您现在的位置: 纽约时报中英文网 >> 纽约时报中英文版 >> 健康 >> 正文

一条长椅、一群老奶奶帮助患者克服抑郁症

更新时间:2018/12/3 21:18:15 来源:纽约时报中文网 作者:佚名

How a bench and a team of grandmothers can tackle depression
一条长椅、一群老奶奶帮助患者克服抑郁症

Late one evening, Dixon Chibanda, a psychiatrist in Harare, Zimbabwe, received a call from a doctor in an emergency room. A 26-year-old woman named Erica who Chibanda had treated months before had attempted suicide. The doctor said he needed Chibanda’s help to make sure Erica didn’t try it again.

一天晚上,津巴布韦首都哈拉雷(Harare)的精神科医生齐班达(Dixon Chibanda)接到了急诊室医生的电话,得知自己几个月前治疗过的一名叫艾瑞卡(Erica)的26岁女性企图自杀。急诊科医生表示,他需要齐班达的协助,确保艾瑞卡不会再试图结束自己的生命。

Erica was at a hospital more than 100 miles (160km) away, however, so Chibanda and her mother came up with a plan by phone. As soon as Erica was released from the hospital she and her mother would come see Chibanda to reevaluate her treatment plan.

然而,艾瑞卡当时在100多英里(160公里)以外的一家医院,所以齐班达和艾瑞卡的母亲在电话上沟通,想出了一个计划。艾瑞卡一出院,就会和母亲一起前往齐班达的诊所,重新评估她的治疗方案。

A week passed, and then two more, with no word from Erica. Finally, Chibanda received a call from her mother. Erica, she told him, had killed herself three days before.

一个星期过去,再过了两个星期,齐班达依旧没有艾瑞卡的消息。最终,齐班达接到了艾瑞卡母亲的电话。她告诉齐班达,艾瑞卡三天前自杀了。

“Why didn’t you come to Harare?” Chibanda asked. “We had agreed that as soon as she’s released, you will come to me!”

齐班达问:“你们为什么没有来哈拉雷呢?我们都说好了,她一出院,你们就会来见我!”

“We didn’t have the $15 bus fare to come to Harare,” her mother replied.

“我们出不起到哈拉雷的15美元公交车费。”她的母亲回答道。

The response left him speechless. In the months that followed, Chibanda found himself haunted by the case. He also knew that Erica’s inability to access care due to distance and cost was not exceptional but, in many countries, in fact was the norm.

这个回答让齐班达无言以对。在随后的几个月,这件事一直困扰着他。他也知道,像艾瑞卡这样由于距离太远、费用过高而无法获得医护服务的并不是特例,而且在很多国家都是常态。

Globally, more than 300 million people suffer from depression, according to the World Health Organization. Depression is the world’s leading cause of disability and it contributes to 800,000 suicides per year, the majority of which occur in developing countries.

根据世界卫生组织的数据,全球超过3亿人患有抑郁症。抑郁症是全世界导致残疾的主要原因之一,并每年导致80万起自杀事件,其中大多数发生在发展中国家。

No one knows how many Zimbabweans suffer from kufungisisa, the local word for depression (literally, “thinking too much” in Shona). But Chibanda is certain the number is high. “In Zimbabwe, we like to say that we have four generations of psychological trauma,” he says, citing the Rhodesian Bush War, the Matabeleland massacre and other atrocities.

没有人知道津巴布韦有多少人患有抑郁症,用津巴布韦话说就是“Kufungisia”(修纳语字面意思是“想太多”)。但齐班达确信这个数字一定很高,他说:“在津巴布韦,我们常说我们四代人都有心理创伤。”他指的就是罗德西亚丛林战争(Rhodesian Bush War)、马塔贝莱兰大屠杀(Matabeleland massacre)等历史惨案。

Yet those suffering from depression have few options due to a dearth of mental health professionals. Chibanda, who is director of the African Mental Health Research Initiative and an associate professor of psychiatry at the University of Zimbabwe and the London School of Hygiene and Tropical Medicine, is one of just 12 psychiatrists practising in Zimbabwe – a country of over 16 million. Such grim statistics are typical in Sub-Saharan Africa, where the ratio of psychiatrists and psychologists to citizens is one for every 1.5 million. “Some countries don’t even have a single psychiatrist,” Chibanda says.

