Why I train grandmothers to treat depression | Dixon Chibanda

Translator: Suet-Ying,Julie Leung

On a warm August morning in Harare,

喺八月嘅一個上晝 喺津巴布韋首都哈拉雷

Farai,

有個叫法拉嘅女人

a 24-year-old mother of two,

佢廿四歲，有兩個仔女

walks towards a park bench.

行去公園嘅一張長櫈度

She looks miserable and dejected.

佢望落去好鬱悶、好沮喪

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

嗰張公園長凳已經 有個八十二歲嘅婆婆坐喺度

better known to the community as Grandmother Jack.

人人都叫佢做 Jack 婆婆

Farai hands Grandmother Jack an envelope from the clinic nurse.

法拉遞畀 Jack 婆婆 一封診所護士畀佢嘅介紹信

Grandmother Jack invites Farai to sit down

Jack 婆婆請佢坐低

as she opens the envelope and reads.

然後打開個信封讀

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

婆婆睇信嘅三分鐘裡邊，冇人講嘢

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

隔咗一陣，Jack婆婆深呼吸

looks at Farai and says,

佢望住法拉講：

"I'm here for you.

「我係來幫你嘅，

Would you like to share your story with me?"

你可唔可以講下你嘅事啊？」

Farai begins,

法拉眼濕濕

her eyes swelling with tears.

She says, "Grandmother Jack,

佢話:「 Jack 婆婆啊，

I'm HIV-positive.

我有愛滋病已經四年。

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

My husband left me a year ago.

老公一年前走咗佬。

I have two kids

我有兩個仔女，

under the age of five.

佢哋都未到五歲。

I'm unemployed.

我失業，

I can hardly take care of my children."

我根本照顧唔嚟我啲仔女。 」

Tears are now flowing down her face.

佢淚流滿面

And in response, Grandmother Jack moves closer,

見到咁，Jack 婆婆坐埋過去

puts her hand on Farai,

輕輕攬住法拉

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

話：「法拉，你可以喊㗎。

You've been through a lot.

你經歷咗好多事，

Would you like to share more with me?"

可唔可以再講多啲畀我聽？」

And Farai continues.

法拉繼續講：

"In the last three weeks,

「喺過去嘅三個禮拜，

I have had recurrent thoughts of killing myself,

我成日喺度諗自殺，

taking my two children with me.

仲想帶埋啲仔女走。

I can't take it anymore.

我頂唔順喇，

The clinic nurse sent me to see you."

所以護士叫我嚟揾你 。」

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

佢哋兩個傾咗大概半個鐘

And finally, Grandmother Jack says,

最尾，Jack 婆婆話：

"Farai,

「法拉，

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

睇嚟『Kufungisisa』 嘅病徵你都有曬。」

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

聽到呢個字，法拉又即刻喊番

So, kufungisisa is the local equivalent of depression

「Kufungisisa」 係當地話「抑鬱症」嘅意思

in my country.

It literally means

直譯就係「諗太多」

"thinking too much."

The World Health Organization estimates

世界衛生組織統計

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

依家全世界有多過三億人有抑鬱症

or what in my country we call kufungisisa.

即係我個國家叫嘅 「Kufungisisa」

And the World Health Organization also tells us

世界衛生組織又話

that every 40 seconds,

全世界每四十秒

someone somewhere in the world commits suicide

就有一個人因為

because they are unhappy,

抑鬱症，或者「Kufungisisa」

largely due to depression or kufungisisa.

而自殺

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

呢啲自殺個案 多數出現喺中、低收入國家

In fact,

事實上

the World Health Organization goes as far as to say

世界衛生組織仲話

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

十五到二十九歲嘅年齡層 佢哋主要嘅死因係自殺

a leading cause of death now is actually suicide.

But there are wider events that lead to depression

但係，導致抑鬱症

甚至自殺嘅原因有好多

and in some cases, suicide,

such as abuse,

例如虐待

conflict, violence,

衝突、暴力

isolation, loneliness --

隔離、孤獨等等

the list is endless.

But one thing that we do know

不過，我哋知道

is that depression can be treated and suicides averted.

抑鬱症有得醫，自殺可以避免

But the problem is

問題係

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

全世界冇咁多 精神科醫生或者心理學家

來睇所有嘅病人

to do the job.

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

譬如，喺中、低收入國家

the ratio of psychiatrists to the population

精神科醫生對人口嘅比例

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

大概係一對一百五十萬

which literally means that 90 percent of the people

即係話，九成需要心理服務嘅人

needing mental health services

will not get it.

