Dr. Abdullahi Jawobah takes us deep into the critically overlooked world of maternal mental health, where his groundbreaking research reveals a staggering statistic: approximately 50% of pregnant and lactating mothers in Sierra Leone experience psychological distress. This silent epidemic has far-reaching consequences not only for mothers but for their unborn children, as Dr. Jawobah explains how stress hormones cross the placenta to affect gene expression in developing fetuses. Addressing this is a pathway to reducing stillbirths, preeclampsia, infant malnutrition, and physical health outcomes.
The conversation illuminates how mothers in Sierra Leone express their psychological suffering through culturally specific language—describing their distress as "my heart is spoiled" or "my heart is crying"—rather than using Western terms like depression or anxiety. Dr. Jawobah shares the heartbreaking cultural context where women who undergo cesarean sections may be viewed as "not fit to be women" and mothers whose babies develop malnutrition might be accused of infidelity, creating significant barriers to seeking mental health support.
What makes this episode particularly powerful is Dr. Jawobah's innovative solution: adapting Zimbabwe's "Friendship Bench" intervention for Sierra Leone. By training elderly women from existing mother-to-mother su
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:03):
Welcome to the HCW Optimistic Voices podcast.
I'm your host, yasmin Vaughn.
On today's episode of thepodcast, we are going to be
discussing a big topic in globalhealth, which is maternal
mental health.
With me today is AbdullahiJawobah.
He's a researcher based inSierra Leone specializing in
global health, particularlymaternal mental health,
(00:24):
parenting, early childhooddevelopment and health system
strengthening in fragile andpost-conflict settings.
He completed his PhD in globalmental health at Queen Margaret
University in Scotland, where heutilized the Design,
implementation, monitoring andEvaluation DIME model to create
a collaborative care model forperinatal mental health in
(00:45):
Sierra Leone.
His doctoral research employeda rapid ethnographic approach
and explored how pregnant womenand new mothers experience and
express psychological distress,along with their coping
mechanisms and health seekingbehaviors.
Additionally, he developed andvalidated a screening tool for
perinatal common mentaldisorders PCMD, and functional
(01:08):
assessment scale.
Abdullahi also culturallyadapted and piloted the
feasibility, acceptability andpreliminary effectiveness of the
friendship bench interventionfor PCMD in Sierra Leone.
Both of these, I believe, arethe papers that he just recently
had published and we'll sharethose in our episode notes.
Currently, he is an NIHDiversity Supplement Research
(01:30):
Fellow and a research associateat Boston College's Department
of Research Program on Childrenand Adversity, rpca, where he
investigates theintergenerational transmission
of trauma from former childsoldiers to their offspring,
focusing on its influence onparenting styles and the mental
health of their children.
So Jawu welcome.
Speaker 2 (01:54):
Thank you very much, yasmin, pleasure to have you.
Speaker 1 (02:00):
Yes, it's so great to have you.
We love bringing on researchersto talk about their work.
Yes, it's so great to have you.
We love bringing on researchersto talk about their work.
So tell us a little bit.
I just gave a big bio coveringa lot of your research and the
work that you're doing.
Speaker 2 (02:18):
But tell us a little bit about you, where you're from
, how you got to where you arenow.
I'm from Sierra Leone where Iwitnessed firsthand the
challenges faced by mothers andfamilies in the post-conflict
setting.
We had like 11 years of civilwar.
Actually I'm a pharmacist.
I'm a clinical pharmacist bybackground, did my master's in
China in pharmacology and laterproceeded to Liverpool School of
Tropical Medicine where I didlike a fellowship, so before
(02:43):
going to Queen Margaret andwhere I did my PhD.
So when I was in Sierra Leone,proud to my PhD program, I was
doing like a pro bono PI formental health coalition, like
doing their research.
And there was instances wherewe came across women that were
locked at the Palemba Roadmaximum security prison and the
(03:06):
crime they committed was likeinfanticide, they killed their
babies.
And when we tried to go furtherwe are doing like a field work,
qualitative research the prisonofficers were telling us that
these women are demon, they arepossessed so like.
It was a surprise to me becauseI knew very well that the
(03:26):
literature is very clear thatfor women to commit such heinous
crime it must have been someassociated with psychological
distress, you know.
So that was when I becamefascinated and my interest grew
towards perinatal mental healthissues in Sierra Leone.
Speaker 1 (03:49):
Wow, what a sad story , but what a formative
experience for you.
Let's take a step back for ourlisteners who are maybe
unfamiliar with the topic.
Can you define for us perinataland maternal mental health and
share how some of that isdifferent from the work that's?
(04:09):
Being done with general mentalhealth.
Speaker 2 (04:14):
Yeah, perinatal mental health actually refers to
the emotional well-being ofwomen during pregnancy and the
postpartum period.
It's general, differs fromgeneral mental health,
especially due to the fact thatit addresses the unique
psychological challenges thatare associated with motherhood
and it is influenced by hormonalchanges and societal
(04:38):
expectations and the new normthat new mothers experience when
they are transitioning from thepregnancy to motherhood.
So, as a result of thesehormonal changes, they develop
like these mood disorders andsometimes it can be very
transient, which occurs likeafter two weeks, which is
referred to as baby blues, butsometimes it persists beyond
(05:01):
that, which develop into what werefer to as postnatal
depression, but sometimes itoccurs during the pregnancy, in
which case we refer to it as theantenatal depression.
And it is very, very importantbecause it has lots of public
health implication, because theunborn baby basically vulnerable
(05:22):
to some of these developments.
So there have been a lot ofevidence-based research that
have shown that, for example,pregnant women, when they are
psychologically distressed, youhave like stress chemicals that
passes through the placenta andswitch off genes of the puters,
the unborn puters, and most ofthese genes has been associated
(05:45):
with genes that are responsiblefor emotional regulation and
these kids are bound to developproblems with emotional
regulation.
They have delay in terms ofsocial development, emotional
development, physical and evenneurocognitive development, and
this basically affect themthroughout their life, because
to adolescents and adults Wow,that's so interesting.
Speaker 1 (06:10):
I've heard previously in the past about, you know,
postpartum depression in womenafter they give birth and how
that affects their ability tocare for the baby.
But depression during pregnancyhaving effects on the mental
health of their future children,I had no idea.
Wow, you mentioned that womenare taking on new roles and that
(06:34):
is why their mental healthtends to change during this
period this new role ofmotherhood and that there were
social factors that influencedthat.
Can you tell us a little bitmore about those social factors?
Speaker 2 (06:47):
Yeah, for example, in Sierra Leone you have like the
homes where you havemulti-generational homes, where
you have like the mom, the dad,the grandpa, the grandma and the
cousin and extended familymembers.
So you have like this mom whois basically taking care of
normal daily chores and she alsohave like some income
(07:09):
generating activities that she'sengaging.
So when they become pregnant,sometimes the experience like
issue is with neglect orcheating from their partners,
lack of support and that extenteven beyond the pregnancy to the
early when they give birth totheir babies.
(07:29):
So for new mothers, theyexperience some of these
challenges in terms of lack ofsupport.
A study that I conducted in myPhD program, which was like a
prevalence study and also riskfactor study, the male
components came out verystrongly that you'll see a good
number of these women that weinterviewed.
(07:50):
They make mention of domesticviolence, there is domestic
abuse, there is gender norms,that's patriarchy that is
involved, you know, and theyhave like this lack of support
and all those basically comestogether and creates lots of
(08:11):
burden on these women, whichinclude like psychological
distress which goes on to affecttheir mood and they develop
things like stress, depressionand anxiety, which in Sierra
Leone we have the colloquial waythat they describe it.
