes are chatting in the shade. A veiled woman, leaning against the facade of the house, joins in the conversation with them. In the corner of the terrace, a young woman looks curiously in our direction. She meets us enthusiastically and introduces herself to us.
Her name is Neema. 18 years old. Welcome and nice to meet you! Neema speaks English fluently and introduces us to the other attendees. We shake hands and exchange the usual greetings in broken Swahili. In the meantime, I'm trying to find out who's a patient here, who's a doctor, a nurse or a family member, but I can't figure it out.
Then an older man appears in a bright green shirt in the doorway. 'Well, we have visitors,' he smiles. Psychiatrist Dilli invites us to take a seat in his doctor's room. Neema, who apparently is one of the patients, is eager to be present. Go and get a chair,' says Dilli. ‘Then you can join us.’ She won't let that be said twice.
Dilli explains how, with the financial support of a German friend and colleague, he set up this centre, together with a team of psychiatric nurses and some administrative staff. The buildings were built together with the villagers.
Most of the people who come to the centre are suffering from schizophrenia, epilepsy, mood disorders and drug addiction. Because the clinic is located on the main road between the villages, it is easily accessible and well known to the villagers. Thanks to years of educational programmes, the population has become well acquainted with something like a mental illness in recent decades, says Dilli, just as it is the case with malaria, HIV and diabetes. Yet many people first seek refuge with a traditional healer from their own community. Only when that doesn't work do they come knocking on the door of the centre. Sometimes patients find their way to the hospital with mainly physical complaints. There is also a small room in the building for them to provide first aid. ‘It's hard to send them home again, isn't it?' Dilli adds dryly.
That pragmatism characterises the whole centre. For example, Dilli suggests that I have some therapy discussions with the patients today. ‘You're here now', he says. In the meantime, he walks past the adjoining house in the yard, where he lives with his wife, son and daughter and grandchildren. And that yard is an extension of the other houses in the village. His wife cooks daily for the family and for the patients and the team. The grandchildren play hide-and-seek in the front yard, where some patients and their relatives are resting in the shade. Besides Dilli, Neema is the only one on the site who speaks enough English, so she translates occasionally for her fellow patients and the nurses. Although we notice from the little things in her behaviour that she hasn't fully recovered yet, she is visibly pleased to be able to take on this task.
A nurse asks via Neema if we don't want to take pictures. To be honest, we didn't intend to do that for privacy reasons. But that too is beyond the African no-nonsense mentality. Everyone wants to be photographed together: patients with us, doctor with us, nurses with doctor, patients with doctor. ‘Send the photos to us afterwards', says Dilli. ‘Then we'll hang them on the wall here.’ What address do we ask for? Dilli looks dubious. He has an email address but rarely uses it. He consults with doctors in the area by phone or on location. He also does not know the address of the centre by heart, although it borders on his own property. They don't do addresses here, but they do word-of-mouth advertising. There is always someone in the village who knows where to deliver the mail. So just send them to the village with the name of the centre on it. Then they will end up.
If you look at this centre from a Western perspective, you could come up with big words and equally big question marks: what about Role Confusion? Professional boundaries? Professional secrecy? Patient privacy? Separation between professional and private life? Where is the Vision text with Long-term objectives? And so on. Nevertheless, I cannot shake off the impression that patients are in good hands, can count on sound and professional care, and all this in an environment that in many aspects seems to be healing for them.
After all, this mental health clinic can only operate with the resources that are available and if everyone does their bit: the care team, the family of the care team, the villagers, the family of patients, and if they are able to do so, the patients themselves as well. That's no different from the other places in Tanzania where we cycled by. You can do it with a good dose of creativity, with healthy common sense and not too much waffling.
Also the fact that the centre is interwoven with the daily life of the estate and the village, seem to have a strongly normalising influence on the home. As a patient, you will find peace of mind to recover, the professional knowledge and reassuring presence of the professional care workers you can call on. At the same time, as a patient, you also have the opportunity to continue to contribute to the general functioning of the centre, not as a kind of occupational therapy or as part of a treatment programme. It is because it can make a real, full contribution to the entire functioning of the centre. In this way, the patients get the confirmation that - despite being ill - they continue to be an active and fully-fledged part of the daily life of the community. Sometimes by resting for a while and letting the people around them take care of them. Sometimes by simply continuing to contribute to the community of people around them within their means.
When I ask Dilli at the end of our visit what his motivation was to specialize in psychiatry, he openly says that in his childhood there were some family members suffering from a mental illness and as a young guy he felt powerless about it. As a doctor, he hopes to be able to do something for others in similar situations, and by saying that, he smiles friendly to Neema. She smiles back, very grateful.
‘Can we perhaps do something for the centre as a thank you for the visit?’ I ask. Dilli sits down at his table and draws up a list of the medication that the region needs the most and that generally works well and is affordable for the people who call on the centre. 'Did you have to have a stock left in Belgium...'
Everyone, doctor, nurses, patients, their family, Dilli's grandchildren, in short, the whole club comes to take a look at the bicycles. All of them are surprised that there is no motor on them. One last selfie at the request of an older patient and then Neema pushes a folded note into my hands that she has written quickly. ‘You should read it later,' she says. I promise to do that. With her in mind.