DATE: September 26, 2008
JAMES PHILLIPS & MARK REGO
PUBLICATION: Connecticut Post (Bridgeport, CT)
Fernando B. is a young, talented weaver who lives in a remote Andean city in Peru. He stayed in his room for two years because terrifying voices and paranoid thoughts plagued him. His mother came to our clinic, the Ayacucho Mental Health Project, desperate and helpless. Carmen, an impoverished 28-year-old single mother, came to us with anxiety and chronic depression because her husband, like her father before him, drank and beat her. With psychiatric treatment, including medication and supportive therapies, both are now significantly improved. We have certainly not solved all their life problems, but they are feeling better, working, and finding more satisfaction in what are difficult life circumstances.
You may be surprised to learn about someone suffering from schizophrenia or severe depression in a rural, Third World country. In the United States, the media (including those relentless commercials for psychiatric medications) have brought mental disorders out of the closet — we now know that these conditions are common and nothing to be ashamed about. Very probably someone in your family suffers from a psychiatric disorder, and probably someone in your neighbor’s family as well.
But people often think that mental disorders only exist in developed countries; that Third World people are too busy trying to put bread on the table to have time for serious anxiety or depression — or for schizophrenia or bipolar disorder. In fact, nothing could be further from the truth.
The World Health Organization estimates that 450 million people suffer from neuropsychiatric disorders, most of them living in poor countries with virtually no access to mental health care.
For the past five years we have worked with a devoted group of individuals in a poor city in Peru to develop and run a free mental health center for people like Fernando and Carmen. We were fortunate to come across this opportunity through a group of Peruvian-American physicians associated with the Peruvian American Medical Society. The PAMS doctors were already running medical missions in remote areas of Peru, and through them we were able to attach ourselves to a small, bare-bones mental health clinic in Ayacucho, a city in the Peruvian Andes.
When we first met the locals and the clinic director, Sister Anne Carbon (a missionary who is also a psychiatric nurse), they had little furniture, few medicines and an unpaid staff. The project since then has been an overall success. We now have our own building, paid nurses, volunteer
Peruvian and American psychiatrists, psychiatric medications, a variety of treatment programs, and we have treated about 3,000 individuals in the last five years. All care is free unless a person can make a small donation to the clinic. Our patients include those with severe illnesses like schizophrenia, bipolar disorder and severe depression, as well as less malignant forms of depression, anxiety disorders, alcoholism, domestic violence, post-traumatic stress disorder (mostly resulting from the brutal guerrilla insurgency in the 1980s and ’90s), and developmental disorders (autism, Down syndrome, etc.). It is fair to say that without our clinic none of these patients, including Carmen and Fernando, would have received any care at all.
This is unfortunately the case in virtually the entire developing world. As indicated above, of the almost half billion people who suffer from neuropsychiatric disorders, most live in developing countries where less than 10 percent have even minimal access to care. What has surprisedus is that although according to the World Health Organization mental disorders are second only to infectious diseases like malaria and HIV/AIDS in the amount of suffering and disability they cause around the world, these disorders receive almost no attention from the large foundations.
For instance, neither the eight United Nations Millennium Development Goals nor the 14 Grand Challenges in Global Health of the Bill & Melinda Gates Foundation even mention mental health.This lack of interest on the part of foundations and health organizations has been shocking to us in our work in Peru. Over the past few years we have combed through books of foundation listings and Internet database listings of philanthropies. We have hired consultants and spoken with many individuals well placed in the philanthropic world. The surprising result of all this research (and many, many letters of appeal) is there is not a single Western organization with an espoused interest in the treatment of mental health problems in the poorer nations of the world.
Even the WHO, which regularly publishes data supporting the need for such help, does nothing more than assign consultants paid by the host country. In our case of Peru, the WHO consultant informed us that Peru has a very adequate structure for this area of health. On paper this is somewhat true, but in reality the system is grossly inadequate (one psychiatrist for a province of 250,000) if it runs at all.
There is no reason to believe that the desperately poor do not suffer from mental disorders and psychological problems because they have other concerns like getting enough to eat. In fact the opposite is more likely true. The grinding stress of poverty induces much mental illness and suffering. Neither is it true that funds could be better spent in other ways. Unlike other health initiatives, mental health is relatively inexpensive. The majority of medicines used in treatment are available in generic form and it is not essential to have doctoral level clinicians to deliver most care. What is necessary, though, is that care be rooted in the community. The current Western model of swooping in and providing large amounts of health care in the form of surgeries and exams and tests will not suit mental health. Care is always ongoing and is best provided by people who literally and figuratively speak the language.
Yet without resources from the developed West, clinics like ours will not sprout up at all, let alone sink the deep roots necessary to stay put and serve their communities. We have no easy explanation for this dramatic gap in international health funding. It is hard to ignore, however, that being desperately poor and mentally ill leaves you at the margins of even the best of intentions. First, world philanthropy must expand its view to take in these neglected millions.
Dr. James Phillips M.D. and Dr. Mark D. Rego M.D. are psychiatrists with practices in Milford.
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