9. Mental Health Services # 2

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There are three MSF project sites in Farchana: (1) the Primary Health Centre, located at the edge of the camp, is where maternity and basic medical care are provided; (2) the Nutritional Centre in the centre of the camp houses the Community Health Service and a Therapeutic Feeding Centre for malnourished children; and (3) the MSF compound, a fifteen minute walk from camp, that has an emergency night-clinic attached.  Mental Health Services works in both of the two centres at the camp.  They consist of simple wooden supports lined with plastic sheeting.  It may seem like a flimsy structure but it’s like a home away from home; a quiet corner of the busy compound where we sit, talk, work, and, if need be, see patients in the room next door.  Four years ago, when this MSF-H project was set up, flowers were planted outside and they are now blossoming lilac and pink.  It’s a small thing, but it’s nice thing. Little pleasures go a far way out here. The flip-chart in the corner—some large pieces of paper stapled to a cobbled-together easel—shows residues of past lectures on personality traits, stigma, Maslow’s hierarchy of needs (need to unpack this one in a place with no soap…), traumatic stress and it’s presenting symptoms, and so on.

Every morning at about 7:30am, the team meets at one of the two sites.  We say our good-mornings and everybody asks everybody else how they slept.  This is the custom, but there is a twist: you answer honestly.  I’m not sure when it came to pass in Canada that the expected answer to the ritualistic “how’re you doing?” was a near-guaranteed “good, you?”  You’d pretty much have to be bleeding out of your eyes before you ventured a “you know, not so hot today.”  But in the camp, people routinely say what’s bugging them, and the morning “how’re you doing?” custom can take fifteen minutes.  I know who’s got diarrhea, who’s feeling a chill from the cool night past, and who’s child has a mild fever that is worrying them.  It’s unexpectedly personal.  I find myself wondering how this could be brought into the Canadian mental health team environment, but then I realise, it is already there, but usually only in groups of 2 or maybe three people who know each other well.  Here the closeness exists to a team of 10 or so, precisely in part because of morning conversations like this.

After this morning harrah, four of the counsellors go off to the « Thé Rencontre » or “Chat with Tea.” This is where everyone is welcome to sit around with friends, to drink insanely sugary tea, and to banter.  All the while, the counsellors circulate, listen, and give their spiel on what mental health services are on offer. It’s a lovely idea, and even though it’s just a large open space with some plastic sheeting over their heads and a few rude wooden benches against the walls, everything changes when you’re sharing drinks. It becomes friendly rather than clinical.  (below is a pic of the corner of tea room, but not during the « Thé Rencontre ».)

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