Why I train grandmothers to treat depression | Dixon Chibanda

Translator: Linda Polakovičová Reviewer: Linda Magáthová

On a warm August morning in Harare,

Jedno teplé augustové ráno v Harare,

Farai,

Farai,

a 24-year-old mother of two,

24-ročná matka dvoch detí

walks towards a park bench.

príde k lavičke v parku.

She looks miserable and dejected.

Vyzerá nešťastne a skľúčene.

Now, on the park bench sits an 82-year-old woman,

Na lavičke sedí 82-ročná žena,

better known to the community as Grandmother Jack.

ktorú v komunite poznajú ako Babičku Jack.

Farai hands Grandmother Jack an envelope from the clinic nurse.

Farai podá Babičke Jack obálku od zdravotnej sestry.

Grandmother Jack invites Farai to sit down

Babička Jack povie Farai, aby si sadla,

as she opens the envelope and reads.

otvorí obálku a číta.

There's silence for three minutes or so as she reads.

Kým číta, ostane na asi tri minúty ticho.

And after a long pause, Grandmother Jack takes a deep breath,

Po dlhej pauze sa Babička Jack zhlboka nadýchne,

looks at Farai and says,

pozrie na Farai a povie:

"I'm here for you.

„Som tu pre teba.

Would you like to share your story with me?"

Povedala by si mi svoj príbeh?“

Farai begins,

Farai začne

her eyes swelling with tears.

s očami plnými sĺz.

She says, "Grandmother Jack,

Hovorí: „Babička Jack,

I'm HIV-positive.

som HIV-pozitívna.

I've been living with HIV for the past four years.

Už štyri roky žijem s HIV.

My husband left me a year ago.

Pred rokom ma opustil manžel.

I have two kids

Mám dve deti

under the age of five.

vo veku do 5 rokov.

I'm unemployed.

Som nezamestnaná.

I can hardly take care of my children."

Ledva sa dokážem postarať o vlastné deti.“

Tears are now flowing down her face.

Slzy jej stekajú po tvári.

And in response, Grandmother Jack moves closer,

Babička Jack sa prisunie bližšie,

puts her hand on Farai,

objíme Farai okolo pliec,

and says, "Farai, it's OK to cry.

a hovorí: „Farai, plakať je v poriadku.

You've been through a lot.

Je toho na teba veľa.

Would you like to share more with me?"

Chcela by si mi povedať viac?“

And Farai continues.

Farai pokračuje.

"In the last three weeks,

„Posledné tri týždne

I have had recurrent thoughts of killing myself,

som opakovane rozmýšľala nad samovraždou,

taking my two children with me.

a že si svoje deti vezmem so sebou.

I can't take it anymore.

Už nevládzem.

The clinic nurse sent me to see you."

Sestrička ma poslala za vami.“

There's an exchange between the two, which lasts about 30 minutes.

Rozprávali sa asi polhodinu.

And finally, Grandmother Jack says,

Nakoniec Babička Jack hovorí:

"Farai,

„Farai,

it seems to me that you have all the symptoms of kufungisisa."

vyzerá to, že máš všetky symptómy kufungisisa.“

The word "kufungisisa" opens up a floodgate of tears.

Slovo „kufungisisa“ spustí vodopád sĺz.

So, kufungisisa is the local equivalent of depression

Kufungisisa je v mojej krajine názvom pre depresiu

in my country.

It literally means

Doslovný preklad je

"thinking too much."

„prehnané rozmýšlanie“.

The World Health Organization estimates

Svetová zdravotnícka organizácia odhaduje,

that more than 300 million people globally, today, suffer from depression,

že viac ako 300 miliónov ľudí na celom svete dnes trpí depresiou,

or what in my country we call kufungisisa.

alebo tým, čo v mojej krajine voláme kufungisisa.

And the World Health Organization also tells us

Svetová zdravotnícka organizácia nám taktiež hovorí,

that every 40 seconds,

že každých 40 sekúnd

someone somewhere in the world commits suicide

niekto niekde vo svete spácha samovraždu,

because they are unhappy,

pretože je nešťastný,

largely due to depression or kufungisisa.

prevažne z dôvodu depresie či kufungisisa.

