In Zimbabwe, Friendship Bench therapy reduces prevalence of depression to less than 14 percent, compared to 50 percent in control group; First at-scale model of community mental health care in Africa has diagnosed and treated over 27,500 people for common mental health disorders
Toronto / Harare — Their offices are simple wooden seats, called Friendship Benches, located in the grounds of health clinics around Harare and other major cities in Zimbabwe.
The practitioners are lay health workers known as community “Grandmothers,” trained to listen to and support patients living with anxiety, depression and other common mental disorders.
But the impact, measured in a ground-breaking study, shows that this innovative approach holds the potential to significantly improve the lives of millions of people with moderate and severe mental health problems in countries where access to treatment is limited or nonexistent.
Six months after undergoing six weekly “problem solving therapy” sessions on the Friendship Benches, participants showed significant differences in severity of depression, anxiety, and suicidal thoughts based on locally-validated questionnaires: the Shona Symptom Questionnaire (SSQ), the Patient Health Questionnaire (PHQ) and the Generalised Anxiety Disorder scale (GAD).
Funded by the Government of Canada through Grand Challenges Canada, the randomised controlled trial was conducted by the University of Zimbabwe, the London School of Hygiene & Tropical Medicine and King’s College London.
The study is published Dec. 27 in JAMA, the world’s most widely-circulated medical journal.
Striking results
* Patients with depression or anxiety who received problem-solving therapy through the Friendship Bench were more than three times less likely to have symptoms of depression after six months, compared to patients who received standard care.
* They were also four times less likely to have anxiety symptoms and five times less likely to have suicidal thoughts than the control group after follow-up.
* 50 percent of patients who received standard care still had symptoms of depression compared to 14 percent who received Friendship Bench (based on PHQ).
* 48 percent of patients who received standard care still had symptoms of anxiety compared to 12 percent who received Friendship Bench (based on the GAD),
and
* 12 percent of patients who received standard care still had suicidal thoughts compared to 2 percent who received Friendship Bench (based on SSQ).
The Friendship Bench intervention was also shown to be well suited to improve health outcomes among highly vulnerable individuals. 86 percent of the study’s participants were women, over 40 percent were HIV positive, and 70 percent had experienced domestic violence or physical illness.
Lead author of the study Dr. Dixon Chibanda, a consultant psychiatrist in Harare, co-founded the Friendship Bench network in response to the appalling shortage of evidence-based treatment for people with mental disorders in Zimbabwe, a problem common throughout Africa.
While about 25 percent of the country’s primary care patients suffer from depression, anxiety and other common mental disorders, Zimbabwe (population 15 million) has only 10 psychiatrists and 15 clinical psychologists.
“Common mental disorders impose a huge burden on all countries of sub-Saharan Africa,” says Dr. Chibanda. “Developed over 20 years of community research, the Friendship Bench empowers people to achieve a greater sense of coping and control over their lives by teaching them a structured way to identify problems and find workable solutions.”
With CDN $1 million in funding from Grand Challenges Canada earlier this year, the Friendship Bench has since been scaled to 72 clinics in the cities of Harare, Gweru and Chitungwiza (total population 1.8 million). Through collaborating with a Médecins Sans Frontières psychiatric program in Zimbabwe, the Friendship Bench is working to create the largest comprehensive mental health program in sub-Saharan Africa.
To date, over 27,500 people have accessed treatment.
“In developing countries, nearly 90 percent of people with mental disorders are unable to access any treatment,” says Dr. Peter A. Singer, Chief Executive Officer of Grand Challenges Canada. “We need innovations like the Friendship Bench to flip the gap and go from 10 percent of people receiving treatment, to 90 percent of people receiving treatment.”
“In many parts of Africa, if you are poor and mentally ill, your chances of getting adequate treatment are close to zero,” says Dr. Karlee Silver, Vice President Programs at Grand Challenges Canada.
“In Zimbabwe, that’s changing thanks to the Friendship Bench, the first project with the potential to make mental health care accessible to an entire African nation.”
In 2017, the team will focus on expanding the model to reach other vulnerable populations, including youth and refugees. In partnership with the Swedish NGO SolidarMed, the team intends to expand implementation of this model in Masvingo province and subsequently in the refugee centres of the eastern highlands on the border with Mozambique.
“The Friendship Bench team, working with the Zimbabwe Ministry of Health, has been able to substantially scale up services for some of the most deprived people in the community,” says Dr. Shekhar Saxena, Director of Mental Health and Substance Abuse at the World Health Organization.
“By supporting the uptake of mental health innovations like the Friendship Bench, Canada is helping to turn the tide in the global mental health challenge.”
The study was conducted from September 2014 to June 2015, and involved:
* Identifying participants at 24 primary care clinics in Harare, divided into an intervention group (287 participants) and a control group (286). Total participants: 573
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Grand Challenges Canada is dedicated to supporting Bold Ideas with Big Impact in global health. We are funded by the Government of Canada and we support innovators in low- and middle-income countries and Canada. The bold ideas we support integrate science and technology, social and business innovation – we call this Integrated Innovation. Grand Challenges Canada focuses on innovator-defined challenges through its Stars in Global Health program and on targeted challenges in its Saving Lives at Birth, Saving Brains and Global Mental Health programs. Grand Challenges Canada works closely with Canada’s International Development Research Centre (IDRC), the Canadian Institutes of Health Research (CIHR) and Global Affairs Canada to catalyze scale, sustainability and impact. We have a determined focus on results, and on saving and improving lives.
