Raise Awareness & Promote Mental Health - Tanzania

TEWWYs Wisdom&Wellness Counselors administered WHOs Patient Health Questionnaire 9 (PHQ9) to random sample size of 418 in Public Health Institutions (PHIs) before COVID halted the Mental Health Intervention Programs (MHIP) in PHIs.

From the responses collected, 
252 individuals, equivalent to 60% of the sample size tested normal,
110 (26%) had mild depression,
43 (10%) had moderate depression and
Less than 1% (3 people) had severe depression.

While the PHI data collection activities and group therapy circles had to be halted due to the pandemic, it was an easy deduction that while many people tested normal, also there is a good number of those who were identified as suffering from mild depression and a few of them from moderate depression that desperately need mental health services.

Upon request from the Local Government Authorities from the municipalities where the Wisdom&Wellness Counselors provided Mental Health support servives, COVID PPEs as needed, TEWWY plans to provided the requested services in the communities and to start specifically gearing our programs towards students.

While we are waiting to hear from the authorities regarding the new procuderes as far as the Public Health Instituion MHIP project is concerned, we are working out the fine details on the new programs to be offered within the government structures and independent educational institutions.

As a mental health stakeholder in the country, Tap Elderly Women's wisdom for Youth (TEWWY) was called-to-action to provide necessary support and resources to underserved communities - in promoting their mental and physical health during the COVID-19 global pandemic.

TEWWYs  Mental Health Intervention Program (MHIP) is implemented across (15) Public Health Institutions (PHIs) in the (5) municipalities of Dar-es-Salaam (Ilala, Kigamboni, Kinondoni, Ubungo, and Temeke). The MHIP has laid the foundation for integrating mental health services in Tanzania’s multisectoral systems. TEWWYs Wisdom&Wellness Counselors (WWCs) provide mental health support services and resources as we collected data integral in understanding the magnitude of the mental health challenges in the Tanzanian communities. The data and lessons learned are recorded, monitored, and evaluated for instrumental implementation in policymaking as needed for reporting to the Tanzania Ministry of Health.

TEWWYs MHIP adapts WHOs mental health Gap Action Program (mhGAP) which offers evidence-based intervention guidelines designed to promote mental health in hopes of preventing and reducing suicides. Such services include access to the following mental health intervention programs:

Wisdom&Wellness Counselor (WWC) ~ In-Person & Mobile Responder
Elderly retired women trained to provide psychosocial mental health support, sharing life-stories, experiences and counseling skills to empower communities through in-person wisdom or online support.

Wisdom &Wellness Corners ~ Beyond What Meets the Eye: Interpersonal Therapy/Counseling [IPT/C]
An identified station at a PHI (or other community locale) where a WWC can connect persons to support services & resources including one-on-one counseling.

Wisdom&Wellness Circles ~ Let’s Share & Care: Interpersonal GroupTherapy [IPT-G] with Life-Skills Building
A safe space where Sharing & Caring have been given a special platform. Persons share life-experiences while gaining life-skills: Self-care & Healthy Lifestyle, Financial Literacy, Job Search and Entrepreneurship.

As COVID-19 took wave across the globe, anxiety levels rose due to uncertainty over contracting the COVID-19 virus and financial management in times when most activities leading to gainful income or activities that bring one joy are a high health risk with possible fatalities. During these unforeseen times, mental health support needs are at an all-time unprecedented high, and most traditional methods of providing such services that have been employed by TEWWY and its Wisdom&Wellness Counselors had to be halted, for the safety of the Wisdom&Wellness Counselors and the communities they serve, playiong our role in flattening the curve.

But there is more than one way to serve the community we love. Following direction from the World Health Organization (WHO) and the Center for Disease Control (CDC), and listening to peoples cries and concerns, Tap Elderly Women Wisdom for Youth adapted its services in a safe way to continue protecting our community and bring its members together.

1,750 masks and 1,500 liters of soaps were handmade in the safe confines of the Wisdom&Wellness Counselors' homes and makeshift shops. These COVID-19 personal protective equipment (PPE), the masks and the soap, all had special mental health messages printed onto them. Gently reminding the community that we care about them, and all around, we all care for each other, the words "Ninajilinda" and "Ninakulinda" meaning "I am protecting myself" and "I am protecting you" message read on the equipment. 