For example, my heart isspoiled, your heart is heavy,
(08:31):
your heart is crying.
So that is how basically theydescribe it locally.
Speaker 1 (08:37):
Okay, so it's not just the internal experience of
the woman taking on this newrole of motherhood, experience
of the woman taking on this newrole of motherhood, but this
isolation that she feels fromothers taking on that role, and
external factors like domesticviolence and things like that
that are contributing to themental health.
Are there other culturalfactors that influence the
(08:59):
presentation and treatment ofthese conditions?
Speaker 2 (09:04):
Yeah, we have gender inequality.
Actually that plays asignificant role and we have,
like some of these women withinthe Sierra Leone setting, when
they give birth, their husbandask them to move to their
mothers, for their mothers tosupport them during the early
phase of that transition instage.
While some do still stay withtheir husbands, and a good
(09:29):
number of them experiencesignificant distress because the
husband, basically during thatstage, is not providing the
support that they needed andthere is this societal
expectation that prevents thesewomen from asking for support
because they deem that societywill think or will perceive them
(09:49):
as not being strong enough tobe a mother.
You know so I've even like uh,I encountered a case of a woman
who gave birth like to cesareansection, and even giving birth
to cesarean section for her wasa depressing issue because she
said her in-laws will deem hernot fit to be a woman.
She cannot like give birth onher own except like without
(10:12):
being supported.
So all these things basicallylike um, create like lots of
psychological distress for thiswoman.
There is also like a local umidiom that they use, which is
referred to as banfa, also likea local idiom that they use,
which is referred to as banfa.
Banfa basically is like women,uh, when they have like these
kids developing kwashiorkodi tolike infant malnutrition, we
(10:34):
have like this um societal wayin terms, especially in this
rural setting, we had to seethis baby and describe them as
banfa banfaa and when you askthem to give an explanation of
what is Banffa, they said thewoman basically might have had
sexual intercourse with thehusband or someone outside the
(10:56):
marriage.
That is what results in thebaby presenting with this
kwashiorko presentation.
So basically these are localidiomatic way that they describe
it, but I'm sure a good numberof nurses and midwives have been
sensitizing some of these womenand even the husband, because
the husbands are the ones thatare very difficult to really
(11:19):
talk to because for them, as faras they are concerned, the
woman is cheating on them.
That is why the baby developssuch presentation.
Speaker 1 (11:29):
Wow, yeah, so there's still a lot of health education
not present in the communitiesto help explain some of these
conditions.
Drowning their babies, um.
I've even heard about, um,women who have obstructed labor
or having prolonged labor.
(11:55):
Uh, also being suspected ofadultery, um, because if not,
then you know why.
Why is this labor notprogressing like it's supposed
to be?
Speaker 2 (12:03):
it must be something that she did, um yeah, sure,
these are like cultural beliefsystem that is really embedded
within you know, this alienculture setting.
Speaker 1 (12:15):
Yeah, so from a community perspective, how do
you go about approachingtackling issues like that, or
does it have to be on theindividual level, or does it
have to be?
Speaker 2 (12:31):
on the individual level.
Well, from the work that we did, actually like we tried to use
this task shifting approach,task shifting, task sharing,
that WHO is recommending we arecommunity members, are being
trained like we'renon-specialists in providing
psychosocial support for thesepregnant women and lactating
(12:53):
mothers.
And we experimented it, like inWaterloo, where we consider two
communities, lompa andCampbelltown, and Campbelltown
was the experimental communitywhile Lompa was the control.
So we have, like this, mothersupport groups that we train.
These are like women that weare trained by the directorate
(13:14):
of nutrition, supported byunicef, to support pregnant
women to attend uh, attend allthe their antenatal care and
also lactating mothers, for themto give like six months
exclusive breastfeeding.
So we leverage on thesemother-to-mother support groups,
we train them and they providedsupport for these pregnant and
(13:36):
lactating mothers and the result, basically, was like mind
blowing.
It proved very, very effectiveand it was quite feasible
because it was like thisfriendship bench developed in
Zimbabwe.
We have like this bench wherethis elderly woman will be
sitting down and the lactatingmother or the pregnant woman
will join them for a talk,therapy and it's like and it's
(13:58):
like a problem-solving approachwhere the pregnant woman or
lactating mother will explainwhat their problems are and they
work with them to support themin addressing these problems,
one after the other, you know.
So community-based approach hasbeen found very, very effective
, and it's also we're able toestablish that in our work at
(14:19):
Waterloo here in Sierra Leone.
The paper has just beenpublished.
Speaker 1 (14:24):
Oh, congratulations.
Yeah, what a cool study.
Can you tell us a little bitmore about who the people who
were trained to do the advisingwere?
Speaker 2 (14:34):
Yeah, the people that we are trained, we are the
mother-to-mother support groups,which are laywomen, are
volunteers living within thecommunity, trusted by the
community, and some of them areappointed by these communities.
You know, and when we weredoing the ethnographic study
that is the formative phase ofour work when we asked these
(14:58):
women to, when we are talkingwith the pregnant women and
lactating mothers, wanting tounderstand how they experience
and express psychologicaldistress and we later ask them
how they cope with it and gethealth-seeking behaviors.
So that was when they told usabout these mother-to-mother
support groups that has beensupporting them.
And when we went to thedirectory they gave us like a
(15:21):
list of these mother-to-mothersupport groups and we recruited
them, we trained them and theyprovided support for about a
month.
So we screened these pregnantwomen, lactating mothers, like
prior to the start of the study,after two weeks and after a
month.
So the result was phenomenal andI think partly one of the
reasons why the result was veryeffective, why the intervention
(15:45):
was very effective, is thismother-to-mother support group
has been engaged in thispregnant to men of lactating
mothers prior to our study.
They've already establishedtrust, so they were like the
liaison between the communityand the community health centers
.
You know they link them up withthe midwives and the nurses
when they visit them at theirhouses and try to talk to them.
(16:07):
You know so Pregnant and Men ofLactate Immunization models
that needed support, they werethe ones that were channeling
them to the community healthcenters and even after the study
, when we went there to engageto talk to them, we realized
that pregnant women andlactating mothers had been even
visiting this mother-to-mothersupport group even after the end
(16:27):
of the study.
Speaker 1 (16:28):
Yeah, yeah, so a sustainable pipeline of of
community support existing meantthat they they were better um
able to to engage with them umand have better results, yeah,
wow yeah, yeah.
Speaker 2 (16:47):
And the other flip of the coin is the fact that even
the mother-to-mother supportgroup, which are elderly women
at community level, when wespoke with them, we realized
that it also have like thispositive psychological impact on
them, because they never knewthat they have anything to give
back to to their communities.
You know they they just thoughtthat they are no longer needed,
(17:08):
they don't have much role toplay.
Well, well, now they seethemselves like speaking to
pregnant women, like 30 motherschanging their lives.
We have like cases, for example,a teenager who was sleeping
with a friend abandoned by herfamily because they consider her
to be like bringing shame tothe family of becoming pregnant
(17:31):
and having a baby, and at theend of that intervention, that
teenager was able to go back toher parents.
The parents were taking care ofthe baby and she returned back
to school.
So these elderly women werereally impressed with what they
are now doing and also, on theother flip of the coin, what we
(17:52):
realize.
The pregnant women andlactating mothers have a lot of
trust with these elderly womenbecause they realize that if it
is like a peer-to-peer supportgroup girls or women of their
age they are probably with likeopening up to them in terms of
the secret, in terms of sharingtheir problems with them,
because they just believe thatthey will explain it to others,
(18:17):
this issue of gossiping.