都得唔到幫助

In my country,

我哋成個國家

there are 12 psychiatrists,

只有十二個精神科醫生

and I'm one of them,

而我係其中嘅一個

for a population of approximately 14 million.

我哋國家人口有一千四百萬

Now, let me just put that into context.

我再畀多啲實際故事

One evening while I was at home,

有一晚，我喺屋企

I get a call from the ER,

收到 ER 打嚟嘅電話

or the emergency room,

ER 即係急症室

from a city which is some 200 kilometers away

間急症室喺離我 兩百公里嘅一個城市度

from where I live.

And the ER doctor says,

個主診醫生話：

"One of your patients,

「你有個病人，

someone you treated four months ago,

你四個月前醫過佢。

has just taken an overdose,

佢啱啱用藥過量，

and they are in the ER department.

依家入咗急症室。

Hemodynamically, they seem to be OK,

佢嘅血液動力正常，

but they will need neuropsychiatric evaluation."

不過需要神經心理科嘅檢查。 」

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

當然，我無可能半夜揸車

and drive 200 kilometers.

揸兩百公里去嗰度

So as best as we could,

所以，我哋唯有

over the phone with the ER doctor,

喺電話度

we come up with an assessment.

諗出對應嘅辦法

We ensure that suicidal observations are in place.

我要確保有人觀察著病人嘅自殺傾向

We ensure that we start reviewing the antidepressants

要確保我哋審視返病人 服用抗抑鬱藥嘅劑量

that this patient has been taking,

and we finally conclude

最後得出嘅結論係

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

Erica —— 呢個係病人嘅名，佢廿六歲

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

喺 Erica 可以出院時

she should come directly to me with her mother,

佢同佢媽媽就應該有直接來揾我

and I will evaluate

然後我就會對佢做檢查同評估

and establish what can be done.

同決定下一步要點做

And we assumed that that would take about a week.

我哋估計 Erica 大概一個禮拜之後就會來

A week passes.

過咗一個禮拜

Three weeks pass.

過咗三個禮拜

No Erica.

我都冇見到 Erica

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

有一日，Erica 媽媽打電話畀我

and she says,

佢話：

"Erica committed suicide three days ago.

「Erica 三日前自殺咗。

She hanged herself from the mango tree

佢喺屋企花園

in the family garden."

一樖芒果樹度吊頸。」

Now, almost like a knee-jerk reaction,

我本能反應噉忍唔住問：

I couldn't help but ask,

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

「噉點解你哋冇嚟哈拉雷揾我？

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

我哋講好咗，Erica 一出院，

you will come to me."

你哋就會嚟揾我 。」

Her response was brief.

佢解釋得好簡單：

"We didn't have the 15 dollars bus fare

「去哈拉雷嘅車費要十五蚊，

to come to Harare."

我哋籌唔到錢。 」

Now, suicide is not an unusual event

喺精神科裏面

in the world of mental health.

自殺唔算罕見

But there was something about Erica's death

但 Erica 嘅死

that struck me at the core of my very being.

好震憾我

That statement from Erica's mother:

佢媽媽嗰句

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

「我哋籌錢唔到 十五蚊嘅車費嚟揾你。」

made me realize

令我醒覺

that it just wasn't going to work,

等病人嚟揾我

me expecting people to come to me.

呢個方法行唔通

And I got into this state of soul-searching,

我開始自我反省

trying to really discover my role

重新諗

我喺非洲做精神科醫生嘅職責

as a psychiatrist in Africa.

And after considerable consultation and soul-searching,

經過一番請教同思考

talking to colleagues, friends and family,

又同同事、家人、朋友傾過

it suddenly dawned on me

我突然醒覺

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

其實非洲最多嘅資源

are grandmothers.

就喺啲婆婆

Yes, grandmothers.

無錯，係婆婆

And I thought,

我喺度諗

grandmothers are in every community.

每個社區都有好多婆婆

There are hundreds of them.

有成幾百個

And --

仲有

(Laughter)

（笑聲）

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

佢哋唔會離職， 唔會換工走人

(Laughter)

（笑聲）

See, the only time they leave

佢哋唯一走佬會去嘅地方

is when they go to a greener pasture called heaven.

就係天堂

(Laughter)

（笑聲）

So I thought, how about training grandmothers

所以我諗，不如訓練呢啲婆婆

in evidence-based talk therapy,

教佢哋循證談話療法

which they can deliver on a bench?