然而,由于缺乏心理健康专业人员,这些抑郁症患者几乎没有什么选择。齐班达是非洲精神卫生研究计划(African Mental Health Research Initiative)主任、津巴布韦大学以及伦敦卫生和热带医学学院的精神病学副教授,是津巴布韦仅有的12名执业精神科医生之一,而津巴布韦有1600多万人。这些严峻的数据在撒哈拉以南的非洲地区是很典型的,这里平均150万公民只有1名精神科医生或心理学家。齐班达说,“有的国家甚至一个精神科医生都没有。”

In brainstorming how to tackle this problem, he arrived at an unlikely solution: grandmothers. Since 2006, Chibanda and his team have trained over 400 of the grandmothers in evidence-based talk therapy, which they deliver for free in more than 70 communities in Zimbabwe. In 2017 alone, the Friendship Bench, as the programme is called, helped over 30,000 people there. The method has been empirically vetted and have been expanded to countries beyond, including the US.

与同事商讨如何应对这一问题时,齐班达发现了一个看起来几乎不可行的解决方案:老奶奶们。自2006年起,齐班达和他的团队已经培训了400多名老奶奶,教会她们循证谈话疗法,并已经在津巴布韦的70多个社区免费提供这项服务。仅2017年一年,这项名为“友谊长椅”的项目就帮助了3万多人。该方法已经经过实践检验,并开始推广到其它国家,甚至包括美国在内。

The programme, Chibanda believes, can serve as a blueprint for any community, city or country interested in bringing affordable, accessible and highly effective mental health services to its residents. As Chibanda puts it: “Imagine if we could create a global network of grandmothers in every major city in the world.”

齐班达相信,任何一个有兴趣为居民提供可负担、可获得、并且高效率的心理健康服务的社区、城市或国家,都可以用该项目作为蓝本。用他的话说:“想象一下,我们可以在全世界的每一个主要城市建立起一个全球老奶奶网络。”

Chibanda always knew he wanted to become a doctor, but dermatology and pediatrics were his original interests. Tragedy awakened him to his calling as a psychiatrist. While in medical school in the Czech Republic, a classmate killed himself. “He was a very cheerful chap – no one expected this guy to harm himself and end his life,” he says. “But apparently he was depressed, and none of us picked up on it.”

齐班达从小就知道自己想成为一名医生,而他最初的兴趣是当皮肤科或儿科医生。但一场悲剧的发生让他意识到,自己应该当一名精神科医生。齐班达在捷克念医学院时,一名同学自杀身亡。他说:“这个同学很开朗——没有人会想到他会伤害自己,结束生命。但很明显他当时很抑郁,但我们没有一个人注意到这一情况。”

Chibanda became a psychiatrist. But it wasn’t until Operation Murambatsvina (“remove the filth”), a 2005 government campaign to forcibly clear slums, which left 700,000 people homeless, that he realised the scale of the problem in Zimbabwe. When he ventured into communities after the campaign, he discovered “extremely high” rates of post-traumatic stress disorder and other mental health issues.

齐班达终于成为一名精神科医生。但直到2005年,津巴布韦政府推行“净化行动”(Operation Murambatsvina),强行清除贫民窟,导致70万人流离失所后,他才意识到津巴布韦问题的严重性。他在这项行动结束后进入社区时,发现居民患创伤后应激障碍和其它心理健康问题的比例“极高”。

In the midst of this work, Erica killed herself, bringing extra urgency to Chibanda’s quest to find a solution for ordinary Zimbabweans.

这项工作进行到一半时,艾瑞卡自杀了。这让齐班达更加迫切地希望为津巴布韦的普通百姓找到解决方法。

Chibanda was the only psychiatrist in the country working in the public health space, but his supervisors told him that there were no resources they could give him. All of the nurses were too busy with HIV-related issues and maternal and child health care, and all the rooms at the local clinic were full. They could, however, give him 14 grandmothers and provide access to the space outside.

齐班达是津巴布韦全国唯一一个在公共医疗领域工作的精神科医生,但他的上级领导告诉他,他们没有资源可以帮助他的工作。所有的护士都忙于与艾滋病相关的问题以及母婴护理,当地诊所的每一个房间都挤满了人。不过,他们可以为他提供14名老奶奶助手以及户外空间。

Rather than throw up his hands, though, Chibanda came up with the idea for the friendship bench. “A lot of people think I’m a genius for thinking of this, but it’s not true,” he says. “I just had to work with what was there.”

齐班达并没有因此感到愤怒苦恼,反而想出了友谊长椅的点子。他说:“很多人认为,我能想到这个点子,简直是个天才。但事实并非如此。我只是不得不就地取材,有什么用什么而已。”

That’s not to say that Chibanda initially believed it would work, though. The grandmothers, who were community volunteers, had no experience in mental health counselling and most had minimal education. “I was sceptical about using old women,” he admits. Nor was he the only one with misgivings. “A lot of people thought it was a ridiculous idea,” he says. “My colleagues told me, ‘This is nonsense.’”

