Through the main gate of the Hatcliffe Polyclinic, at the end of an alleyway dividing two cabins, two brown benches sit side by side under a tree. On one of the benches is Siridzai Dzukwa, 52, deep in conversation with Elector Mudziwechi, 25, who talks softly, her head lowered.
They are discussing things that few people talk about in Zimbabwe, such as anxiety, depression and suicide. Dzukwa is a lay health worker, known as a community “grandmother”; Mudziwechi has been struggling since her husband left her two years ago. And for people like her who are coping with mental health issues, this simple wooden bench is a site of hope in a desperate situation.
At state-run clinics around the country, there are benches under trees where patients can speak to trained volunteers for free about their worries and problems. The Friendship Bench Project mainly uses older women as counselors, because these “grandmothers” tend to be respected and trusted.
Dzukwa has been volunteering on the Friendship Bench at Hatcliffe Polyclinic, 12 miles (19km) northeast of Harare, for more than 10 years. She gets regular training from the Harare City Health Department on how to conduct talk therapy and a government allowance of $122 per month. She says she and the other counselors have handled all sorts of cases, from people who are suicidal to others who are struggling to come to terms with divorce or the death of a spouse, and some facing gender-based violence or living with HIV/AIDS.
Poor mental health is a major public health issue in Zimbabwe, with depression one of the leading causes of morbidity and disability, especially among women and other vulnerable populations. The subject is rarely addressed in public – people with mental illness are often seen as cursed or possessed as punishment for evildoing – so many people suffer in silence. Medical practitioners are known to underdiagnose the condition.
How Depression Affects Women
In Zimbabwe, as in much of the world, mental disorders such as depression and anxiety mainly affect women. Unipolar depression, also known as major depressive disorder, is predicted to be the second-leading cause of global disability burden by 2020 and it is twice as common in women.
Mudziwechi, a mother of three, says she almost killed herself after her divorce. Even before then, she struggled with depression in her marriage. “Despite my husband working, he never contributed toward the upkeep of the kids and our home,” she says. Her husband became physically and emotionally abusive.
In 2015, Mudziwechi’s husband forced her and her children out of the family home and divorced her. For a long time, she was in denial about the divorce. A friend told her about the Friendship Bench in June, and she started going every week. She recently finished a six-week session with Dzukwa, but still visits the bench when she needs additional support.
“I received counseling, particularly in coming to terms with the separation from my former husband, enabling me to move on with my life,” says Mudziwechi. “I started looking at how other women of my age were making it in their lives despite not having husbands. I then decided to do some piecework in my community to earn some money and sometimes selling second-hand clothing.”
“We encourage most women to use their hands, and start income-generating projects such as selling clothes, fruits and vegetables, and providing cleaning services, as well as assisting homesteads with their farming activities,” Dzukwa says. “We don’t tell our clients what to do, but we ask them using a three-step therapy strategy – kuvhura pfungwa (open the mind), kusimudzira (uplifting) and kusimbisa (strengthening).”
The counselors may suggest that someone could be suffering from kufungisisa, or “thinking a bit too much” – the Shona language equivalent of “depression” – and guide them through the different stages of talk therapy, says Dixon Chibanda, the project’s senior psychiatrist and principal investigator, who came up with the idea in 2006. “We use Indigenous terms, words that people in the community can identify with.”
Chibanda says the benches help fill a gap in Zimbabwe’s healthcare services caused by the failure of doctors to recognize mental disorders in their patients combined with an under-resourced healthcare system. About 25 percent of the country’s primary-care patients suffer from depression, anxiety and other common mental disorders, but there are only 10 psychiatrists and 15 clinical psychologists serving its population of 15 million.
More Effective Than Conventional Treatment
First launched in the high-density suburb of Mbare in 2007, the Friendship Bench Project received 1 million Canadian dollars (U.S.$780,000) from the Canadian government last year. It now has benches in 72 clinics around Harare, with the health department employing more than 250 community health workers to counsel patients. As of June 2017, more than 40,000 people have visited Friendship Benches around the country.
A recent study of the program, which followed 573 patients with anxiety or depression for six months, revealed that weekly talk therapy sessions with a trained community member were more effective than conventional treatments.
Half of the participants saw a nurse, who gave them some counseling and prescribed medication if needed. The other half visited the Friendship Bench. At the end of the study, half of those who received the standard treatment still showed symptoms of depression, but only 13 percent of the Friendship Bench patients still had symptoms.
Mudziwechi says her sessions on the bench under the tree have allowed her to move on with her life and find the means to provide for her children. She still struggles to pay her children’s school fees, but she is no longer suicidal.
“The bench has helped me remain strong despite the challenges of life, and look for ways of surviving,” she says. “It’s still not easy, but I am not where I was before I came to the bench.”