The Global Health Cafe community met again recently and explored issues of mental health, migration and economies of migration with special guests, Turkish Psychiatrist, Dr Vesile Senturk and Kenyan Economist Agnes Gitau. The context:
Despite the notable public health improvements across Africa, there are still significant challenges that remain. All the current global health initiatives; SDGs including UHC (Universal Health Coverage), GHSA (Global Health Security Agenda), One Health, provide optimism for sustainable health solutions in Africa. However, if Africa is to truly improve the health of its population and attain the desired goals of these initiatives, collective and African-led efforts are needed. Local leadership has proven vital in disease outbreak response and is a strong example of the effective and sustainable benefits of African-led approaches to public health improvement across much of the Continent.
The Global Health community in Britain is growing and those with a passion for Africa are increasingly seeking to amplify their voice and ability to remedy these problems. There is a sizeable community of Africans outside of Africa and they too have a role to play in ‘Africanled’ approaches. The Global Health Cafe is a new platform formed by Global Mental Health Expert, Dorcas Gwata and Global Policy Expert Ade Adeyemi with great support from Dr Titilola Banjoko (Director of Performance, Planning and Informatics, NHS) and Professor Aliko Ahmed (Director of Public Health England, East of England), the founders of Better Health for Africa. Our regular Global Health Café meet-ups take place in Westminster, London. Enthusiasts come from a wide range of backgrounds and experiences to meet and discuss Global Health issues, with a view to stimulate progressive dialogue that can inform innovation, health policy, evaluation and practise. Progress so far Recently, we have explored the impact of Brexit on Global Health, career opportunities in Global Health and this month we will be discussing the relationship between mental health and the economics of migration with special guests Turkish Psychiatrists Dr Vesile Senturk and Kenyan Economist Agnes Gitau.
We will explore the mental health outcomes in migrant communities with a particular focus on Turkey and Kenya; looking at the economic, cultural and social impacts of migration on these countries. We will also focus on lessons that low income countries can learn from middle income countries, where we will move to understand the effects of migration on these countries and make representations to the appropriate authorities.
We explore business opportunities and the economies of migration in Global Health, in the paradigm of a politicized migration. Are we missing the business opportunities than can arise from migration, could economies of migration help to develop health care systems and businesses in Africa? The Global Health Café series is an African-led platform, with focus on health in Africa, importantly so because, despite progress Africa continues to carry the heaviest burden of global disease. The future Over time we will be looking to develop these discussions on bigger think-tank platforms, seeking funding to grow our influence in Global Health.
The timing could not be more right with the new appointment of Dr Tedros Gebreyesus WHO Director General, the first African to hold this post. The community that gathers at the Café will serve as the “vehicle” for informed and credible delivery of sustainable public health improvements in Africa, supporting the new WHO DG in its own little way. All efforts to support and magnify our impact are welcome
Dorcas Gwata, Global Mental Health Expert and
Ade Adeyemi, Global Health Policy Expert
Thank you to all our volunteers on the Global Health Cafe series, we very much appreciate your efforts
All rights reserved September 2017
Ghosts of Freetown
You are not Haiti,
You have no Wycleff Jean,
And too far to make your problems our own,
So we can’t hear the crackling of your fires,
Nor smell your smokes of desperation.
The forests are buried as coffins,
Children drowning in mud
While the world chews the cud.
Is it because your skin is muddy
That there’s no humanity for your agony?
And what of those who look like you,
What did they say, what did they do?
How lonely is misery,
Though diamonds bring much much company!
But diamonds are stone they cannot see,
And children are precious beyond measure.
Today your real treasure returns to the dust,
Africa has buried her future again!
Weep not too hard, times death is mercy.
The future is buried again dear Africa,
Buried with hope, not just any hope,
With the hope, and a prayer to the Nile,
That one day we will all be free,
Truly free, as free as death,
Free, as these ghosts of Freetown.
Poem by Zimbabwean Award Winning Writer Philani Amadeus Nyoni
I co-wrote this article with my Clinical Supervisor Dr Tami Kramer in response to MP Chuka Umunna’s recent ground breaking link between gangs and mental health. The evidence is clear, there is a growing epidemic of knife crime in our inner cities that requires innovation and triangulated approaches to tackle gang crime and improve outcomes in young people. Far too many young people are living with trauma, high exposure to violence and sexual exploitation which increases risk of poor mental health in their adulthood.
