Why I train grandmothers to treat depression | Dixon Chibanda

Prevodilac: Psiho cose Lektor: Ivana Krivokuća

On a warm August morning in Harare,

Jednog toplog avgustovskog jutra u Harareu,

Farai,

Faraj,

a 24-year-old mother of two,

24-godišnja majka dvoje dece,

walks towards a park bench.

šeta prema klupi u parku.

She looks miserable and dejected.

Izgleda jadno i utučeno.

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

Na klupi u parku sedi žena od 82 godine,

better known to the community as Grandmother Jack.

poznatija zajednici kao baka Džek.

Farai hands Grandmother Jack an envelope from the clinic nurse.

Faraj predaje baki Džek kovertu od medicinske sestre.

Grandmother Jack invites Farai to sit down

Baka Džek poziva Faraj da sedne

as she opens the envelope and reads.

dok otvara kovertu i čita.

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

Nastupa tišina koja traje oko tri minuta dok ona čita.

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

Nakon duže pauze, baka Džek duboko uzdahne,

looks at Farai and says,

pogleda u Faraj i kaže:

"I'm here for you.

„Tu sam za tebe.

Would you like to share your story with me?"

Da li bi želela da podeliš svoju priču sa mnom?“

Farai begins,

Faraj počinje,

her eyes swelling with tears.

njene oči su otečene od suza.

She says, "Grandmother Jack,

Ona kaže: „Bako Džek,

I'm HIV-positive.

ja sam HIV pozitivna.

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

Živim sa HIV-om protekle četiri godine.

My husband left me a year ago.

Moj muž me je ostavio prošle godine.

I have two kids

Imam dvoje dece

under the age of five.

ispod pet godina.

I'm unemployed.

Nezaposlena sam.

I can hardly take care of my children."

Jedva mogu da se brinem o svojoj deci.“

Tears are now flowing down her face.

Suze se sada slivaju niz njeno lice.

And in response, Grandmother Jack moves closer,

Kao odgovor na to, baka Džek se primakne,

puts her hand on Farai,

stavi svoju ruku na Faraj

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

i kaže: „Faraj, u redu je plakati.

You've been through a lot.

Prošla si mnogo toga.

Would you like to share more with me?"

Da li bi želela da podeliš još stvari sa mnom?“

And Farai continues.

Faraj nastavlja:

"In the last three weeks,

„U poslednje tri nedelje,

I have had recurrent thoughts of killing myself,

stalno su mi se ponavljale misli da se ubijem

taking my two children with me.

i da povedem svoje dvoje dece sa sobom.

I can't take it anymore.

Ne mogu da izdržim više.

The clinic nurse sent me to see you."

Medicinska sestra me je poslala kod tebe.“

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

Nastaje razmena između njih dve, koja traje oko 30 minuta.

And finally, Grandmother Jack says,

I na kraju, baka Džek kaže:

"Farai,

„Faraj,

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

čini mi se da ti imaš sve simptome kufungisise.“

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

Reč „kufungisisa“ otvara zadržavanu poplavu suza.

So, kufungisisa is the local equivalent of depression

Pa, „kufungisisa“ je lokalni ekvivalent depresije

in my country.

u mojoj zemlji.

It literally means

To doslovno znači

"thinking too much."

„previše razmišljanja“.

The World Health Organization estimates

Svetska zdravstvena organizacija

procenjuje da više od 300 miliona ljudi širom sveta danas boluje od depresije,

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

or what in my country we call kufungisisa.

ili onoga što mi u mojoj zemlji zovemo kufungisisa.

And the World Health Organization also tells us

Svetska zdravstvena organizacija nam takođe govori

that every 40 seconds,

da svakih 40 sekundi

someone somewhere in the world commits suicide

neko negde u svetu izvrši samoubistvo

because they are unhappy,

zato što je nesrećan,

largely due to depression or kufungisisa.

uglavnom zbog depresije ili kufungisise.

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

Većina ovih smrti se dogodi u slabije ili srednje razvijenim zemljama.