www.grandchallenges.ca
National Public Radio, USA, The Friendship Bench Can Help Chase The Blues Away, click here
SciDev, UK, Bench talk boosts mental health in Zimbabwe, click here; French: Des méthodes innovantes pour stimuler la santé mentale au Zimbabwe, click here
Press Trust of India, ‘Friendship Bench’ may help fight mental illness, click here
BBC World Service English to Africa, Focus on Africa, starts at the 15:30 mark, click here,
BBC Swahili, UK, Gumzo la benchi, tiba ya magonjwa ya kiakili, click here
Newser, USA via Fox News, ‘Friendship Bench’ chats ease symptoms of depression, says study, click here
Medical Daily, USA, Are ‘Friendship Benches’ The Cure For Depression, Anxiety In Poor Countries?, click here
IndoAsian News Service, India, Community-based Therapy May Alleviate Depression, Anxiety: Study, click here
Newser, USA, 5 most incredible discoveries of the week, click here
Upworthy, USA, This country has only 10 psychiatrists. That’s where ‘professional grandmothers’ come in, click here
Agencia EFE, Spain Charlas Semanales Con Abuelas Reducen Dramaticamente Enfermedades Mentales (Weekly talks with grandmothers dramatically reduce mental illness), via Yahoo News, USA, click here
South Africa Broadcasting Corp.
Ontario Farmer, Canada helps Zimbabwe with bench strength
Forskning, Norway, Mindre depresjon med bestemor på en benk, click here
Psychology Today, USA, What if You’re Depressed or Anxious and Can’t Find Help? Friendship Benches offer a new tool in the fight against depression and anxiety, click here
FJ China (+ several other news sites), China, 这群大妈每天找人闲聊,却做着救人的大事被称为“黄金夫人, click here
Good News Network, USA, ‘Friendship Benches’ Alleviate Mental Illness Symptoms For Thousands, click here
Health Canal, USA, Friendship Bench therapy reduces anxiety and depression in Zimbabwe, click here
Psych Central, USA, Friendship Bench Therapy Proves Effective in Treating Mental Illness, click here
MedIndia, India, Friendship benches help reduce mental illness in developing countries, click here
MedScape, USA, Novel Strategy May Boost Access to Mental Health Care, click here
Quo, Spain, En este puedes confiar: nace el banco de la amistad (Psychology — In this you can trust: the Friendship Bench is born; It is a resource that has proven extremely useful for treating depression), click here
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News release in full, click here
Coverage summary, click here
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Study funded by Saving Brains shows Kangaroo Mother Care kids 20 years later are better behaved, have larger brains, higher paycheques, more protective and nurturing families
Two decades after a group of Colombian parents were shown how to keep their perilously tiny babies warm and nourished through breastfeeding and continuous skin-to-skin contact, a new groundbreaking study finds that as young adults their children continue to benefit from having undergone the technique known as Kangaroo Mother Care.
In young adulthood, they are less prone to aggressive, impulsive and hyperactive behaviour compared to a control group of premature and low birth weight contemporaries who received “traditional” inpatient incubator care. They are more likely to have survived into their 20s. Their families are more cohesive. They have bigger brains.
Supported by the Government of Canada through Grand Challenges Canada’s “Saving Brains” program, as well as Colombia’s Administrative Department of Science, Technology and Innovation (COLCIENCIAS), the study is published today in the journal Pediatrics.
“This study indicates that Kangaroo Mother Care has significant, long-lasting social and behavioural protective effects 20 years after the intervention,” says lead researcher Dr. Nathalie Charpak, of the Kangaroo Foundation in Bogotá.
The technique’s early impact was still present 20 years later for those who started life as the most fragile individuals, she says. Families trained in Kangaroo Mother Care were more likely to remain together and to be more protective and nurturing, reflected in their children’s lower school absenteeism, ability to express feelings, and reduced hyperactivity, aggressiveness and antisocial conduct as young adults.
“A premature infant is born somewhere in the world every two seconds,” says Dr. Peter A. Singer, Chief Executive Officer of Grand Challenges Canada. “This study shows that Kangaroo Mother Care gives premature and low birth weight babies a better chance of thriving. Kangaroo Mother Care saves brains and makes premature and low birth weight babies healthier and wealthier.”
What is Kangaroo Mother Care?
About 15 million premature infants are born each year, according to the World Health Organization. Preterm birth complications are the leading cause of death among children under 5, responsible for nearly 1 million deaths in 2015; many survivors face a lifetime of disability, including learning disabilities and visual and hearing problems.
Premature and low birth weight infants generally require extra care to avoid illness and death from secondary, preventable complications such as hypothermia and infection. This is a particular problem in developing countries, where incubators and similar technologies are often scarce, over-crowded or unreliable, as well as costly.
A trained Kangaroo Mother Care parent or caregiver becomes a child’s incubator and its main source of food and stimulation. The technique involves continuous skin-to-skin contact between caregiver and infant, with the baby nested in a “kangaroo” position on the caregiver’s chest as soon as possible after birth. The technique is accompanied by exclusive breastfeeding.
Kangaroo Mother Care also requires and prepares the mother and child to go home as soon as possible from the hospital, after which there is rigorous monitoring of baby and mother until the infant reaches one year of corrected age (the baby’s age based on due date rather than date of birth). Family solidarity around the frail child is a key element in the success of the Kangaroo Mother Care technique.
Revisiting Kangaroo Mother Care babies 20 years later
The Kangaroo Foundation research compared 18 to 20 year olds who, as premature and low birth weight infants, had been randomized at birth to receive either Kangaroo Mother Care (KMC) or traditional incubator care until they could maintain their own body temperature.