MP Chuka Umunna demands that the knife crime epidemic in London should be treated at a ‘mental health’ issue among young people (Evening Standard, 7 June 2017)
Chukka Umunna MP for Streatham is to be applauded for raising the profile of knife crime in London and the link with young people’s mental health. Police reports indicate the frequency of knife crimes have been rising. Scotland Yard reported in the Evening Standard on 19 June 2017 that over 2700 people were charged with possessing knives in the capital in the previous year. Data on serious youth violence, which is also rising, indicates use of a knife in almost half of cases. Presentations to hospital Accident and Emergency Centres following knife crime have increased, resulting in both life changing traumatic injuries and death. Most of the victims and perpetrators are young, frequently from neighbouring if not the same localities. Every fatal stabbing is a tragedy leaving behind devastated, grieving families and communities.
What lies behind this increase of knife carrying? For some, carrying and use of weapons is part of a broader pattern of serious antisocial behavior, and might be associated with other serious violence, gangs or the drug trade. However according to a Police and Crime Committee report (Serious Youth Violence, July 2016) gang activity accounted for less than 5% of knife crimes and that following an incident of serious violence, some young people will carry a knife if they feel unsafe. Many ordinary young people believe that they need to be prepared to defend themselves, displaying perception of a feeling of threat combined with a need to respond on their own, possibly indicating that they don’t perceive other means or sources of support to manage the threat.
The links between knife crime and young people’s mental health are manifold. At the one end of the spectrum, young people who develop seriously antisocial behavior suffer high rates of neurodevelopmental and emotional difficulties (such as Attention Deficit Hyperactivity Disorder, specific learning difficulties, anxiety, depression, substance misuse, Post Traumatic Stress Disorder, self harm and suicidality). Vulnerable girls are groomed and exploited by young men in gangs to become agents for drugs, weapons and sex. These difficulties occur most frequently in families facing multiple adversities such as poverty, isolation, domestic violence and parental mental health difficulties. At the other end of the spectrum young people within ordinarily supportive families are experiencing fear and anxiety about their personal safety, and are traumatised by actual or virtual exposure (via social media) to threats, stabbings and even murder. Support needs to be available to these young people and their families.
The police have been visible in launching a number of initiatives to specifically tackle knife crime in the capital, such as Operation Sceptre since 2015, which includes a range of components, from law enforcement to school education programmes. But as implied by Chukka Umunna addressing the underlying risks and full impact of knife crime requires broader, bold, innovative measures. This systemic problem requires multiple complex interventions across agencies and services with high levels of cross sector collaboration.
One such evidenced based intervention, Multisystemic Therapy has offered community and home-based intervention for young people and families in parts of England. It targets factors underlying young people’s involvement in knife crime, or other forms of antisocial behavior including individual, family and community vulnerabilities. Counselling Psychologist, Jai Shree Adhyaru notes that MST endeavors to bring systems together to work collaboratively to reduce risk, for example by supporting families to work with local schools and police, addressing parental and child anxiety using educative as well as psychological intervention.
Our Trust, CNWL NHS Foundation Trust is at the forefront of providing mental health interventions for young people affected by gang culture within Westminster Integrated Gangs Unit (IGU), a unique multi-agency team which has contributed to reduction of serious youth violence. The IGU team incorporates police, probation, youth workers, employment specialists and Clinical Nurse Specialist, Dorcas Gwata with Consultant Child Psychiatrist supervision. Dorcas works outside traditional settings using innovative methods to access young people affected by gang culture. Her work challenges the notion of ‘hard to reach’ groups by seeing young people wherever they are, in youth clubs, schools and prisons. Dorcas added ‘We have taken what works in the clinic onto the streets. We are working to divert vulnerable young people from the dangers of knife crime and supporting parents who are otherwise struggling to parent their children whilst validating their efforts and appraising their values within their culture and religion. We are looking to expand our outreach and run community based mental health support in areas of high exposure to knife crime’. The role of the Child Psychiatrist is to offer support with understanding the needs of very complex young people and families; identification of specific mental health needs; and advising on the most appropriate intervention approaches. Those who offend will face enforcement but gang involved young people are also helped to address their difficulties and supported to find healthier lifestyles.
While Child and Adolescent Mental Health Services need to offer intervention for more serious psychiatric disorders, involvement from Public Health is required to develop interventions which reduce the background risks for involvement with knife crime, i.e. targeting the strengthening of family resilience and the cohesion and safety of local communities. Schools, youth services, youth justice and Local Authorities are essential partners alongside voluntary sector organisations such as Redthread ( who work specifically with youngsters in gangs). Innovative approaches which are sensitive to the cultural diversity of our population are urgently needed.
