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Mar 2004 |
“I often think of the day care centres and the mental health
centre as oases of humanity amidst the daily misery.”
The population of Armenia has to endure extremely trying economic
conditions. Things are even worse for the mentally handicapped and mentally ill
in this country in the Caucasus. For years, Médecins Sans Frontières
has been actively trying to improve the inhumane conditions in the psychiatric
institutions there, and is now taking a new approach: along with their families,
those needing attention are now being treated as outpatients. Tido von Schön-Angerer
is a doctor and has been working as country coordinator in Armenia with Médecins
Sans Frontières for a number of years. In the following interview, he explains
how this aid works.
How do things look for the mentally handicapped and the mentally ill
in Armenia?
Over half of the population of Armenia lives below the official poverty line,
and has to survive on less than 17 euros a month. The mentally ill and their families
are often amongst the poorest of the poor, since the time-consuming care called
for in such cases often means it is impossible to work. On top of the disastrous
economic consequences, the mentally ill and their families also have to cope with
being shunned and stigmatised. There is a long-standing tradition of family solidarity
in Armenia, but many of these people are nonetheless unable to cope with the social
isolation they are subjected to. Consequently, the mentally ill and the mentally
handicapped are often kept out of the public eye, and are forced to live in inhumane
conditions. Some are even sectioned on a permanent basis.
Are those affected and their families entitled to any state support?
Theoretically, the mentally ill are entitled to free treatment. But with the country’s
insufficient healthcare budget, this right invariably only exists on paper. The
benefits for the handicapped, to which many are entitled, amounts to a maximum
of eight euros a month – and that’s not even enough to buy bread.
Poverty is therefore extreme, especially in winter when temperatures can sink
to as low as minus 30°C and when some people attempt to heat their rooms using
waste from the rubbish tip. We consequently provided 270 families with warm blankets
and heating this winter.
Was there any kind of outpatient healthcare for the mentally ill and
mentally handicapped before Médecins Sans Frontières set up its
aid programme in cooperation with the Armenian ministry of health?
We spent many years working in various psychiatric clinics in Armenia, in order
to create at least half-decent conditions. We also repeatedly tried to get many
people whose hospitalisation had been totally unnecessary released. But it soon
became clear that this was impossible without the necessary outpatient care in
place. During the Soviet era, the job descriptions “social worker”
and “clinical psychologist” didn’t even exist. The standard
of the psychiatric treatment is often very low, and is in many cases limited to
merely issuing repeat prescriptions without any kind of consultation – that
is, assuming that the medicine is actually available at all. No, a day care centre
like the one we have established is completely new to Armenia.
Are there any special schools for children with mental problems or
handicaps?
Yes, there are homes for such cases, but they are permanently overcrowded. More
and more poverty-stricken families are attempting to get their perfectly healthy
children taken in at these homes so that they at least have something to eat and
clothes to wear. And from the point of view of the people running these homes
it is, of course, easier to look after these healthy children. Until recently
it was even not uncommon for some particularly extreme cases of mentally ill or
handicapped children to be put in psychiatric clinics for adults, which are totally
unsuitable.
What is the approach of the Médecins Sans Frontières
project?
We are endeavouring to provide holistic aid in line with the local conditions.
On the one hand, we have the day care centres which draw people out of their isolation.
With our wide array of occupational therapy, these centres offer them the opportunity
to discover new things, take part in new activities and learn new things, through
which they are able to regain their self-confidence. On the other hand, there
is the mental health centre, where anyone who needs it can obtain free expert
help from psychiatrists, psychologists and social workers. I often think of the
day care centres and the mental health centre as oases of humanity amidst the
daily misery. We have invested a great deal of time and effort into involving
the ministry of health in this project, so that it is a positive learning experience
for everyone involved.
What sort of changes do you see in the children and adults who regularly
visit a Médecins Sans Frontières day care centre?
Bearing in mind the previous neglect and isolation, the changes are often quick
and phenomenal: for example, it’s not unusual for a visitor to the centre
to start talking again after many years of silence, or for someone to learn how
to interact socially with others for the first time. Others that we help become
much more balanced and consequently need less inpatient care.
Are the family members happy to go along with the consultation and
support offered, and does it change the way the families live together?
The majority of families welcome the project. Some family members even take on
active roles by helping out in the day care centres. But the increase in the self-confidence
of some of the visitors to the centres has also resulted in conflicts, and even
in violence, within the families. This was usually the case when the family members
could not accept that their mentally ill relative suddenly had a mind of their
own. As a result, we also work intensively with the families.
How long does Médecins Sans Frontières plan to continue
to run the scheme, and are there any plans to hand it over to the ministry of
health or an Armenian NGO?
We will remain at the helm until the end of 2006 at least, after which the scheme
will probably be taken over by the ministry of health and a local organisation
– albeit only to a certain degree. Sustainability is only possible to a
limited extent in such a poor country, and that’s not our objective anyway.
We want to help the people here and now. And if we manage to make people think
differently about the mentally ill and the mentally handicapped in Armenia, we
have already achieved a great deal.
| Médecins Sans Frontières provides STD treatment
and voluntary counseling and testing for HIV in a clinic in Bagratashen (a town
on the border between Armenia and Georgia) and also carries out prevention activities
with sex workers in northern Armenia. In Berd, close to the border with Azerbaijan,
Médecins Sans Frontières works with a local women’s group
to provide peer counseling for the community on family planning, safe pregnancy
and newborn care. Médecins Sans Frontières runs an outpatient mental
health center and offers occupational therapy at a day center in Sevan. Support
for mental health services in Nagorno-Karabakh began in May 2003. In Yerevan,
Médecins Sans Frontières has run a combined medical, psychological
and social care program for young people in the Vardashan Institute since 1997.
Work treating tuberculosis in Nagorno-Karabakh came to an end in December 2002. |
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COUNTRY PROFILE
Armenia
Population: 3,790,000
Life expectancy: 73 years
MSF international staff: 14
MSF national staff: 91 |
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