During that initial randomized control trial in 1993-96, researchers documented the short and mid-term benefits of KMC training on the infants’ survival, brain development, breastfeeding and the quality of mother-infant bonding.
In 2012-2014, 264 of the original participants who weighed less than 1800 grams at birth were re-enrolled (61% of infants that qualified).
Looking at mortality, the research found that KMC offered significant protection against early death. The mortality rate in the control group (7.7 percent) was more than double that of the KMC group (3.5 percent).
Among other results of the study:
- School: The KMC group spent about 23 percent more time in preschool and had less than half the rate of school absenteeism compared to the control group.
- Work: As young workers, their average hourly wages were almost 53 percent higher.
- Family: A higher percentage of KMC children (almost 22 percent) grew up living with both parents. The families of KMC children were found to be more stimulating, protective, and dedicated to their children compared to the families in the control group.
- Behaviour: Scores for aggressiveness and hyperactivity were 16 percent lower in the KMC group, particularly among less-educated mothers. Scores for externalization (the ability to express feelings, especially negative feelings), a trait associated with risk of juvenile delinquency, academic failure, and inadequate social adjustment, were 20 percent lower in the KMC group on average. The parents of KMC children also reported that their children exhibited less antisocial behaviour compared to the reports of the parents of the counterparts in the control group.
- Cerebral development: Compared with those in the control group, KMC participants had larger brains – significantly larger volumes of total grey matter, cerebral cortex, and left caudate nucleus, which plays a vital role in how the brain learns, specifically related to the storing and processing of memories.
- Overall IQ: Tests after 20 years show a small but significant (3.6 percent) advantage in overall intelligence (IQ) for the most fragile KMC babies (those with an abnormal or transient neurological exam at 6 months) compared to similar infants in the control group.
The world needs Kangaroo Mother Care
Dr. Charpak notes that as neonatal technology becomes more accessible throughout the world, more premature and low birth weight infants are saved with fewer serious consequences in later years.
“That is why the detection of ‘minor’ consequences becomes important,” she says. “Minor effects like mild cognitive deficits, lack of fine coordination, poor hearing or eyesight and attention deficit can often go undetected but have a profound effect on the lives of families.
“The findings of our 20-year KMC study should inform the modalities of medical, psychological and social postnatal interventions such as Kangaroo Mother Care so that we can continue to reduce the disorders caused by prematurity and low birth weight.”
Dr. Charpak says that this new knowledge must be used to extend KMC coverage to the 18 million premature and low birth weight infants born each year who are candidates for the technique.
“We firmly believe that this is a powerful, efficient, scientifically based health care intervention that can be used in all settings, from those with very restricted to unrestricted access to health care,” she says.
“This study demonstrates that Kangaroo Mother Care can make all the difference in the world for premature and low birth weight infants,” says Dr. Karlee Silver, Vice President Programs at Grand Challenges Canada. “Kangaroo Mother Care is a cost-effective, modern method of care that can and should be applied in every country.”
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About Grand Challenges Canada
Grand Challenges Canada is dedicated to supporting Bold Ideas with Big Impact in global health. We are funded by the Government of Canada and we support innovators in low- and middle-income countries and Canada. The bold ideas we support integrate science and technology, social and business innovation – we call this Integrated Innovation. Grand Challenges Canada focuses on innovator-defined challenges through its Stars in Global Health program and on targeted challenges in its Saving Lives at Birth, Saving Brains and Global Mental Health programs. Grand Challenges Canada works closely with Canada’s International Development Research Centre (IDRC), the Canadian Institutes of Health Research (CIHR) and Global Affairs Canada to catalyze scale, sustainability and impact. We have a determined focus on results, and on saving and improving lives.
http://www.
About Saving Brains
Saving Brains is a partnership of Grand Challenges Canada, Aga Khan Foundation Canada, the Bernard van Leer Foundation, the Bill & Melinda Gates Foundation, The ELMA Foundation, Grand Challenges Ethiopia, the Maria Cecilia Souto Vidigal Foundation, the Palix Foundation, UBS Optimus Foundation and World Vision Canada. It seeks and supports bold ideas for products, services and implementation models that protect and nurture early brain development relevant to poor, marginalized populations in low- or middle-income countries.
http://www.