Chukka Umunna’s call to action should be heard by all who believe that London remains a relatively safe city, that should be enjoyed by all, free from fear, most especially by our children and young people.
Dr Tami Kramer, Consultant Child and Adolescent Psychiatrist
Dorcas Gwata. Clinical Mental Health Leader, Intergrated Gangs Unit
June 2017. All rights reserved.
The Nursing Times kindly featured my career journey as a role model in nursing. I weep as I reflect on this journey, many challenges all of which I embraced as opportunities for a better tomorrow.
Dorcas Gwata started as a hospital cleaner, and now she’s a clinical nurse specialist who works with young people affected by gangs
Dorcas Gwata’s career has been nothing short of impactful. In addition to her current work in the UK, Ms Gwata has worked in healthcare on a global scale in order to address poor access to healthcare in low-income countries. She worked on the Friendship Bench Project in Zimbabwe, an evidence-based programme that uses problem solving to address mental health issues in the community.
Ms Gwata’s current role is very much community based. She works with Central and North West London NHS Foundation Trust’s Westminster Integrated Gangs Unit where her team uses innovative methods to engage with young people who are involved with or affected by gangs.
“We meet them wherever they are – in schools, youth clubs, prisons or hospitals,” she tells me.
Adolescents affected by gang culture have high exposure to trauma and are often shunned by society, resulting in isolation, Ms Gwata explains.
She has been in this role since 2013. The Integrated Gangs Unit was set up when strong evidence emerged of the effects of gangs and gang culture on the mental health of adolescents.
Although her specific role is within a specialised unit, Ms Gwata works with a multi-agency team, which she says helps broaden her perspective in helping young people affected by gangs.
“Adolescents affected by gang culture have high exposure to trauma”
“The greatest value of this role is the innovation and clinical skills that I am able to bring to the team, while also understanding the roles that different agencies play in keeping the community safe from gang culture,” Ms Gwata says.
She is someone who has worked hard to reach her current role. Ms Gwata started out as a hospital cleaner at the Edinburgh Royal Infirmary. She then worked as a healthcare assistant.
As a healthcare assistant, Ms Gwata was looking after a woman with anorexia, a condition she says she didn’t fully understand at the time. But they developed a good therapeutic relationship, and one day the patient asked: “Have you ever thought about becoming a nurse?”
It struck a chord with Ms Gwata.
“I always thought that was powerful coming from a patient, and I started my training soon after,” Ms Gwata says. She started training as a nurse in the late 1990s.
“In each role, I have learned so much about humanity and the challenges that people face, particularly about people from low-income communities,” she says.
Ms Gwata worked in various roles after getting her nursing qualification, including time at an A&E and working for the charity Africans Unite Against Child Abuse (Afruca). It was then that she was approached to take on a role in the Integrated Gangs Unit.
“I have learned so much about humanity and the challenges that people face”
“It was a great opportunity to get involved in adolescent mental health and address the trauma they face due to high exposure to violence and sexual exploitation,” she explains.
Ms Gwata says that studying public health and gender violence prepared her well for this role, as did her role with Afruca. This position allowed her to come into contact with survivors of human trafficking, female genital mutilation and witchcraft branding. Her experiences have all helped in her role working with adolescents affected by gangs and gang culture.
“Nursing is a unique role”
Ms Gwata has received a number of honours for her role in healthcare, including the Zimbabwe International Womens’ Humanitarian Award in 2016. But in the end, it’s the support from family and friends that “kisses her heart”, she says.
“Nursing is a unique role that puts us in contact with people at their most vulnerable times,” she says. “I have learned so much about myself and humanity through nursing.”
Director at Tribal Sands
All rights reserved
Global Mental Health Specialist, Dorcas Gwata and Tarik Endale analyse the top priorities for Dr Tedros Gebreyesus as he takes over the leadership of the World Health Organisation.
The global health community is alight in African colours, the continent’s voice has been amplified with the appointment of Dr Tedros Ghebreyesus as Director General of the World Health Organization (WHO), the first African to hold this post. Dr Tedros brings a depth of experience in public health given his previous role as Ethiopia’s Health Minister (he was also Foreign Minister from 2012-2016). He understands the global health platform, and with Africa carrying the world’s heaviest burden of disease with increased vulnerability to outbreaks, the Ethiopian will need to draw on his knowledge and experience to address the global health challenges that sit heavily on the African continent and beyond. His competence will be measured on his ability to deliver on core and emerging issues. He comes into office against the backdrop of a catastrophic Ebola crisis in which WHO was criticised for a slow response, he will need to rise above the challenges and deliver on elements that he specified.
