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Traditional Healers can Heal the Mind, as well as Body

By David SouthDevelopment 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.”

Published: August 2008

Resources

  • 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.
    Website: http://www.unfpa.org

Development Challenges, South-South Solutions was launched as an e-newsletter in 2006 by UNDP’s South-South Cooperation Unit (now the United Nations Office for South-South Cooperation) based in New York, USA. It led on profiling the rise of the global South as an economic powerhouse and was one of the first regular publications to champion the global South’s innovators, entrepreneurs, and pioneers. It tracked the key trends that are now so profoundly reshaping how development is seen and done. This includes the rapid take-up of mobile phones and information technology in the global South (as profiled in the first issue of magazine Southern Innovator), the move to becoming a majority urban world, a growing global innovator culture, and the plethora of solutions being developed in the global South to tackle its problems and improve living conditions and boost human development. The success of the e-newsletter led to the launch of the magazine Southern Innovator.

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ORCID iD: https://orcid.org/0000-0001-5311-1052.

© David South Consulting 2022

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Psychiatric Care Lacking For Institutionalised Seniors

Don Weitz wears a T-shirt bluntly saying, “Fry rice – not brains.”

By David South

Today’s Seniors (Canada), November 1992

Seniors who live in nursing homes and homes for the aged are receiving an inadequate amount of psychiatric care, according to a study conducted by Toronto’s Baycrest Centre for Geriatric Care. 

Dr. David Conn, director of psychiatry at Baycrest and an author of the report, says action must be taken to remedy this situation, since at least 80 per cent of elderly long-term care residents suffer from some form of mental disorder. 

The issue of psychiatric care for seniors is complex. There are many, often strongly-held, opinions about the nature of this care and what measures will genuinely improve the mental well-being of seniors in institutions. 

According to The Senior Citizens’ Consumer Alliance for Long-Care Reform, Ontario has the highest rate of institutionalisation of seniors in the world, with 7.5 per cent of seniors over the age of 65 and 15 per cent over 75 in institutions. The Alliance demanded in its reforms in Ontario that seniors’ mental health problems be taken more seriously and be included in any assessment for care. 

Baycrest’s report surveyed 1,148 medical directors and nursing directors in over 500 nursing homes and homes for the aged across Ontario. The 601 who responded reported that 37 per cent of their residents received no psychiatric care, while only 12 per cent received more than five hours per month. The most common psychiatric problems under treatment were depression, agitation, wandering and physical aggression. 

“Recognition of significant mental disorders in nursing homes is a recent phenomenon because geriatric psychiatry is a relatively new field,” says Dr. Conn. “The usual approach has been to reach for the prescription pad. We know now that antidepressants have been underused and tranquillizers overused.

“To deliver effective psychiatric care requires more than just psychiatrists – teams of psychiatric nurses can also be involved. Hopefully the staff of these institutions will become better educated as a result of this report.”

Dr. Kenneth Shulman, head of psychiatry at the Sunnybrook Health Sciences Centre, feels the worst neglect occurs in private rest homes. 

“There is general lack of accountability when it comes to geriatric psychiatric services.” Schulman advocates a coordinated, comprehensive regional network of services. 

Dr. Conn is sensitive to reports of sexual, physical and mental abuse of residents in some institutions. He says staff as well as residents of institutions can benefit from psychiatric consultations. “If more psychiatric consultants were available, the staff could also receive help in working out their problems,” he says. “Unfortunately the fee-for-service system doesn’t include paying for visiting staff.

“Being in an institution is not easy for anyone. It often means being apart from family, living with strangers, loss of freedom and having to live by the institution’s timetable.”

One of the most controversial of psychiatric treatments is electroconvulsive therapy (ECT). ECT involves placing electrodes on the sedated patient’s head and passing 100 to 175 volts of electricity into one of the lobes of the brain to induce grand mal seizure and coma. 

Opponents of ECT say the procedure can cause memory loss and confusion, and in some cases proves fatal. A 1985 Ontario government task force report recommended against using ECT in certain cases: “For patients whose work requires a clear and precise memory, ECT is probably contraindicated.”

But many other sources say that while ECT has been abused in the past and, like many other medical procedures, may not be a pretty sight, it is sometimes effective in combating depression. 

Dr. Conn confirms that the controversial procedure is still being used on seniors. “ECT is used on very depressed people,” he says. “It is a hospital-based service. The patient is admitted to a psychiatric unit of the hospital. We do it at Baycrest. It is only a last resort and has often been life-saving.”

Don Weitz, a senior citizen and spokesperson for Resistance Against Psychiatry, doesn’t mince words about what he says is the adverse effects of electroshock therapy and psychiatric practice in general. He wears a T-shirt bluntly saying, “Fry rice – not brains.”

“We have known about the adverse effects of shock for years,” says Weitz. “Research from the ‘40s and ‘50s was very clear that there was brain damage.

“What doctors mean by improvement is in fact post-injury euphoria – the brain will overcompensate with giddiness, and this only lasts for two to four weeks. Doctors seldom test people for more than two or three months afterwards.”

“What we know for sure is that within the institutions, they would rather give drugs or shock than talk to seniors. I think this should be called elder abuse – what else could it be? Is it such a mystery why people are depressed in institutions where they are abused? Psychiatrists have a vested interest in billing OHIP for pushing the button.”

But Dr. Shulman disagrees with blaming the atmosphere of institutions. “It is simplistic to think that the environment is responsible for aggressiveness or other problems,” he says. “These people are cognitively impaired – it could be medication-related or something else. These are complicated issues.”

For any nursing home workers who want further advice about psychiatry, Baycrest has produced a “Jargon-free” guide called Practical Psychiatry in the Nursing Home. 

More from Canada’s Today’s Seniors

Feds Call For AIDS, Blood System Inquiry: Some Seniors Infected

Government Urged To Limit Free Drugs For Seniors

Health Care On The Cutting Block: Ministry Hopes For Efficiency With Search And Destroy Tactics

New Seniors’ Group Boosts ‘Grey Power’: Grey Panthers Chapter Opens With A Canadian Touch

Seniors Falling Through The Health Care Cost Cracks

ORCID iD: https://orcid.org/0000-0001-5311-1052.

© David South Consulting 2021