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
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
I gracefully strolled into Marion Boehm’s art space and Parisian time seemed to stand still. My entire world was instantly drawn to the most magnificent piece of art I had seen in a while. In this drama of a community that the artist had created, a group of African women stood tall in their elegance, their long colonial dresses hiked up to their breasts, giving way to their wide hips.
This was no ordinary art. Imaginary soft winds seemed to whisk the delicately entwined indulgent natural fabrics, revealing mysteries of under layers worthy of huge ceremonial events. These women had a presence, they were there and I was one of them, I was amongst them. I moved closer to the piece, my consciousness slowly bringing me back to my surroundings. I was reminded of the Herero women of Namibia who adopted their colonialist style long after their freedom. Culture and conflict whipped into voluminous long wide dresses that hang on layers of wide petticoats, the kind that demands grand postures, good mannerisms and certainly no running or fretting.
Artists and art enthusiasts mingled away in whispery conversations at the Paris Art Fair. Oblivious of their presence, I moved my gaze from one art piece to another, only to return back to that one piece within the gallery. I was in conversation with this community: I heard their laughter, not their suffering, I saw their vulnerability and their resilience, I knew of their grief; and yet their compassion and beauty outweighed their struggles. The artist had gone a long way in validating their humanity.
“Who is the artist?” I asked around.
Marion Boehn stood in her truth and presence. She was friendly and accessible, her art work much more pronounced than the tone of her voice, artists are introverts like that, leaving all emotions to splash out in their work.
I stumbled on my speech, reciting my Southern African heritage, our collective colonial history and a culture that has remained somewhat unshaken in the face of a dark history. Marion knew what I was on about, of course she did, she had lived in Southern Africa for years observing African lives and cultures and summing them up in her art. I was immediately at home with her, I felt I could trust her with our culture, that she would always portray the truth, even if the truth is not always pleasant.
In documenting the stories of these communities, Marion did not seek to invoke pity or misery, she wanted to tell the story of their beautiful natural skins, their hair, fabrics and smiles, the kind you may never see in a glossy magazine, and in doing so she shaped the narrative of everyday African women and who we truly are.
“How much is this piece?” Emma Menell from Tyburn Gallery asked me the next day when I returned for another dose of Marion’s work.
“Are you sitting down?” I turned to look at Emma and smiled.
Above photo credit to Art-Co Gallery and top photo credit to Marion Boehm’s FB page.
Thank you to Marion Boehm and the team at Art-Co Gallery
Director of Tribal Sands
Above photo credit to Art-Co Gallery
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
This year, I am incredibly proud to a sponsor at the National Arts Merits Awards (NAMA) in Zimbabwe. My brand, Tribal Sands is sponsoring the category of ‘Outstanding First Creative Published Writing. I love reading, so much can come from reading. Books are growth, reading is development, we must all do all I can to foster Zimbabwean talent. Beyond sponsorship, I am looking to run yearly writers workshops that provide a space for upcoming writers to to grow and share their work.
Thanks to all who support this important work.
I am very grateful to LSE Academic, Dalia Majongwe and Zimbabwean Poet, Philani Amadeus Nyoni for their active support on this project.
Director Tribal Sands
To mark World Mental Health Day 2016, Tribal Sands will be collaborating with the exclusive Tyburn Gallery in Central London on Monday 10 October from 6pm-9pm for an evening of discussions. The Africa Diaspora led event will discuss the remarkable progress we have made as well as the challenges that persist.
This year’s World Mental Health Day explores the theme of psychological emergencies, in view of the recent challenges in migration around the globe. The event will address a wide range of challenges in the African continent and those experiences of Africans living away from their home country.
There are many health care professionals of African Heritage working in the UK, part of African Diaspora. It is recognised that people of different ethnic minority groups have different experiences of mental health due to differing socio-economic exposure and challenges
Dorcas Gwata is an Award Winning Zimbabwean-born Public Health Specialist Nurse who works on a specific project looking at mental health needs of young people involved in gangs at CNWL in London. Dorcas studied Public Health at the London School of Hygiene and Tropical Medicine and has an interest in Global Health and Research in Gender Violence. She has trained and worked in Zimbabwe, India Tanzania, Ethiopia, and Uganda and recently explored mental health recovery models in Sri Lanka.
A panel will discuss some of the remarkable progress that we have achieved in improving minority health. Clinical Psychologist Tarisai Bere, who works on The Friendship Bench Project in Zimbabwe, will discuss the effectiveness of using community health workers to deliver low cost mental health interventions in low resourced countries. They will discuss the importance of mobilising and strengthening community resilience and innovation to tackle global events that continue to impact on communities and individual mental health.
