There is teaching session at every SMRU clinic each week. The medics and nurses had their assessment this Wednesday, so there was no teaching scheduled for yesterday afternoon. I am not supposed to deviate from the agreed curriculum, but it contains nothing about mental health problems. So when the nurses asked for a bit of teaching, I thought I’d talk about depression and anxiety. By doing this, I was hoping to find out more about their experience of mental illness in the local population.
I was teaching midwives, too, so I started off discussing post natal depression, thinking that this was probably well recognised in all cultures. I had some interesting questions:
“Does depression cause women to reject their new babies and abandon them?”
“When a woman doesn’t want a pregnancy, is it because she is depressed?”
“We had a crazy pregnant woman who was in labour, and she ran away from the clinic to find her husband. He was also crazy. She put up a fight when we tried to persuade her to come back to the delivery ward.” (Folie a deux?)
As you can imagine, this set off a lot of discussion. The teaching tends to be very didactic – teacher speaks, student writes notes, no discussion, because it is all straightforward and factual. So my style of Socratic questioning, discussing possibilities and story telling is quite an eye opener for them. I had more insight into what goes on at the maternity clinic from their questions, but I moved on to discuss depression with the other staff, who had been listening in.
Yes, they knew some people like this who felt sad and unhappy. I explained that depression is more than just being sad, but this is a difficult concept to get across in UK, never mind with health workers who have only had six years of schooling. I asked about suicide and they said that some people did kill themselves, but no one could understand why. I’ve found that Karen people don’t often discuss feelings with health workers, and it is quite plausible for those with depression to withdraw socially, so nobody knows how grim they feel.
Moving on to anxiety was easier. Everyone knew about fear, about adrenalin and physical aspects of anxiety. They all recognised health anxiety. I was talking about phobias and I could sense this concept was not understood. So I talked about being irrationally afraid of spiders and how this could be treated by gradual desensitisation. One nurse said,”Do I need this treatment, I’m afraid of poisonous snakes?” No, that doesn’t require treatment unless it takes over your entire life and you’re obsessed. It isn’t irrational at all. But it got me thinking; I don’t like snakes but I hadn’t even thought of venomous reptiles in this locality…
When I described post traumatic stress disorder, no one recognised this. “I know someone who lost a leg from a landline explosion, but the only thing he was worried about was getting a prosthetic leg and walking again.”
It seems as though I have got more to learn than the health workers.