And most of these deaths are occurring in low- and middle-income countries.

K väčšine z týchto úmrtí dochádza v krajinách s nízkym či stredným príjmom.

In fact,

Svetová zdravotnícka organizácia dokonca tvrdí,

the World Health Organization goes as far as to say

that when you look at the age group between 15 to 29,

že pre vekovú skupinu 15 až 29 rokov

a leading cause of death now is actually suicide.

je hlavnou príčinou smrti samovražda.

But there are wider events that lead to depression

Existuje široká škála udalostí, ktoré spôsobujú depresiu,

and in some cases, suicide,

a v niektorých prípadoch samovraždu.

such as abuse,

Sú nimi týranie,

conflict, violence,

konflikt, násilie,

isolation, loneliness --

izolácia, samota –

the list is endless.

zoznam je nekonečný.

But one thing that we do know

Vieme však,

is that depression can be treated and suicides averted.

že depresia sa dá liečiť a samovraždám sa dá predísť.

But the problem is

Problém je však v tom,

we just don't have enough psychiatrists or psychologists in the world

že vo svete nemáme dostatok psychiatrov a psychológov,

to do the job.

ktorí by mohli pomôcť.

In most low- and middle-income countries, for instance,

V krajinách s nízkym a stredným rozpočtom, napríklad,

the ratio of psychiatrists to the population

je priblížný podiel psychiatrov

is something like one for every one and a half million people,

jeden na jeden a pol milióna ľudí,

which literally means that 90 percent of the people

čo doslova znamená, že 90 percent ľudí,

needing mental health services

ktorí potrebujú služby duševného zdravia,

will not get it.

ich nedostanú.

In my country,

V mojej krajine

there are 12 psychiatrists,

je 12 psychiatrov,

and I'm one of them,

ja som jedným z nich,

for a population of approximately 14 million.

na približne 14 miliónov ľudí.

Now, let me just put that into context.

Dajme si to do kontextu.

One evening while I was at home,

Jedného večera som sedel doma

I get a call from the ER,

a zrazu mi zavolali z pohotovosti,

or the emergency room,

from a city which is some 200 kilometers away

v meste vzdialenom 200 kilometrov

from where I live.

od môjho bydliska.

And the ER doctor says,

Lekár z pohotovosti mi povedal:

"One of your patients,

„Jedna vaša pacientka,

someone you treated four months ago,

ktorú ste liečili pred štyrmi mesiacmi,

has just taken an overdose,

sa práve predávkovala

and they are in the ER department.

a nachádza sa na pohotovosti.

Hemodynamically, they seem to be OK,

Po hemodynamickej stránke je v poriadku,

but they will need neuropsychiatric evaluation."

ale bude potrebovať neuropsychiatrické vyšetrenie.“

Now, I obviously can't get into my car in the middle of the night

Samozrejme, nemôžem uprostred noci sadnúť do auta

and drive 200 kilometers.

a precestovať 200 kilometrov.

So as best as we could,

Takže, čo najlepšie, ako sme mohli

over the phone with the ER doctor,

sme telefonicky s daným lekárom

we come up with an assessment.

vypracovali posudok.

We ensure that suicidal observations are in place.

Zaistili sme, že pacientka bude pozorovaná pre prípad samovraždy.

We ensure that we start reviewing the antidepressants

Zaistili sme prehodnotenie antidepresív,

that this patient has been taking,

ktoré táto pacientka brala,

and we finally conclude

a nakoniec sme dospeli k záveru,

that as soon as Erica -- that was her name, 26-year-old --

že hneď ako Eriku – tak sa volala, mala 26 rokov –

as soon as Erica is ready to be released from the ER,

hneď ako Eriku budú môcť prepustiť z pohotovosti

she should come directly to me with her mother,

má aj s mamou prísť ku mne,

and I will evaluate

a ja zhodnotím

and establish what can be done.

a určím, čo sa dá robiť ďalej.

And we assumed that that would take about a week.

Predpokladali sme, že to bude trvať týždeň.

A week passes.

Týždeň prešiel.

Three weeks pass.