等佢哋可以坐喺公園長櫈度幫人

Empower them with the skills to listen,

根據認知行為療法

教佢哋聆聽嘅技巧

to show empathy,

教佢哋表達同情心

all of that rooted in cognitive behavioral therapy;

empower them with the skills to provide behavior activation,

教佢哋技巧來引導病人做正確行為 安排病人嘅活動

activity scheduling;

and support them using digital technology.

同埋教佢哋學識用數碼科技

You know, mobile phone technology.

譬如︰手機

Pretty much everyone in Africa has a mobile phone today.

依家, 喺非洲人人都有手機

So in 2006,

喺 2006 年

I started my first group

我組織到

of grandmothers.

第一班婆婆

(Applause)

（掌聲）

Thank you.

多謝

(Applause)

（掌聲）

Today, there are hundreds of grandmothers

今日，我哋有幾百個婆婆

who are working in more than 70 communities.

分散喺七十幾個社區度做嘢

And in the last year alone,

單單係舊年

more than 30,000 people received treatment

已經有三萬以上嘅津巴布韋人

on the Friendship Bench

喺社區嘅「友誼長櫈」計劃度

from a grandmother in a community in Zimbabwe.

接受咗一個婆婆嘅治療

(Applause)

（掌聲）

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

最近，我哋喺 美國醫學研究協會嘅雜誌

in the Journal of the American Medical Association.

發表文章講述呢啲計劃同婆婆嘅工作

And --

仲有

(Applause)

（掌聲）

And our results show that six months after receiving treatment

我哋嘅研究結果顯示

接受過婆婆治療嘅病人 喺六個月後

from a grandmother,

people were still symptom-free:

依然無復發嘅徵像

no depression,

無抑鬱

suicidal ideation completely reduced.

少咗好多自殺嘅傾向

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

我哋嘅研究顯示 —— 呢個係臨床試驗

in fact, this clinical trial showed

臨床試驗結果顯示

that grandmothers were more effective at treating depression

婆婆醫抑鬱症仲有效過醫生

than doctors and --

(Laughter)

（笑聲）

(Applause)

（掌聲）

And so,

所以

we're now working towards expanding this program.

我哋依家努力擴展呢個計劃

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

依家，全球有六億 六十五歲以上嘅人口

And by the year 2050,

到 2050 年

there will be 1.5 billion people aged 65 and above.

會有十五億 六十五歲以上嘅人口

Imagine if we could create a global network of grandmothers

想像一下, 如果我哋能夠 喺全世界所有主要城市

in every major city in the world,

建立一個國際婆婆網絡

who are trained in evidence-based talk therapy,

而啲婆婆又受過 循證談話療法嘅訓練

supported through digital platforms,

有電子平台支援佢哋

networked.

又有網絡將佢哋聯繫起來

And they will make a difference in communities.

佢哋會為社區做出好多貢獻

They will reduce the treatment gap

佢哋會縮窄當地

for mental, neurological and substance-use disorders.

心理、神經同濫用藥物問題上嘅 醫療供求差距

Finally,

最後

this is a file photograph of Grandmother Jack.

呢張係 Jack 婆婆嘅相

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

法拉喺「友誼長櫈」 同婆婆有六次療程

Today, Farai is employed.

依家，法拉揾到工做

She has her two children at school.

佢兩個仔女讀緊書

And as for Grandmother Jack,

至於 Jack 婆婆

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

喺二月嘅一個上晝 佢本來會嚟見佢第 257 位病人

She didn't show up.

但係佢無出現

She had gone to a greener pasture called heaven.

佢去咗天堂

But I believe that Grandmother Jack,

但我相信，Jack 婆婆

from up there,

喺天堂同緊其他婆婆打氣

she's cheering on all the other grandmothers --

the increasing number of grandmothers who are making a difference

而且越來越多婆婆加入呢個計劃

in the lives of thousands of people.

改變千萬人嘅人生

我仲諗 Jack 婆婆一定會好驚嘆

And I'm sure she's in awe

when she realizes that something that she helped to pioneer

佢帶頭開始嘅計劃

is now spreading to other countries,

已經發展到其他國家

like Malawi,

例如馬拉維

the island of Zanzibar

桑給巴爾群島

and coming closer to home here in the Unites States

同埋呢度

in the city of New York.

美國嘅紐約市

May her soul rest in peace.

願 Jack 婆婆安息

Thank you.

多謝

(Applause)

（掌聲）

(Cheering)

（歡呼）

(Applause)

（掌聲）