In fact,

U stvari,

the World Health Organization goes as far as to say

Svetska zdravstvena organizacija ide čak i dalje i kaže da,

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

kada pogledate starosnu grupu između 15 ili 29 godina,

a leading cause of death now is actually suicide.

vodeći uzrok smrti sada je zapravo samoubistvo.

But there are wider events that lead to depression

Ali postoje širi događaji koji vode ka depresiji

and in some cases, suicide,

i u nekim slučajevima, samoubistvu,

such as abuse,

kao što je zlostavljanje,

conflict, violence,

konflikt, nasilje,

isolation, loneliness --

izolacija, usamljenost -

the list is endless.

lista je beskonačna.

But one thing that we do know

Ali jedna stvar koju znamo

is that depression can be treated and suicides averted.

je da se depresija može lečiti i samoubistvo se može izbeći.

But the problem is

Ali problem je u tome

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

što mi jednostavno nemamo dovoljno psihijatara ili psihologa u svetu

to do the job.

da urade taj posao.

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

U većini slabije i srednje razvijenih zemalja, na primer,

the ratio of psychiatrists to the population

broj psihijatara u odnosu na populaciju

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

je nešto nalik jedan na svaki jedan i po milion ljudi,

which literally means that 90 percent of the people

što doslovno znači da 90 posto ljudi

kojima trebaju usluge u oblasti mentalnog zdravlja

needing mental health services

will not get it.

njih neće dobiti.

In my country,

U mojoj zemlji,

there are 12 psychiatrists,

imamo 12 psihijatara,

and I'm one of them,

i ja sam jedan od njih,

for a population of approximately 14 million.

za populaciju koja broji približno 14 miliona.

Now, let me just put that into context.

Dozvolite mi da to stavim u kontekst.

One evening while I was at home,

Jedne večeri dok sam bio kod kuće,

I get a call from the ER,

dobio sam poziv iz urgentnog centra,

or the emergency room,

ili hitne pomoći,

from a city which is some 200 kilometers away

iz grada koji je udaljen nekih 200 kilometara

from where I live.

od mesta gde ja živim.

And the ER doctor says,

I doktor iz urgentnog centra kaže:

"One of your patients,

„Jedna od tvojih pacijentkinja, neko koga si lečio pre četiri meseca,

someone you treated four months ago,

has just taken an overdose,

se upravo predozirala

and they are in the ER department.

i nalazi se na odeljenju urgentnog centra.

Hemodynamically, they seem to be OK,

Hemodinamički, čini se da je dobro,

but they will need neuropsychiatric evaluation."

ali će joj trebati neuropsihijatrijska procena.“

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

Ja očigledno ne mogu da sednem u svoj auto usred noći

and drive 200 kilometers.

i da vozim 200 kilometara.

So as best as we could,

Tako da, što smo bolje mogli,

over the phone with the ER doctor,

putem telefona sa doktorom iz urgentnog centra,

we come up with an assessment.

dolazimo do procene.

We ensure that suicidal observations are in place.

Postaramo se da te suicidalne opservacije budu na mestu.

We ensure that we start reviewing the antidepressants

Postaramo se da počnemo da pregledamo antidepresive

that this patient has been taking,

koje je ova pacijentkinja uzimala,

and we finally conclude

i konačno zaključujemo

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

da čim se Erika - tako se zvala, 26 godina starosti -

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

da čim Erika bude spremna da bude otpuštena iz urgentnog centra,

she should come directly to me with her mother,

treba da dođe direktno kod mene sa svojom majkom

and I will evaluate

i ja ću proceniti

and establish what can be done.

i ustanoviti šta može da se uradi.

And we assumed that that would take about a week.

Pretpostavili smo da će to trajati oko nedelju dana.

A week passes.

Nedelja prođe.

Three weeks pass.

Tri nedelje prođu.

No Erica.

Nema Erike.

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

Jednog dana dobijem poziv od Erikine majke,

and she says,

i ona kaže:

"Erica committed suicide three days ago.

