Tackling mental illness in the world's toughest places

Apr 07, 2017
10-Minute Read
This year’s World Health Day theme is Depression: Let’s talk. As someone who has survived a mental illness, Megan Radford is glad the conversation is beginning -- especially for women in the world’s toughest places. Photo above: The writer in Tunisia. Photo: Rabii Kalboussi

Crying on the floor in my pitch-black bathroom was not the end I envisioned for my journalism adventures. But two summers ago, that’s where I was.

I graduated with a Master of Arts in Journalism in the spring of 2011. The preceding year had been one of the happiest of my life, doing my internship in Malaysia and making true friends who banded together over our shared love of storytelling. I was ready to take on the world.

Six months later, I was on my way to doing just that. I left Toronto, first moving to Senegal, then to Tunisia. Over the course of a year I had worked for Al Jazeera, the CBC, and a host of other media from the UK to South Africa.

When I wasn’t freelancing, I spent most days writing and editing for an English-language start-up with a team of other young journalists from around the world. We went to art exhibits, music shows, and spent weekends at the beach. I was literally living a dream I had penned in English class when I was fifteen years old.

A dark turn
But that dream had the makings of a nightmare as well. With the rise of terrorism in Tunisia, Libya and Egypt, the stakes for those of us reporting the news got higher.

I told stories of rape, assassination, human rights abuses, and a second Tunisian revolution. I closed the windows of my apartment in downtown Tunis so the tear gas wouldn’t seep in, and I went to sleep with the echo of chants for freedom in my head.

Young men standing and sitting on top of a brick structure raise their arms with flag behind them.People gather at the funeral of an assassinated Tunisian leader. Photo: Megan Radford

After a year and a half in Tunisia, I moved to Egypt to teach English, hoping for a safer life. But the frequent sexual harassment I experienced in Cairo set me on edge, and I began to crumble like a burned out wick.

Around this time, a former coworker of mine, along with his friend, were reported missing in Libya. The Islamic State, or Daash as they are often called in North Africa, claimed responsibility. The news threatened to black out my usual optimism. It was time to go home.

Getting help and finding hope
And that’s how I ended up on the floor of a windowless room, in darkness, on a beautiful summer’s day. I was home and safe in Canada, but the trauma of the three years prior had followed me.

On my way home from my wonderful job, my colleague’s face flashed in my mind and I inexplicably began to cry. In my head, a pounding refrain told me, “He’s dead. He’s dead. Oh my God, he’s dead.” A few years later, my prediction would be confirmed, but that afternoon I was already certain the worst had happened to my former colleague.

My journalism training had prepared me to recognize the symptoms of Post-Traumatic Stress Disorder, or PTSD, and I knew I had to get help.

PTSD makes a prison of your own mind. Even after you are no longer in danger, your body’s fight or flight mechanism pumps you with adrenalin at the slightest provocation. Flashbacks, during the day or while you sleep, can be as frightening as the real experience. A seemingly innocuous event- a stranger bumping into you in the grocery line, or a car backfiring- can send you into a tailspin of terror.

Because of my work medical benefits, I was able to begin the counselling I needed to put the past behind me. Biking around my new city, doing art therapy, spending time with family, and journaling contributed to my healing.

I move through my days now with an acute understanding that I am one of the lucky ones- both because I was never physically harmed by the trouble I saw, and that I had access to services and support that pulled me out of the darkness.

A devastating illness
That’s not the case for most people around the world who must endure unspeakable trauma in silence and isolation. In Kenya, many women live under constant threat of sexual assault, gender-based violence, poverty and disease.

Being exposed to this kind of adversity leaves them at greater risk of developing severe mental health issues. But the stigma associated with being “crazy” prevents many people from seeking treatment. Even if they do, the health systems available to them often aren’t equipped to cope with the demand.

Mental illness takes a significant toll on your ability to function in any job. When you’re a single mom and have the added pressure of being the sole breadwinner, depression, anxiety and PTSD can cripple your ability to cope, with devastating financial consequences.

Which is why World Vision staff working in the slums of Nairobi, Kenya, recognized that something had to be done for the mental health needs of women in the community. It wasn’t enough to educate women, provide primary health program and develop their livelihoods: World Vision also had to help women deal with the stress of their everyday lives, and trauma that they had already suffered.

Community support makes all the difference
World Vision, in partnership with the Ministry of Health and the community, undertook a clinical trial of Problem Management Plus (PM+), a mental health tool created by the World Health Organization that assists adults who are exposed to adversity.

PM+ uses five 90 -minute sessions over five weeks to help women manage stress and problems and build social supports so they can be productive. It may not seem like a lot, compared with the robust care people here in Canada might receive for mental illness. But for a woman who has never had this kind of support, the relief they feel at being able to talk to someone about their experience is profound.

By training community health workers, PM+ was made accessible to the people right in their homes. It was also discreet, as neighbours didn’t know what kind of illness the workers were paying a visit for.

Two women sit across from each other on plastic chairs, holding papers, while one talks.
Community health workers in Kenya train in a PM+ workshop. Photo: World Vision Kenya

“There is some heaviness we ladies experience that we can’t tell our relatives,” one woman said. I can imagine the kinds of things she’s referring to: grinding poverty, losing children, unpredictable political situations, gender-based violence. But the confidentiality of the community health program allowed her to “feel at ease and share.”

Taking away the devils
The study concluded that the 209 women who received PM+ had much higher improvement than the 212 who received the usual care from nurses at local clinics. They missed fewer days of work, and suffered less of the symptoms associated with their mental illness.

One woman told the health workers that before the program, she was planning to kill her son and herself with rat poisoning due to her depression. But after talking with the workers, she learned breathing exercises and other coping mechanisms that, she says, “take away the devils”.

In areas like Nairobi, support like this is vital to the survival of communities and families. Of the 2313 women screened for the program, 50% had experienced sexual violence, and 75% had been physically assaulted. A full 36% of the women showed clinical levels of psychological distress and low functioning. How can communities thrive when 36% of its women experience a debilitating illness with little chance of care?

Helping more people, more ways
World Vision is now working with the Kenyan Ministry of Health to train healthcare staff in PM+. These professionals will then pass on their knowledge to other health professionals, so the whole healthcare system will be ready to deal with the devastating effects of anxiety, depression and PTSD.
A smiling woman holds a little boy in an orange Halloween pumpkin shirt.Mental health programs help women in Kenya lead better lives. Photo: Zipporah Kageha, World Vision

I can’t tell you how much hope this brings me. I am so glad that I work for an organization that takes gender-based violence and mental illness seriously. My own career and life choices may have led me into the situations that caused my PTSD. Coming home meant a reprieve from the violence and harassment. But for women and girls in the developing world, there is no escape.

No escape, except through programs like World Vision’s development projects. Holistic health, economic opportunities, and education allow women and girls to take charge of their own future and find a way out of the cycle of gender-based violence. Will you participate in bringing hope to girls and their communities? Sponsor a girl child today.