HEILBRON, 18 June 2008 (PlusNews) - About 100 home-based care workers were expected at a recent one-day workshop by the South African Depression and Anxiety Group (SADAG) in the small farming town of Heilbron in Free State Province.
On the day only about 30 participants, mostly middle-aged women wearing the sturdy shoes and wool berets favoured by their generation, trickled into the community centre. The workshop had to compete with an address by the local mayor, who was also distributing free blankets.
SADAG, a non-governmental organisation (NGO) that promotes mental health, was offering the care workers lunch and the opportunity to learn how to identify and deal with mental health problems in their clients and themselves.
Home-based caregivers are in the frontline of South Africa's HIV/AIDS response, especially in rural areas like Heilbron, where the shortage of healthcare professionals is most acute. Their training, however, is limited to identifying and dealing with the physical symptoms of HIV, and counselling patients on how to live positively with the virus.
They are less well equipped to deal with the emotional and psychological consequences of an HIV-positive diagnosis. "We do deal with patients who find out they're [HIV] positive and they lose it," Gladys Seabi, a care worker who attended the workshop, told IRIN/PlusNews. "They end up with depression that's untreated, and I don't know how to help them because I haven't been trained in it."
SADAG's volunteer trainers, usually students in their third or fourth year of a psychology degree, conduct one-day workshops for home-based care workers all over the country.
A day is only enough to teach basics like the causes, symptoms and effects of depression and stress; the warning signs of suicide; how to help a child cope with death; and how to start a support group, but there is a toll-free line the care workers can call if they need more information after the workshop.
The organisation has also developed a "speaking book" on HIV and depression with soundtracks in several local languages that the care workers can give to clients with low literacy levels, but caregivers are encouraged to refer clients with suspected depression to their local clinic or hospital.
"If they have a switched-on nursing sister they'll identify it as depression," said Zane Wilson, SADAG's founder and director. "But if that doesn't happen, which is in about 50 percent of cases, we get the caregiver to go back [to the clinic or hospital] with the patient and one of our brochures, and try to actually educate the nurse."
A double stigma
After years of struggling with her own undiagnosed depression, Wilson abandoned her career as a successful businesswoman and founded SADAG in 1997. At the time, she said, there was a perception that mental illness only affected white people.
"There's more awareness now that it can affect anyone, and that anyone with a severe illness, whether it's cancer or HIV, is more vulnerable," she told IRIN/PlusNews.
But the stigma attached to mental illness persists, and when combined with HIV-related stigma it can be devastating. "In the black community it's not acceptable to be depressed and to drink medicine," commented Matshepo Molefe, one of SADAG's trainers.
Gugu Nyathikazi, another trainer, recalled that after her father died when she was a child, none of her relatives thought to take her for counselling. "You're just supposed to be strong and get over it or they'll say you're bewitched and take you to a traditional healer," she said.
Most of Seabi's patients with mental health problems go to traditional healers rather than the local clinic. "They give them muti [traditional medicine] that doesn't help," she said.
Recognising that traditional healers are often a patient's first port of call, SADAG recently started running training workshops for them. "We teach [the traditional healers] the basics of depression and say to them, 'If you can't get patients well then send them to a clinic,'" said Wilson.
|We're always listening to other people's problems, and at home we're busy with [those of] our families|
Care workers also vulnerable
A second goal of SADAG's workshops is to help home-based care workers recognise their own potential for depression. A study by SADAG, in conjunction with the University of Witwatersrand, in Johannesburg, found that 89 percent of home-based HIV/AIDS care workers in two South African provinces were depressed or showed signs of depression.
"They may not even recognise it, but they get stressed and burnt out and then leave, and that's a disaster," said Wilson.
Anje Manfroni, the director of Ekupholeni Mental Health Centre, a non-profit facility in the township of Katorus, east of Johannesburg, pointed out that the lives of care workers often differed little from those of their clients. The small government stipends they earned were usually not enough to lift them out of poverty and, in most cases, their families have also been affected by HIV.
"It's really overwhelming," agreed Gloria Ndwandwe, a care worker and counsellor at Ekupholeni. "We're always listening to other people's problems, and at home we're busy with [those of] our families."
The problems Seabi encounters in the homes of her clients sometimes keep her awake at night. "I've been doing this since 2001," she said. "I'm passionate about the work but there are those who burn out, who can't cope anymore."
The SADAG workshop suggests ways for care workers to manage their stress and get support when they need it. Seabi said she deals with stress by talking to her mother and attending regular debriefing sessions with her colleagues, but Nyathikazi, the SADAG trainer, said not all care workers looked after their mental health.
"I think they don't talk [about themselves] sometimes because they think they have to be strong for their patients," she said. "We do find that most care workers find it difficult, and these workshops help because they think it's just them."