Mental Health Needs Assessment Points Way for Village Families in Tanzania
Pregnant and post-partum women along with fathers who are vulnerable to mental stress because of family conflict, physical illness or disability, food or economic insecurity, and many other threats are at the center of Global Volunteers’ Reaching Children’s Potential Program (RCP) Mental Wellness Initiative. A 2023 needs assessment identified priority areas for intervention, treatment and education in the Ukwega Ward of Tanzania. Read on to learn how you can provide needed therapeutic services to Tanzanian mothers.
In low-income countries such as Tanzania, access to mental health services is severely limited. According to the World Health Organization (WHO), only 0.04 psychiatrists and 0.005 psychologists per 100,000 population are available to the country’s people, with the fewest accessible in rural areas. Nationally, only 124 mental health outpatient facilities and 662 psychiatric beds in general hospitals are available to the country’s population of 62 million, according to WHO’s Mental health Atlas.
To begin to close gaps in education, interventions and treatment in partner communities, Global Volunteers launched the Mental Wellness Initiative within the RCP Program in 2021. Beginning with informational mental wellness workshops, community meetings and formal presentations by regional mental health professionals, the program raised awareness of the causes and treatments for mental illness and common conditions such as anxiety and depression.
Integration of mental wellness into primary care is the goal of the medical staff at Ipalamwa General Clinic (IGC), the central component of Global Volunteer’s RCP Program. To accomplish this critical capacity, in 2022, Doctor-in-Charge Silas Mosha requested a formal mental health needs assessment for the service area of the Ukwega Ward, which comprises Global Volunteers’ five partner communities. Through collaboration with Colorado State University and alumni volunteer Dr. Shelley Haddock, the two-phased community mental health needs assessment was conducted in January and July, 2023. Preliminary results, which guide our family psycho-education project, identify significant need for treatment in the areas of depression, alcohol abuse, gender-based violence and suicidal ideation. These issues are frequently cited in all regions of the country, and are greatest in rural areas with high poverty rates. With incidence rates now revealed among families served by the RCP Program, priorities can be established for allocating resources in these areas.
Since 2021, a workshop series has been provided at Global Volunteers’ RCP Learning Center, at village meetings and in church presentations to address these needs as expressed in home visits by RCP caregivers. This community outreach is vital to normalize the topic of mental wellness and encourage a community-wide vision of optimal mental wellness. With such needs and vision articulated, Global Volunteers can target volunteers’ assistance in optimal ways on service programs continually throughout each year.
Volunteers with professional expertise and lived experience in priority mental wellness areas are essential – and central – to addressing the pressing need in the Ukwega Ward. Through our ambitious outreach to Global Volunteers alumni, we’ve engaged volunteers from a variety of disciplines – from psychiatry to transformational NLP – and lived experience, to help build an expansive, inclusive foundation for community mental health. The following are but a few profiles of volunteers who have contributed to this ground-breaking initiative.
Shelley Haddock, PhD, LMFT
Professor, Marriage and Family Therapy Program, Human Development and Family Studies, CO State University
Although Shelley didn’t initially plan to share her expertise as a psychology professor and private marriage and family therapist in her July, 2022 Tanzania service program, when she learned about the Mental Wellness Initiative, launched only months earlier, she was intrigued by the opportunity to set up a framework to assess the mental health needs in the Ukwega Ward. After working with Dr. Silas to learn about his vision for identifying the incidence of mental health conditions, she returned home determined to help him acquire this high-priority information. She returned in January, 2023 to conduct the first phase – a qualitative survey with community leaders and invited community members. In July, 2023, she completed the quantitative phase of the study with 10 staff and local interviewers and Tanzanian psychiatrist Dr. Petro Lusasi of Ilula Regional Hospital. “I was invited to research the common problems that the people in the villages are having in terms of mental health and family relationships,” she explained. “That way, we’ll be able to design services that will be supportive and meet the unique needs they ask us to meet.”
Dana Pepp, LCSW
As a licensed professional social worker with 30 years experience, Dana Pepp was grateful to take on assignments of personal and professional interest with RCP Caregivers in the Ukwega Ward. Teaching clear communications, healthy marriage strategies and self-care are her specialties, so over two service programs, Dana brought her expertise to mothers in communications workshops and yoga training sessions with Caregivers. Global Volunteers knows that self-care and mental well being is important for all those working in caregiving and consulting roles. Ensuring that each Caregiver has the necessary skills and space to develop their own coping mechanisms is of great importance. This includes learning about stress management, cumulative and critical incident stress, and secondary trauma, including various means for identifying negative coping mechanisms. We’re grateful for volunteers like Dana who serve to improve RCP staff’s well being as well as the well being of the families in the RCP Program.
Penny Louise Flavin, DNP, APRN, CNP
As a retired medical professional and five-time Global Volunteer, Penny Louise performed several hundred physical exams in 2019 on our Peru Service Program, so she responded to the request to help launch mothers’ mental health support and Alcoholics Anonymous (AA) groups in the Ukwega Ward. In late July, 2023, Penny Louise conducted group therapy sessions with RCP families and presented workshops on depression, alcohol abuse, family planning and sexually transmitted diseases in addition to nutrition during pregnancy and post-partum along with diabetes prevention, treatment. “My purpose in volunteering is to edify others; to promote self-awareness, self-worth, self-esteem, self-knowledge and self-care in the individuals I am asked to serve,” she said. “One mother who had attempted suicide said after the workshop she was much more hopeful, had learned coping mechanisms and interventions to decrease her depression. Many of the attendees verbalized that they had learned many new facts and were grateful that I took the time to come to Tanzania to teach them very practical applicable knowledge and interventions for a healthier lifestyle and self care.”