然而,这并不意味着齐班达最开始认为这样做能成功。这些老奶奶们是社区志愿者,并没有心理咨询工作的经验,大部分人基本没有受过教育。他承认说:“我对请老奶奶们帮忙还是有疑虑的。”他也不是唯一一个有疑虑的人。“很多人都认为这是一个荒谬的想法,”他说道。“我的同事告诉我,‘这是在胡闹’。”

Lacking any other option, though, Chibanda began training the grandmothers as best he could. At first, he tried to adhere to the medical terminology developed in the West, using words like “depression” and “suicidal ideation”. But the grandmothers told him this wouldn’t work. In order to reach people, they insisted, they needed to communicate through culturally rooted concepts that people can identify with. They needed, in other words, to speak the language of their patients. So in addition to the formal training the received, they worked together to incorporate Shona concepts of opening up the mind, and uplifting and strengthening the spirit.

但由于没有其它的选择,齐班达便开始尽自己所能,培训这些老奶奶。最开始,他试着遵循西方医学的专业词汇,用“抑郁症”、“自杀念头”等词语。但老奶奶们告诉他,这没用的。她们坚持表示,为了能真正地与人沟通,她们需要用能引起共鸣的、深深地植根于本土文化中的理念进行交流。换句话说,她们需要用患者听得懂的语言。因此,除了接受正规的培训之外,齐班达还和老奶奶们一起,将修纳语里面敞开心扉、振奋精神、加油鼓劲的概念整合进去。

“The training package itself is rooted in evidence-based therapy, but it’s also equally rooted in indigenous concepts,” Chibanda says. “I think that’s largely one of the reasons it’s been successful, because it’s really managed to bring together these different pieces using local knowledge and wisdom.”

齐班达说:“培训本身是植根于心理学的循证治疗,但也同样植根于本土理念。我认为这是项目成功的原因之一,因为它真的能够利用当地的知识和智慧将不同的信息串在一起。”

Efficacious and replicable

灵验且可复制的方法

As I stepped out of the car, Rudo Chinhoyi, a tiny woman with an easy smile and dusting of white hair, rushed out of her cinderblock house to meet me. “Hello!” she beamed, throwing her arms around me. “How are you doing? Welcome!”

我下车时,个子矮小的奇诺伊(Rudo Chinhoyi)从她的煤渣砖小屋里冲出来见我。她满头白发,面带笑容,张开双手拥抱我,笑着说:“你好呀!过得好吗?欢迎欢迎!”

Grandmother Chinhoyi, as she is known around here, has been with the Friendship Bench programme from the start. “I joined this programme because I wanted to help people in the community,” she says. “It was too much – the depressed people. There were so many of them and I wanted to reduce the numbers.”

附近的人都喊她奇诺伊奶奶,她从一开始就加入了友谊长椅项目。她说:“我参与这个项目是因为我希望帮助社区居民。得抑郁症的人太多了,有的人还很严重。我想帮助他们,想要减少患抑郁症的人数。”

“I’ve always been like that, wanting to help others,” she adds with a smile and a shrug. “I value human beings so much.”

她笑着耸了耸肩,补充说, “我一直都是这样,想要帮助别人,我非常珍惜人类同胞。”

Chinhoyi, who is 72, has lost count of the number of people she has treated on an almost daily basis over the past 10-plus years. She regularly meets with HIV-positive individuals, drug addicts, people suffering from poverty and hunger, unhappy married couples, lonely older people and pregnant, unmarried young women. Regardless of their background or circumstances, she begins her sessions the same way: “I introduce myself and I say, ‘What is your problem? Tell me everything, and let me help you with my words.’”

奇诺伊今年72岁,过去的十年几乎天天都在做心理辅导工作,治疗过的抑郁症患者已经数不过来了。她经常会见艾滋病患者、吸毒成瘾者、贫困饥饿的人、不开心的已婚夫妇、孤独的老年人和未婚先孕的年轻女性。无论他们来自什么背景,现状如何,她都用同样的方法开始心理咨询工作。“我介绍我自己,然后问他们:‘你的问题是什么?把所有的事情告诉我,让我用自己的语言为你提供帮助吧。’”

After hearing the individual’s story, Chinhoyi guides her patient until he or she arrives at a solution on their own. Then, until their issue is completely resolved, she follows up with the person every few days to make sure they are sticking to the plan.