According to his Vision Statement, Dr Tedros’ has put forth five major leadership priorities for his tenure as WHO Director General, the first of which is “Health for All.” A key underpinning of this priority is the push for Universal Health Coverage. Former Director General Margaret Chan once said that Universal Health Coverage is “part of her DNA.” In this, Dr Tedros is following in her footsteps by stating that “all roads lead to universal coverage.” This includes commitments to strengthening primary health care, which comes just in time for the 40th anniversary of the landmark Alma-Ata Declaration on primary healthcare, and increasing access to life-saving products as demonstrated by his support of the recent United Nations High Level Panel on Access to Medicines report.
This ties neatly into his second priority of public health emergencies. Mirroring the language and aims of the International Health Regulations, this means strengthening the ability of member states to prevent, detect, and respond to public health threats. Ensuring a proper defense against outbreaks also requires the WHO to strengthen their own ability to lead and coordinate effective and rapid responses through the reformed Health Emergencies Program. The importance of these improvements were made painfully clear during the Ebola outbreak in West Africa, where weak country health systems could not cope on their own and the sluggish and poorly-coordinated global response led to countless more deaths.
Women, children, and adolescents feature strongly in his top priorities for the future direction of the WHO. Across the spectrum of health, women, children, and adolescents often suffer from a lack of access to services, increased vulnerability in humanitarian settings, inattention to their unique health needs, unbalanced representation in leadership, and a dearth of data at the intersection of gender and health needed to develop appropriate programs and policies. Dr Tedros has stated that he plans to “re-orient the WHO’s approach” on the matter, to which advocates for women’s health such as Shannon Kowalski of the International Women’s Health Coalition have rebutted with demands such as expanded access to safe, legal abortions (particularly important in the face of the “Global Gag Rule” imposed by the US), robust attention to ongoing Zika transmission, and ensuring that universal health coverage does not leave women and girls behind.
Fourth on the new Director-General’s list of priorities is addressing the impact of climate and environmental change on health. Currently, 12.6 million people die each year due to unhealthy environments and if trends continue as they are, climate change is expected to cause approximately 250,000 deaths per year between 2030 and 2050. The WHO board endorsed a work plan on climate change and health in 2015 to push the development of partnerships, awareness, evidence, and public health responses to reduce contributions to future harmful climate change and reduce health vulnerabilities to the damage that has already been done. The continued commitment of the organisation under the stewardship of Dr Tedros will be crucial to improved implementation of the Paris Agreement on climate change, which so far has been ratified by 147 of the 197 parties to the convention.
Finally, Dr Tedros has promised to deliver a “transformed WHO” as “we live in a changing world, and WHO must be able to change with it.” He hopes to regain the world’s trust in the body’s ability to lead the effort towards a healthier planet by reforming how the organisation runs, responds, measures performance, and attracts talent and funding. This looks to be the most critical and by far the most daunting piece of his proposal. The WHO has recently come under fire for spending more on travel expenses than on any disease program other than polio, which is particularly pertinent as the possibility of polio eradication closes in, putting the massive amount of funds generated by polio programs at risk. The World Health Assembly just approved a 2018-2019 budget of US$4.4 billion. However, this money has to be fundraised and the leading donor, the United States, has proposed massive reductions in global health funding while the second leading donor, the Bill and Melinda Gates Foundation, have stated that they will not compensate for any of that lost funding. To address this, Chelsea Clinton and Devi Sridhar have proposed that he quickly cement this vision into clear and transparent policies in order to win back confidence and potentially gain increased dues and voluntary contributions. He has already put forth plans for a professional fundraising office, similar to that of UNICEF.
When asked how he intended to approach looming funding issues, Dr Tedros concluded that “we have to make our case. We have to use champions to help countries and donors understand the benefits of WHO. We have to prepare, just like a court case.”
Dorcas Gwata (@zambezi40) is a Global Mental Health Specialist, and a visiting lecturer at the London School of Hygiene and Tropical Medicine.
Tarik Endale (@the_etheropian) is an MSc student at LSHTM and visiting Researcher at the Mental Health Innovation Network.