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Example coverage:
Newswires / syndicates:
Reuters, UK, Skin-to-skin ‘kangaroo’ baby care tied to better health years later, click here
Agencia EFE, Spain, Los beneficios de método canguro para bebé prematuros duran décadas, dice un estudio, click here
HealthDay, USA, ‘Kangaroo Mother Care’ May Improve Preemies Lives into Adulthood (via US News and World Report), click here
Deutsch Presse Agentur, Germany, Känguru-Methode kann Frühchen lebenslang nützen (Kangaroo method can improve premature life), click here; in Spanish: Los bebés prematuros se benefician del contacto constante con la piel de la madre, según estudio, click here
Anadolu Agency, Turkey, “Kanguru bakımı” çocukların sağlığını ve zekasını olumlu etkiliyor, click here
IndoAsian News Service, India, Kangaroo mother care helps premature babies thrive, click here
Press Trust of India, Kangaroo cuddles can help premature babies thrive: study, click here
ANSA newswire, Italy, Pelle a pelle con mamma e papà, benefici ‘canguro-terapia’ durano decenni, click here
* * * * *
CBC, Canada, Kangaroo care for preemies shows profound power of touch, click here
BBC World Service (Health Check) 9 minutes long, starts ~16 min mark, click here
The Guardian, UK: ‘Kangaroo care’ makes premature babies healthier and wealthier, study finds, click here
Daily Mail, UK (page 23), How ‘kangaroo cuddles’ can help premature babies: Infants given skin-to-skin contact with mothers develop better than those placed in incubators, click here
The Telegraph, UK, ‘Kangaroo mothering’ helps boost a child’s health and intelligence, study finds, click here
Huffington Post, USA: Incredible Study Shows Cuddling Preemies Helps Them For Decades click here
Forbes, USA, Kangaroo Care Still Benefits Preemies 20 Years Later, click here
NBC News, USA, Cuddling Preemies Kangaroo Style Helps Into Adulthood, click here
LiveScience, USA, Benefits of ‘Kangaroo Mother Care’: Do They Last?, click here
O Globo, Brazil: Método canguru faz prematuros serem adultos mais saudáveis e promissores (Kangaroo method makes premature babies are healthier and more promising adults), click here
Deutsche Welle, Germany, Portuguese: Método canguru beneficia prematuros no longo prazo, click here
Psychology Today, USA, What We Can Learn from Kangaroos, click here
Topsante (via Yahoo News, France), Le peau à peau pour accompagner les bébés prématurés, click here
Die Welt, Germany, Känguru-Methode nützt Frühchen noch Jahre später, click here
Parents .com, USA, Babies Given Kangaroo Care Show Benefits Decades Later, click here
WebMD, USA, Kangaroo mothering ‘helps premature babies’, click here
Spektrum, Germany, Känguru-Methode hilft Frühchen über Jahrzehnte (Kangaroo care helps preemies decades later), click here
Medpage Today, USA, Kangaroo Care Linked to Long-Term Benefits, click here
Epoch Times, China, “袋鼠育儿法”有助于提升早产儿的健康和智力 “Kangaroo Parenting Act” to help improve the health and intelligence of premature children, click here
International Business Times, UK: How ‘kangaroo mothers’ help tiny, premature babies survive and thrive, click here
International Business Times, India: ‘Kangaroo mother care’ turns out to be vital for pre-term babies, click here
Sunday World, UK, ‘Kangaroo mothering’ helps premature babies thrive, click here
ORF Science, Germany, Känguru-Methode schützt Frühchen, click here
Helsingin Sanomat, Finland, Kenguruhoidetuilla keskosilla on aikuisena isommat aivot – ja palkkapussi, click here
Sveriges Radio, Sweden, För tidigt födda verkar gynnas av känguruvård, click here
HealthMag, Greece, Η αγκαλιά “καγκουρό” κάνει πιο υγιή και πιο έξυπνα τα παιδιά (The “kangaroo” hug makes healthier and smarter children), click here
HKN, Korea: 캥거루 케어’ 받은 아이, 똑똑하고 튼튼하다 (‘Kangaroo Care’ receiving child is smart and durable), click here
Klix, Bosnia and Herzegovina: Klokan metoda čini nedonoščad zdravijom i bogatijom (Kangaroo method seems premature babies healthier and richer), click here
Videnskab, Denmark: ‘Kængurupleje’ gavner for tidligt fødte bedre end kuvøse (‘Kangaroo Care’ benefit premature better than incubator), click here
Ethnos, Greece: Τα πρόωρα βρέφη γίνονται πιο υγιή και… πλούσια με τη φροντίδα «καγκουρό» (Premature babies are healthier and … rich with care “kangaroo”), click here
* * * * *
Full coverage summary, click here
News release in full, click here
]]>100+ presentations on cases worldwide, from Syria, Central America, Africa, Guantanamo Bay; Sexual violence as torture; Treatment and recovery from atrocities; Enforcing nations’ legal obligation to provide rehabilitation
Over 300 participants — 70% of them clinical professionals — from 80 nations will exchange expertise, experience and research on torture rehabilitation at the three-day event, organized by the Denmark-based International Rehabilitation Council for Torture Victims.
More than 100 presentations will address issues ranging from widespread torture in Syria, the refugee transit camps of southern Europe and elsewhere, the plight of Central American migrants, and a trio of talks on the US detention centre opened in 2006 at Guantanamo Bay, Cuba, where the denial of help to survivors is called “torture by other means.”
Torture thrives in the 21st Century. Amnesty International has documented cases over the past five years in more than 140 countries — three-quarters of all nations — leaving victims to deal with a range of long-term consequences.
Torture victims have the right to rehabilitation under the UN Convention against Torture and other Cruel, Inhuman or Degrading Treatment or Punishment. Only a small percentage of victims, however, have access to services says the IRCT, an umbrella organization with more than 150 member institutions worldwide.
The symposium is billed as the first global event to look in detail and across disciplines at how to deliver on the right to rehabilitation.
Symposium speakers include service providers, researchers, clinicians, lawyers, funders and policymakers.
Presentations are clustered around three questions:
- What works for who, where and why? Trends and developments in research on rehabilitation methods
- What are the challenges in implementing the right to rehabilitation?
- Getting the needed political, financial, legal and public support
- What can we learn from others? Sharing knowledge with other human rights and health sectors
A complete set of conference abstracts is available online:
Oral presentations: http://bit.
Posters: http://bit.
Torture by other means: The denial of rehabilitation help to Guantanamo Bay survivors
Three presentations, summarized in abstracts here: http://bit.
