TEDWomen 2017
Dixon Chibanda: Why I train grandmothers to treat depression
Dixon Chibanda: 點解我會訓練婆婆治療抑鬱症
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津巴布韋有一千六百萬人口，但係全國只有十二個心理醫生，而 Dixon Chibanda 係其中嘅一位。Chibanda 意識到佢嘅國家永遠冇可能有足夠資源用傳統方法醫治心理病。於是，佢搵到一個需要好少資源嘅妙法，就係婆婆。呢段講話非常出色且勵志，我哋可以從中了解到「友誼長櫈」呢個計劃，同佢點訓練婆婆學識用「循證談話療法」為有需要嘅人帶來關懷、希望。
Dixon Chibanda - Psychiatrist
Dixon Chibanda is passionate about the human brain, how it influences our behavior and what we can do to make everybody happy. Full bio
Dixon Chibanda is passionate about the human brain, how it influences our behavior and what we can do to make everybody happy. Full bio
Double-click the English transcript below to play the video.
00:12
On a warm August morning in Harare,
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喺八月嘅一個上晝
喺津巴布韋首都哈拉雷
喺津巴布韋首都哈拉雷
00:16
Farai,
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有個叫法拉嘅女人
00:18
a 24-year-old mother of two,
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佢廿四歲，有兩個仔女
00:21
walks towards a park bench.
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行去公園嘅一張長櫈度
00:24
She looks miserable and dejected.
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佢望落去好鬱悶，好沮喪
00:28
Now, on the park bench
sits an 82-year-old woman,
sits an 82-year-old woman,
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嗰張公園長凳已經
有個八十二歲嘅婆婆坐喺度
有個八十二歲嘅婆婆坐喺度
00:33
better known to the community
as Grandmother Jack.
as Grandmother Jack.
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人人都叫佢做 Jack 婆婆
00:39
Farai hands Grandmother Jack
an envelope from the clinic nurse.
an envelope from the clinic nurse.
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法拉遞俾 Jack 婆婆
一封診所護士俾佢嘅介紹信
一封診所護士俾佢嘅介紹信
00:47
Grandmother Jack invites Farai to sit down
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Jack 婆婆請佢坐低
00:50
as she opens the envelope and reads.
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然後打開個信封讀
00:53
There's silence for three minutes
or so as she reads.
or so as she reads.
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婆婆睇信嘅三分鐘裡邊，冇人講嘢
00:58
And after a long pause,
Grandmother Jack takes a deep breath,
Grandmother Jack takes a deep breath,
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隔咗一陣，Jack婆婆深呼吸
01:02
looks at Farai and says,
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佢望住法拉講：
01:06
"I'm here for you.
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「我係來幫你嘅，
01:10
Would you like to share
your story with me?"
your story with me?"
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你可唔可以講下你嘅事啊？」
01:13
Farai begins,
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法拉眼濕濕
01:15
her eyes swelling with tears.
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01:19
She says, "Grandmother Jack,
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佢話:「 Jack 婆婆啊，
01:22
I'm HIV-positive.
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我有愛滋病已經四年。
01:24
I've been living with HIV
for the past four years.
for the past four years.
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01:28
My husband left me a year ago.
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老公喺一年前走咗佬。
01:30
I have two kids
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我有兩個仔女，
01:32
under the age of five.
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佢哋都未到五歲。
01:34
I'm unemployed.
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我失業，
01:35
I can hardly take care of my children."
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我根本照顧唔嚟我啲仔女。 」
01:40
Tears are now flowing down her face.
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佢淚流滿面
01:43
And in response,
Grandmother Jack moves closer,
Grandmother Jack moves closer,
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見到咁，Jack 婆婆坐埋過去
01:47
puts her hand on Farai,
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輕輕攬住法拉
01:49
and says, "Farai, it's OK to cry.
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話：「法拉，你可以喊㗎。
01:53
You've been through a lot.
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你經歷咗好多事，
01:56
Would you like to share more with me?"
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可唔可以再講多啲畀我聽？」
01:59
And Farai continues.
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法拉繼續講：
02:02
"In the last three weeks,
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「喺過去嘅三個禮拜，
02:04
I have had recurrent thoughts
of killing myself,
of killing myself,
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我成日喺度諗自殺，
02:09
taking my two children with me.
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仲想帶埋啲仔女走。
02:12
I can't take it anymore.
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我頂唔順喇，
02:15
The clinic nurse sent me to see you."