Director at TribalSands. June 2017
All rights reserved
I love the arts and culture, I love reading, At my best I am tucked away in a good book, immersed in new found characters many of whom challenge our status quo on deep issues in our society. I remember missing my train stops so many times when I was reading Non Violet Bulawayo’s We need new Names’, I struggled to get into Home Going by Yaa Ghasi, but once I was away, I was in those slave caves with all the characters, I dont want ever finish that book.
A good writer has the ability to draw the reader in until their own emotions are in questions, My moral campus was shaken when I read ‘Lolita’ by Vladmir Nabakov, Nabakov was insainly mesmerizing, I felt something of an anger, irritability, and and endless inquisitiveness. That Nabakov continuously pleads with the reader to stay with him is the precise art of writing, creative writing at its best. The Poison Wood Bible by Barbara Kingsolver, is up there with my favorites, I loved how the father was such a significant figure, yet the reader doesn’t actually get to meet him.
On the Zimbabwean scene many writers are breaking ground, despite and perhaps even because of the challenges. The art of writing comes from something deep within. I absolutely love Petinah Gappah’s work and cant wait to read her new book ‘In Search of Livingstone’ Companions‘ For mesmerising and intoxicating poetry and writing without limits or fear, I run to Philani Amadeus Nyoni.
Writing is art, it has the ability to invoke feelings and gives the writer freedom and permission to explore and draw the reader in, thats why I return to it again and again, and why I sponsored the Zimbabwe National Merit Awards in the category of Outstanding First Creative Published Writing.
From the nominees, Kelvin Mangwende’s story touched my heart.
“I was born in Murewa at St Paul’s Mission, I attended several primary schools namely Chiremba, Nyandoro, Mabvuku and Farai Primary School in Chitungwiza” Kelvin begins his story.
“I migrated one place to another because of the difficult circumstances that I was living in. My parents divorced when I was 4 years old, I lived with my step mother for two years but the environment was harsh, my mother came and took me then I was living with her mother in Chitungwiza. My secondary education I attended Seke 4 high, Zengeza 4, Cecil Hardy High School then Herentals. I passed my O’levels, but I didn’t proceed to A’level. My mother passed away in 2002 after she divorced with my step father. I continued to stay with my grandmother unfortunately she too passed away soon after,” Kelvin says.
“The property that my mother has left for me including the house was taken by my grandfather leaving me without a roof over my head. I started writing in Grade 6 composing poems even at a Secondary School I was a Play-Write, writing drama scripts for the school,” Kelvin adds.
As a reader and a lover of arts, I wondered how distance and travel influenced the writer, or to a deeper extend how loss and grief had shaped his writing. Kelvin was keen to share his story, he wanted to share this journey, the journey of a young Zimbabwean writer, who had experiences layers of looses, travelled around Southern Africa, in search of himself and a place to call home. A writer who had been nominated for a NAMA Award
“I went to Namibia looking for a job but it was not easy that time,” Kelvin continued. “I started to sell brooms and mops in the street, I was writing my books in the street even under a tower light in the evening. I wrote the Rainbird is Dead and Chaminuka in Namibia. I still remember when I submitted my manuscripts to a local publisher in Zimbabwe in 2002 they didn’t bother to look inside or read them because they were looking for big names, they gave me back my manuscripts back in 2010! It was a huge set back how come a manuscripts stay such a time without a review? I found a part time job in Namibia as a Pre-School teacher. I was a story telling residence teaching English, I continued to write on the streets of Windhoek walking with my manuscripts in the sapping sun.”
“I am a Play-Write, essayist, and poet. I published my book Chaminuka when I was in South Africa, I wrote Chimurenga in Mozambique. I published The Rainbird is Dead an anthology of poems when I was in Angola, I wrote the The Black Stars and Sons and Daughters in Namibia,” Kelvin adds.
“I travelled a lot experiencing different cultures. The Rainbird is dead was featured in the best 100 African Poets. I have featured in several anthologies across the globe. My book ‘Misodzi Yerombe’ was nominated for the NAMA 2017 Award. I was ecstatic, it was a great step ahead. I wrote that book when my relatives didn’t care about me especially my biological father. That book touched my heart it portrays the life that I had lived, the pain, suffering and the isolation,” Kelvin adds.
“I wondered about the lack of female nominees this year?” I asked Kelvin. He laughed off my question then said, that is bizarre because most of my writing had largely been influenced by female writers.