The 1,500L of soap produced a total of 6000 bottles of 250mL volume. 6,000 recipients in the base of the pyramid were naturally the target population. For those already living on an income insufficient to support themselves and/or their families,  affording the basic necessities like soap and mask to prevent oneself from contracting the virus is sometimes not possible. In times when financial situations are uncertain across the world, for some, having access to soap and clean water could mean the difference between life and death.  

6000 liters of soap were hand-produced and distributed by the TEWWY team to Tanzanians residing across Dar-es-Salaam. Keeping an eye on the current situation, TEWWY continues to assess the risk and plan to respond accordingly. As the soaps made a very huge impact in our societies, TEWWY intends to continue providing this life-threatening disease-preventing PPE. With 8,500 more bottles already purchased, we are on a mission to gather support from everybody who has been affected by the pandemic, to join forces with us in helping save lives in our communities.

TAP ELDERLY WOMEN’S WISDOM FOR YOUTH
Sakura Street, Sinza Makaburini
P. O. Box 32705
Dar-es-Salaam, Tanzania
[Text]: +255 757 327 878 | [Call]: +255 737 773 982
tewwy@tewwy.org | www.tewwy.org

[01/20 - 01/24, 2020]: Wisdom & Wellness Partner [WWP] Report
 

• Facilitators

Wisdom & Wellness Leaders [WWLs]

Rustica Tembele - Founder & CEO    |    Neema Tembele - Founder & COO    |    Almasi Saidi - CFO

Wisdom & Wellness Officers [WWOs]

Gibson Mulokozi - Monitoring & Evaluation Officer        |        Gaspar Kanijo - Programs Officer

Wisdom & Wellness Counselors [WWCs]

• Caroline Swai - Vijibweni Health Center
• Suzan Njana – Kigamboni Health Center
• Alfreda George - Chekeni Mwasonga Dispensary
• Lucy Chikongoye - Tegeta Dispensary
• Rebecca Gyumi - Mwananyamala Hospital
• Margret Kayombo - Amana Hospital
• Pauline Ngwawasya - Msongola Dispensary 
• Sakina Bushiri - Pugu Dispensary
• Christine Mande - Buza Dispensary
• Grace Mshanga – Mbagala Rangi Tatu Health Center 
• Aveline Hokororo - Kizuiani Dispensary
• Radegunda T. Minja - Sinza Health Center
• Joyce Msai - Makurumula Dispensary
• Emma Mwakasungula – Mbezi Dispensary
• Mary Kingu - Tandale Dispensary

• Activity: WWP - Health Care Facility Visit

TEWWY’S WWCs provide one-on-one wisdom and wellness counseling support as needed and collect data for the identification of potential Wisdom and Wellness support and resources beneficiaries at the allocated public health institutions. Voluntary enrollment and participation affords an individual a plethora of mental health support services and resources, such as Mental Health Wisdom & Wellness SMS Promotion Campaign and Wisdom & Wellness Circles.

Objective:

Each WWC to administer at least 25 patient questionnaires per facility.
Outcome: [8] Dispensary  [4] Health Center   [3] Hospital

Tools & Resources

Hardware: Tablet

Software: SurveyMonkey

Consent Forms

1. Overall Survey: 277                   Female: 206        Male: 71
2. Accepted:  266                           Declined: 11            Skipped: 0

Wisdom & Wellness Circles: 

Subscribe: 195   Unsubscribe: 26   Skipped: 86

Wisdom & Wellness Mental Health  SMS Promotion Campaign

Subscribe: 194   Unsubscribe:  20       Declined:  63
  

Thematic Analytics 

Self-efficacy:

• 151 respondents (67.11%) said they are faced by financial challenges.
• 119 respondents (52.89%) said they were faced with social issues.
• 20 respondents   (8%) didn’t have a positive attitude towards themselves while 
• 16 respondents (6.7%) were not sure of where they stood.