So secrecy is very, veryimportant, and they believe that
these elderly women will beable to keep their secrets and
they can also benefit from theirlife experience as well.
Speaker 1 (18:31):
Oh, wow, so multi-generational support being
fostered there.
So it sounds like even thepregnant women feel that they're
not seen and not supported.
But the elderly women beingable to have a role in society
was significant for them as well.
Wow.
Speaker 2 (18:48):
Yeah, sure.
Speaker 1 (18:50):
Sure, yeah, sure Sure .
Speaker 2 (19:01):
Yeah, that's amazing.
So did you, in this study, seea lot of influence on
health-seeking behavior as well?
Yeah, during the study, werealized that a good number of
these pregnant women like takingmothers.
We are not seeking supportbecause of the stigma and the
labeling, Because even when wetry to interview these women
pregnant women, lactatingmothers and even the elderly
women we generated a clinicalvignette from the ethnographic
(19:26):
data that we collected.
Let's assume that there is thislady who is about 25 years.
Prior to her pregnancy, she wasdoing fine, she was very
cheerful, but when she becamepregnant she started withdrawing
, keeping to herself, nottalking to people, crying all
(19:46):
the time.
So we generated it like fromthe data that we collected at
community level, and we askedthem in a search community how
do the community see them, howdo they describe them?
We realize that there are a lotof psychological labels that
they give to these women there.
They consider these people aspeople that some consider them
to be rich, some call them likejealous women, some consider
(20:07):
them to be like troublesome,some even describe them as
trauma.
So they have various labelsthat they give to them and I
think this labeling also servesas a barrier for these women in
terms of accessing care orseeking support.
Speaker 1 (20:28):
Yeah, so helping to remove some of the stigma within
the mother-to-mother supportgroups was helpful to increase
their ability to access services.
Amazing, yeah, sure.
And were the older women mostlygiving advice or just mostly
(20:50):
listening?
Mostly giving advice or justmostly listening?
Was there any training for themon what kind of advice to give,
or did you guys depend on theirwisdom of age?
Speaker 2 (21:02):
Yeah.
So that was also another aspectthat came out during the
qualitative interview that wedid at the end of the
intervention.
These mother-to-mother supportgroups told us that prior to
this intervention, when theyapproached these pregnant women
to encourage them for them toattend antenatal care services
(21:22):
or the exclusive breastfeedingif they approached them, they
realized that they are moody.
They said they would just passand move to the next house.
With our intervention they arenow confident enough to engage
them, even when they are seeingextreme form of depression with
them, with the skill we impartedto them.
So what we did is like weculturally adapted the
(21:43):
friendship bench interventiondeveloped by professor chibanda
in zimbabwe, which was like aproblem solving approach.
So what the elderly women weare doing is like engaging the
pregnant women and lactatingmothers, asking them what are
the problems they'reexperiencing.
So they will list, for example,like five problems and out of
these five problems they willask them which of these problems
(22:04):
is the single most importantone, and the pregnant women and
lactating mother will identifythat problem.
And, being that these arepregnant women and lactating
mothers will identify thatproblem.
And, being that these pregnantwomen and lactating mothers and
even the mother-to-mothersupport group, some of them have
low literacy and numeracy.
We try to develop veryuser-friendly manuals for them
that they can relate with.
(22:25):
So, basically, the elderlywoman was there to brainstorm
with them of solutions to thatparticular problem.
But the solutions, basically, orthe potential solutions, comes
from the pregnant woman or thelactating mothers and what we
realized at this point when theyare psychologically distressed,
(22:49):
their brain cannot functionproperly.
Distressed, their brain cannotfunction properly.
So the elderly woman is thereto guide them and support them
in making decisions with regardsto these options that they want
to explore, and they will nowgo and explore this option.
For example, if the pregnantwoman or lactating mother said
the husband has not providedanything, abandoned them, they
(23:10):
don't have life food to eat,they will then ask the pregnant
or lactating mothers what arethe options they have.
Some of them might say, okay,there is this microfinance loan
that is available.
They will then map out astrategy for them to access it.
They will access it and start,let's say, having some form of
(23:30):
business that they are doing.
After a week, they will comeback to the mother-to-mother
support groups and give themlike a feedback, and the
mother-to-mother support groupwill now try to know what worked
and what didn't work.
And if it worked, they will nowproceed to the next problem.
And if it didn't work, theywill now brainstorm and to try
(23:52):
to profile solution around it.
And what we realized for themost part after the first second
problem, the women are nowconfident enough to address the
remaining problems, you know so,more or less it's a way of like
giving them life, lifelongskills in addressing problems
throughout their life, becauseeven after the pregnancy or the
(24:17):
postnatal period, Wow, wow.
Speaker 1 (24:22):
So it's really more of a therapy relationship of
guiding and helping them exploretheir own emotional experience,
guiding their options, but notforcing or influencing in a
negative way.
That's so interesting.
Speaker 2 (24:37):
Sure, and we made it very flexible.
Flexibility was key because werealized that sometimes, in some
of these cases, the husband,basically, is the one or the
partner is the one that is theproblem and the pregnant woman
or lactating mother want toaccess care, but they are afraid
of the partner, for the partnernot to know that they are
(25:00):
accessing care.
So, unlike the intervention inZimbabwe, where the friendship
bench was placed next to thecommunity health center, the
pregnant woman or lactatingmother has to visit.
In this case, sometimes evenfor has to visit.
In this case, sometimes, evenfor them to visit, they have,
they need to have, like,permission from the partner.
You know.
So we made it very flexible thatthis mother-to-mother support
(25:21):
group, if they don't see these,uh, pregnant, lactating mother,
they themselves can visit themat their homes and when they go
there, if, like, the partner isthere, they will use their eyes
to communicate to them.
You know, so that they willmove from outside, maybe like to
inside the house or look for asafer place, space where they
can interact.
(25:42):
You know, so, all these, likesome of the things that we
brought in as part of thecultural adaptation, so that it
will be very flexible for them.
You know, in terms of theimplementation and that also
came out during the post-pilotinterviews that they really
appreciated that flexibility.
Speaker 1 (26:04):
Yeah, that makes a lot of sense.
It sounds like you guys havereally worked hard, not just to
find tools that will be usefulin the context, but to approach
the participants and say youknow, let's adapt these tools to
the work that we're doing.
Yeah, that drives us.
Speaker 2 (26:25):
Yeah, that's right.
Speaker 1 (26:40):
Great Well, you spoke at our maternal and child
health conference one of themornings on this into clinical
practice and how health careproviders can help screen women
and maybe even make referrals tothese kinds of networks
(27:08):
integrate this within thematernal child health program,
especially so when it is withinthe national mental health
policy and strategic plan butnot translated to the maternal
child health program.
Speaker 2 (27:17):
And there are lots of calls from the WHO, the global,
the GCC that is, global Canadachallenge and so many other
international organization forthe need.
Even the Lancet Commission alsorecommended for mental health
to be integrated within thematernal child health program.
And so that is what actually weare working towards, because in
(27:40):
this study we also developedlike a screening tool that
speaks to the local context.
For example, one of the 10items within that tool is
talking about shame.
If the pregnant woman orlactating mother has felt shame
for the past two weeks and shameis a very, very important
phenomenon that basically drivesthese women towards isolating
(28:03):
themselves, especially if theyhave, like pregnancy out of
wedlock or other aspects aroundtheir social life.
Isolating themselves,especially if they have like
pregnancy out of wedlock or someother aspect around their
social life, you know.
