A psychotherapist in Kathmandu (7)

Workshops with the community health workers:

As the health workers did not speak English and many were completely illiterate, I was given the responsibility of conducting the workshops using the arts, with the help of translators from the Nepali team. I told them how much I wish I spoke Nepali because I would be chatting with them and getting to know all the challenges they face doing their work. But instead, we would speak in pictures.

I invited them to imagine that they were a part of the rich Himalayan natural world and to speak from that perspective. The task was for them to introduce themselves as if they were a specific part of nature. They would talk in the first person.
Firstly, I shared my choice to model what the task was. I felt it gave permission for them to be simple and to the point using the arts to express their qualities, skills, wishes and dreams.
I showed my picture and describe it in the first person: 

I am a river. I go through the mountain steadily to the left and the to the right. No matter how difficult it is I keep going forward. Always looking ahead never looking back. That was how I was feeling. When they heard the translation they all got the message. We had great connection through our smiles and body language. They all engaged in making an image, looking as eager as children on their first day of school. They then shared their images in a very honest way. We felt deeply touched and moved by it. Again, I was reassured about the power of images to convey deep feelings and experiences.

We talked about what made them become volunteer workers and about the challenges they faced. These people work for nothing doing a very important job in remote parts of the Himalayas walking hours and hours to reach the community. They proudly wear their blue Sarees which identify them as community workers. They know nothing about the mental health we know, but yet, I am sure they found ways to counsel people in distress. I had tremendous respect for them.

Joao the Unity Health director, made a collection of very compelling images of people in distress. The intention was to help the volunteers recognise that physical illness can in fact be somatisation of mental health difficulties.  Again, the workers engaged with the activity and looked at the pictures with interest and knowledge. I had an impression that some of the images were impacting certain individuals in a different way and I wondered whether they were triggering personal experiences. I wanted to convey understanding if this was the case for them so I voiced that images can be disturbing and impact us in different ways. Some of the images were about domestic violence and I believe this is a situation that a number of the workers experience themselves. 

At the end of the activity they were to share their discussions in groups. The health assistants summarised their thoughts and feelings and Sailesh the psychiatric nurse wrapped up everyone’s contributions in a debrief.  We all took part in conducting the exercises on the day. I was very impressed by the Nepali professionals working with us. The clinical psychologist, the psychiatric nurse and the country representative translated to the workers with professionalism and insights. I felt a huge privilege to be among these people. 

This is of course just the very beginning of a project of helping the community to be aware of mental health issues and the health assistants seemed to have enjoyed our input. We hoped that they would feel more equipped to notice symptoms of mental distress, adding to their understanding of health in future.  I was incredibly tired after a very long, intense, exciting and thought-provoking experience.

Unity in Health, the charity I was working for holds a mental health clinic once a month for this community. A clinical psychologist, a psychiatrist and a mental health nurse will come back in 5 days to hold the clinic and deliver medication. Suddenly, I felt embarrassed to say I found the journey there too hard knowing how hard it must be for these workers to have to make that tough journey to the mountains again. 

The next Day we were going to tell a story about managing feelings to school children using a story about a frog feeling nervous. Vera, the Portuguese IT and graphic designer beautifully created the pictures without words. We decided that I would tell the story being the frog and she would be the other characters who met the frog. We rehearsed and created gestures and sounds that we believe would capture the children’s interest. All would be with a translator.  However, disappointingly, there was a national strike that day and we could not travel through the mountains because it wasn’t safe.
We left the mountains at 5:30 am, driving 8 hrs to arrive exhausted in a hotel in the middle of nowhere. The next day we travelled another 7 hours to Kathmandu. The weekend was for visiting the beautiful Thamel and Durber Square…

See my next post for the marathon of lectures on working with special needs, the states of mind of adolescents and further thoughts on how to set up school counsellors at the university of Tribhuvan.