Fieldset
"This world is beautiful with people": Mental health in kuchlak

Stress can have a huge impact on mothers and babies. In the rural town of Kuchlak, Pakistan, Rosy meets a team of counsellors making a real difference to families living in challenging circumstances...

Rosy Lee and members of the Kuchlak counselling team

The mother and child health care clinic in Kuchlak is a 20 minute drive out of Quetta down a dusty highway in a beige landscape that only recently sprang with bits of greenery. It’s desert country, and sits amongst a natural amphitheater of mountains.

On clear days when the dust is settled, the mountains are breathtaking and remind me of the Rockies back in Canada.

As the Human Resources and Finance Manager, I have little to do with the day-to-day medical activities but everything to do with our staff. It’s a position that holds me in the center of things, giving me good reason to get out of the office and have a presence on the ground where the majority of our staff work.

At the clinic, I am a sympathetic ear for the concerns of staff, allowing me the opportunity to take the pulse of the team.

Tireless support

Perhaps it is this people-oriented approach that made me gravitate towards the work of our mental health team. Each day, the four psychosocial counsellors – Malek, Mewish, Laiba, and Aminullah – work tirelessly to support the outpatient department and ambulatory therapeutic feeding centre, the Birthing Unit, and our cutaneous leishmaneisis treatment facilities in an integrated approach.

Not only does this team use empathy and extraordinary listening powers to support our patients, but their work blends seamlessly with the clinic’s other medical activities to support the work of all our medical staff.

An integrated approach: Empowering patients and addressing underlying issues

Integrate (verb) – to form, coordinate, or blend into a functioning or unified whole.

In a day and age where mental illness is on the rise in Europe and North America, our small mother and child health clinic in Pakistan is no exception...

Cutaneous leishmaneisis patients face stigmatization from their communities for their disfiguring lesions, postpartum depression is found in the Birthing Unit, and marital challenges are common.

In the therapeutic feeding centre for children with malnutrition, mothers experience depression and anxiety from the stress of raising large households in an impoverished environment. With one of the highest birth rates in the world, the average family in Balochistan has six children.

We are all realizing we have the same problem, we get strength from each other

“If you are affected physically, it also affects your mental health,” Mewish told me. I am sitting with her and Laiba in the women's mental health room which is lined with orange cushions around its perimeter. “So when you give importance to the physical, you should also give importance to the mental.”

“Symptoms are physical, thoughts, and behaviour,” Laiba adds. “If one position is disturbed, the others also have a disturbance. First, we help her realize she has a behaviour problem or thought. Then we make her mind positive.”

Mewish and Laiba are explaining to me the connection between physical and mental health issues. Not only does a patient’s mental health lead to direct physical manifestations – such as in the case of stress – but mental health often affects the success and sustainability of the treatment for other issues.

Often we can’t change their situation, but with counselling we can help them cope with their stress and realize their own potential

The counsellors tell me a story about a malnourished baby who was not gaining weight after multiple follow-ups in the feeding centre. Eventually, the team referred the baby to the mental health team where the mother was diagnosed with depression.

In their sessions, the mother was encouraged to form attachments with her baby through breastfeeding and physical contact. A few weeks later, the team was delighted to see that the baby had gained several life-saving pounds.

“Often we can’t change their situation, but with counselling we can help them cope with their stress and realize their own potential.”

Support group sessions and the healing power of community

The team also facilitates support group sessions, which have proven to be an effective way to address common issues while also managing the growing number of patients who need mental health support.

Laiba and Mewish admit that people are not always immediately receptive to counselling. They often want medicine and the mental health team is challenged to build trust and consensus amongst patients. “In the groups, we explain the symptoms and we let the patients agree that yes, we have this problem,” Laiba says. “They discuss how they feel. How they cope with stress. We are all realizing we have the same problem, we get strength from each other.”

This world is beautiful with people. We are not meant to be lonely

In Kuchlak, the support group sessions have been a great source of support for patients -- so much so that members from the community come to the maternal child health centre seeking the groups. “They are communicating with each other and spreading the message,” Mewish says, happy at the prospect that her lessons are reaching beyond the clinic walls into the surrounding communities.

“People are meant to be together”

I am sitting with Malek, our mental health supervisor. He has been working for MSF since 2009 when the mental health activities in Kuchlak maternal and child health centre were focused on supporting war refugees from Afghanistan.

Back then, the mental health team was only three people: Malek, a senior counsellor named Fozia, and their supervisor Sue Petri, who I can tell has had a profound impact on Malek’s personal and professional development.

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He tells me about the history of the mental health activities in Kuchlak. Back in 2008, two years after the clinic opened, a significant number of patients were observed complaining about aches and pains with no apparent physical condition. In many cases, an assessment revealed the cause to be psychosomatic.

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Rosy Lee and members of the Kuchlak mental health team
From left to right: Laiba (Counsellor), Aisha (LHV Supervisor), Mewish (Counsellor), Rosy (HR & Finance), Palwasha (Community Health Worker), Maryrose (Midwife Manager), Razia (Community Health Worker), Saima (Community Health Worker)

From  2014, the direction of the clinic shifted from caring for war-related stressors towards supporting mother and child health issues. At the same time, the strategy for the mental health team shifted to the integrated approach.

Malek tells me about how rewarding he finds his work. Not only does he find meaning in his role as a supervisor, passing on the knowledge he once received to his team members, but he also believes deeply in the impact that the clinic’s mental health services have.

“We believe here that when you share, you are relaxing. Sharing is caring,” he said, echoing a popular English saying that felt profound in the moment as it spanned across cultures.

“We have a saying here: ‘God is one’,” he told me. “It means that only God is on his own. The rest of us people are meant to be together. Look around you – if you were here in the clinic and no one was here, you would feel fear. But this world is beautiful with people. We are not meant to be lonely.”

Increasing needs in Kuchlak

The team admits that, despite the integrated approach, they don’t have the time needed to spend with each individual department. Their workload is constant and the needs are increasing.

For my part, I am simply proud that our clinic offers these important services. Moreover, I am proud of our mental health team. They are improving our patient care in immeasurable ways; not only by their method of approaching the body as a holistic and interconnected system, but also in the care and empathy that they show for each and every patient.

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