“My latest publication of 2017 is a collection of short stories named Runako they is four short stories Mhindupindu, Runako, Akava Matindingoma, Kudzingirira Mhepo,” Kelvin concludes.
I am very grateful to Archie Mhone and Mr Nicholas Moyo at the Ministry of Arts and Culture for smoothing every process. I look forward to further collaborations.
Thank you to Professor Diane Jeater for her insights, I am honoured to be in your circles.
Well done to all the nominees for in the category of NAMA First Published Creative Writing. Nominees were:
Tears and Scars by Penjeni Madzikangava
Behind the Wall Everywhere by Farai Mungoshi (Winner)
Misodzi Yerombe by Kelvin Mangwende
Director of Tribal Sands
All rights reserved. 2017
This year, I was hugely honoured to win the Zimbabwe International Women Humanitarian Award (ZIWA), I was totally humbled, I cried. I cried to all the work that I continue to pour into my work in Global Mental Health and my grassroots work with young people affected by gangs in London. I cried to the sadness that my mother is sadly no longer with us to share these beautiful moments, I also cried with joy, sheer joy and gratitude for the journey I have walked. Humanitarian work is taxing and is selfless, as humanists our compassion has no boarders of boundaries, we care because it is the right thing to do. Any validation is extremely heart warming and pushes us to do even more for vulnerable people. Below is my interview with The Heroine Collective.
As a Public Health Specialist, Dorcas Gwata’s work is wide-reaching. Recently awarded the Zimbabwe International Women Humanitarian Award, Dorcas is connected to a large range of mental health projects across the UK, Zimbabwe and Tanzania; she works to safeguard and raise awareness on issues like FGM, HIV and AIDS, as well as the health impacts of gang culture.
“I come from a family of grassroots civil-servants,” she says when I ask her about her early influences. “My mother had great compassion for helping vulnerable groups – particularly women and children. These humanist seeds were planted in me long ago.” From her studies at the London School of Hygiene and Tropical Medicine, to working as a cleaner in an Edinburgh hospital – where she got first-hand experience of the issues faced by low-income groups – she is passionate about equality. “I advocate tirelessly for these groups because I understand the issues,” she says.
After her studies, Dorcas worked as a Mental Health Adviser for AFRUCA (Africans Unite Against Child Abuse), a charity which was formed as a response to the Victoria Climbié case in 2000. Victoria, an 8 year old Ivorian girl, who’d been suffering severe abuse without appropriate social-care intervention, was eventually murdered by her guardians in 2000. The case was widely reported by the media. Dorcas says it “struck a code”, resulting in much-needed change across care systems, and raising questions on the role that religion and culture plays in shaping cultural practises. At AFRUCA, Dorcas explored African cultural practises such as FGM, Human Trafficking, Witchcraft Branding and child chastisement. “Working here shaped my understanding of advocacy in terms of looking at what makes policies successful at grassroots levels.”
Despite the notable health improvements in the African population in the last decade, the continent still faces enormous healthcare challenges. “There is no health without mental health,” Dorcas explains. “Physical health is intrinsically tied to mental health and in low-income countries these challenges are compounded by poverty, poor access to healthcare, and poor healthcare systems. Mental health across the globe receives very little recognition and funding – and this is even more the case in low-income countries.”
But Dorcas says she is always moved by the resilience of people who are so disproportionately burdened with such challenges. “I think communities in high-income countries could learn so much from those who have so little – they’d do well to adopt their models of social and cultural cohesion.”
Dorcas was tasked with evaluating the African Ebola crisis of 2013-16; she describes it as one of the most striking epidemics of our time. “Viruses don’t respect borders,” she says, acknowledging the speed that the disease travelled across countries. “I learned – more than ever – that the best of our scientific knowledge is not complete without a robust understanding of local cultural practices. I also learned that communities have capacity to mobilise themselves, even when governments fail to do so. And it’s important that Africans take ownership of our own challenges, and provide better healthcare for the African population. Equally, we need to credit the African response to the Ebola crisis – Nigeria was Ebola-free before the U.S.A. was.”
Dorcas is currently working on mental health interventions in London for young people and families involved in gangs, and also young girls affected by sexual exploitation through gang culture. Her current research supports adolescents who often have high exposure to trauma, and are often stigmatised and/or isolated from their wider society. “My work takes a broader approach to understanding the push-and-pull factors that drive young people in and out of gangs,” she says and notes that a significant proportion of young people involved in gangs come from minority backgrounds and suffer high levels of poverty. “My role challenges the notion of ‘Hard to Reach’ groups. It adapts culturally-adjusted methods of outreach engagement – we’ve taken the clinic to the streets, for example. It’s our priority to keep young people safe from knife-crime and to keep young girls safe from sexual exploitation.”