Says UK-based human rights expert and presenter Polly Rossdale, the condition of those subjected to detention and abuse at Guantanamo Bay since 2006 is “not adequately described by (post-traumatic stress disorder).”
And no single torture victim in the world today has received more international attention and support than Mustafa al-Hawsawi, according to two members of his defence team – Dr. Mitch Robinson of the US Department of Defence and Prof. Jess Ghannam, University of California, Berkeley.
Transported to multiple CIA black sites between 2003 and 2006 then transferred to Guantanamo Bay, Mr. al-Hawsawi’s case has been highlighted by the UN, the Inter-American Commission on Human Rights, NGOs such as Amnesty International, and others. Yet, he receives no formal rehabilitation.
Dr. Robinson and Prof. Ghannam argue that despite the Obama administration’s denunciation of torture, the United States continues a policy of government-sanctioned abuse by actively denying rehabilitation efforts, allowing victims to suffer for years from injuries inflicted.
Case study: Syria
It is estimated that up to one third of the 20 million people currently fleeing violence and conflict have been subjected to torture or ill-treatment or are secondary victims.
For more than three years, US human rights lawyer Christy Fujio has worked with doctors and lawyers in Syria documenting torture and other atrocities that have happened during that country’s bloody six-year civil war.
Ms. Fujio is among a committed group of human rights investigators gathering medical documentation of torture to build a strong, credible body of evidence to launch prosecutions when the conflict ends. All of these people know someone – a family member, friend, neighbour – who has been detained and tortured, often to death. Many of them have themselves been detained and tortured.
Her presentation is one of three related to Syria, summarized in abstracts online here: http://bit.
Sexual violence as torture
A deep stream of presentations relates to torture in the form of sexual violence against females and males (a collection of abstracts by experts from the UK, Australia, Congo, Senegal, Mexico, Denmark, Norway: http://bit.
Related issues include the restoration of victims’ dignity through livelihoods (abstract: http://bit.
Other topics include:
- Survivors of torture in detention, mass displacement camps, and post conflict settings, and victims of ongoing or systemic torture (abstract: http://bit.ly/2ghXuG3)
- Torture in the slums of Dhaka, Bangladesh (abstract: http://bit.ly/2f5t4F6)
- Treating elderly victims of torture and trauma (abstract: http://bit.ly/2fxXd0i)
- Rehabilitation of torture victims as a precondition to reconciliation in Bosnia and Herzegovina (abstract: http://bit.ly/2fGvwQF)
- Experiences of refugees transiting Serbia (abstract: http://bit.ly/2f5C7G9)
- Treating victims of torture in prison (abstract: http://bit.ly/2fi0VZf)
On the final day of the conference, a major workshop is devoted to the training of community mental health workers to deliver torture rehabilitation services in low resource, conflict-affected settings.
Keynote Speech – The Women of Atenco
In May 2006, Mexican police arrested 45 women selling flowers in the market square of San Salvador Atenco. They were responding to protests by a local peasant group and by the time the operation was over, two were dead, dozens were seriously injured and many of those arrested were sexually assaulted. Not a single person has been convicted as a result of the assaults.
Two of those women, Norma Jimenez and Italia Mendez, will be keynote speakers at the IRCT International Scientific Symposium. They will tell the story of the Women of Atenco, now known around the world because of their fight to bring the perpetrators to justice. The Inter-American Commission on Human Rights has filed an application with the Inter-American Court of Human Rights, noting the “existence of severe acts of physical and psychological violence, including diverse forms of sexual violence against 11 women and rape in the case of seven women”.
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Comments
“Centres worldwide involved in torture rehabilitation tend to work in isolation. This event is intended to help galvanize a sense of community, to develop an understanding within this inter-disciplinary field of the need to move forward together.”
“The rehabilitation of torture victims can take months or even years and is essential to allowing them to return to as full a life as possible. Addressing the damage created by torture takes time and requires long-term material, medical, psychological and social support.”
“States have a duty to provide rehabilitation but many countries do not live up to that obligation. By doing so, they are not only violating international law but also denying victims the care that they are entitled to and that they desperately need.”
— IRCT Secretary General Victor Madrigal-Borloz
“In providing rehabilitation services, practitioners have also developed in-depth knowledge essential to contributing toward the prevention of torture. Rehabilitation, in many ways, also affects the overarching goal of ending torture.”
“Unfortunately, rehabilitation centres, where they exist, are struggling to survive. The provision of rehabilitation must be sustainable, provided by countries and available to all victims until the practice of torture has been eradicated.”
— Edith Escareño Granados, General Coordinator, Colectivo Contra la Torture y la Impunidad, Mexico
International Rehabilitation Council for Torture Victims
Based in Copenhagen, Denmark, the IRCT is a health-based umbrella organization that supports the rehabilitation of torture victims and the prevention of torture worldwide.
Members comprise more than 150 independent organizations in over 70 countries, the largest membership-based civil society organization to work in the field of torture rehabilitation and prevention. Rehabilitation centres are working directly with clients, developing new treatment approaches, capturing data and ensuring as many victims as possible receive the best treatment possible.
These centres provide a high standard of specialized rehabilitation services to torture victims each year.
Despite an overwhelming demand for their services, many IRCT member centres are facing great financial challenges and some are struggling to survive. In recent years, seven member centres have either closed their rehabilitation section or closed down entirely and every year several are on the brink of closing.
The International Rehabilitation Council for Torture Victims (IRCT) concluded its fifth General Assembly 9 December 2016 with a resolution titled “The Mexico Consensus,” available online athttp://bit.