Debbie Ariyo OBE, Chief Executive of AFRUCA Charity will discuss her work with victims of trafficking, role of religion and culture in mental health. She will also discuss female genital mutilation (FMG) and witchcraft branding and challenges African parents face in the UK.
Farai Sevenzo, a film Maker and broadcast journalist, urges that Africans need to tell their own stories. He will discuss the role of the media in raising mental health awareness and the ever conflicting issues of how Africa and Africans are depicted in global media.
East African economist, Agnes Gitau will discuss the important role of developing social enterprises that shift communities out of poverty and reduce individual and community vulnerabilities.
Elroy Palmer MBE will speak on gangs and mental health and the brilliant work that charities like St Giles Trust are doing to help young vulnerable groups from violence to constructive and safe lifestyles that help them to grow as part of society.
Dorcas will be joined by members of the CNWL-Tanzania Link, and its chair Dr Tami Kramer and other committee members.
Stigma continues to be a huge challenge amongst a minority group and a barrier to accessing early help. Although we have achieved remarkable progress in tackling HIV and recently the Ebola crisis, the mental health impact of these epidemics persists in African communities with African women carrying the heaviest burden of the diseases.
Join us for an evening of conversations and networking
Tribal Sands October 2016
Global Health is increasingly interconnected and interdependent. As health systems and resources in Africa are increasingly compromised, there is growing evidence to suggest that the African Diaspora has a critical role in scaling up health services in the continent. The Zimbabwean Diaspora has a wealth of expertise and bi-cultural skills. They understand the social, cultural and political context of their home country and are well placed to deliver training and interventions in local norms. In Zimbabwe, we have effectively contributed to the scale of mental health training for health professionals and provided culturally adjusted mental health interventions through training and interventions.
There are few accounts of evidence-based interventions for depression and common mental disorders (CMD) in primary care in low income countries (Chibanda et al 2016. The Friendship Bench program provides indigenous culturally adjusted problem solving therapy in areas with high exposure to HIV and social deprivation. The word ‘bench’ derives from the Shona word ‘Chigaro chekupanamazano’ which translates as ‘bench to sit and exchange ideas’ Therapy is delivered by female lay health care workers who are familiar with the local challenges and are culturally accepted to deliver mental health interventions in their local areas. This collaborative mental health program was started by a local Psychiatrist, Dr Dixon Chibanda in response to a request from the local stakeholders for a ‘no- cost’ community mental health intervention and is now being scaled up to wider parts of the country. The Bench itself is a specifically wooden bench placed in the grounds of the Primary Health care setting where the screening and psychological therapy takes place.
More than 300 lay health workers have now been trained to deliver these interventions across the country. I have worked on the Mbare Friendship Bench project and have been involved in training lay health workers in scale up training program.
London has a diverse population, and the demographics are increasingly changing. My public health role explores and provides mental health interventions for young people and families affected by gang culture in inner London. 80% of this cohort are from minority backgrounds, and affected by trauma of events from migration, stabbings, kidnapping, sexual violence and poverty.
My qualitative research extrapolates lessons learnt from the Friendship Bench model of care into my clinical work with young people and families affected by gang culture in Central London. It informs evidence based of culturally adjusted model of care in high resourced setting which is struggling to achieve better health outcomes for minority populations. It explores the broader issues of cultural adjusted interventions that are useful in improving engagement with ‘hard to reach’ groups and explores the lessons that NHS can learn from low in-come countries like Zimbabwe. These lessons could inform a potential scale up of these culturally adjusted interventions in wider parts of the UK.
In Zimbabwe we have used the WHO Mental Health Gap Training package to deliver training in the assessment and management of self- harm and suicide as well as addressed the global safeguarding challenges faced by vulnerable individuals affected by mental illness. Our Diaspora involvement seeks to validate efforts of health care professionals working in low resourced environment, scale up skills and knowledge at grassroots level and in doing so strengthens our partnerships.
This has by no means, one woman’s journey. I am hugely indebted to my clinical supervisor, Dr Tami Kramer, my partner in clinical excellence. I am forever grateful Raj Boom for giving me a chance. Debbie Ariyo OBE and her wonderful charity AFRUCA, will always have a warm place in my heart. In Zimbabwe, I am warmed by the kindness shown to my by the Friendship Brench staff, in particular the Community Health Workers and Dr Dixon Chibanda and Dr Melanie Abas. I am grateful to the young people and families that I look after in the Gangs-Mental Health project, it is they who push my clinical and innovative skills.
Thank you to the Florence Nightingale Travel Grant, I am very grateful.