„Erika je izvršila samoubistvo pre tri dana.

She hanged herself from the mango tree

Obesila o drvo manga

in the family garden."

u porodičnoj bašti.“

Now, almost like a knee-jerk reaction,

Gotovo kao automatska reakcija,

I couldn't help but ask,

nisam mogao da izdržim, a da je ne pitam:

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

„Ali zašto niste došle u Harare, gde ja živim?

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

Dogovorili smo se da ćete, čim vas otpuste iz urgentnog centra,

you will come to me."

doći kod mene.“

Her response was brief.

Njen odgovor je bio kratak.

"We didn't have the 15 dollars bus fare

„Nismo imale 15 dolara za autobusku kartu

to come to Harare."

da bismo došle u Harare.“

Now, suicide is not an unusual event

Samoubistvo nije neuobičajen događaj

in the world of mental health.

u svetu mentalnog zdravlja.

But there was something about Erica's death

Ali postojalo je nešto u vezi sa Erikinom smrću

that struck me at the core of my very being.

što me je pogodilo do srži mog bića.

That statement from Erica's mother:

Ta izjava Erikine majke:

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

„Nismo imale 15 dolara za autobusku kartu da bismo došle kod vas"

made me realize

naterala me je da shvatim

that it just wasn't going to work,

da to jednostavno neće funkcionisati,

me expecting people to come to me.

da očekujem da ljudi dolaze meni.

And I got into this state of soul-searching,

I dospeo sam u to stanje duhovne potrage,

trying to really discover my role

pokušavajući da zaista otkrijem moju ulogu

as a psychiatrist in Africa.

kao psihijatra u Africi.

And after considerable consultation and soul-searching,

I nakon značajnih konsultacija i duhovne potrage,

talking to colleagues, friends and family,

razgovora sa kolegama, prijateljima i porodicom,

it suddenly dawned on me

iznenada mi je svanulo

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

da, zapravo, jedan od najpouzdanijih izvora koje mi imamo u Africi

are grandmothers.

su bake.

Yes, grandmothers.

Da, bake.

And I thought,

Pomislio sam,

grandmothers are in every community.

bake su u svakoj zajednici.

There are hundreds of them.

Na stotine njih.

And --

I -

(Laughter)

(Smeh)

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

I one ne odlaze iz svojih zajednica u potrazi za zelenijim pašnjacima.

(Laughter)

(Smeh)

See, the only time they leave

Vidite, jedini put kada odlaze

is when they go to a greener pasture called heaven.

je kada idu na zeleniji pašnjak koji se zove nebo.

(Laughter)

(Smeh)

So I thought, how about training grandmothers

Tako da sam razmišljao o tome kako bi bilo obučavati bake

in evidence-based talk therapy,

terapiji kroz razgovor koja je zasnovana na dokazima,

which they can deliver on a bench?

a koju one mogu da sprovedu na klupi?

Empower them with the skills to listen,

Da ih osnažimo veštinama da slušaju,

to show empathy,

da pokažu empatiju,

all of that rooted in cognitive behavioral therapy;

svemu ostalom na čemu se bazira kognitivno bihejvioralna terapija;

empower them with the skills to provide behavior activation,

da ih osnažimo veštinama da pruže aktiviranje ponašanja,

activity scheduling;

planiranje aktivnosti

and support them using digital technology.

i da ih podržimo pomoću digitalne tehnologije.

You know, mobile phone technology.

Znate, mobilne tehnologije.

Pretty much everyone in Africa has a mobile phone today.

Gotovo svi u Africi imaju mobilni telefon danas.

So in 2006,

Pa, 2006. godine,

I started my first group

osnovao sam svoju prvu grupu

of grandmothers.

baki.

(Applause)

(Aplauz)

Thank you.

Hvala vam.

(Applause)

(Aplauz)

Today, there are hundreds of grandmothers

Danas postoje stotine baka

who are working in more than 70 communities.

koje rade u više od 70 zajednica.