Coverage:
NY Times, Watching Trump, Many Fear a Leap Backward on Torture, click here
Agence France Presse, Posición de Donald Trump erosiona la prohibición absoluta de la tortura, click here
News release in full, click here
Coverage summary, click here
]]>20-Jun-2014
Calling global mental health problems “acute and urgent,” 37 leading medical authorities from 11 countries have published a joint declaration calling for basic mental health care in Africa.
The experts also call for global mental health objectives to be included among the United Nations’ post-2015 Sustainable Development Goals, for a special UN General Assembly High Level Meeting on Mental Health by 2017, and for efforts to end the stigma and human rights violations inflicted on mental health patients.
Published in the journal Global Health Action, the declaration was authored by 13 experts and others from eight countries including South Africa, Togo, Kenya, Mozambique, India, Sweden and Canada.
Adding their names to the declaration: 24 more authorities, from Nigeria, Tanzania, Egypt, Sweden and South Africa, site of a February meeting focussed on the mental health situation in Africa.
While action is needed worldwide, the experts say, nowhere is that need greater than in Africa, where mental health disorders account for “a huge burden of disease and disability, and where in general less than 1% of the already small health budgets are spent on these disorders.”
African and other member nations of the World Health Organization have adopted a Comprehensive Mental Health Action Plan, the authors say, and “Africa now has an historic opportunity to improve the mental health and wellbeing of its citizens, beginning with provision of basic mental health services and development of national mental health strategic plans (roadmaps).”
On 24 and 25 February 2014, a group of people with a common interest in mental health met at the Stellenbosch Institute for Advanced Study (STIAS) in South Africa at a roundtable meeting to address the topic: Mental Health Challenges in Sub-Saharan Africa: Moving to Implementation. Participants included representatives of persons with psychosocial disabilities, NGOs, policymakers, academics, research funders, service providers and others — from throughout Africa, Sweden, Canada, the US, Germany, and the World Health Organization (WHO).
“Mental, neurological, and substance use disorders constitute a very high burden of disease globally, and depression is the leading cause of disability throughout the world,” says lead author Prof. Abdallah Daar of the University of Toronto, lead author of the paper and a member of the UN Secretary-General’s Scientific Advisory Board.
“A growing body of scientific evidence shows that much can be done for treatment, at moderate additional costs, and with significant economic benefits to countries, while at the same time reducing suffering and improving, and often saving, the lives of those who are affected.”
At a global level, the paper notes, the 194 member states of the WHO (including those from Africa) have adopted the Comprehensive Mental Health Action Plan (MHAP) with the objectives of advancing the mental health agenda in the world. This plan is supported by technical tools like the mhGAP Intervention Guide for non-specialist health settings, to assist in scaling up services. In Africa, these provide important opportunities for country-led intervention.
“We believe that action is urgently needed, not just by governments and other groups as set out below but also by international donors who contribute to health budgets and influence health policy, the mental health professional community, medical and public health schools, research institutions, and research funding bodies.”
The group says an African National Mental Health Strategy and Plan (Roadmap) should, among other things, establish “parity in resources for mental and physical health alike”; integrate mental health care services into primary health care and provide resources for training, supervision and support for personnel dealing with the issue.
As well, the plans need to take a “life-course” approach, “recognizing that there are different needs at different stages in life such as pregnancy, infancy, childhood and older age, and that investment in early intervention can reduce later disability.”
Targeted action is required to address specific needs of women, the very poor, the homeless, and other groups, many of them “historically neglected.” “Such specific focus is necessary because these groups may have different risk factors, disease prevalence, and help-seeking behaviors.”
Among other recommendations, national strategic plans should
- Be “person-centered and holistic, providing psychological and social care as well as improving access to biomedical services;
- Respond to the mental health consequences of violence in society, especially against women and children;
- Provide evidence-based and culturally appropriate care; and
- Pay particular attention to the link between mental health and other health and development priorities like HIV/AIDS and maternal and child health: “Integrating mental health into other health and development initiatives provides an opportunity to improve outcomes in other sectors, while allowing efficient investment in mental health through these other programs.”
- Ensure availability of essential mental health medications and basic services; and
- Develop robust legislation against inhumane practices, such as institutionalization, imprisonment, isolation, discrimination in access to public goods, and other violations of human rights.
Some countries — such as South Africa and Ethiopia — have made progress in developing national mental health policy frameworks and strategic plans, offering other African countries a useful model to adopt, complemented by the WHO’s Comprehensive Mental Health Action Plan.
The public may sign a petition based on the declaration at: http://www.ipetitions.com/petition/declaration-on-mental-health-in-africa-moving-to
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News release in full, click here
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23 October 2013
4 projects nominated for grants up to $2 million;
10 projects awarded $270,000
Grand Challenges Canada, funded by the Government of Canada, today extended a total of $10.1 million to 14 bold, creative projects aimed at improving the early brain development of kids in low-resource countries.
Projects in Jamaica, Colombia, Bangladesh and Indonesia are scale-up award nominees (board-approved grants up to CDN $2 million, pending successful contract negotiations).
Seed grants of CDN $270,000 each are given to seven organizations overseas — in Vietnam (2 grants), Bangladesh, India, Kenya, Zambia and Peru. And three seed grants are given to Canadian organizations: the Hospital for Sick Kids, Toronto (two grants), and the University Health Network, Toronto.
All 14 projects will be implemented in developing countries: five in Africa, six in Asia and three in Latin America and the Caribbean.