So basically, it's like nowwhat we are trying to do is move
towards like doing like arandomized control study using
multi-centers, and at that pointat least we will have generated
that proof of concept and weall see how best we can scale up
(28:25):
at national level Because, likethe intervention, as we can see
, is like a task sharingapproach, we are not using
health workers that are alreadyin short supply.
We already have shortage ofhealth care workers.
So this mother to mother supportgroup are found across the
country and, in line withProfessor Chibanda's philosophy
(28:47):
you know when he was designingthis intervention in terms of
using elderly women.
This issue of attrition is very, very difficult to see because
if we train like young women,there will come a time when they
will travel to bigger cities tosee greener pastures.
But these elderly women arefound across all communities
across the country.
So the idea actually is toreally integrate it within the
(29:09):
maternal child health program,have these tools and the tools
actually I also translated itinto graphic presentation so
which means that the mother tomother support group can also
use these tools in screening andalso in doing their follow up
with these women.
So that is what basically weare looking forward to and we
(29:30):
can't wait to meet the ministryin due course to see how best we
can work towards that, becausewe engaged them before the start
of the study and I've also didlike a dissemination.
So the next aspect will be likeuptake, which is very, very
important.
Speaker 1 (29:47):
Yeah, so this is something that you see has to be
done at the health system level, at the national level, with
policymakers, and at the verytop, not just a clinic to clinic
, hospital, hospital behavior,because really, what you're
doing is integrating.
I mean you're integrating carewithin the system.
(30:10):
It's comprehensive care now,instead of just focused on one
thing but seeing a person as awhole person.
Speaker 2 (30:29):
And we also, during the intervention, have these
referral pathways where thismotor support group can refer
cases that are very resistant totheir support towards the
community health centers.
We have some CHOs, communityhealth officers that went
through some training by WHO interms of providing the image gap
, which is like thepsychological treatment I mean
(30:53):
through a task sharing approach,and also we have, like, at
district level, we have mentalhealth nurses that are also
providing support.
So there is this cascadingeffect in terms of referral
pathways from model to modelsupport groups towards, in terms
of the pathways from moderateto moderate support groups to us
up to like, a district level.
And the other aspect that Iwould also like to make mention
(31:14):
of the fact is the fact that wealso had like a lexicon that we
generated from the datacollection process.
That is how women at communitylevel communicate psychological
distress without using anxiety,depression, which are like the
stigmatizing Western constructthat is driving them away from
(31:34):
seeking support.
So what we realized?
That using those things likewell, hearts, that is, their
heart is foil, like things liketheir heart is heavy, their
heart is crying, their mind isnot steady we realized that
those were like colloquialterminologies which are
non-stigmatizing and whichbasically can facilitate not
(31:59):
only their seeking of supportbut also engaging with these
treatment services.
These treatment services andthose are the lexicon that we
also want to engage with theseinstitutions.
For example, I'm like alecturer at Comas engaging, for
example, like Comas College ofMedicine, jala and other
(32:20):
training institutions so thatthis can be included in the
training curriculum, so thatwhen they are engaging these
pregnant and lactating mothersthey start talking about Puellat
.
They should know that there issomething in addition to the
physical component.
There is also a psychologicalcomponent that is involved,
because a good number of themrealize that they do a lot of um
support to these women.
(32:41):
They do like tests.
They cannot see anything.
So meaning that there is likethis somatization that is going
on.
You know, somatization from theliterature is very widespread
in asia and africa as well.
You know we are like thispsychological stuff.
All the psychological distressthey are experiencing is
presenting as physical symptoms,like digestive issues, like
(33:04):
probably um respiration, likepain, you know.
So all these are basicallysomatizations which are coming
from the psychological distress.
So at least it will besomething like an eye opener for
healthcare workers to look outfor and refer some of these
women for psychological support.
Speaker 1 (33:25):
Yeah, yeah.
So the hope is that clinicalcare people can learn to
recognize it, not just in termsof the success that you've had
in this project and the workthat you're doing.
What are some of the keychallenges, though, that you've
(33:55):
seen in doing this research?
Speaker 2 (33:59):
Some of the challenges that we experience is
in terms of the implementationof the study.
You know, at the ruralcommunity setting it's a bit
easier compared to the urbansetting and but notwithstanding
(34:22):
that, from the lessons thatwe've learned from the urban
setting, where we conducted thisstudy, we'll definitely be able
to also replicate it within theurban setting.
So, for now, some of thechallenges I think we have is in
terms of having funding, interms of doing a randomized
control study, but in terms ofthe piloting phase, we didn't
(34:45):
have much problems in terms ofchallenges because we engaged
stakeholders and we engaged thechiefs, we engaged the Mami
Queens, so all of them wereinvolved and we got their
support and it was very easy forus in terms of doing our pilot
study, doing our pilot study,you know.
(35:11):
But another challenge I thinkthat is worth mentioning is this
aspect of Linking themother-to-mother support groups
and the pregnant women,lactating mothers.
You know, because when we didlike the screening, there was a
time when we we have, like this,research assistant that did the
screening, we screened them andthose that got above the cutoff
(35:33):
point, we had the one that werecruited.
So when the mother to mothersupport group went to locate
them, some of them theiraddresses.
We are not like they cannot.
We cannot locate them becauseof the addresses and some of of
them we are not having phonenumbers.
You know they gave us the phonenumbers of their relatives.
Speaker 1 (35:52):
So those are like some of the technical challenges
that we had yeah, yeah, wewe've experienced some of the
same technical challenges andand tracing people, and and
that's not uncommon in research,but it sounds like you guys did
a lot of work to make sure thatthis was well integrated into
the community.
Um, and that's not uncommon inresearch, but it sounds like you
guys did a lot of work to makesure that this was well
integrated into the communityand that you had community
(36:13):
support.
You weren't just coming in andenforcing it, but seeing what
already existed and buildingupon it.
Speaker 2 (36:21):
Yeah, sure.
Speaker 1 (36:25):
Great.
Speaker 2 (36:42):
Go ahead, structured format, you know.
And yeah, I think one of thethings that I'm looking forward
to is not to let them down andalso to scale it to other
communities after the randomizedcontrol study.
I'm going to say yes, man.
Speaker 1 (37:01):
Yeah, no, I love that .
I love that it's something thatthey love so much that they
want it to continue, and I hopethat it will as well.
And it would also be veryinteresting to see, over time,
if you're able to measure theimpact it has over many years
and many, many pregnant women.
Speaker 2 (37:21):
Sure, definitely, that's also something we'll be
looking forward to, and anotheraspect that we are also looking
forward to, and another aspectthat we are also looking forward
to into the future, is how bestwe can also be able to refer
some of these women to some ofthe services that they really
needed in terms of support.
You know, yeah.
Speaker 1 (37:48):
Services like.
Speaker 2 (37:51):
This is like like, for example, um, some of them we
are having uh, problems with,for example, like abuse, you
know how we can be able to linkthem, for example, like the, you
know, social support servicesto support them in some of these
problems that they'reexperiencing, which is unique,
(38:13):
you know, and which sometimes,as an intervention, the
intervention basically does nothave much to do in terms of,
like, supporting them throughthat pathway, you know.
So, linkages with services issomething also we are looking
forward to.
Speaker 1 (38:30):
Well, are there other areas?
You know it sounds like.
Your paper on the culturaladaptations of the language
that's used to describe anxietyand depression is being
published.
Your pilot study on thesemother-to-mother support groups
is being published.
What's next?
