By David South, Development Challenges, South-South Solutions
SOUTH-SOUTH CASE STUDY
Mental healthcare is critical to physical health and overall wellbeing, yet it is seriously neglected around the world – and especially in poorer countries.
Often seen as a luxury for the wealthy or an indulgence for the weak, mental health services are often left at the bottom of any list of development priorities. Yet Professor Martin Prince of King’s College London in the United Kingdom found that an estimated 14 percent of the global burden of disease is due to neuropsychiatric disorders, mostly depression, alcohol- and substance-use disorders, and psychoses.
Since the contribution of mental disorders to physical illness is inadequately appreciated, the actual global burden of mental disorders is probably higher than this. Dr. Shekhar Saxena of the World Health Organization has reported that a scarcity of resources for mental health is compounded by inequities and inefficiencies in the delivery of mental healthcare.
As a result, people who need care get none. “The treatment gap – the proportion of those who need but do not receive care – is too high for some mental disorders,” Saxena said. As many as one in three people with schizophrenia and one in two with other mental disorders do not receive any treatment. The WHO has reported that the treatment gap for serious disorders is 76 percent to 85 percent for low- and middle-income countries. And the organization says shortages of healthcare professionals have been shown to be the main limiting factor in delivering mental healthcare in most low- and middle-income countries.
But an ingenious solution to this problem has emerged in the South American country of Ecuador. It involves turning to the traditional healers who are already well-established in communities. They are both cheaper and faster than waiting for medical psychiatrists to turn up in poor communities, and they can start right now to provide the support people need in a culturally tolerant way. Their effectiveness has been proven by Dr. Mario Incayawar, director of the Runajambi Institute for the Study of Quichua Culture and Health in Otavalo.
“Poor countries where you find numerous traditional healers could benefit the most,” he said.
In findings published in the prestigious British Journal of Psychiatry (The British Journal of Psychiatry (2008) 192: 390-391. doi: 10.1192/bjp.bp.107.046938), Incayawar found there are just 800 psychiatrists in Ecuador, and most live in the cities and speak Spanish. The native population on the other hand, mostly speak the local Quechua language and are served by only one psychiatrist, but thousands of traditional healers.
In the Andean mountain city of Otavalo, most people are descendents of the ancient Inca people. Health conditions are poor and far worse than in Spanish-speaking regions. Over 3 million of Ecuador’s 12 million residents speak Quechua, many of them living in indigenous communities high up in the mountains, bypassed by development. Roughly 90 percent of indigenous communities live below the poverty level, a fact reflected in high maternal and infant mortality rates. In some remote communities, maternal mortality reaches 250 deaths per 100,000 live births, compared to the national average of 130, and one in 10 infants does not live to see his or her first birthday.
For 5 million Indigenous people in Ecuador, for example, there is not one single mental professional paid to work within the Indigenous communities.
Traditional healers’ practices are widespread around the world, yet their diagnostic skills have rarely been investigated. Incayawar’s study found the yachactaitas (Quichua healers) in the Andes were able to identify cases of psychiatric illness in their communities. During the study over 18 months, 10 yachactaitas participated in the identification of 50 individuals with a condition. None of the participants was found to be healthy in biomedical or psychiatric terms when reviewed by psychiatrists. The results suggest yachactaitas can be an early warning system for identifying general psychiatric cases in their communities through their powers of observation.
“From the Quichua perspective, it is a matter of common sense,” said Incayawar. “We have a sizable number of traditional healers, why not promote their clinical skills for taking care of our communities.”
“Healers are paid in cash or by gifts such as a bag of potatoes, a basket of eggs, or a couple of chickens. The Quichua people are not familiar with psychiatrists or mental health professionals.”
He also sees a bright future for the role of the traditional healer: “Young people feel less threatened to pursue a career as a traditional healer. Currently, the trend points to an increase of traditional healers.”
In the future, Incayawar would like to see a happy co-habitation between the scientifically-trained psychiatrists, and the traditional healers: “We would like to see traditional healers working in a respectful partnership with biomedically trained mental health workers. The collaboration between equals … could be something to work on for the coming decade.”
- Dr Mario Incayawar has new book coming out in February 2009 called “Psychiatrists and Traditional Healers: Unwitting Partners in Global Mental Health,” Publisher: John Wiley & Sons.
It can be pre-ordered here: Amazon.co.uk And the draft chapters read here: www.mediafire.com
- An innovative UNFPA project has managed to give the Quecha-speaking descendents of the Incas the benefits of both traditional and modern medicines in a culturally sensitive manner.
This work is licensed under a
Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 License.