Self-esteem:

• 8 respondents (3%) said they cannot work as effectively as other people around them.
• 26 respondents (11%) said they are not able to accomplish their set goals.
• 63 respondents (28.6%) said they were not sure if they could accomplish the goals they set.
• 10 respondents (4%) said they were not able to keep calm when they are faced with a challenging life situation.

Sense of belonging:

• 20 respondents (9.37%) disagreed not to talk to their families and friends when they encounter a challenging life situation while
• 21 respondents (10%) were not sure if they are respected in the societies they belong to.

Feedback from the Field:

Wisdom & Wellness Counselors [WWCs] - [# of Clients]

• Caroline Swai - Vijibweni Health Center [8]
• Suzan Njana – Kigamboni Health Center [N/A]
• Alfreda George - Chekeni Mwasonga Dispensary [3]
• Lucy Chikongoye - Tegeta Dispensary [16]
• Rebecca Gyumi - Mwananyamala Hospital [20]
• Margret Kayombo - Amana Hospital [12]
• Pauline Ngawasya - Msongola Dispensary [20]
• Sakina Bushiri - Pugu Kajiungeni Dispensary [13]
• Christine Mande - Buza Dispensary [27]
• Grace Mshana – Mbagala Rangi Tatu Health Center [25]
• Aveline Hokororo - Kizuiani Dispensary [13]
• Radegunda T. Minja - Sinza Health Center [40]
• Joyce Msai - Makurumla Health Center [11]
• Emma Mwakasungura – Mbezi Dispensary [13]
• Mary Kingu - Tandale Dispensary [13]

Wisdom & Wellness Circles [WWCrs] - Each Facilitated by the (3) WWCs of the Municipality
Municiality:      Location                                                Theme                                           # of Attendees
                 
Temeke      Mbagala Zakhem Dispensary    Self-Awareness                 3
Kinondoni   Mwananyamala Hospital        Women-Related Issues           3
Ilala       Rugambwa Hospital            Dysfunctional Family           4
Kigamboni   Chekeni Mwasonga             Awareness & Family Conflict    3
Ubungo      Mbezi Dispensary             Mental Health Awareness        4

Emerging stories

“I met a depressed 21 year old boy  whose studies were cut short in 2014 due to family conflicts. Aside from suffering from a sexually transmitted disease (STD), he couldn’t afford the medication for treatment. I was so moved by this and as a human being I had to give him money to contribute to at least half of his prescribed medication. I am determined to support this young man by making follow-up visits to ensure that his health stabilizes while at the same time I will be counselling him. I could tell that he needed somebody to confide to and I would like to be the shoulder for this young man to lean on. ” Alfreda George, WWC.

In another health facility, Margaret Kayombo had this to say: 

“I was very honored to meet a woman, a retired nurse, who was filled with a great appreciation of the work that TEWWY is doing. She said the services we are offering at the health facilities are extremely useful and overdue for the Tanzanian community. She applauded us and encouraged us to continue without despairing as this is such a noble cause”. 

Emma Mwakasungula is yet another WWC who narrated the following: 

“I met a 35 year old divorce man aged 35 years who wanted to discuss with us about life. He said he is divorced, has no job and he was HIV positive. He wanted to be helped, he wanted a shoulder to lean on. I assured him of my readiness to help.”

Key findings

• In all the facilities that the WWCs have been to, it was evident that clients were hesitant to be interviewed as most of them don’t understand who or what TEWWY is yet and what the program is about. Some of them even asked the WWCs what was in it for them for participating in the survey, implying some sort of financial compensation or such. This is a concern that has been foreseen by the TEWWY Team, and will continue to be under observation. 

• The program being implemented by the different  facilities directly impacts the patients that the WWCs have access to. For instance, in some facilities there are some special programs designed to promote the health care of infants,toddlers &/or pregnant women,  and on such days, it’s highly expected that the patients most likely to come to this particular facility on that day is a pregnant woman &/or mother, limiting the survey pool. 

• Conducting the assessment at the Outpatient Department (OPD) is not a very conducive idea. Sometimes in the middle of the assessment, a patient gets called to see the doctor and naturally, the exercise must stop because after all the patients’ main motive to go to the hospital was to see a doctor because they are sick. Experience shows that the patients do not come back to finish the assessment after they are done with the doctor.  This can be frustrating to the WWCs because they cannot reach the target. 