Speaker 2 (38:47):
Well, the next aspect is, as I said, looking for
grants and do like a randomizedcontrol study and see how best
we can scale it up to othercommunities and districts across
the country.
Speaker 1 (39:01):
Amazing.
Well, best of luck with thoseresearch grants in that way.
Is there anything else you'dlike our audience to know about
your research and work inperinatal mental health?
Speaker 2 (39:11):
We also have, like, two papers that I'm also working
on, which definitely will bepublished very soon.
One of them is looking at theprevalence and the risk factors
and the prevalence it willsurprise you to know that it's
about 50%, so meaning that oneout of every two pregnant women,
lactating mothers, isexperiencing psychological
(39:33):
distress.
And also the other paper islooking at the maternal child
health impact of thepsychological distress.
You know, because you can seeit clearly from the data we
collected, we are womendescribing that a particular
woman at the community, forexample, like Adama, experienced
(39:55):
miscarriage because of thedistress she was experiencing
from the partner, or sheexperienced stillbirth.
So all these at community level, you can see elderly women or
the pregnant or lactating motherlike describing that when the
woman is going through thepsychological distress, even the
baby in the womb is having like, so which in western constructs
(40:21):
we can in fact, as like in thetradition, you know.
So basically, at level, theycan describe it colloquially of
which we can extrapolate and seethe Western equivalent of it,
you know.
So we're also working towardspublishing those two papers as
well.
Speaker 1 (40:39):
It's amazing.
Well, we look forward toreading those as well.
You're not just taking yourwork and taking these Western
terms and forcing it on thesecommunities, but exploring it
within the community and sayinghow does this equivocate to
something that you know is inthe DSM?
Question that we ask all of ourguests is what are you
(40:59):
optimistic about?
Speaker 2 (41:02):
Well, I'm optimistic about the scaling up of this
intervention because I am very,very sure that if we can scale
up this intervention at nationallevel and have each and every
community havingmother-to-mother support groups
that are not only supportingwith the infant malnutrition
(41:23):
program but also supporting withthe psychological aspect of
pregnant women and lactatingmothers, I foresee that in the
long run, there will be adecline in things like cases of
eclampsia and preeclampsia,which has been directly linked
with psychological distress.
We can also see a decrease interms of infant malnutrition, of
(41:44):
which we have the evidencelinking them as well, and even
things like stillbirth, you know, and low birth weight, you know
, and all these indicatorsactually, which we are always
struggling with, you know, forme, which I consider to be
distal, you know, distal factorsso, of which we need to address
(42:05):
the proximal factors, which arelike the psychological
components, psychological aspectof pregnancy, when a lactating
mother is.
Speaker 1 (42:13):
Yeah, so it does come back to maternal and child
mortality as well.
Not just their mental healthand their morbidity and their
well-being, but even hasimplications for that as well.
Speaker 2 (42:28):
Yeah, definitely, yes , that as well.
Yeah, definitely, yasmin.
Speaker 1 (42:30):
Yeah Well, thank you so much for joining our episode
today.
It's been a pleasure talkingwith you and hearing about this
work and the way that you'reexploring how to help women and
children through this innovativeapproach.
Speaker 2 (42:46):
Thank you very much, Yasmin.
Speaker 3 (42:51):
Thanks for listening.
If you enjoyed this episode,please subscribe, share it with
others, post about it on socialmedia or leave a rating and
review.
To catch all the latest from us, you can find us at Helping
Children Worldwide on Instagram,linkedin, twitter and Facebook
Hashtag Optimistic VoicesPodcast.
Welcome to the HCW Optimistic Voices podcast.
I'm your host, yasmin Vaughn.
On today's episode of thepodcast, we are going to be
discussing a big topic in globalhealth, which is maternal
mental health.
With me today is AbdullahiJawobah.
He's a researcher based inSierra Leone specializing in
global health, particularlymaternal mental health,
(00:24):
parenting, early childhooddevelopment and health system
strengthening in fragile andpost-conflict settings.
He completed his PhD in globalmental health at Queen Margaret
University in Scotland, where heutilized the Design,
implementation, monitoring andEvaluation DIME model to create
a collaborative care model forperinatal mental health in
(00:45):
Sierra Leone.
His doctoral research employeda rapid ethnographic approach
and explored how pregnant womenand new mothers experience and
express psychological distress,along with their coping
mechanisms and health seekingbehaviors.
Additionally, he developed andvalidated a screening tool for
perinatal common mentaldisorders PCMD, and functional
(01:08):
assessment scale.
Abdullahi also culturallyadapted and piloted the
feasibility, acceptability andpreliminary effectiveness of the
friendship bench interventionfor PCMD in Sierra Leone.
Both of these, I believe, arethe papers that he just recently
had published and we'll sharethose in our episode notes.
Currently, he is an NIHDiversity Supplement Research
(01:30):
Fellow and a research associateat Boston College's Department
of Research Program on Childrenand Adversity, rpca, where he
investigates theintergenerational transmission
of trauma from former childsoldiers to their offspring,
focusing on its influence onparenting styles and the mental
health of their children.
So Jawu welcome.
Speaker 2 (01:54):
Thank you very much, yasmin, pleasure to have you.
Speaker 1 (02:00):
Yes, it's so great to have you.
We love bringing on researchersto talk about their work.
Yes, it's so great to have you.
We love bringing on researchersto talk about their work.
So tell us a little bit.
I just gave a big bio coveringa lot of your research and the
work that you're doing.
Speaker 2 (02:18):
But tell us a little bit about you, where you're from
, how you got to where you arenow.
I'm from Sierra Leone where Iwitnessed firsthand the
challenges faced by mothers andfamilies in the post-conflict
setting.
We had like 11 years of civilwar.
Actually I'm a pharmacist.
I'm a clinical pharmacist bybackground, did my master's in
China in pharmacology and laterproceeded to Liverpool School of
Tropical Medicine where I didlike a fellowship, so before
(02:43):
going to Queen Margaret andwhere I did my PhD.
So when I was in Sierra Leone,proud to my PhD program, I was
doing like a pro bono PI formental health coalition, like
doing their research.
And there was instances wherewe came across women that were
locked at the Palemba Roadmaximum security prison and the
(03:06):
crime they committed was likeinfanticide, they killed their
babies.
And when we tried to go furtherwe are doing like a field work,
qualitative research the prisonofficers were telling us that
these women are demon, they arepossessed so like.
It was a surprise to me becauseI knew very well that the
(03:26):
literature is very clear thatfor women to commit such heinous
crime it must have been someassociated with psychological
distress, you know.
So that was when I becamefascinated and my interest grew
towards perinatal mental healthissues in Sierra Leone.
Speaker 1 (03:49):
Wow, what a sad story , but what a formative
experience for you.
Let's take a step back for ourlisteners who are maybe
unfamiliar with the topic.
Can you define for us perinataland maternal mental health and
share how some of that isdifferent from the work that's?
(04:09):
Being done with general mentalhealth.
Speaker 2 (04:14):
Yeah, perinatal mental health actually refers to
the emotional well-being ofwomen during pregnancy and the
postpartum period.
It's general, differs fromgeneral mental health,
especially due to the fact thatit addresses the unique
psychological challenges thatare associated with motherhood
and it is influenced by hormonalchanges and societal
(04:38):
expectations and the new normthat new mothers experience when
they are transitioning from thepregnancy to motherhood.
So, as a result of thesehormonal changes, they develop
like these mood disorders andsometimes it can be very
transient, which occurs likeafter two weeks, which is
referred to as baby blues, butsometimes it persists beyond
(05:01):
that, which develop into what werefer to as postnatal
depression, but sometimes itoccurs during the pregnancy, in
which case we refer to it as theantenatal depression.
