Sit down, take a load off and chat to a friendly gogo
An innovative programme that taps into community strengths and resources — and especially the unique abilities of its senior citizens — is transforming mental health in Zimbabwe.
It’s called the Friendship Bench and was the brainchild of Harare psychiatrist Dr Dixon Chibanda, who had been concerned about the gaps in healthcare in his country. But a tragic event galvanised him into action: a client committed suicide.
When he asked her mother why she had not come to him for help, she said: “She did not have the $15 need for transport.”
It shocked him. “I thought, what was my role as a psychiatrist?”
Like most sub-Saharan countries, Chibanda says, Zimbabwe devotes only about 1% of its medical health budget to mental health care, with the bulk going to fund institutions like hospitals. Most of his patients were suffering with common mental health issues like anxiety and depression; they did not need institutionalisation.
In Zimbabwe, with its history of extreme violence and high rate of poverty, the incidence of depression, anxiety and post-traumatic stress disorder is high, as is the suicide rate.
The government was aware of the problem, he says, and tasked him with finding solutions. However, he was told there would be no budget and he could not use any of the state’s buildings because there was no room. The clinic nurses would also not be at his disposal because they were too busy, Chibanda explains in a TED talk and a short film, called The Friendship Bench, to be screened at the Encounters SA International Documentary Festival.
Most people would throw their hands up, but Chibanda did not shy away. Plus there was a glimmer of hope in the form of 14 grandmothers, “gogos”, who had been assisting at the community clinics. They were to be his human resources.
And so the Friendship Bench was born, where a patient carrying a heavy mental load and in need of solace and advice, can find a gogo waiting on a plain wooden bench at clinics across Zimbabwe. The service is free to the patient, and each gogo receives training as a lay counsellor and is provided with a manual. But it is very much voluntary work because after their training and internship — which can take two years — they receive only $30 a month, plus their uniform and the stationery they need.
Still, the gogos interviewed for the film say the work has changed their lives too. It has given them a role in the community, a purpose and even a chance to make additional income.
Here the barriers between counsellor and patient dissolve as they meet frequently and offer phone counselling too. After receiving therapy, some of the clients join community groups to start small businesses, with some of the profits going back into funding the programme.
Chibanda emphasises that the Friendship Bench model is different in many ways from traditional Western therapy. Many of the clients have to travel long distances to get there, and their problems involve their own mental health as well as legal, financial and other difficulties. They need to go away from their first session with a usable solution and not be required to return many times.
Chibanda says 100,000 patients have been helped and 1,000 counsellors trained. The simple but effective method has been extended to other African countries and even travelled as far as Jordan and the US.
Chibanda’s story has been picked up by New York-based Sealion Films and the documentary is directed by SA filmmaker Reabetswe Moeti-Vogt. Producer Graham Leader said from New York that he had heard Chibanda’s TED talk on the radio, “which lit the fire. I then tracked him down — it took three months before I was able to get hold of him on the phone. When I described my vision for the film, he told me he’d ‘been waiting for me’. We started filming in July 2021.”
• The 2024 Encounters SA International Documentary festival takes place in Cape Town and Johannesburg from June 20-30.