奇诺伊听完每个患者的故事后,为他们提供指导,直到他们自己找到解决方案为止。待问题完全解决后,她会每隔几天跟进患者的近况,确保他们有遵循原定的计划。

Once, for example, Chinhoyi met with a man whose wife had just run off with the landlord of their rental home. “The husband wanted to take an axe to attack the couple, but I convinced him not to,” Chinhoyi says. “I told the guy, ‘If you go to prison, your kids will be left alone, it’s not worth it.’” Rather than resort to violence, the man divorced his wife, she says, and is now happily remarried.

比如有一次,一位男士找到奇诺伊,表示自己的妻子刚刚离开他,和他们原来的房东同居。奇诺伊说:“那位丈夫想带着斧头去砍他们俩,但我说服他不要去。我和他说,‘如果你进了监狱,你的孩子就没有人照顾了,不值得’。”奇诺伊告诉我们,那位男士最终和妻子离婚,没有使用武力解决问题, 现在也已经再婚,过得很幸福。

Having come from the same communities as their patients, Chinhoyi and the other grandmothers have often lived through the same social traumas. Yet Chibanda and his colleagues have been shocked to find that the grandmothers themselves present surprisingly low rates of post-traumatic stress disorder and other common mental health ailments. “What we see in them is this amazing resilience in the face of adversity,” he says.

奇诺伊和其他的老奶奶都和患者来自同一个社区,通常经历过类似的社会创伤。然而,齐班达和他的同事们惊讶地发现,这些老奶奶们的创伤后应激障碍和其它常见心理疾病发病率非常低。他说:“我们发现,她们面对逆境的能力让人惊叹。”

Nor do the grandmothers seem to get burnt out despite counselling people on the brink of crisis day after day. “We’re exploring why this is, but what seems to be emerging is this concept of altruism, in which the grandmothers really feel that they get something out of actually making a difference in the lives of others,” Chibanda says. “It gives them a lot of great benefits, too.”

尽管这些老奶奶们日复一日给在危机边缘的人提供咨询,她们看起来却没有受到影响。齐班达说:“我们正在寻找原因,但这种利他主义的观念似乎是原因所在。这些老奶奶真的感觉到,通过帮助他人改变生活,自己也收获了一些东西。这也给为她们带来了很多好处。”

By 2009, Chibanda was already sure the programme was working, both in terms or improving quality of life for participants and reducing suicide. Harare’s city health department, which pays for the programme, was fully on board, and patients were being regularly referred from clinics, schools, the police and more. But if the Friendship Bench was going to be recognised and replicated around the world, Chibanda would first need to prove scientifically that it works.

到2009年,齐班达已经确信,无论是在改善参与者的生活质量还是降低自杀率方面,这个项目都很有效果。为该项目出资的哈拉雷市卫生部门也完全参与进来,不断地有患者从诊所、学校、警察局等地转诊前来治疗。但如果友谊长椅项目要在全世界范围内获得认可和推广,齐班达首先需要用科学证据证明这个项目是有效的。

In 2016, Chibanda – collaborating with colleagues from Zimbabwe and the UK – published the results of a randomised control trial of the programme’s efficacy in the Journal of the American Medical Association. The researchers split 600 people with symptoms of depression into two groups. They found that after six months, the group that had seen the grandmothers had significantly lower symptoms of depression compared to the group that underwent conventional treatment.

齐班达与津巴布韦和英国的同事合作,2016年在《美国医学会杂志》上发表了该项目疗效随机对照试验的结果。研究人员将600名抑郁症患者分为两组。他们发现,六个月后,与接受常规治疗的人群相比,见过老奶奶的这一组人的抑郁症症状明显降低。

“We were thrilled to bits with the results, which showed the intervention is having a big effect on people’s daily lives and ability to function,” says Victoria Simms, an epidemiologist at the London School of Hygiene and Tropical Medicine and co-author of the study. “It’s about giving people the tools they need to solve their own problems.”

伦敦卫生和热带医学学院的流行病学家、该研究的合作者西姆斯(Victoria Simms)表示:“我们很兴奋,这些结果表明,干预措施对人们的日常生活产生了巨大影响,让生活可以正常运作。它为人们解决自身的问题提供了所需的工具。”

Two more scientific trials are now underway, she adds, including one examining a new Youth Friendship Bench programme in Harare and another set up specifically for young people who are HIV-positive.