• While being stationed at the Out-Patient Department (OPD) places the WWC in an optimum position to conduct the mental health assessment, it does have its disadvantages. Whether or not the survey has been completed, when the patient’s turn to go see the doctor reaches, obviously the exercise has to cease continuation; and upon completion of the doctor consultation, patients don’t always tend to return to compete the assessment with the WWC.

Lesson Learned and Our Proposed Way Forward

• TEWWY must take deliberate measures to raise awareness on the services and support resources offered through  its intervention program. Majority of the patients interviewed at the different facilities have commended TEWWY on  its good work.. TEWWY intends to bank on this feedback received from the patients, mental health coordinators and the focal contact persons at the OPD to generate a widespread message on social media, television & radio, podcasts and any other channels through the community to educate on mental health and the services offered that are accessible to all.

• Continuous mentoring and coaching of the WWCs remains to be critical. Although the WWCs are retirees from the public sector, they are at different levels of grasping and understanding the project. TEWWY team has to be on their toes to be able to provide the support that might be needed/required by the WWC while they are at the different facilities conducting the assessment. It is a crucial phase for both the WWCs and the TEWWY team, but also a very rewarding learning phase. 

• Both the WWCs and the TEWWY team must be aggressive in getting the work done. Sometimes when the WWCs go to the facilities they do not get the required support from the Mental Health Focal Persons. Some of the Focal persons have the misconception that the WWC are getting a lot of money to do the assessment and they sort of like to get a share. This has got to be explained again and again that there are no financial benefits from doing this work other than getting the satisfaction that data is being generated through the assessment to help the Ministry of Health to come up with plans that will be inclusive of mental health, something that is currently lacking. 

• WWCs must find out which peak days exist in their assigned facilities to be able to reach the set target which allow us to collect sufficient data to be used for planning purposes.  

• WWCs are advised to be more conversant on issues related to mental health through extensive reading about the subject matter and not just relying on the training that they received.   

Key issue from the wellness Circles

• The time set for the wellness circles (from 4 – 5 pm) does not seem to be conducive to many, would be willing participants. Since there is no budget for the wellness circles for the current project, TEWWY has got to think seriously on how to make the wellness circles real. From the few wellness circles stories that we have been hearing from the WWCs, the circles are seen to be a very important forum and space for people to come and open up on the issues that have been torturing them for some time, For TEWWY, our philosophy is Without Wellness Circles the work is incomplete. We will be proud to tell a success story about how many people have benefited from the wellness circles and how many we have helped to lessen their mental health burdens through the WC and how many people we have saved from committing suicide due to mental depression or the like.

• The venue for the WC again is not conducive to the clients. Again, this is something that we have started brainstorming on how best to make this happen without being a burden to the clients for the WC. In discussion with the WWC, many ideas are emerging. There are those who say each WWC conducts a WC at the or near the facility that she served. According to them they will be able to get the clients that were interviewed and especially so since they will not have to travel long distance to another facility for the WC.

• Do we need to propose a different time for WC? This again is something that we are discussing. But if this is changed it will mean two days per week instead of the one day that is in the project document. Considering the small transport fee that the WWC are getting, we might be asking too much from them. We are still contemplating as to whether that should be ell taken of in the next phase of the project or do we approach other donors to fill in that gap? 

Lessons Learnt and proposed way forward

• There is no doubt that the Wisdom & Wellness Circles are badly needed. We are creating/providing space for communities that have been lacking mental health support which has led to a scary number of suicides. 

TEWWY is designing various methodologies for the effective Wisdom & Wellness Circles. A lot of research is going into finding the most effective way to conduct the circles.

