Saràh Dina is an Australian clinical psychologist. She has completed a mission as a mental health officer in Baluchistan, Pakistan, and describes her experience.
“A lot of people are surprised that talking and counselling can help. It is a very medication dependent society. When someone has a problem they tend to just take a pill.
A doctor who was working near Baluchistan noticed that many women came to one of our clinics with physical complaints that couldn’t be explained medically. When they looked into it in more depth it was clear that there were psychological reasons for their pain.
Most of our patients were female and predominantly adults, but we also saw some children. The majority of our beneficiaries came from low socioeconomic backgrounds.
On the surface, it can seemed like any other place in the world but when you dug a bit deeper you found that the reasons for the patient’s problems were very specific to the region.
Some people had been exposed to war and conflict. Many had experienced a lot of grief and loss, also in relation to situations like maternal and child deaths. Some women in their late thirties or early forties had already had more than 10 children, some as many as 15 or 16, and not all children had survived. We saw cases of women for example who had lost four or five children, yet the expectation was that they just move on after each death.
A typical case?
It is difficult to describe a typical case, but as an example we had women come to see us who lost their husbands many years ago during the war, and yet they still retained a glimmer of hope that they might still be alive. This could haunt some women for the rest of their lives.
They were now required to be financially responsible for their children if they had no other family around to help, and this put a lot of pressure on them.
Some women also faced violence in the family home, and came to see the counsellors to seek relief from it all, not being able to talk about this in such a frank and open way elsewhere.
We also had men and women come to us with symptoms of post-traumatic stress disorder. Some had nightmares and flashbacks to periods in their lives that they would rather have forgotten – from war and conflict, to violence at home.
Many people had been taking psychiatric medication for many years and when they came to us they said that the medication did not help them. This was likely due to an over-prescription of unsuitable medication and a misdiagnosis.
At the beginning we were not sure how the programme would work because the concept of counselling and mental health was very new in Baluchistan, but over the years we saw a very positive increase in people accessing our services. On average, our counsellors were seeing five patients per day, which was a lot as you spent a considerable amount of time with each patient, and patients came to see us three or four times.
Some people stopped after these sessions because they felt better, others needed to come back. We were not equipped to deal with acute psychiatric problems, such as psychosis. These patients had to be referred to specialised centres.
We could see patients for many years, but it was not our aim either to provide long term counselling.
A positive experience
Given the uncertainty of the context where I was working, I was never sure if I would be able to have a follow-up appointment with a patient. The team of counsellors would inform me of any progress with any particular women I had met.
One woman came to see one of the counsellors and knew I was nearing the end of my stay. Not knowing if we would meet again she asked the counsellor to teach her a few words of English.
She then thanked me in broken English over the phone for our work.
I realised that you can communicate with people with depth and kindness, without speaking the same language.”