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所以護士叫我嚟揾你 。」
02:20
There's an exchange between the two,
which lasts about 30 minutes.
which lasts about 30 minutes.
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佢哋兩個傾咗大概半個鐘
02:25
And finally, Grandmother Jack says,
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最尾，Jack 婆婆話：
02:28
"Farai,
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「法拉，
02:30
it seems to me that you have
all the symptoms of kufungisisa."
all the symptoms of kufungisisa."
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睇嚟『Kufungisisa』
嘅病徵你都有曬。」
嘅病徵你都有曬。」
02:37
The word "kufungisisa"
opens up a floodgate of tears.
opens up a floodgate of tears.
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聽到呢個字，法拉又即刻喊番
02:44
So, kufungisisa is the local
equivalent of depression
equivalent of depression
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「Kufungisisa」
係當地話「抑鬱症」嘅意思
係當地話「抑鬱症」嘅意思
02:48
in my country.
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02:50
It literally means
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直譯就係「諗太多」
02:52
"thinking too much."
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02:56
The World Health Organization estimates
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世界衛生組織統計
02:59
that more than 300 million people
globally, today, suffer from depression,
globally, today, suffer from depression,
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依家全世界有多過三億人有抑鬱症
03:05
or what in my country
we call kufungisisa.
we call kufungisisa.
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即係我個國家叫嘅
「Kufungisisa」
「Kufungisisa」
03:08
And the World Health
Organization also tells us
Organization also tells us
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世界衛生組織又話
03:12
that every 40 seconds,
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每四十秒
03:15
someone somewhere in the world
commits suicide
commits suicide
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全世界就有一個人自殺
03:19
because they are unhappy,
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因為佢哋唔開心
03:21
largely due to depression or kufungisisa.
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好可能因為有抑鬱症
或者「Kufungisisa」
或者「Kufungisisa」
03:24
And most of these deaths are occurring
in low- and middle-income countries.
in low- and middle-income countries.
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呢啲自殺個案
多數出現喺中、低收入國家
多數出現喺中、低收入國家
03:29
In fact,
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事實上
03:30
the World Health Organization
goes as far as to say
goes as far as to say
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世界衛生組織仲話
03:34
that when you look at the age group
between 15 to 29,
between 15 to 29,
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十五到二十九歲嘅年齡組
佢哋主要嘅死因係自殺
佢哋主要嘅死因係自殺
03:38
a leading cause of death
now is actually suicide.
now is actually suicide.
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03:43
But there are wider events
that lead to depression
that lead to depression
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但係，導致抑鬱症
甚至自殺嘅原因有好多
03:47
and in some cases, suicide,
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03:49
such as abuse,
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例如虐待
03:51
conflict, violence,
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衝突、暴力
03:53
isolation, loneliness --
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隔離、孤獨等等
03:56
the list is endless.
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03:59
But one thing that we do know
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不過，我哋知道
04:01
is that depression can be treated
and suicides averted.
and suicides averted.
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抑鬱症有得醫，自殺可以避免
04:06
But the problem is
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問題係
04:07
we just don't have enough psychiatrists
or psychologists in the world
or psychologists in the world
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全世界冇咁多
精神科醫生或者心理學家
精神科醫生或者心理學家
來睇所有嘅病人
04:11
to do the job.
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04:12
In most low- and middle-income
countries, for instance,
countries, for instance,
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譬如，喺中、低收入國家
04:15
the ratio of psychiatrists
to the population
to the population
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精神科醫生對人口嘅比例
04:18
is something like one for every
one and a half million people,
one and a half million people,
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大概係一對一百五十萬
04:22
which literally means
that 90 percent of the people
that 90 percent of the people
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即係話，九成需要心理服務嘅人
04:26
needing mental health services
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都得唔到幫助
04:28
will not get it.
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04:30
In my country,
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我哋成個國家
04:31
there are 12 psychiatrists,
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只有十二個精神科醫生
04:34
and I'm one of them,
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而我係其中嘅一個
04:36
for a population
of approximately 14 million.
of approximately 14 million.
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我哋國家人口有一千四百萬
04:40
Now, let me just put that into context.
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我再畀你多啲背景
04:43
One evening while I was at home,
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有一晚，我喺屋企
04:46
I get a call from the ER,
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收到 ER 打嚟嘅電話
04:48
or the emergency room,
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ER 即係急症室
04:51
from a city which is some
200 kilometers away
200 kilometers away
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間急症室喺離我
兩百公里嘅一個城市度
兩百公里嘅一個城市度
04:54
from where I live.