And in the last year alone,

I samo u protekloj godini

more than 30,000 people received treatment

je više od 30 000 ljudi dobilo lečenje

on the Friendship Bench

u projektu Prijateljska klupa

from a grandmother in a community in Zimbabwe.

od baka u jednoj zajednici u Zimbabveu.

(Applause)

(Aplauz)

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

Nedavno smo objavili ovaj rad koji su ove bake sprovele

in the Journal of the American Medical Association.

u časopisu Američkog medicinskog udruženja.

And --

I -

(Applause)

(Aplauz)

And our results show that six months after receiving treatment

I naši rezultati pokazuju da, šest meseci nakon što dobiju lečenje

from a grandmother,

od bake,

people were still symptom-free:

ljudi su i dalje oslobođeni simptoma:

no depression,

bez depresije,

suicidal ideation completely reduced.

suicidalne misli su smanjene.

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

U stvari, naši rezultati - ovo je bilo kliničko ispitivanje -

in fact, this clinical trial showed

ovo kliničko ispitivanje je u stvari pokazalo

that grandmothers were more effective at treating depression

da su bake bile mnogo više efikasnije u lečenju depresije

than doctors and --

od doktora i -

(Laughter)

(Smeh)

(Applause)

(Aplauz)

And so,

Tako da,

we're now working towards expanding this program.

mi sada radimo na tome da proširimo program.

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

Trenutno postoji više od 600 miliona ljudi u svetu starijih od 65 godina.

And by the year 2050,

Do 2050. godine,

there will be 1.5 billion people aged 65 and above.

biće 1,5 milijardi ljudi starosti od 65 godina i preko toga.

Imagine if we could create a global network of grandmothers

Zamislite da možemo da stvorimo globalnu mrežu baka

in every major city in the world,

u svakom većem gradu u svetu,

who are trained in evidence-based talk therapy,

koje su obučene za terapiju razgovorom koja je zasnovana na dokazima,

supported through digital platforms,

uz podršku putem digitalnih platformi,

networked.

umreženih.

And they will make a difference in communities.

One će doneti promenu u zajednicama.

They will reduce the treatment gap

One će smanjiti raskorak u lečenju

for mental, neurological and substance-use disorders.

kod mentalnih i neuroloških poremećaja i bolesti zavisnosti.

Finally,

Konačno,

this is a file photograph of Grandmother Jack.

ovo je fotografija bake Džek.

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

Faraj je imala šest sesija na klupi sa bakom Džek.

Today, Farai is employed.

Danas, Faraj je zaposlena.

She has her two children at school.

Dvoje njene dece ide u školu.

And as for Grandmother Jack,

A što se bake Džek tiče,

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

jednog jutra u februaru,

očekivali smo da će se naći sa svojim 257. klijentom na klupi.

She didn't show up.

Nije se pojavila.

She had gone to a greener pasture called heaven.

Otišla je na zeleniji pašnjak zvani nebo.

But I believe that Grandmother Jack,

Ali ja verujem da baka Džek,

from up there,

negde odozgo,

she's cheering on all the other grandmothers --

ona navija za sve ostale bake -

the increasing number of grandmothers who are making a difference

sve veći broj baka koje ostavljaju traga

in the lives of thousands of people.

u životima hiljada ljudi.

And I'm sure she's in awe

I siguran sam da je ona ponosna

when she realizes that something that she helped to pioneer

kada shvati da se nešto čemu je pomogla kao pionir

is now spreading to other countries,

sada širi na druge zemlje,

like Malawi,

kao što su Malavi,

the island of Zanzibar

ostrvo Zanzibar

and coming closer to home here in the Unites States

i bliže vašem domu ovde u Americi

in the city of New York.

u gradu Njujorku.

May her soul rest in peace.

Neka joj duša počiva u miru.

Thank you.

Hvala vam.

(Applause)

(Aplauz)

(Cheering)

(Ovacije)

(Applause)

(Aplauz)