Director, Tribal Sands
‘If you meet a guy in a bar and go back to his place with him, if he doesn’t have a bookshelf, don’t sleep with him!’
I love this quote by John Walters …
When Multi Award-Winning Zimbabwean Designer, Pam Samasuwo-Nyawiri recently launched her book and global brand, A Woman With No Country, AWWNC she very kindly asked me to give a talk on ‘A Woman who Reads’
Books are sexy, I argued.
A woman who reads lives a thousand lives, she is reflective, globalised and has travelled the world through many characters.
My grandmother lived beyond a hundred years, she never new her date of birth. A lioness of her kind, she born nine children, uneducated, yet she was the sharpest woman I have ever known.
Every night after a meal of sadza and vegetables, always vegetables because meat was for special occasions, we would huddle around the smokey fire, our weepy wooded eyes glaring, roasted nuts tossing in a chipped mud pot. Grandma would be begin the stories with:
‘Paivapo‘ which translates to ‘once upon a time’ in our Shona language.
And so the stories unfolded, some fictional, humorous and always cultural. Most were flavoured with superstition, designed to instil a childhood fear that still haunts me. To this day I am petrified of snakes and darkness. These elders pitched their stories around their long lived experiences and cultural exposures. In many ways they wanted a better life for the children who sat around them in those dark nights, they dreamed of a better tomorrow. All this was communicated rather artistically in African proverbs, rituals and the highest regard for our cultural values.
There were no writers or publishers in my village to capture these moments, the stories are documented in an oral history that touches the core of my heart and spirit. In many happy and sad moments I return back to that fire place in search of clarity, peace and providence.
I love reading, I love the feel of books, the crispy turn of a page, I love dribbling over my book when I fall asleep, my life synchronised into these characters that I have grown to love and loathe.
I can never loan my books out, I struggle with that, I miss my books, those characters who have become friends beyond the pages. I would rather buy you a book than lend you one.
The world is too often a stressed out space, we have over complicated the simple construct of humanity. Although we have made remarkable progress in science and technology, our attitudes to the value of life are still ancient. In this agitated world, it is poetry and yoga that ground me. I often come back to Ben Okri work, I adore Warsan Shire writing. I come to Warsan’s poetry for validation of my feminism, strength and silence. In this poetry, Warsan nails down the mood of the world:
“later that night
i held an atlas in my lap
ran my fingers across the whole world
where does it hurt?
― Warsan Shire
Over the years, I have loved reading so many books but a few stand out. To Kill a Mocking Bird by Harper Lee blew me away it still does, I come back to that book so often in search of justice, The Poison Wood Bible by Barbara Kingsolver is one of the finest books of our time, I read Facing the Congo by Jeffery Tayler at a critical time in my life, forever loved it, We need new names by Non Violet Bulawayo is a beauty of a book, its humour is a necessary as the harrowing stories behind it.
I always have two books on the go, I am currently reading ‘The other woman’ by Yewanda Omotoso, stunning read, so well written and Mars His Sword by Philani Amadeus Nyoni, a sparkling poetic infusion of love and humanity.
As the famous writer Mark Twain said, ‘The secret to getting ahead is to get started’
Let’s get reading!
To order Philani Amadeus Nyoni’s book, email email@example.com
Director Tribal Sands
All rights reserved
Where there is no Psychiatrist, Community Health Workers have been proven to be effective in providing high quality stepped up care to improve mental health outcomes in populations with high exposure to HIV and despairing social stressors such as domestic violence, substance misuse, poverty and complex cultural factors that add to the burden of disease.
I love working in grassroots health programs. Over the years I have been privileged to work with Tarisai Bere, a leading Psychologist on the Friendship Bench project in Zimbabwe. There is an intimacy that comes with working in partnerships between the Diaspora and home based programs, over time I have grown to cherish the warm relationships that we have developed with the Community Health Workers who are the real champions of the Friendship Bench. They embody their roles with a great sense of ownership and responsibility to their local communities. I love that they break into a song every so often, and address their own mental health challenges through community cohesion. Culture is pivotal in identifying and understanding complex social changes and these Community Health Workers understand this all too well.
We have achieved remarkable milestones in improving mental health in Zimbabwe, indeed high income countries have much to learn from the Zimbabwean model of stepped up care. Psychologist Tarisai Bere is a driving force in innovation and integration of mental health development in Zimbabwe. Tarisai takes time from her busy schedule to talk to Dorcas Gwata, Director of Tribal Sands:
Tarisai, you are one of the leading Psychologists working in Zimbabwe, can you tell us how it all started?