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04:56
And the ER doctor says,
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個主診醫生話：
04:57
"One of your patients,
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「你有個病人，
04:59
someone you treated four months ago,
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你四個月前醫過佢。
05:01
has just taken an overdose,
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佢啱啱用藥過量，
05:03
and they are in the ER department.
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依家入咗急症室。
05:05
Hemodynamically, they seem to be OK,
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佢嘅血液動力正常，
05:07
but they will need
neuropsychiatric evaluation."
neuropsychiatric evaluation."
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不過需要神經心理科嘅檢查。 」
05:11
Now, I obviously can't get into my car
in the middle of the night
in the middle of the night
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當然，我無可能半夜揸車
05:14
and drive 200 kilometers.
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揸兩百公里去嗰度
05:16
So as best as we could,
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所以，我哋唯有
05:18
over the phone with the ER doctor,
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喺電話度
05:21
we come up with an assessment.
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諗出對應嘅辦法
05:24
We ensure that suicidal
observations are in place.
observations are in place.
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我確保有人會觀察病人有冇自殺傾向
05:29
We ensure that we start reviewing
the antidepressants
the antidepressants
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我哋一齊去檢查病人
服用抗抑鬱藥嘅劑量
服用抗抑鬱藥嘅劑量
05:32
that this patient has been taking,
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05:34
and we finally conclude
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最後得出嘅結論係
05:37
that as soon as Erica --
that was her name, 26-year-old --
that was her name, 26-year-old --
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Erica ——
呢個係病人嘅名，佢廿六歲
呢個係病人嘅名，佢廿六歲
05:40
as soon as Erica is ready
to be released from the ER,
to be released from the ER,
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喺 Erica 可以出院時
05:44
she should come
directly to me with her mother,
directly to me with her mother,
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佢同佢媽媽應該直接來揾我
05:47
and I will evaluate
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我會對佢做檢查同評估
05:49
and establish what can be done.
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同決定下一步要點做
05:51
And we assumed that that would
take about a week.
take about a week.
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我哋估計 Erica
大概一個禮拜之後就會來
大概一個禮拜之後就會來
05:54
A week passes.
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過咗一個禮拜
05:56
Three weeks pass.
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過咗三個禮拜
05:57
No Erica.
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我都冇見到 Erica
05:59
And one day I get a call
from Erica's mother,
from Erica's mother,
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有一日，Erica 媽媽打電話畀我
06:02
and she says,
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佢話：
06:04
"Erica committed suicide three days ago.
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「Erica 三日前自殺咗。
06:07
She hanged herself from the mango tree
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佢喺屋企花園
06:12
in the family garden."
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一樖芒果樹度吊頸。」
06:16
Now, almost like a knee-jerk reaction,
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我本能反應噉，忍唔住問：
06:19
I couldn't help but ask,
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06:21
"But why didn't you come
to Harare, where I live?
to Harare, where I live?
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「噉點解你哋冇嚟哈拉雷揾我？
06:25
We had agreed that as soon
as you're released from the ER,
as you're released from the ER,
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我哋講好咗，Erica 一出院，
06:28
you will come to me."
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你哋就會嚟揾我 。」
06:30
Her response was brief.
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佢嘅解釋好簡單：
06:34
"We didn't have the 15 dollars bus fare
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「去哈拉雷嘅車費要十五蚊，
我哋籌唔到錢。 」
06:37
to come to Harare."
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06:40
Now, suicide is not an unusual event
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喺精神病嘅領域度
06:44
in the world of mental health.
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自殺唔算罕見
06:47
But there was something
about Erica's death
about Erica's death
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但 Erica 嘅死
06:49
that struck me at the core
of my very being.
of my very being.
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畀我好大嘅震動
06:54
That statement from Erica's mother:
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佢媽媽嗰句
06:57
"We didn't have 15 dollars bus fare
to come to you,"
to come to you,"
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「我哋籌錢唔到
十五蚊嘅車費嚟揾你。」
十五蚊嘅車費嚟揾你。」
07:03
made me realize
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令我醒覺
07:05
that it just wasn't going to work,
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等病人嚟揾我
07:07
me expecting people to come to me.
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呢個方法行唔通
07:10
And I got into this state
of soul-searching,
of soul-searching,
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我開始自我反省
重新諗
07:14
trying to really discover my role
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我喺非洲做精神科醫生嘅定位
07:18
as a psychiatrist in Africa.
