永續發展｜生命的守護者：奶奶們的奇蹟故事 As trained talk therapists, Zimbabwean grandmothers are saving lives

世界上許多奶奶們都因其豐富的經驗與智慧受到尊重，特別是在非洲，奶奶們更是受到崇敬。因此他們被一項拯救生命的心理健康計畫「友誼長椅（Friendship Bench）」所招募。

在心理疾病被汙名化的辛巴威（Zimbabwe），有些地方甚至認為精神病患者是被「附身」。

「辛巴威的自殺率在全世界中有著高排行，而這有著1,500萬人口的南非國家，卻只有15名精神科醫生，包括意識到該嚴重性的Dixon Chibanda醫生。」

Chibanda醫生的轉捩點發生在十多年前：當時他正在治療一位有自殺傾向的年輕女性，但她未能如約回診，經詢問後他從女子的母親那裡得知：女子其實付不起從鄉村到首都Harare的15元公車費，而最後，自殺還是發生了。

這個事件讓Chibanda醫生決定做出改變。

「我明白只期望人們來就診是不夠的。」然後，他突然想到：「在非洲，我們最可靠的資源就是奶奶們，每個社區都有奶奶，為什麼不訓練奶奶們進行以證據為基礎的談話療法呢？」

因此，Chibanda醫生在2006年首次與在Harare市的Mbare小鎮的奶奶們合作。如今已有逾2,000位奶奶藉由參與「友誼長椅計畫」，在辛巴威全國100個社區中提供幫助。「友誼長椅計畫」得名於這些治療師志工通常會坐在位於醫院前的簡樸木質長椅上，聆聽人們的問題並給予關懷。

迄今，有數以萬計的人們因這項計畫獲得了幫助，並且不需要預約、面對令人緊張的繁瑣程序以及被批判的恐懼。

「在像辛巴威這樣的國家，精神病是令人羞恥的，因此，使用能被人們所接受的用語非常重要。」友誼長椅計畫的現任首席執行長Chibanda醫生表示。

因此，這些奶奶們不說憂鬱症，他們使用「kufungisisa」的詞來代替，這在辛巴威的的通行用語Shona中有點類似過度思考的意思（譯者：無法直譯，對於負面思考的負面標籤，亦感抱歉）。而且，這些年長的婦女們比起醫生更容易被辛巴威人所接受。

負責財務與集團業務的董事會成員Michael Schmelmer表示：「這個計畫已被證明非常成功，因為這些奶奶們能幫助人們建立社區中的歸屬感，並展現驚人的同理心。而百靈佳殷格翰一直都是「友誼長椅計畫」的長期支持者，因為我們認為精神健康是影響各年齡層數百萬人生活的重大議題，這也是為什麼我們也專注在相關的研究上。」

「在非洲，我們最可靠的資源就是奶奶們，每個社區都有一些奶奶，為何不培訓她們進行證據導向的談話療法呢？」-Dixon Chibanda醫生。

他們使用「kufungisisa」的詞來代替，這在辛巴威的的通行用語Shona中有點類似過度思考的意思（譯者：無法直譯，對於負面思考的負面標籤，亦感抱歉）。

此外，這些年長的女士們比醫生更容易受到人們的接納。

如今，已有逾2,000位奶奶藉由參與這個計畫，並在辛巴威全國100個社區中提供幫助。

「在像辛巴威這樣的國家，精神病是令人羞恥的，因此，使用能被人們所接受的用語非常重要。」－友誼長椅計畫的現任首席執行長Chibanda醫生。

照顧弱勢族群

自本世紀初以來，辛巴威面臨經濟、暴力、飢餓、疾病與醫療資源稀缺的衝擊，諸如流行病或乾旱引起的飢餓不斷地重演，更加劇了這些問題的挑戰。因此，友誼長椅的奶奶們，在社會、文化與公共衛生效益上扮演了極其重要的社會角色。

「我們的臨床研究顯示，與奶奶定期見面的患者，從第一次在長椅上的會談後六個月都沒有再發作，奶奶比醫生更有效地治療了憂鬱症。」Chibanda醫生說道。

Chibanda醫生和他的同事正積極將這個計畫推廣到其他國家，Chibanda醫生說：「全球65歲以上的人口超過6億，想像一下，如果我們能在全世界每個首都建立一個全球心理培訓的奶奶組織，這將對社會產生巨大的影響，並填補治療的差距。」

SUSTAINABILITY

As trained talk therapists, Zimbabwean grandmothers are saving lives

Grandmothers, worldwide, are respected as experienced and wise. In Africa, they are particularly revered — which is why they have been enlisted for the “Friendship Bench,” a life-saving mental health program in Zimbabwe.