*** All participants named in this report are employees &/or officers of Tap Elderly Women's Wisdom for Youth and have given explicit consent for their names to be used without alteration ***

TAP ELDERLY WOMEN’S WISDOM FOR YOUTH

Sakura Street, Sinza Makaburini
P. O. Box 32705
Dar-es-Salaam, Tanzania
[Text]: +255 757 327 878 | [Call]: +255 737 773 982
tewwy@tewwy.org | www.tewwy.org

[12/16 - 12/20, 2019]: Wisdom & Wellness Partner [WWP] Report

1. Facilitators

Wisdom & Wellness Leaders [WWLs]

• Rustica Tembele - Chief Executive Officer
• Neema Tembele - Chief Operations Officer
• Almasi Saidi - Chief Financial Officer

Wisdom & Wellness Officers [WWOs]

• Gibson Mulokozi - Monitoring & Evaluation Officer
• Gaspar Kanijo - Programs Officer

Wisdom & Wellness Counselors [WWCs]

• Caroline Swai - Vijibweni Health Center
• Suzan Njana – Kigamboni Health Center
• Alfreda George - Cheek Mwasonga Dispensary
• Lucy Chikongoye - Tegeta Dispensary
• Rebecca Gyumi - Mwananyamala Hospital
• Margret Kayombo - Amana Hospital
• Pauline Ngawasya - Mongolia Dispensary 
• Sakina Bushiri - Pugu Dispensary
• Christine Mande - Buza Dispensary
• Grace Mshana – Mbagala Rangi Tatu Health Center 
• Aveline Hokororo - Kizuwiani Dispensary
• Radegunda T. Minja - Sinza Health Center
• Joyce Msai - Mazurumla Dispensary
• Emma Mwakasungura – MBEZI Dispensary
• Mary Kingu - Tandale Dispensary

1. Activity: WWP - Health Care Facility Visit

TEWWY’s WWCs provide one-on-one wisdom and wellness counseling support as needed and collect data for the identification of potential Wisdom & Wellness support and resources beneficiaries at the allocated government health care facilities. Voluntary enrollment and participation affords an individual a plethora of mental health support  services and resources, such as Mental Health Wisdom & Wellness SMS Promotion Campaign and Wisdom & Wellness Circles.

Objective

Each WWC will administer and submit no less than “X” responses per facility:
__50__ /Dispensary__50__/Health Center __50__/Hospital

Tools & Resources

Hardware: Tablet

Software: SurveyMonkey, TeleRivet

Consent Forms

OverallSurvey:
Accepted: __232__ Declined: __4__

Wisdom & Wellness Circles:
Subscribe: _____ Unsubscribe: _____ Declined: _____ 

Mental Health Wisdom & Wellness SMS Promotion Campaign:
Subscribe: __N/A__ Unsubscribe: __N/A__ Declined: __9___  

 Wisdom & Wellness Baseline Survey Statistics 

WWCs Submitted Responses: _12_/15 WWCs

Reason(s): Poor internet connection

Total Responses Received: __232__  Completion Rate: ___ 65___%

Complete Responses: __150__      Incomplete Responses: __82__

Age: Average Respondent’s Age: __32__

Response from the Wisdom & Wellness Partner: Kigamboni Health Center

WWC: _Suzanne Njana_________________________________________________

Feedback from Field

Most Wisdom & Wellness Counselors experience challenges of transportation due to the minimal allowance allocation.

“I would like to request of the organization’s administration to consider increasing the transportation allowance. For most of us, we end up taking more than one or two buses; sometimes we have to make multiple connections, even be forced to board a Bajaj, which is quite costly - just to get the the facilities to provide mental health services”

Response from the Wisdom & Wellness Partner: Mwasonga Dispensary

WWC: __Alfreda George________________________________________________   

Feedback from Field:

Inclement weather/heavy rains derailed the activity.

“Due to heavy rains I got at the health facility late considering the fact that I also have connect two bus routes to get there. Not only did the heavy rains on the that day alter my internet connection, but also prohibit hospital visits at a greater extent thus no responses from clients were sent on that day.”

Response from the Wisdom & Wellness Partner: Mbagala Rangi Tatu HC 

WWC: __Grace Mshanga________________________________________________

Feedback from Field:

WWC was unable to provide service due to access restriction as a result of the WW Focal Contact Person’s absence.       

 “Sadly, the hospital’s health officer in charge denied me the permission to provide service at the OutPatientDepartment [OPD] since the focal contact person wasn’t available. After several futile attempts to explain who I was and why I was there, I finally gave up around 1:30pm.”