I wish my mother were alive to see the seeds she planted. I miss her dearly. I blame her entirely for my restlessness in seeking a better tomorrow.
Winning the Zimbabwean International Women Humanitarian Award in 2016 was one of Dorcas’ career highlights, and she notes the responsibility that comes with it to mentor others. She was also named Nursing Standard Nurse of the Year 2015 for her work with young people involved in gangs. “The real heroes of that award are the young vulnerable people I look after – people who are striving for a better and safer life, often with little acknowledgement,” she says.
But it isn’t just the awards that inspire her; she loves the arts. “I believe the arts have an important place in people’s recovery and well being,” she says. “What would it mean for patients in a mental health hospital to hear a few lines of poetry or the thump piano?” She feels the arts ground her, and often looks to women in this field for inspiration. “I love Ngozi Chimamanda Adichie’s writing,” she says. “I remember meeting her briefly once, and she said to me: ‘We need to hear about Zimbabwe. Keep writing about Zimbabwe’. And Arundhati Roy – her pen knows no boundaries. She’s unapologetic about advocating for the voiceless, for the forgotten groups in her society. I take a leaf out of her book.”
I am grateful to The Heroine Collective for featuring me on their sacred space.
Tribal Sands 2017
The Global Health community is full of health enthusiasts, and technocrats who are hungry to bring in new ideas and challenge the status quo in our daily practise. This year we responded to that calling and created a Global Health Cafe, a new hub that discusses and analyses issues in Global Health and invites new thinking and critique that pushes us away from our usual narrative. I am thrilled to partner with Chatham House Global Health Policy expert Adebusuyi Adeyemi in forming this informative platform that bring together a vibrant Global Health community.
At Global Health Cafe, we seek to hold regular sessions with changing topics, anchored to Global Health. We kicked off our first session in March with a timely discussion on the impact of Brexit on Global Health. The uncertainties that over shadow this debate were ever evident, and so were the fresh ideas on how Global Health can enhance use of technology to overcome boundaries set by global policies. Ade and I very much look forward to our next Global Health Cafe discussion.
Thanks to our volunteers Dalia Majongwe and Tarik Endale for their invaluable contribution to the growth of this health platform.
Thank you kindly to Sinead Mac Manus at the Health Foundary for housing us for our discussions
He is young and transient, the kind that would write a letter in one continent and post it in another. I first got of wind of Abdul Adan’s writing through Philani Amadeus Nyoni, a fellow countryman whose ideas and pen are equally off the radar. I met Abdul at the 2016 Africa Writes Festival, an encounter months in the planning. He is warm, his mannerism reflects a cultured upbringing, yet his writing is unleashed. Writers are the most insecure and vulnerable creatures, he once acknowledged. I push boundaries and insist on calling him Adan which he allows. Adan embodies all that is global, an undeclared nomad he pitches his tent as he wishes and articulates the world through inquisitive anthropological lenses. He takes the reader along, and holds them in a suspense that lingers way beyond the last page.
Abdul Adan talks to Dorcas Gwata, Director of Tribal Sands
Abdul you were shortlisted for the Caine Prize Award 2016, how did it feel to be nominated?
I was very excited at the news of my nomination. It meant I will get a trip to England, meet people who are passionate about what I do, and get to learn more about myself in the process. This is the first literary shortlist I have been on, and the second time the Caine Prize took me on a trip—for almost making the 2013 shortlist.
The Caine Prize 2016 ultimately went to a South African writer, should writing be competitive?
Writing, being art, shouldn’t be competitive. Prizes, though, will have to be won by one writer at a time, so that there’s a reason for curiosity, suspense, and a means to give money to a writer every year. Who is to say for sure the five of us wrote the ‘best’ stories submitted? It was a strong list but still… Any shortlist is a reflection of the collective tastes, experiences, or even politics of the judging panel.
In your short story ‘The Lifebloom Gift’ you lead the reader through comfortable and uncomfortable conversations about sexuality and mental illness … what inspired Ted’s character?