And it is very, very importantbecause it has lots of public
health implication, because theunborn baby basically vulnerable
(05:22):
to some of these developments.
So there have been a lot ofevidence-based research that
have shown that, for example,pregnant women, when they are
psychologically distressed, youhave like stress chemicals that
passes through the placenta andswitch off genes of the puters,
the unborn puters, and most ofthese genes has been associated
(05:45):
with genes that are responsiblefor emotional regulation and
these kids are bound to developproblems with emotional
regulation.
They have delay in terms ofsocial development, emotional
development, physical and evenneurocognitive development, and
this basically affect themthroughout their life, because
to adolescents and adults Wow,that's so interesting.
Speaker 1 (06:10):
I've heard previously in the past about, you know,
postpartum depression in womenafter they give birth and how
that affects their ability tocare for the baby.
But depression during pregnancyhaving effects on the mental
health of their future children,I had no idea.
Wow, you mentioned that womenare taking on new roles and that
(06:34):
is why their mental healthtends to change during this
period this new role ofmotherhood and that there were
social factors that influencedthat.
Can you tell us a little bitmore about those social factors?
Speaker 2 (06:47):
Yeah, for example, in Sierra Leone you have like the
homes where you havemulti-generational homes, where
you have like the mom, the dad,the grandpa, the grandma and the
cousin and extended familymembers.
So you have like this mom whois basically taking care of
normal daily chores and she alsohave like some income
(07:09):
generating activities that she'sengaging.
So when they become pregnant,sometimes the experience like
issue is with neglect orcheating from their partners,
lack of support and that extenteven beyond the pregnancy to the
early when they give birth totheir babies.
(07:29):
So for new mothers, theyexperience some of these
challenges in terms of lack ofsupport.
A study that I conducted in myPhD program, which was like a
prevalence study and also riskfactor study, the male
components came out verystrongly that you'll see a good
number of these women that weinterviewed.
(07:50):
They make mention of domesticviolence, there is domestic
abuse, there is gender norms,that's patriarchy that is
involved, you know, and theyhave like this lack of support
and all those basically comestogether and creates lots of
(08:11):
burden on these women, whichinclude like psychological
distress which goes on to affecttheir mood and they develop
things like stress, depressionand anxiety, which in Sierra
Leone we have the colloquial waythat they describe it.
For example, my heart isspoiled, your heart is heavy,
(08:31):
your heart is crying.
So that is how basically theydescribe it locally.
Speaker 1 (08:37):
Okay, so it's not just the internal experience of
the woman taking on this newrole of motherhood, experience
of the woman taking on this newrole of motherhood, but this
isolation that she feels fromothers taking on that role, and
external factors like domesticviolence and things like that
that are contributing to themental health.
Are there other culturalfactors that influence the
(08:59):
presentation and treatment ofthese conditions?
Speaker 2 (09:04):
Yeah, we have gender inequality.
Actually that plays asignificant role and we have,
like some of these women withinthe Sierra Leone setting, when
they give birth, their husbandask them to move to their
mothers, for their mothers tosupport them during the early
phase of that transition instage.
While some do still stay withtheir husbands, and a good
(09:29):
number of them experiencesignificant distress because the
husband, basically during thatstage, is not providing the
support that they needed andthere is this societal
expectation that prevents thesewomen from asking for support
because they deem that societywill think or will perceive them
(09:49):
as not being strong enough tobe a mother.
You know so I've even like uh,I encountered a case of a woman
who gave birth like to cesareansection, and even giving birth
to cesarean section for her wasa depressing issue because she
said her in-laws will deem hernot fit to be a woman.
She cannot like give birth onher own except like without
(10:12):
being supported.
So all these things basicallylike um, create like lots of
psychological distress for thiswoman.
There is also like a local umidiom that they use, which is
referred to as banfa, also likea local idiom that they use,
which is referred to as banfa.
Banfa basically is like women,uh, when they have like these
kids developing kwashiorkodi tolike infant malnutrition, we
(10:34):
have like this um societal wayin terms, especially in this
rural setting, we had to seethis baby and describe them as
banfa banfaa and when you askthem to give an explanation of
what is Banffa, they said thewoman basically might have had
sexual intercourse with thehusband or someone outside the
(10:56):
marriage.
That is what results in thebaby presenting with this
kwashiorko presentation.
So basically these are localidiomatic way that they describe
it, but I'm sure a good numberof nurses and midwives have been
sensitizing some of these womenand even the husband, because
the husbands are the ones thatare very difficult to really
(11:19):
talk to because for them, as faras they are concerned, the
woman is cheating on them.
That is why the baby developssuch presentation.
Speaker 1 (11:29):
Wow, yeah, so there's still a lot of health education
not present in the communitiesto help explain some of these
conditions.
Drowning their babies, um.
I've even heard about, um,women who have obstructed labor
or having prolonged labor.
(11:55):
Uh, also being suspected ofadultery, um, because if not,
then you know why.
Why is this labor notprogressing like it's supposed
to be?
Speaker 2 (12:03):
it must be something that she did, um yeah, sure,
these are like cultural beliefsystem that is really embedded
within you know, this alienculture setting.
Speaker 1 (12:15):
Yeah, so from a community perspective, how do
you go about approachingtackling issues like that, or
does it have to be on theindividual level, or does it
have to be?
Speaker 2 (12:31):
on the individual level.
Well, from the work that we did, actually like we tried to use
this task shifting approach,task shifting, task sharing,
that WHO is recommending we arecommunity members, are being
trained like we'renon-specialists in providing
psychosocial support for thesepregnant women and lactating
(12:53):
mothers.
And we experimented it, like inWaterloo, where we consider two
communities, lompa andCampbelltown, and Campbelltown
was the experimental communitywhile Lompa was the control.
So we have, like this, mothersupport groups that we train.
These are like women that weare trained by the directorate
(13:14):
of nutrition, supported byunicef, to support pregnant
women to attend uh, attend allthe their antenatal care and
also lactating mothers, for themto give like six months
exclusive breastfeeding.
So we leverage on thesemother-to-mother support groups,
we train them and they providedsupport for these pregnant and
(13:36):
lactating mothers and the result, basically, was like mind
blowing.
It proved very, very effectiveand it was quite feasible
because it was like thisfriendship bench developed in
Zimbabwe.
We have like this bench wherethis elderly woman will be
sitting down and the lactatingmother or the pregnant woman
will join them for a talk,therapy and it's like and it's
(13:58):
like a problem-solving approachwhere the pregnant woman or
lactating mother will explainwhat their problems are and they
work with them to support themin addressing these problems,
one after the other, you know.
So community-based approach hasbeen found very, very effective
, and it's also we're able toestablish that in our work at
(14:19):
Waterloo here in Sierra Leone.
The paper has just beenpublished.
Speaker 1 (14:24):
Oh, congratulations.
Yeah, what a cool study.
Can you tell us a little bitmore about who the people who
were trained to do the advisingwere?
Speaker 2 (14:34):
Yeah, the people that we are trained, we are the
mother-to-mother support groups,which are laywomen, are
volunteers living within thecommunity, trusted by the
community, and some of them areappointed by these communities.
You know, and when we weredoing the ethnographic study
that is the formative phase ofour work when we asked these
(14:58):
women to, when we are talkingwith the pregnant women and
lactating mothers, wanting tounderstand how they experience
and express psychologicaldistress and we later ask them
how they cope with it and gethealth-seeking behaviors.
So that was when they told usabout these mother-to-mother
support groups that has beensupporting them.