Prešli tri týždne.

No Erica.

Eriky nikde.

And one day I get a call from Erica's mother,

Jedného dňa mi zavolala Erikina mama

and she says,

a povedala:

"Erica committed suicide three days ago.

„Erika pred tromi dňami spáchala samovraždu.

She hanged herself from the mango tree

Obesila sa na mangovníku v rodinnej záhrade.“

in the family garden."

Now, almost like a knee-jerk reaction,

Takmer bleskovo som zareagoval

I couldn't help but ask,

a musel som sa opýtať:

"But why didn't you come to Harare, where I live?

„Prečo ste ale neprišli za mnou do Harare?

We had agreed that as soon as you're released from the ER,

Dohodli sme sa, že hneď ako ju pustia z pohotovosti,

you will come to me."

prídete za mnou.“

Her response was brief.

Jej odpoveď bola stručná.

"We didn't have the 15 dollars bus fare

„Nemali sme 15 dolárov na autobus do Harare.“

to come to Harare."

Now, suicide is not an unusual event

Samovražda nie je zriedkavá

in the world of mental health.

v oblasti duševného zdravia.

But there was something about Erica's death

Avšak Erikina smrť

that struck me at the core of my very being.

ma zasiahla veľmi hlboko.

That statement from Erica's mother:

Výrok Erikinej mamy:

"We didn't have 15 dollars bus fare to come to you,"

„Nemali sme 15 dolárov, aby sme prišli za vami,“

made me realize

ma donútil si uvedomiť,

that it just wasn't going to work,

že to nebude fungovať,

me expecting people to come to me.

a nemôžem očakávať, že ľudia za mnou prídu.

And I got into this state of soul-searching,

Začal som si spytovať svedomie

trying to really discover my role

a snažil som sa naozaj nájsť svoje miesto

as a psychiatrist in Africa.

ako psychiater v Afrike.

And after considerable consultation and soul-searching,

A po dlhých konzultáciách a sebaanalýze,

talking to colleagues, friends and family,

rozhovoroch s kolegami, známymi a rodinou,

it suddenly dawned on me

som si zrazu uvedomil,

that actually, one the most reliable resources we have in Africa

že vlastne najspoľahlivejším zdrojom, ktorý v Afrike máme,

are grandmothers.

sú babičky.

Yes, grandmothers.

Áno, babičky.

And I thought,

Pomyslel som si,

grandmothers are in every community.

že babičky sú v každej komunite.

There are hundreds of them.

Sú ich stovky.

And --

A –

(Laughter)

(smiech)

And they don't leave their communities in search of greener pastures.

A zo svojich komunít neodchádzajú v ústrety lepšej budúcnosti.

(Laughter)

(smiech)

See, the only time they leave

Odchádzajú jedine, ak idú

is when they go to a greener pasture called heaven.

k lepšej budúcnosti v nebi.

(Laughter)

(smiech)

So I thought, how about training grandmothers

Preto som si povedal, že by sme mohli babičky zaúčať

in evidence-based talk therapy,

v terapeutických rozhovoroch na báze dôkazov,

which they can deliver on a bench?

a to potom môžu využivať na lavičkách.

Empower them with the skills to listen,

Posilníme ich zručnosťou počúvať,

to show empathy,

prejavovať empatiu,

all of that rooted in cognitive behavioral therapy;

na základe kognitívnej behaviorálnej terapie;

empower them with the skills to provide behavior activation,

posilníme ich zručnosťami poskytnúť behaviorálnu aktiváciu,

activity scheduling;

plánovanie aktivít;

and support them using digital technology.

a poskytneme im podporu digitálnych technológií.

You know, mobile phone technology.

Veď viete, technológia mobilných telefónov.

Pretty much everyone in Africa has a mobile phone today.

V podstate každý v Afrike má dnes mobil.

So in 2006,

V roku 2006

I started my first group

som teda založil svoju prvú skupinu babičiek.

of grandmothers.

(Applause)

(potlesk)

Thank you.

Ďakujem.

(Applause)

(potlesk)

Today, there are hundreds of grandmothers

Dnes máme stovky babičiek

who are working in more than 70 communities.

pracujúcich vo viac než 70 komunitách.

