On Culture and Health What Can The NHS Learn From Zimbabwe?

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Professor Vikram Patel

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.


Mbare, Harare, Zimbabwe

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.

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With Dr Tami Kramer, Consultant Child and Adolescent Psychiatrist. My clinical supervisor on the Gangs-Mental Health Project.

Thank you’s
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.
Dorcas Gwata
Director, Tribal Sands
ZHTS Trustee

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