There are a few gurus before me in this field whose footsteps I’m following in.
The Friendship Bench started in 2006 in Mbare (which is one of the oldest high density areas in Harare) when a group of stakeholders came together to look into mental health issues in Zimbabwe particularly in the Primary Health Care clinics. It was a combination of Doctors from the UK (Dr Abas and Dr Vikram Patel), Doctors from Zimbabwe led by Dr Chibanda, Psychologists and researchers from the University of Zimbabwe and other stakeholders. They came up with the tool we now use to screen common mental disorders, the Shona Symptoms Questionnaire 14. A few Health Promoters (HPs) from Mbare were trained to screen and provide the intervention for Kufungisisa -Common Mental Disorders. In 2014- 2015 a Randomised Control Trial was carried out in 24 clinics and the results showed that the HPs could deliver the intervention successfully and outcomes of the CMDs improved.
The Friendship Bench (FB) project has grown from a pilot project in Mbare to a large scale up, how did you get involved with it?
I officially joined the FB during the adaptation of the Problem Solving Therapy as part of the clinical team in 2013. In the year 2014 to 2015, I assisted with the coordination of the Randomised Control Trial. This year I’ve been mainly involved with the training of the intervention to the HPs, checking its fidelity and the implementation of the scale up to the about 60 clinics in Zimbabwe.. I also provide clinical supervision and this is more of a referral point for severe and suicidal cases. We have trained close to 300 HPs in Harare, Gweru and Chitungwiza. It’s been an amazing journey.
What are you proudest moments on the Friendship Bench Project?
I have plenty but if I were to pick one I would say the journey I’ve had with the Community Health Workers during and after training. I’ve seen them grow from strength to strength, absorbing the knowledge imparted on them like superstars. To be honest I didn’t think they would be able to understand a psychological intervention with their educational background but they all surprised me. It’s been such a blessing to work with them, and I think there is nothing more gratifying than hearing your elders pray for you in gratitude thanking the Lord for you as teacher. Indeed a proud moment.
The FB model has helped to bring mental health into the open, what lessons do you think high income countries can learn from low income countries like Zimbabwe?
A problem shared is a problem half solved Dorcas, this is the greatest strength of this model. The intervention allows you to talk about your issues. In speaking out and emptying out your problems someone (in individual sessions) is there to guide you and hold your hand then a whole village in Circle Kubatana Tose (group therapy) is there to strengthen you. The richness of our culture of Ubuntu,(a person is a person through other people) spirituality and togetherness is what makes this model work best. You are allowed to open your mind to finding solutions in a loving and safe environment-Humbly under a tree on a bench. People are not afraid of speaking out anymore, there is no fear of judgement and a lot of misconceptions about mental illnesses are being corrected. Our grandmothers (the CHWs), do it with so much love and passion.
The ladies report that the problem solving tool and the Circle Kubatana Tose (CKT) has helped them greatly in improving their own health, and are you surprised by this outcome and what lessons other health care systems can adapt in improving the health of the health care workers.
I’m not surprised at all. Circle Kubatana Tose is the group therapy of the intervention where the ladies meet to share their own problems be it personal or work related. They help each other through different challenges. It’s amazing how sometimes when they are not sure of how to console someone they will just sing, pray and dance until they are all in good spirits. It’s truly amazing therapy. It’s important to keep in mind that these ladies have issues of their own and need to be taken care of. CKT gives them and their supervisors a chance for self care before they go out and do their work. They then teach CKT to their clients after 3 individual sessions, which is another platform for them to engage in group therapy.
You were one of the leading Psychologists on the Tendai Project which was based in Parirenyatwa Hospital; can you tell us more about the project and its findings?
The ‘Tendai’ project was an initiative to treat depression and improve adherence in People living with HIV. For ‘Tendai’ we used Problem Solving Therapy and Lifesteps which is an adherence intervention for Anti Retroviral Therapy (ART) adherence. We culturally adapted Lifesteps and named it Nzira Itsva which can be loosely translated to New Direction or New Map in English. We did a pilot trial to see if reducing depression and providing a psychological adherence intervention would improve outcomes of taking the ART. The preliminary results were quite positive so we are now working on doing a Randomised Control Trial in the Primary Health Care clinics. We have published on the work done so far in two journals, the Journal of Tropical Medicines and the Journal of Health Psychology and we have two more publications we are working on.
Rates of Gender Based Violence (GBV) in Sub-Sahara are particularly concerning, Zimbabwe included, what more can we do to provide better mental health care for those affected and traumatised by gender violence.