And in the last year alone,

Iba v poslednom roku

more than 30,000 people received treatment

sa viac než 30 000 ľudí liečilo u babičky

on the Friendship Bench

na Lavičke priateľstva

from a grandmother in a community in Zimbabwe.

v komunite v Zimbabwe.

(Applause)

(potlesk)

And recently, we published this work that is done by these grandmothers

Nedávno sme vydali prácu o úspechoch týchto babičiek

in the Journal of the American Medical Association.

v zborníku americkej medicínskej asociácie.

And --

A –

(Applause)

(potlesk)

And our results show that six months after receiving treatment

A výsledky ukazujú, že šesť mesiacov po liečení u babičky

from a grandmother,

people were still symptom-free:

ľudia stále nevykazujú žiadne príznaky:

no depression,

žiadna depresia,

suicidal ideation completely reduced.

myšlienky na samovraždu sú úplne preč.

In fact, our results -- this was a clinical trial --

Popravde naše výsledky – išlo o klinické skúšky –

in fact, this clinical trial showed

tieto klinické skúšky ukázali,

that grandmothers were more effective at treating depression

že babičky sú pri liečbe depresie efektívnejšie

than doctors and --

než doktori, a –

(Laughter)

(smiech)

(Applause)

(potlesk)

And so,

A tak

we're now working towards expanding this program.

sa teraz snažíme tento program rozšíriť.

There are more than 600 million people currently aged above 65 in the world.

Momentálne je vo svete viac ako 600 miliónov ľudí nad 65 rokov.

And by the year 2050,

Do roku 2050

there will be 1.5 billion people aged 65 and above.

ich bude 1,5 miliardy.

Imagine if we could create a global network of grandmothers

Predstavte si, že by sme mohli vytvoriť globálnu sieť babičiek

in every major city in the world,

v každom veľkom meste vo svete,

who are trained in evidence-based talk therapy,

ktoré sú zaučené v terapeutických rozhovoroch na báze dôkazov,

supported through digital platforms,

podporované digitálnymi platformami,

networked.

internetovo prepojené.

And they will make a difference in communities.

Dokážu v komunitách vykonať zmenu.

They will reduce the treatment gap

Znížia rozdiel v starostlivosti

for mental, neurological and substance-use disorders.

pre mentálne, neurologické a závislostné poruchy.

Finally,

Nakoniec,

this is a file photograph of Grandmother Jack.

tu vidíte fotku Babičky Jack.

So, Farai had six sessions on the bench with Grandmother Jack.

Farai mala 6 sedení na lavičke s Babičkou Jack.

Today, Farai is employed.

Dnes je Farai zamestnaná.

She has her two children at school.

Jej dve deti chodia do školy.

And as for Grandmother Jack,

A Babička Jack

one morning in February, we expected her to see her 257th client on the bench.

mala v jedno februárové ráno stretnúť svojho 257. klienta.

She didn't show up.

No neukázala sa.

She had gone to a greener pasture called heaven.

Odišla v ústrety lepšej budúcnosti v nebi.

But I believe that Grandmother Jack,

Verím však, že Babička Jack zhora

from up there,

she's cheering on all the other grandmothers --

povzbudzuje všetky ostatné babičky –

the increasing number of grandmothers who are making a difference

narastajúci počet babičiek, ktoré pomáhajú zmeniť

in the lives of thousands of people.

životy tisícov ľudí.

And I'm sure she's in awe

Som si istý, že žasne,

when she realizes that something that she helped to pioneer

keď si uvedomuje, že niečo, čo pomohla zaviesť,

is now spreading to other countries,

sa teraz rozširuje do iných krajín,

like Malawi,

ako Malawi,

the island of Zanzibar

ostrov Zanzibar

and coming closer to home here in the Unites States

a aj bližšie k domovu tu v Spojených štátoch

in the city of New York.

v meste New York.

May her soul rest in peace.

Nech odpočíva v pokoji.

Thank you.

Ďakujem.

(Applause)

(potlesk)

(Cheering)

(jasanie)

(Applause)

(potlesk)