I drove a medical transportation car back in 2011. One day I took a middle aged woman from a St. Louis hospital to a small Missouri town where she lived. Her place was behind a small Episcopalian church and her overweight son of about 25 lay outside in the yard, stroking a dog. The details are now sketchy but he looked really well rested. Something about his eyes stuck with me, and he ended up becoming Ted Lifebloom three years later. His particular disorder came out of my own loneliness those first years in America. People seemed too cold and detached for me; I couldn’t see at what level I could connect. I had just come from this other part of the world where people are more demonstrative, and where even a quick chat with a stranger carries with it some genuine emotion. I was really confused by all the airy polite smiles on the faces of people who really barely acknowledged me. By the time I wrote the story my earlier confusion had long ended, but the memory of it had to be pumped into Ted for preservation but also for my own self-education.
Would a female African writer been able to write the same story with the same level of autonomy and authority?
Of course. I don’t see why not, but I am inclined to think African critics might be harsher with her.
How and why did you give yourself permission to write the narrative of character completely different from your own cultural background?
Well, by 2014, when I wrote the story, I had made so many American friends and was just about getting to feel out America’s cultural core. I had undergone my fair bit of Americanization already. I was even understanding their humour, something that eluded in the years prior. And when you feel the humour of a place, you know you are home. I should also add that we are not the only ones who are exotic. White people too can offer plenty in the same regard. They have written about us for ages, perhaps its time we returned the favour, don’t you think (smiles)
You embody many different cultural backgrounds, Somali, Kenyan, American and recently Kazakhstan, who do you pledge your heritage to?
I don’t care much for flags and borders. I only acknowledge them as far as staying out of trouble. I love all these places equally, but I can adjust faster into some than others. In the US for instance, it took me years to feel the humour alone, while in Kazakhstan, my Kazakhanization was well underway within months. Speaking of heritage my nomadic roots is probably what I hold in the best regard.
In 2015 you attended a Writing workshop in Zimbabwe, what did you make of the country?
Harare looked like a cleaner less populated version of Nairobi. People were very friendly. In fact, this is the friendliest country I have visited. Barbara Mhangami, a fellow participant at the workshop, took me to Harare’s city centre where, while she tended to her business in the shops behind me, I listened to a young, thin, street preacher most intently. I remember that we went to a tailor’s shop, too, and saw nice, hardworking godly women whose mere sight invokes their country’s innocence and the day to day mixture of optimism and just cold discipline. We have lost that innocence here in Kenya. I miss it actually.
In ‘The Somalification of James Karangi’ you tell a hilarious, and somewhat disturbing tale about a Kikuyu suitor who must go through painful experiences like chewing khat and wear ing a noose around his neck in order to be ‘Somalified’. Was this a critic of Somali conservatism and African tribalism?
I suppose so, but I can’t say criticism of Somali conservatism was on my mind as I was writing. I was just having fun, and trying get James to undergo something darkly comical. Generally though, I do keep a keen eye out for prejudices against anyone, even from my own people.
Who do you read and how do other writers inspire you?
I am a very slow reader and only pick up a book if I really believe in it, usually through a friend’s recommendation. I read a lot of short stories back when I was starting out. Among those I read extensively was Anton Chekhov, Guy De Maupassant, Chinua Achebe, H. H Munro, and Bessie Head. I am not reading anyone now in particular. I just open random excerpts, stories, and read to the end if I like them. I think am one of the least read people writing today.
Chekhov, Achebe, and Munro, pretty much taught me how to write stories. I don’t bother with their themes when reading as a writer. I only pay attention to the flow, and the transition between scenes, diction, etc. Writers are craftsmen, and all craftsmen have secrets; I try deciphering their journey in a story, undo their knots, and suddenly the whole thing isn’t that mysterious. This is when I jump up and say, ‘So that was it? I can do that.’ The only problem is that sometimes the English is just not enough. The really worthy ideas, though, compel me to find ways of skirting around the English problem.
Tell us three random things we don’t know about you?
a) I am a recovering chess addict. I can’t go cold turkey, but I am playing less than I used to.
b) I got my first ever smart phone four months ago. It’s an old Samsung, gifted to me by little brother. I still don’t know how to use it well.
c) I get lucid dreams quite often. Sometimes I would ask the people in my dreams if they know I am dreaming them up. Other times, I would run around and engage in little mischievous exploits—stuff I thought about in the real world but couldn’t do—telling everyone, ‘It’s just a dream, folks. All is legal. Chill out.’
Abdul Adan, thank you for talking to me on Tribal Sands
Director of Tribal Sands November 2016.