Afro-Bolivian communities and primary care physicians trained in mental health and psychosocial support
Coroico, Chulumani, Tocaña, La Paz, March 28, 2022 (PAHO)
More than 60 health professionals, including physicians, nurses and nurses' aides from 39 health centers in La Paz, Bolivia, received training to treat mental, neurological and substance use disorders; and community leaders learned the importance of the principles of Psychological First Aid (PFA): look, listen and link to address mental health in crisis situations.
With a distant look on her face and an attitude of trying to reminisce, a leader of the afro-descendant community in Bolivia explains that more than a year ago she did not know who to talk to about how she felt and recalls that many members of the community felt the same way. She agrees to give her testimony but asks that her name not be used.
Children, grandmothers, single women, men with no steady job, all felt a sense of despair. Others lost friends and family. It was serious"
However, she now knows how to approach mental health issues, who and where to turn to, and how helpful it can be to observe, listen and connect in the community in a time of crisis. These three verbs turned into action can make all the difference.
She is one of the 22 leaders who were trained in Psychological First Aid (PFA) within the Project "Responding to mental health and psychosocial support needs (MHPSS) during COVID-19 in indigenous and afro-descendant communities of the Americas", which was developed by the Departmental Health Service (SEDES) in La Paz, with the technical support of the Pan American Health Organization/World Health Organization (PAHO/WHO) and CBM Global, together with the National Afro-Bolivian Council (CONAFRO), in coordination with the Bolivian Ministry of Health and Sports. This project was funded by Canada's Public Health Agency.
When the pandemic forced mandatory quarantines in the country, one of the first things I asked myself was how are we going to survive without money? I felt an icy cold all over my body, I even felt pain in my chest, I couldn't sleep, I was so worried".
Testimony of a leader of the afro-descendant community in Bolivia who prefers to remain anonymous. She admits it is the first time that she speaks about this.
"It used to be difficult."
The Afro-Bolivian communities
Dr. Luna was one of those trained in La Paz along with 60 other health professionals, including doctors, nurses and nursing assistants from 25 health centers in the municipalities of Sur Yungas and 14 in the Nor Yungas province
The doctor is stationed in Tocaña, one of the most traditional afro-descendant communities, a picturesque village embedded deep in the Yungas, which can be reached in about three hours along a rocky, winding and narrow road; it is home of the Afro-Bolivian culture, no more than 100 families, most of them coca leaf growers.
Afro-descendant communities are located in the warm lands of the Yungas, over 1,782 meters above sea level. Although some of the afro-descendants have migrated throughout the country, the majority live in communities located in the municipalities of Yanacachi, Chulumani, Irupana, La Asunta, Coroico, Coripata, Caranavi and Inquisivi in the Department of La Paz - one of the most important in the country.
All communities are part of health network 8, the intervention center of the "Responding to mental health and psychosocial support (MHPSS) needs during COVID-19 in indigenous and afro-descendant communities of the Americas" project.
Health personnel must have the ability to recognize the symptoms and signs of both physical and mental illnesses."
Dr. Claudia Luna, professional at MISALUD program (community physicians providing primary health care in Bolivia).
Training non-specialized personnel
To achieve these objectives, the project implemented a series of training workshops and awareness-raising processes. In addition, it developed a communication plan that involved materials for local radio stations and for the communities' social networks. With a ludic approach, they used drawing techniques to understand their perceptions of mental health.
To build the capacity of non-specialized health personnel in mental health, three workshops were conducted using PAHO/WHO "Psychological First Aid (PFA): Guide for Field Workers" and WHO´s "mhGAP Intervention Guide for mental, neurological and substance use disorders at the non-specialized health care level" (mhGAP-IG).
Participants were expected to acquire the ability to provide psychosocial help and care for patients with mental and neurological disorders at the non-specialized health care level, especially in PFA and in cases of depression, psychosis, epilepsy, dementia, self-harm and suicide, among others.
This process also included pre- and post PFA and mhGAP-IG tests. The first data collection tasks and follow-up of the visits of patients with mental, neurological and substance use disorders in indigenous and Afro-Bolivian communities were assigned in the context of the project.
The human rights approach to people with mental disorders was a central focus of the training. This is a crucial issue in Afro-Bolivian communities, historically suffering from discrimination and stigmatization.
The project in Bolivia had three central objectives: to strengthen national capacities to coordinate, plan and provide MHPSS services to indigenous and afro-descendant communities affected by the COVID-19 pandemic; to improve the capacity of healthcare sectors to provide quality MHPSS services to these communities affected by the pandemic; and to empower communities to use MHPSS services and local services, adapted to provide MHPSS in accordance with the culture and traditions of the community.
​Look, listen and link
Work was also carried out with leaders -men and women- of afro-descendant communities. With presentations, examples, analysis and reflection, about 22 leaders embraced PFA's three basic principles of action: look, listen and link to provide help in crisis situations.
"We managed to understand the importance of first taking care of ourselves in order to offer help. We also understood that, as leaders, we are fundamental in an emergency to be able to get close to the people affected, listen to their needs in a difficult time, and help them receive support", explains Nilo Vásquez, CONAFRO´s leader.
Dr. Lenildo De Moura, PAHO/WHO International Advisor on Non-Communicable Diseases and Mental Health, and facilitators Pamela Castro, Ketty Estrada, Iracema Justiniano, Samadhi Salguedo and Sandra Mallo participated in the project development process.
La PAHO, established in 1902, is the world's oldest international public health organization. It works with its member countries to improve the health and quality of life of the people of the Americas. It also serves as the Regional Office for the Americas of the World Health Organization (WHO).
Mental Health and COVID-19
Mental Health and Psychosocial Support in Emergencies (MHPSS)