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07:21
And after considerable consultation
and soul-searching,
and soul-searching,
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經過一番諮詢同思考
07:25
talking to colleagues, friends and family,
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又同同事、家人、朋友傾過
07:28
it suddenly dawned on me
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我突然醒覺
07:31
that actually, one the most reliable
resources we have in Africa
resources we have in Africa
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其實非洲最多嘅資源
07:36
are grandmothers.
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就喺啲婆婆
07:39
Yes, grandmothers.
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無錯，係婆婆
07:41
And I thought,
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我係度諗
07:43
grandmothers are in every community.
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每個社區都有好多婆婆
07:46
There are hundreds of them.
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有成幾百個
07:48
And --
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仲有
07:49
(Laughter)
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（笑聲）
07:50
And they don't leave their communities
in search of greener pastures.
in search of greener pastures.
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佢哋唔會離職， 唔會換工走人
07:55
(Laughter)
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（笑聲）
07:57
See, the only time they leave
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佢哋唯一會去嘅更好嘅地方
07:59
is when they go to a greener
pasture called heaven.
pasture called heaven.
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就係天堂
08:01
(Laughter)
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（笑聲）
08:02
So I thought, how about
training grandmothers
training grandmothers
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所以我諗，不如訓練呢啲婆婆
08:06
in evidence-based talk therapy,
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教佢哋循證談話療法
08:09
which they can deliver on a bench?
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等佢哋可以坐喺公園長櫈度應用
08:13
Empower them with the skills to listen,
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根據認知行為療法
教佢哋聆聽嘅技巧
08:16
to show empathy,
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表達同情心
08:19
all of that rooted
in cognitive behavioral therapy;
in cognitive behavioral therapy;
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08:22
empower them with the skills
to provide behavior activation,
to provide behavior activation,
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教畀佢哋技巧來激活病人嘅行為
同安排病人嘅活動
同安排病人嘅活動
08:27
activity scheduling;
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08:28
and support them using digital technology.
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同埋教佢哋學識用數碼科技
08:33
You know, mobile phone technology.
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譬如，手機
08:35
Pretty much everyone in Africa
has a mobile phone today.
has a mobile phone today.
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依家, 喺非洲人人都有手機
08:38
So in 2006,
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喺 2006 年
08:40
I started my first group
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我組織到第一班
08:44
of grandmothers.
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婆婆
08:45
(Applause)
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（掌聲）
08:49
Thank you.
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多謝
08:50
(Applause)
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（掌聲）
08:53
Today, there are hundreds of grandmothers
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今日，我哋有幾百個婆婆
08:56
who are working
in more than 70 communities.
in more than 70 communities.
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分散喺七十幾個社區度做嘢
09:00
And in the last year alone,
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單單係舊年
09:03
more than 30,000 people received treatment
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已經有三萬以上嘅津巴布韋人
09:08
on the Friendship Bench
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喺社區嘅「友誼長櫈」嘅計劃度
09:09
from a grandmother
in a community in Zimbabwe.
in a community in Zimbabwe.
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接受咗一個婆婆嘅治療
09:13
(Applause)
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（掌聲）
09:21
And recently, we published this work
that is done by these grandmothers
that is done by these grandmothers
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最近，我哋喺
美國醫學研究協會嘅雜誌
美國醫學研究協會嘅雜誌
09:26
in the Journal of the American
Medical Association.
Medical Association.
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發表文章講述呢啲計劃同婆婆嘅工作
09:29
And --
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仲有
09:30
(Applause)
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（掌聲）
09:32
And our results show
that six months after receiving treatment
that six months after receiving treatment
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我哋嘅研究結果顯示
接受過婆婆治療嘅病人
喺六個月後
喺六個月後
09:38
from a grandmother,
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09:40
people were still symptom-free:
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依然無復發嘅徵像
09:42
no depression,
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無抑鬱
09:44
suicidal ideation completely reduced.
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少咗好多自殺嘅傾向
09:47
In fact, our results --
this was a clinical trial --
this was a clinical trial --
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我哋嘅研究顯示 ——
呢個係臨床試驗
呢個係臨床試驗
09:50
in fact, this clinical trial showed
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臨床試驗結果顯示
09:52
that grandmothers were more effective
at treating depression
at treating depression
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婆婆醫抑鬱症仲有效過醫生
09:56
than doctors and --
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09:57
(Laughter)
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（笑聲）
09:58
(Applause)
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（掌聲）
10:06
And so,
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所以
10:08
we're now working towards
expanding this program.
expanding this program.