I think people suffer a lot in silence both men and women. We need to talk about Gender Based Violence a lot more and break the silence. A lot of people who experience Gender Based Violence suffer from different types of mental conditions but do not know where to go for help. We need to create a lot more awareness.
How can the Zimbabwean Diaspora add value in scaling up mental health training in Zimbabwe?
By coming home more often, to understand what’s happening, and help put Zimbabwe on the Global Mental Health map. We might not be able to turn around mental health care in one year but as the saying goes a journey of a thousand miles, begins with one step. Do what you can, if it’s volunteering for two weeks, we need more hands, if its research that will bring in help and money then do it, and it doesn’t have to be huge donations but maybe just your time and passion.
You lived in London briefly and moved back to Zimbabwe, have you ever looked back on that decision, and what keeps you anchored to Zimbabwe?
I lived in London for almost two years and I won’t lie I do miss London at times but coming back home was the best decision I ever made. Being in London and celebrating different cultures made me realise that there was a lot I didn’t know about myself, my heritage and my culture. I came back home to find myself. I began to learn more about my heritage, born of the Chief Tangwena clan I fell in love with my history. In learning more, I came face to face with some beliefs and practices that were unhelpful too. This was at a time when a lot of people were dying of HIV and soon after the introduction of more ART in Zimbabwe. What was striking for me was the misconceptions and the negative attitudes that surrounded the condition and especially the mental disorders associated with it. HIV induced psychosis, depression, anxiety, PTSD and other mental disorders were mistaken for evil demons and curses. I realized that a lot of people were dying because of lack of information. I went back to college to study Psychology; I wanted to be in a position to help more. That was the beginning of my journey in mental health. It’s true what they say that when you find your life’s purpose, everything falls into place. After my graduation I joined the 3 year in house training for clinical psychology at Parirenytwa Hospital where I was able to meet and provide therapy to more people with different mental health disorders and living with HIV. The Tendai project came to me like an answer to a prayer because my passion has always been to integrate Mental Health and HIV care. Tendai gave me a chance to do that. Through Tendai I was then introduced to the Friendship bench where I now help people at a wider range. I also help people with other chronic illnesses and not just HIV. I go to work to do my hobby, my career is my passion this is what keeps me anchored in Zimbabwe, that, my amazing husband and children and the wonderful weather of course. Precious sun!!!
Who are your mentors and why do they stand out?
My parents really, my dad was a community leader for as long as I can remember, liberation fighter, he helped rebuild our community in the 80s. I saw him single handily working very hard to make sure that our community had more schools, more houses, better roads, clinics and other infrastructures. He is a building constructor by profession but a lot of the things he did, he did for others. He was always very passionate about our community’s welfare.
My mum was always the unsung hero, and the passion I have to help people comes from her. After the liberation war she volunteered to teach old women to read and write, I think it was called adult literacy then. She taught the young women to be entrepreneurs through sewing school uniforms, baking cakes and knitting woollies and a lot of them started their own businesses which are still standing up to now. What was outstanding for me though was the campaign she started in our community to encourage parents to educate the girl child. Back then people didn’t believe in sending the girl child to school and she went from one house to the other encouraging fathers to send their girls to school, so yes when I grow up I want to be my mum lol.
Career wise my mentor is without a single doubt Dr Melanie Abas. I met her in 2013 and these past 3 years have been the climax of my career. She has pushed me to do things I didn’t think I was capable of. She has believed in me so many times when I doubted myself. In the past three years she has encouraged me to publish in a peer reviewed scientific journal, and has pushed me to speak on international platforms. Highlight of my career would be when I shared the podium with her as key note speaker at the Malawi, Scotland, Mental Health Conference held annually in Malawi. I think she knows I suffer from stage fright so every time I am about to speak and she is there she whispers “you are going to be great, you’re a natural” I am forever grateful for her passion in selflessly building and mentoring other people.
Back home, I have learnt a lot from Dr Chibanda who is also a fantastic mentor. He also pushed me to do a lot and has always been very supportive. He has taught me a lot about the local and global mental health. He has over the years encouraged me to take risks and better myself academically and professionally.
‘I was thinking too much': experiences of HIV-positive adults with common mental disorders and poor adherence to antiretroviral therapy in Zimbabwe
Tarisai, thank you for talking to me on Tribal Sands, please continue on with this brilliant grassroots work.
Thank you to Dr Dixon Chibanda and Dr Melanie Abas and all the wonderful staff at the Friendship Bench Project as well as those who worked at the Tendai Project in Parirenyatwa Hospital in Harare, Zimbabwe. Thanks to my colleagues at Zimbabwe Health Training Support Charity.
Director Tribal Sands
Trustee for ZHTS