And when we went to thedirectory they gave us like a
(15:21):
list of these mother-to-mothersupport groups and we recruited
them, we trained them and theyprovided support for about a
month.
So we screened these pregnantwomen, lactating mothers, like
prior to the start of the study,after two weeks and after a
month.
So the result was phenomenal andI think partly one of the
reasons why the result was veryeffective, why the intervention
(15:45):
was very effective, is thismother-to-mother support group
has been engaged in thispregnant to men of lactating
mothers prior to our study.
They've already establishedtrust, so they were like the
liaison between the communityand the community health centers
.
You know they link them up withthe midwives and the nurses
when they visit them at theirhouses and try to talk to them.
(16:07):
You know so Pregnant and Men ofLactate Immunization models
that needed support, they werethe ones that were channeling
them to the community healthcenters and even after the study
, when we went there to engageto talk to them, we realized
that pregnant women andlactating mothers had been even
visiting this mother-to-mothersupport group even after the end
(16:27):
of the study.
Speaker 1 (16:28):
Yeah, yeah, so a sustainable pipeline of of
community support existing meantthat they they were better um
able to to engage with them umand have better results, yeah,
wow yeah, yeah.
Speaker 2 (16:47):
And the other flip of the coin is the fact that even
the mother-to-mother supportgroup, which are elderly women
at community level, when wespoke with them, we realized
that it also have like thispositive psychological impact on
them, because they never knewthat they have anything to give
back to to their communities.
You know they they just thoughtthat they are no longer needed,
(17:08):
they don't have much role toplay.
Well, well, now they seethemselves like speaking to
pregnant women, like 30 motherschanging their lives.
We have like cases, for example,a teenager who was sleeping
with a friend abandoned by herfamily because they consider her
to be like bringing shame tothe family of becoming pregnant
(17:31):
and having a baby, and at theend of that intervention, that
teenager was able to go back toher parents.
The parents were taking care ofthe baby and she returned back
to school.
So these elderly women werereally impressed with what they
are now doing and also, on theother flip of the coin, what we
(17:52):
realize.
The pregnant women andlactating mothers have a lot of
trust with these elderly womenbecause they realize that if it
is like a peer-to-peer supportgroup girls or women of their
age they are probably with likeopening up to them in terms of
the secret, in terms of sharingtheir problems with them,
because they just believe thatthey will explain it to others,
(18:17):
this issue of gossiping.
So secrecy is very, veryimportant, and they believe that
these elderly women will beable to keep their secrets and
they can also benefit from theirlife experience as well.
Speaker 1 (18:31):
Oh, wow, so multi-generational support being
fostered there.
So it sounds like even thepregnant women feel that they're
not seen and not supported.
But the elderly women beingable to have a role in society
was significant for them as well.
Wow.
Speaker 2 (18:48):
Yeah, sure.
Speaker 1 (18:50):
Sure, yeah, sure Sure .
Speaker 2 (19:01):
Yeah, that's amazing.
So did you, in this study, seea lot of influence on
health-seeking behavior as well?
Yeah, during the study, werealized that a good number of
these pregnant women like takingmothers.
We are not seeking supportbecause of the stigma and the
labeling, Because even when wetry to interview these women
pregnant women, lactatingmothers and even the elderly
women we generated a clinicalvignette from the ethnographic
(19:26):
data that we collected.
Let's assume that there is thislady who is about 25 years.
Prior to her pregnancy, she wasdoing fine, she was very
cheerful, but when she becamepregnant she started withdrawing
, keeping to herself, nottalking to people, crying all
(19:46):
the time.
So we generated it like fromthe data that we collected at
community level, and we askedthem in a search community how
do the community see them, howdo they describe them?
We realize that there are a lotof psychological labels that
they give to these women there.
They consider these people aspeople that some consider them
to be rich, some call them likejealous women, some consider
(20:07):
them to be like troublesome,some even describe them as
trauma.
So they have various labelsthat they give to them and I
think this labeling also servesas a barrier for these women in
terms of accessing care orseeking support.
Speaker 1 (20:28):
Yeah, so helping to remove some of the stigma within
the mother-to-mother supportgroups was helpful to increase
their ability to access services.
Amazing, yeah, sure.
And were the older women mostlygiving advice or just mostly
(20:50):
listening?
Mostly giving advice or justmostly listening?
Was there any training for themon what kind of advice to give,
or did you guys depend on theirwisdom of age?
Speaker 2 (21:02):
Yeah.
So that was also another aspectthat came out during the
qualitative interview that wedid at the end of the
intervention.
These mother-to-mother supportgroups told us that prior to
this intervention, when theyapproached these pregnant women
to encourage them for them toattend antenatal care services
(21:22):
or the exclusive breastfeedingif they approached them, they
realized that they are moody.
They said they would just passand move to the next house.
With our intervention they arenow confident enough to engage
them, even when they are seeingextreme form of depression with
them, with the skill we impartedto them.
So what we did is like weculturally adapted the
(21:43):
friendship bench interventiondeveloped by professor chibanda
in zimbabwe, which was like aproblem solving approach.
So what the elderly women weare doing is like engaging the
pregnant women and lactatingmothers, asking them what are
the problems they'reexperiencing.
So they will list, for example,like five problems and out of
these five problems they willask them which of these problems
(22:04):
is the single most importantone, and the pregnant women and
lactating mother will identifythat problem.
And, being that these arepregnant women and lactating
mothers will identify thatproblem.
And, being that these pregnantwomen and lactating mothers and
even the mother-to-mothersupport group, some of them have
low literacy and numeracy.
We try to develop veryuser-friendly manuals for them
that they can relate with.
(22:25):
So, basically, the elderlywoman was there to brainstorm
with them of solutions to thatparticular problem.
But the solutions, basically, orthe potential solutions, comes
from the pregnant woman or thelactating mothers and what we
realized at this point when theyare psychologically distressed,
(22:49):
their brain cannot functionproperly.
Distressed, their brain cannotfunction properly.
So the elderly woman is thereto guide them and support them
in making decisions with regardsto these options that they want
to explore, and they will nowgo and explore this option.
For example, if the pregnantwoman or lactating mother said
the husband has not providedanything, abandoned them, they
(23:10):
don't have life food to eat,they will then ask the pregnant
or lactating mothers what arethe options they have.
Some of them might say, okay,there is this microfinance loan
that is available.
They will then map out astrategy for them to access it.
They will access it and start,let's say, having some form of
(23:30):
business that they are doing.
After a week, they will comeback to the mother-to-mother
support groups and give themlike a feedback, and the
mother-to-mother support groupwill now try to know what worked
and what didn't work.
And if it worked, they will nowproceed to the next problem.
And if it didn't work, theywill now brainstorm and to try
(23:52):
to profile solution around it.
And what we realized for themost part after the first second
problem, the women are nowconfident enough to address the
remaining problems, you know so,more or less it's a way of like
giving them life, lifelongskills in addressing problems
throughout their life, becauseeven after the pregnancy or the
(24:17):
postnatal period, Wow, wow.
Speaker 1 (24:22):
So it's really more of a therapy relationship of
guiding and helping them exploretheir own emotional experience,
guiding their options, but notforcing or influencing in a
negative way.
That's so interesting.
Speaker 2 (24:37):
Sure, and we made it very flexible.
Flexibility was key because werealized that sometimes, in some
of these cases, the husband,basically, is the one or the
partner is the one that is theproblem and the pregnant woman
or lactating mother want toaccess care, but they are afraid
of the partner, for the partnernot to know that they are
(25:00):
accessing care.