“Impoverished brains result in impoverished countries,” says Dr. Peter A. Singer, CEO of Grand Challenges Canada. “For a wide range of sad, all-too-familiar and preventable reasons, an estimated 200 million children under 5 years old in the world’s 112 low- and middle-income countries will fail to reach their brain’s full development potential.”
“These projects illustrate well the success of our search for ‘bold ideas with big impact,’ pioneering new approaches worldwide to maximize the number of kids in low-resource countries who achieve and contribute to their fullest capabilities,” Dr. Singer added.
Says Mrs. Laureen Harper, honourary chairperson of the program: “The Grand Challenges Canada Saving Brains program is designed to help millions of children in developing countries who fail to reach their full development potential due to such factors as malnutrition, infection, birth complications, or a lack of nurturing and stimulation at an early age.”
Says the Honourable Christian Paradis, Canadian Minister of International Development and Minister for La Francophonie: “Our Government, under the leadership of Prime Minister Harper, is committed to advancing the health of the world’s most vulnerable mothers, newborns and children. We are proud to partner with Grand Challenges Canada to find innovative solutions to the most pressing global health challenges. The Saving Brains program is just one example of how innovation can help improve the lives of children in their earliest days. ”
Seed grant awards
Hospital procedures: mitigating harm of pain to brain development of a tiny preterm baby
The Centre for Global Child Health, Hospital for Sick Children (Toronto, Canada)
Working in Ghana, this project will introduce ways of alleviating pain for infants born prematurely and treated in special neonatal intensive care units (NICU)s — the tiniest of kids who experience moderate to severe pain several times daily due to diagnostic and therapeutic procedures such as blood sample collections and medicine injections.
Project leader Dr. Bonnie Stevens of Toronto’s Hospital for Sick Children says the severity of brain defects found later among children born preterm can be linked to the number of painful procedures experienced in the NICU.
“Higher volumes of painful procedures with inadequately managed pain have also been associated with cognitive, language and motor problems, and low academic achievement,” says Dr. Stevens. “Although the consequences of pain are known, procedural pain is frequently under-managed and under-prioritized.”
Worldwide, about 13 million infants are born preterm each year — a number growing steadily thanks to modern technologies. And even in North America, Europe and Australia, surveys show “neonates” are exposed to an average of 4 to 14 painful procedures daily, with only about 1 in 3 receiving pain relief.
Less is known about neonatal pain management in low- and middle-income countries, where the incidence of neonatal sickness and death is highest. However, a survey in Kenya showed that infants in seven special care newborn nurseries experienced, on average, four painful procedures daily, half of them injections and blood sample withdrawals. No form of analgesia was documented.
The project will introduce Ghanaian caregivers and parents to an integrated “Toolkit for Minimizing the Impact of Pain in Infants,” adapted from successful practices in Canada. Videos and other educational materials will detail simple, universally affordable, proven ways to mitigate procedural pain for an infant, such as:
- Sweet solutions (e.g., sucrose or glucose) administered orally prior to a painful procedure;
- Kangaroo care, where infants are held in skin-to-skin contact with a parent;
- Facilitated tucking, where infants are held in a fetal-like position to provide support and boundaries;
- Breastfeeding.
Combined, these interventions have a demonstrated cumulative pain-relieving effect.
“Inadequate resources are cited as the major impediment to pain management in infants as well as a lack of knowledge, severe staff shortages and formal training about pain. The proposed Toolkit intervention will address these issues,” says Dr. Stevens.
The project draws on existing partnerships between the University of Ghana School of Nursing, Korle Bu Teaching Hospital in Accra and Toronto’s Hospital for Sick Children, together training 1,000 pediatric nurses in Ghana over the next 10-15 years, supported by a Canadian government grant. Plans calls for the toolkit’s integration into the curriculum at the School of Nursing (where there is limited pain content) and its use scaled up to reach additional countries.
Says Dr. Stevens: “Decreasing the intensity of painful procedures in hospitalized infants using simple, inexpensive, evidence-based strategies has the potential to minimize both immediate stress and suffering, and the known longer-term impact of pain on the developing neonatal brain and cognitive deficits.”
Malaria in the womb: New malaria policies to protect early brain development in Malawi
University Health Network (Canada)
Each year, about 125 million pregnant women are at risk of placental malaria (PM) and about 25% of all pregnancies in sub-Saharan Africa are complicated by PM at delivery.
PM has profound maternal and fetal health consequences, including increased risk of anemia, preterm birth, fetal growth restriction and delivery of low birth weight infants. The impact of in-utero malaria exposure on fetal neurodevelopment is unknown, however researchers with the project team recently linked malaria-exposure in animals with persistent and long-term deficits in memory and behaviour.
Dr. Kevin Kain of the Toronto-based University Health Network, leader of this project in Malawi, says malaria exposure in the womb “may derail the developmental trajectory of generations of children.” And a shift in understanding — that malaria exposure may result not just in infant mortality and low birth weight but affects also long-term neurodevelopment “represents a change in paradigm that will initiate a re-evaluation of public health policies designed to protect women and children from the deleterious consequences of PM.”
Today’s approach to this problem — intermittent preventive treatment of pregnant women with sulfadoxine-pyrimethamine — is losing effectiveness due to rising drug resistance, resulting in persistent infections.
The new project involves a novel antenatal care policy that focuses resources on accurate point-of-care malaria diagnosis and effective case- management of infection to reduce the burden of malaria in pregnancy and protect early brain development.