Frank Harrington, RN
When Frank was preparing to serve the RCP Program in January, 2023 at the Ipalamwa General Clinic, he expected to assist Dr. Silas with routine exams and perhaps help deliver a baby over two weeks. When he learned about the opportunity to share his journey from alcoholism to sobriety, he added workshops on the causes and damages of alcohol abuse to his daily schedule. “I’m a sober alcoholic; been in AA for 35 years, haven’t had a drink in that time, Frank explained. “So I know I can relate to those who want to quit drinking and need to know about the damages of alcohol on the body, a developing fetus, a breastfeeding mother and baby, and the constellation of effects on the family.” He presented workshops to fathers, mothers, and family members together. “The need for this kind of program in this community is heartbreaking,” Frank reported. “There’s no resource like AA in this region, nothing remotely resembling a treatment center, and the physicians here are not medically equipped to deal with severe alcohol withdrawal. There’s a lot to be done. It’s challenging and rewarding, and kind of a privilege to try to tackle it.”
Jennifer Kudelka, MSW, LICSW
A Hennepin County social worker in Minnesota, Jenn is a first-time Global Volunteer who wondered at first how her skills would translate culturally in Tanzania, when she served in April, 2023. “I came to realize there’s a spot for everyone to share what you know,” she said after a few days attending home visits with RCP Caregivers. “So take that worry and just chuck it out the window,” she laughed.” Anybody can fit somewhere, in some way.” Jenn counseled caregivers on conducting client assessments and skills in listening and watching non-verbal cues in monthly visits with RCP families. At the RCP Learning Center, she produced a workshop on healthy pregnancies, and answered common questions on physical and emotional changes during pregnancy and childbirth. At a village elementary school, she launched a formative discussion with teachers on the negative impacts on children’s self-esteem and motivation when corporal punishment is used in the classroom. Jenn said the practice is often employed by educators who mistakenly believe physical punishment is the only option for controlling students. She was grateful to have the opportunity to raise positive discipline alternatives that divert unwanted behavior. “It’s about bringing what you already have and know, and sharing with people who need, request and crave that.”
Jeanne Villa, Master Transformational NLP Practitioner, Family Constellations Facilitator
“In looking back at my own experience with unwrapping the gift of knowledge about the Mental Wellness Initiative, I was moved, first of all, that it existed, Jeanne said. In her work coaching and guiding individuals through life changes and helping clients pursue optimal mental, physical and spiritual health, she’s learned to listen deeply, with an open heart to their fears and obstacles. This compassionate witnessing of others’ lives is what she hoped to offer RCP mothers in April, 2023. She conducted two workshops a day for mothers of all ages. “We discussed primarily how one takes care of themselves based on their beliefs, when they were younger and where they are now,” Jeanne explained. ” For instance, how do they begin to resolve the past in order to be more present now and begin to plan for their future.” The sessions grew in size as word spread about the comfort and care the mothers experienced through Jeanne’s methods. “We talked about how we can’t change the past. The past is gone, but we can try to resolve and understand a little bit more about what happened to create our experiences from the past.” Jeanne followed this discussion with practical skills for stress reduction and self-examination. “What I was trying to do was give them some more tools so that when they come up against or are dealing with issues, they can understand and hopefully resolve what they’re dealing with currently in their lives.”
Han (Hannah) Nguyen, MD, PGY2
Hannah joined her sister on Global Volunteers’ Medtronic corporate group in 2022 to volunteer her medical skills abroad. As a physician specializing in psychobiology, she was especially interested in contributing to the community’s knowledge and education about the relationship of bodily functions with behavior and cognition. “I was privileged to speak on mental health to community leaders and families in a village that had suffered two suicide attempts (one completed) within the last year. They asked me to address the topics of depression, suicide, effects of alcohol use during pregnancy or childhood, and the importance of supportive parents on the overall development and wellness of the child.” She said the discussion centered around alcohol abuse, especially the growing use by teens and children. More than 19 percent of young students in the region reported ever drinking alcohol – mostly ulanzui or local beer, produced from bamboo shoots. Other sources of alcohol were produced from cashew seeds and coconut leaves. “I was pleasantly surprised that mental health awareness is reaching remote villages in Africa. It was a reminder that child adolescent mental health is not only a priority in the U.S., but the work of a child and adolescent psychiatrist is needed here and there, more than ever.”
Healthcare Professionals Sought to Continue Progress
All the professionals agree that a steady stream of volunteers from all healthcare backgrounds are greatly needed to share their skills with local professionals, caregivers, village leaders and RCP families. Said Jeanne: “I would encourage anyone who has any kind of counseling, therapeutic, or psychology background to increase your own practice back home by sharing some of what you’ve learned with the Mental Wellness Initiative. The Tanzanian people are warm, they’re compassionate, they’re real. They make your soul smile. They’re really wonderful to work with. And I will miss them. And I will be back.”
Jenn agreed: “It has made me more acutely aware of my privilege. I definitely will have more appreciation and be aware of walking a little softer on the earth. And you don’t know unless you just do it. Sometimes you just gotta say yes.”
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