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我哋依家努力擴展呢個計劃
10:14
There are more than 600 million people
currently aged above 65 in the world.
currently aged above 65 in the world.
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依家，全球有六億
六十五歲以上嘅人口
六十五歲以上嘅人口
10:21
And by the year 2050,
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到 2050 年
10:23
there will be 1.5 billion people
aged 65 and above.
aged 65 and above.
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會有十五億
六十五歲以上嘅人口
六十五歲以上嘅人口
10:29
Imagine if we could create
a global network of grandmothers
a global network of grandmothers
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想像一下, 如果我哋能夠
喺全世界所有主要城市
喺全世界所有主要城市
10:35
in every major city in the world,
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建立一個國際婆婆網絡
10:39
who are trained
in evidence-based talk therapy,
in evidence-based talk therapy,
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而啲婆婆又受過
循證談話療法嘅訓練
循證談話療法嘅訓練
10:44
supported through digital platforms,
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有電子平台支援佢哋
10:46
networked.
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又有網絡將佢哋聯繫起來
10:48
And they will make a difference
in communities.
in communities.
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佢哋會為社區做出好多貢獻
10:53
They will reduce the treatment gap
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佢哋會舒緩當地心理、神經
10:55
for mental, neurological
and substance-use disorders.
and substance-use disorders.
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同濫用藥物問題上嘅
醫療服務供求差距
醫療服務供求差距
11:00
Finally,
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最後
11:01
this is a file photograph
of Grandmother Jack.
of Grandmother Jack.
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呢張係 Jack 婆婆嘅相
11:05
So, Farai had six sessions on the bench
with Grandmother Jack.
with Grandmother Jack.
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法拉喺「友誼長櫈」
同婆婆有六次療程
同婆婆有六次療程
11:12
Today, Farai is employed.
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依家，法拉揾到工做
11:14
She has her two children at school.
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佢兩個仔女讀緊書
11:18
And as for Grandmother Jack,
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至於 Jack 婆婆
11:20
one morning in February, we expected her
to see her 257th client on the bench.
to see her 257th client on the bench.
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喺二月嘅一個上晝
佢本來會嚟見佢第 257 位病人
佢本來會嚟見佢第 257 位病人
11:28
She didn't show up.
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但係佢無出現
11:31
She had gone to a greener
pasture called heaven.
pasture called heaven.
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佢去咗天堂
11:34
But I believe that Grandmother Jack,
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但我相信，Jack 婆婆
11:37
from up there,
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喺天堂同緊其他婆婆打氣
11:39
she's cheering on
all the other grandmothers --
all the other grandmothers --
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11:42
the increasing number of grandmothers
who are making a difference
who are making a difference
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越來越多婆婆會加入呢個計劃
11:46
in the lives of thousands of people.
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改變千萬人嘅人生
我相信，佢一定會好驚嘆
11:50
And I'm sure she's in awe
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11:52
when she realizes that something
that she helped to pioneer
that she helped to pioneer
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佢帶頭開始嘅計劃
11:57
is now spreading to other countries,
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已經發展到其他國家
12:00
like Malawi,
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例如馬拉維
12:01
the island of Zanzibar
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桑給巴爾群島
12:02
and coming closer to home
here in the Unites States
here in the Unites States
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同埋喺呢度
12:06
in the city of New York.
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美國嘅紐約市
12:09
May her soul rest in peace.
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願 Jack 婆婆安息
12:12
Thank you.
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多謝
12:13
(Applause)
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（掌聲）
12:16
(Cheering)
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（歡呼）
12:18
(Applause)
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（掌聲）
Translated by Julie Leungsuetying
ABOUT THE SPEAKER
Dixon Chibanda - PsychiatristDixon Chibanda is passionate about the human brain, how it influences our behavior and what we can do to make everybody happy.
Why you should listen
Dixon Chibanda is the director of the African Mental Health Research Initiative (AMARI). He's based in Zimbabwe, where he works on the Friendship Bench program, a cognitive behavioral therapy–based approach to kufungisisa, the local term for depression, literally translated into “thinking too much.” At the Friendship Bench, patients receive individual problem-solving therapy from a specifically trained lay health worker.
Chibanda is passionate about connecting with ordinary people in ways that improve their lives using simple but effective programs that can be carried out by non-specialists or professionals. He likes to think outside the box as he explores ways of helping people with conditions such as depression, PTSD and ADHD.
Dixon Chibanda | Speaker | TED.com