她补充说,目前正在进行另外两项科学试点,其中一项是在哈拉雷验证新的青年友谊长椅项目,另一项试点专门针对携带艾滋病毒的年轻人。

The programme has also expanded to several countries, and in doing so, Chibanda and his colleagues have found not only that it translates well across cultures but also that grandmothers aren’t the only ones capable of giving effective counseling. In Malawi, the Friendship Bench uses elderly counsellors of both genders, while Zanzibar uses younger men and women. New York City’s counsellors are the most diverse, including individuals of all ages and races, some of whom come from the LGBTQ community. “We cover all the bases,” says Takeesha White, executive director of the Office of Strategic Planning and Communications at the NYC Department of Health’s Center for Health Equity. “New York City’s population is very broad.”

友谊长椅项目还推广到了其它多个国家。齐班达和他的同事们通过这项活动发现,该项目可以在文化背景不同的地区推进,而且能够提供有效咨询的人也不仅仅是老奶奶而已。在马拉维,友谊长椅的咨询师有年长的男性和女性,而在桑给巴尔(Zanzibar),提供咨询的是年轻男女。纽约市的咨询师最为多元化,有不同种族和年龄层的各类人,其中有的人来自LGBTQ(女同性恋者、男同性恋者、双性恋者、跨性别者、酷儿)群体。纽约市卫生局健康公平中心的战略规划及沟通部门主任怀特(Takeesha White)表示:“纽约的人口非常多元化,而我们覆盖了每一类群体。”

Many of the New York counsellors have successfully overcome addictions and other life challenges themselves. “We’re committed to having folks with lived experiences, who can speak the language of recovery and of dealing with addiction,” White says. “Before you know it, you’re not on a bench, you’re just inside of a warm conversation with someone who cares and understands.”

许多纽约的咨询师曾成功地克服了本身的成瘾问题和其他生活上的挑战。怀特表示:“我们致力于招募有类似经历、了解恢复的过程、知道如何处理成瘾问题的人士。你只是感觉在和有类似经验、关心你的人进行一次温暖人心的对话,并不会意识到自己正坐在长椅上接受心理咨询。”

The New York City benches – which are bright orange – were piloted in 2016 and launched in mid-2017, attracting some 30,000 visitors during their first year. The city so far has three permanent benches in the Bronx, Brooklyn and Harlem, and the programme hosts pop-ups at festivals, churches, food pantries, parks and more. Friendship Bench counsellors also make themselves available immediately following community tragedies, including a recent suicide completed in public in East Harlem.

纽约市的友谊长椅是亮橙色。于2016年开始试点,并于2017年中旬正式推出,仅第一年已吸引到3万名访客。目前该市在布朗克斯、布鲁克林和哈莱姆有三条永久长椅,而且还会在节庆地点、教堂、慈善餐厅、公园等地进行快闪(pop-up)咨询活动。友谊长椅的咨询师也可以在社区发生悲剧的第一时间介入。最近,他们就介入了纽约市东哈莱姆的公共场所发生的一起自杀事件。

“When I visited New York, I was pleasantly surprised to find that the issues New Yorkers deal with are very similar to the issues here in Zimbabwe,” Chibanda says. “It’s issues related to loneliness, to access to care, and to just being able to know that what you’re experiencing is treatable.”

齐班达说:“我到访纽约时,很惊喜地发现,津巴布韦人和纽约人面临着非常相似的问题。这些问题和孤独有关,和能否获得关心有关,有时人们只是需要知道自己经历的危机是有办法解决的。”

While many more psychiatrists work in New York City than in Zimbabwe, the ratio of doctors to residents – about one for every 6,000 people in New York – is still problematic for providing access to care, especially for the underprivileged. The same holds true in many other places around the world, including the UK, which is now considering rolling out a Friendship Bench programme in London.

虽然纽约市的精神科医生人数要远远高于津巴布韦,但纽约的医生和居民人数之比仍在1:6000左右。要确保每一个人、尤其是弱势群体可以获得治疗仍然困难重重。同样的道理也适用于包括英国在内的世界多个国家地区,英国也正考虑在伦敦推出友谊长椅项目。

“This isn’t just a solution for low-income countries,” Simms says. “This may well be a solution that every country in the world could benefit from.”

西姆斯表示:“这种解决方案并不仅仅适用于低收入国家,世界上每一个国家都可能从中获益。”

“全文请访问纽约时报中文网,本文发表于纽约时报中文网(http://cn.nytimes.com),版权归纽约时报公司所有。任何单位及个人未经许可,不得擅自转载或翻译。订阅纽约时报中文网新闻电邮:http://nytcn.me/subscription/”

相关文章列表