Between 2012 and 2015, the Ministry of Public Health of the DRC and several other international and local stakeholders joint efforts in an attempt to integrate a package of mental health services into the basic health care system of the district Lubero in the DRC.
In 2019, local stakeholders such as the Institut Supérieur des Techniques Médicales de Kananga, and the National Program of Mental Health of the DRC came with an initiative to conduct an evaluation of this specific project in order to document lessons learned . This information might inform policy makers and other stakeholders how to continue and expand these efforts while ensuring increased access to and use of available services that in the end should lead to better mental health and increased feelings of well-being among the population of the DRC.
Culture 4 Change participated in the analysis and documentation of lessons learned.
Results of the pilot project in Lubero were positive in the sense that it has been possible to introduce a basic package of mental health services within a health care system of a so called fragile country. 18 supervisors and 52 health care providers have been trained in the provision of mental health care related services; these people were also able to support the 44 community health workers that were active in their communities. Between 2012 and 2015, 3.941 people that suffered from a mental health condition visited the different health centres or district hospital of Lubero in order to get help for their mental health related problems. Despite these positive results, many challenges have been observed.
After analysis, the relatively low number of people that visited the health centres for mental health care appears to be the result of: a lack of community based actors (non-medical persons) that were informed about the existence of available services; the lack of access to the mental health services in place (distance, infrastructure, fear of stigma) and a failing health system in general that appears to be a major precondition for the integration of mental health service in any health care system.
A major recommendation after the analysis of results is the implication of a heterogeneous group of local agents of change responsible for the implementation of interventions and actions that are not necessarily medical oriented and to implicate religious leaders, traditional healers and other social actors that play an important role in the dissemination of messages and best practices at local level.
Mass fainting in Cambodian garment factories remains unexplained for years now. The latest incident was reported in the Phnom Penh Post here on 25th December 2019. Poor working conditions in the factories explain any individual fainting, but the massive ‘waves’ of fainting is a phenomenon not explained. A way of expressing social protest is a possibility. But to understand the ‘cultural language’ of this protest, one needs to take the explanations of the people that faint seriously. This is what we did with culture4change, and here is an article of Maurice Eisenbruch about it: Mass fainting in Cambodian garment factories https://buff.ly/2Ssb4cf (foto KI media 2016)
In Brussels, many migrant women without legal status have no or limited access to health care and other basic services. Their access to descent care is mainly hampered by a lack of information, limited financial resources and poor experiences in the past.
In 2019, three organizations (Médecins du Monde, Culture 4 Change (C4C) and Theatre & Reconciliation) joint efforts to help migrant women without legal status to reduce levels of stress, hopelessness and lack of energy and to come out of their isolation. One of the major challenges of the project was to mobilize migrant women to participate in this specific project; a theatre production that aims to reinforce the social cohesion of people with a different culture, background and age.
Action research conducted by C4C during the implementation process was conducted in order to know which elements contributed to increased feelings of trust and reinforced autonomy among the target group and more willingness to support migrants among a larger population. We could clearly see how the mood of the participants in this project that lasted till June 2019 and that resulted in a final theatre show, entitled Liaisons Joyeuses, was influenced by playing together which allowed the reestablishment of social relations and a revitalization through the expression of feelings and the creation of a (dramatic) tension on the set using different modalities and resources. Expressing emotions in a secure context, being able to relate to the here and now, moving the body, using voice, music, form and rhythm, were all elements that permitted our target group to regain confidence, self-esteem and autonomy and to restore relations, all elements that have a positive influence on the mental health of people and that can be obtained by relative simple techniques without the interference of medical or therapeutic specialists. We were also surprised by the large number of people that came to see our target group and expressed their willingness to be actively involved in efforts to support our target group in daily life.
Our major conclusion is that mental health can indeed be improved by social action, based upon a better understanding of what a given situation really means for a target group and their immediate social environment. We believe this finding may help in formulating answers to problems that are often unnecessarily medicalized.
Nearly 2.5 billion smallholders cultivate the world's arable land, strategically positioned to tackle multiple Anthropocene challenges. When consciously adopting ecologically-based pest management practices, they can improve resource use efficiency, slow biodiversity loss, curtail environmental pollution and safeguard human health (see Wyckhuys et. al, Ecological illiteracy can deepen farmers' pesticide dependency).
In Cambodia we try to help changing the culture of applying pesticides. The Antwerp Institute of Tropical Medicine does research in relations between exposure to pesticide and illness. The next step is to understand the the farmers’ willingness and ability to take up new information, endorse environmental activities, and use these changes in culture to increase positive behavioural change. On the picture is my good friend Channeang who is always the best guide one can find!