The work is expected to provide “compelling evidence that will directly impact national and international policies on the prevention of malaria in pregnancy. If our findings support an intervention that leads to improved neurocognitive outcome for exposed infants, it will refocus public health policies towards protecting fetal brain development.”
Project collaborators include the University of Malawi, and the University of Liverpool, UK.
An Integrated Toolkit to Save Newborns’ Brains in Kenya
The Centre for Global Child Health, Hospital for Sick Children (Toronto, Canada)
The first month of life is a critical period in brain growth and development that can be affected in many ways, including from hypothermia and infection.
Reducing the number of these impediments to young brain growth is the aim of a toolkit created by Toronto’s Hospital for Sick Kids for use initially by mothers in Kenya.
Contents of the tool kit (which costs less than $5) include:
- A clean delivery kit to minimize infection at time of delivery
- A sterilizing gel that, applied to the umbilical stump, reduces certain severe infections by 75% and mortality from all causes by 25 to 40%;
- An emollient to promote skin integrity, helping to reduce infection and prevent hypothermia (and shown to reduce mortality in hospitalized preterm infants)
- A handheld scale to spot early warnings signaled by an infant’s weight, and a ThermoSpot to identify hypothermia and fever
- A mylar infant sleeve and reusable heating device to treat hypothermia
Information on infant stimulation, involving play and communication strategies proven beneficial to neurodevelopment in low birth weight newborns.
If any danger signals are found, community health workers will refer cases to appropriate health care.
“We believe that improved neurodevelopment outcomes at age 1 will translate into sustainable longer term gains in academic performance, employment, productivity, and ultimately more human capital,” says project leader Dr. Shaun Morris of the Hospital for Sick Kids.
Project collaborators include the Aga Khan University, Kenya.
Iron-fortified biscuits to reduce maternal and child anemia
St John’s Research Institute, Unit ofCBCI Society for Medical Education, Bangalore, (India)
Anemia — a low level of red blood cells causing a body’s reduced capacity to carry oxygen — results from micronutrient deficiencies, most often iron.
India has one of the highest rates of anemia globally: over 79% of children aged 6 to 8 months and 58% of the 26 million pregnant women each year. Some 17 million of these women have access to iron pills yet 11 million do not take them for the recommend time (adherence rate: 35%). Why? The pill is big and tastes metallic.
Yet iron deficiency anemia dramatically affects the health of a pregnant woman and her unborn baby, increasing risks of death and sickness during childbirth, including hemorrhage and low-birth weight. Long-term, iron deficiency anemia delays psychomotor development and impairs cognitive development in infants, preschool and school-aged children around the world.
Moreover, researchers say, the effects of anemia are, “not likely to be corrected by subsequent iron therapy… anemic children will have impaired performance in tests of language skills, motor skills, and coordination, reportedly equivalent to a 5 to 10 point deficit in IQ.”
Part of the answer may be an iron-fortified biscuit for use by pregnant women, indistinguishable in taste from popular Indian biscuits.
Coupled with marketing, project leaders say their new biscuit is more likely to be used by previously non-adherent pregnant women, and increase iron stores in newborns, “which translates to more sustainable and protected early brain development.”
“After extensive consumer research, the nutrition team led by Dr A.V. Kurpad and the project collaborators, Violet Health Inc have developed several prototypes specifically designed with the tastes and preferences of pregnant women in India,” says project leader Dr. Pratibha Dwarkanath of St John’s Research Institute, unit of CBCI Society for Medical Education.
“We estimate our solution to be more cost-effective than the iron pill, while reaching more anemic women and their children”
“After proof of concept, we anticipate a scaled trial in Karnataka within three years and reducing anemia in women and infants.”
Project collaborators include Violet Health, Inc., NY, and the Indian Institute of Management, India Bangalore.
And many others: News release in full: here
Example coverage:
The Hindu, click here
New Indian Express, click here
Africa Science News Service, click here
Agencia EFE, click here
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10-Oct-2012
On World Mental Health Day, Grand Challenges Canada funds a burst of 15 innovative projects spanning the globe — Asia, Africa, Caribbean
Grand Challenges Canada, which is funded by the Government of Canada, today announced a landmark $19.4 million in support of 15 innovative, pioneering projects designed to improve mental health diagnosis and care in developing countries, many of them nations ravaged by conflict and disaster as well as poverty. The projects were selected through competitive scientific peer review from among 97 ideas submitted in response to a Grand Challenge to propose innovations that increase access, improve treatment, and address stigma for people with mental health disorders in developing countries.
Globally close to 450 million people have mental health disorders; more than 75% of that number live in developing countries. And, according to the World Health Organization, 85% of developing world patients with serious mental disorders receive no treatment at all.
“Mental health disorders are a leading cause of suffering and disability everywhere, but the problem is especially acute in the developing world,” said Dr. Peter A. Singer, CEO of Grand Challenges Canada. “There is very little funding for mental health innovations in low- and middle-income countries, where mental illness is the most neglected of many neglected diseases. It’s a terrible denial of human potential.”
“Canada has a long and proud tradition of fostering innovation to improve the lives of people living in some of the most desperate situations, ” said the Honourable Jim Flaherty, Minister of Finance for Canada. “Global Mental Health is a significant challenge which, left unaddressed, could undermine the health, social and economic futures of developing countries.”
15 projects in 14 low and middle income countries will test bold new ideas for addressing mental health issues, where patients are often severely stigmatized – even chained or locked up in the absence of understanding or care.
News release in full, click here
Example coverage by: Agence France Presse, click here; by the InterPress News Service, click here; by the BBC, click here
More coverage links and summary, click here
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