In Zimbabwe, mental illness is stigmatized; in some places, those affected are even thought to be possessed.

“Zimbabwe has 15 million people, but only 15 psychiatrists, including Dr. Dixon Chibanda. The Southern African country also has one of the world’s highest rates of suicide — as Dr. Chibanda knows all too well.”

The tipping point for Dr. Chibanda came more than a dozen years ago, after a suicidal young woman he was treating didn’t keep her scheduled appointment. Making inquiries, he learned from her mother that the daughter hadn’t come because she couldn’t afford the $15 bus trip from the countryside to his office in Harare, the nation’s capital. Instead, she killed herself.

That’s when Dr. Chibanda decided something had to change.

“It became clear to me that it won’t work when I expect people to come to see me,” Dr. Chibanda says. Then it dawned on him: “The most reliable resource that we have in Africa are grandmothers. There are some in every community, so why not train grandmothers to conduct evidence-based talk therapy?”

And so, in 2006 Dr. Chibanda started working with his first group of grandmothers in Mbare, a township in Harare. Today, more than 2,000 grandmothers provide help in more than 100 communities across Zimbabwe as part of the project, known as Friendship Bench. It is so named because these volunteer therapists sit on simple wooden benches, often in front of hospitals, and listen to people’s concerns and issues.

So far, tens of thousands of people have received help through the program — without appointments or attempting to navigate a nerve-wracking bureaucracy or the fear of being judged.

“In a country like Zimbabwe, where mental illness is shameful, it is important to use language that is accepted by people,” says Dr. Chibanda, who is now CEO of the Friendship Bench program.

And so grandmothers don’t talk about depression. Instead, they use the word “kufungisisa”— which in the Shona language that’s widely spoken in Zimbabwe, means “thinking too much.” What’s more, these older women are much more readily accepted by Zimbabweans than doctors are.

Boehringer Ingelheim has been a long-time supporter of the Friendship Bench program. “This concept has proven to be very effective, as the grandmothers help people feel rooted in the community and are amazingly empathetic,” says Michael Schmelmer, Member of the Board of Managing Directors with responsibility for Finance and Group Functions.

“We in Boehringer Ingelheim support this project as we, too, believe that mental health is an issue of huge concern, touching the lives of millions of all ages,” Mr. Schmelmer says. “This is why we also focus on mental health in our research. Initiatives like this can make a big difference in the lives of people.”

"The most reliable resource that we have in Africa are grandmothers. There are some in every community, so why not train grandmothers to conduct evidence-based talk therapy?"

Dr. Dixon Ch banda

Grandmothers don't talk about depression.

They use the word "kufungisisa," which in Shona, the language widely spoken in Zimbabwe, means "thinking too much."

In addition, the older ladies are much more readily accepted by the population than doctors.

Today, more than 2,000 grandmothers provide their help in over 100 communities across

Zimbabwe as part of the project.

“In a country like Zimbabwe, where mental illness is shameful, it is important to use language that is accepted by people.

”Dr. Dixon Chibanda,
Founder and CEO of the Friendship Bench program

Administering to the vulnerable

Since the beginning of this century, Zimbabwe has been dealing with socio-economic challenges, violence, hunger, disease and a neglected healthcare system worsened by intermittent shocks, including pandemics and drought-induced hunger.

And so, the Friendship Bench grandmothers are providing an important social, cultural and public health benefit.

“Our clinical study,” Dr. Chibanda says, “shows that patients who met regularly with a grandmother were still symptom-free six months after their first session on the bench. Grandmothers can treat depression more effectively than doctors.”

Dr. Chibanda and his colleagues are working to expand the project to other countries. “There are more than 600 million people worldwide who are older than 65,” he says. “Imagine if we could establish a global network of grandmothers trained in psychology in every capital in the world. That would make an enormous difference in the communities and close the treatment gaps.”