So, unlike the intervention inZimbabwe, where the friendship
bench was placed next to thecommunity health center, the
pregnant woman or lactatingmother has to visit.
In this case, sometimes evenfor has to visit.
In this case, sometimes, evenfor them to visit, they have,
they need to have, like,permission from the partner.
You know.
So we made it very flexible thatthis mother-to-mother support
(25:21):
group, if they don't see these,uh, pregnant, lactating mother,
they themselves can visit themat their homes and when they go
there, if, like, the partner isthere, they will use their eyes
to communicate to them.
You know, so that they willmove from outside, maybe like to
inside the house or look for asafer place, space where they
can interact.
(25:42):
You know, so, all these, likesome of the things that we
brought in as part of thecultural adaptation, so that it
will be very flexible for them.
You know, in terms of theimplementation and that also
came out during the post-pilotinterviews that they really
appreciated that flexibility.
Speaker 1 (26:04):
Yeah, that makes a lot of sense.
It sounds like you guys havereally worked hard, not just to
find tools that will be usefulin the context, but to approach
the participants and say youknow, let's adapt these tools to
the work that we're doing.
Yeah, that drives us.
Speaker 2 (26:25):
Yeah, that's right.
Speaker 1 (26:40):
Great Well, you spoke at our maternal and child
health conference one of themornings on this into clinical
practice and how health careproviders can help screen women
and maybe even make referrals tothese kinds of networks
(27:08):
integrate this within thematernal child health program,
especially so when it is withinthe national mental health
policy and strategic plan butnot translated to the maternal
child health program.
Speaker 2 (27:17):
And there are lots of calls from the WHO, the global,
the GCC that is, global Canadachallenge and so many other
international organization forthe need.
Even the Lancet Commission alsorecommended for mental health
to be integrated within thematernal child health program.
And so that is what actually weare working towards, because in
(27:40):
this study we also developedlike a screening tool that
speaks to the local context.
For example, one of the 10items within that tool is
talking about shame.
If the pregnant woman orlactating mother has felt shame
for the past two weeks and shameis a very, very important
phenomenon that basically drivesthese women towards isolating
(28:03):
themselves, especially if theyhave, like pregnancy out of
wedlock or other aspects aroundtheir social life.
Isolating themselves,especially if they have like
pregnancy out of wedlock or someother aspect around their
social life, you know.
So basically, it's like nowwhat we are trying to do is move
towards like doing like arandomized control study using
multi-centers, and at that pointat least we will have generated
that proof of concept and weall see how best we can scale up
(28:25):
at national level Because, likethe intervention, as we can see
, is like a task sharingapproach, we are not using
health workers that are alreadyin short supply.
We already have shortage ofhealth care workers.
So this mother to mother supportgroup are found across the
country and, in line withProfessor Chibanda's philosophy
(28:47):
you know when he was designingthis intervention in terms of
using elderly women.
This issue of attrition is very, very difficult to see because
if we train like young women,there will come a time when they
will travel to bigger cities tosee greener pastures.
But these elderly women arefound across all communities
across the country.
So the idea actually is toreally integrate it within the
(29:09):
maternal child health program,have these tools and the tools
actually I also translated itinto graphic presentation so
which means that the mother tomother support group can also
use these tools in screening andalso in doing their follow up
with these women.
So that is what basically weare looking forward to and we
(29:30):
can't wait to meet the ministryin due course to see how best we
can work towards that, becausewe engaged them before the start
of the study and I've also didlike a dissemination.
So the next aspect will be likeuptake, which is very, very
important.
Speaker 1 (29:47):
Yeah, so this is something that you see has to be
done at the health system level, at the national level, with
policymakers, and at the verytop, not just a clinic to clinic
, hospital, hospital behavior,because really, what you're
doing is integrating.
I mean you're integrating carewithin the system.
(30:10):
It's comprehensive care now,instead of just focused on one
thing but seeing a person as awhole person.
Speaker 2 (30:29):
And we also, during the intervention, have these
referral pathways where thismotor support group can refer
cases that are very resistant totheir support towards the
community health centers.
We have some CHOs, communityhealth officers that went
through some training by WHO interms of providing the image gap
, which is like thepsychological treatment I mean
(30:53):
through a task sharing approach,and also we have, like, at
district level, we have mentalhealth nurses that are also
providing support.
So there is this cascadingeffect in terms of referral
pathways from model to modelsupport groups towards, in terms
of the pathways from moderateto moderate support groups to us
up to like, a district level.
And the other aspect that Iwould also like to make mention
(31:14):
of the fact is the fact that wealso had like a lexicon that we
generated from the datacollection process.
That is how women at communitylevel communicate psychological
distress without using anxiety,depression, which are like the
stigmatizing Western constructthat is driving them away from
(31:34):
seeking support.
So what we realized?
That using those things likewell, hearts, that is, their
heart is foil, like things liketheir heart is heavy, their
heart is crying, their mind isnot steady we realized that
those were like colloquialterminologies which are
non-stigmatizing and whichbasically can facilitate not
(31:59):
only their seeking of supportbut also engaging with these
treatment services.
These treatment services andthose are the lexicon that we
also want to engage with theseinstitutions.
For example, I'm like alecturer at Comas engaging, for
example, like Comas College ofMedicine, jala and other
(32:20):
training institutions so thatthis can be included in the
training curriculum, so thatwhen they are engaging these
pregnant and lactating mothersthey start talking about Puellat
.
They should know that there issomething in addition to the
physical component.
There is also a psychologicalcomponent that is involved,
because a good number of themrealize that they do a lot of um
support to these women.
(32:41):
They do like tests.
They cannot see anything.
So meaning that there is likethis somatization that is going
on.
You know, somatization from theliterature is very widespread
in asia and africa as well.
You know we are like thispsychological stuff.
All the psychological distressthey are experiencing is
presenting as physical symptoms,like digestive issues, like
(33:04):
probably um respiration, likepain, you know.
So all these are basicallysomatizations which are coming
from the psychological distress.
So at least it will besomething like an eye opener for
healthcare workers to look outfor and refer some of these
women for psychological support.
Speaker 1 (33:25):
Yeah, yeah.
So the hope is that clinicalcare people can learn to
recognize it, not just in termsof the success that you've had
in this project and the workthat you're doing.
What are some of the keychallenges, though, that you've
(33:55):
seen in doing this research?
Speaker 2 (33:59):
Some of the challenges that we experience is
in terms of the implementationof the study.
You know, at the ruralcommunity setting it's a bit
easier compared to the urbansetting and but notwithstanding
(34:22):
that, from the lessons thatwe've learned from the urban
setting, where we conducted thisstudy, we'll definitely be able
to also replicate it within theurban setting.
So, for now, some of thechallenges I think we have is in
terms of having funding, interms of doing a randomized
control study, but in terms ofthe piloting phase, we didn't
(34:45):
have much problems in terms ofchallenges because we engaged
stakeholders and we engaged thechiefs, we engaged the Mami
Queens, so all of them wereinvolved and we got their
support and it was very easy forus in terms of doing our pilot
study, doing our pilot study,you know.
(35:11):
But another challenge I thinkthat is worth mentioning is this
aspect of Linking themother-to-mother support groups
and the pregnant women,lactating mothers.
You know, because when we didlike the screening, there was a
time when we we have, like this,research assistant that did the
screening, we screened them andthose that got above the cutoff
(35:33):
point, we had the one that werecruited.
So when the mother to mothersupport group went to locate
them, some of them theiraddresses.
We are not like they cannot.
We cannot locate them becauseof the addresses and some of of
them we are not having phonenumbers.
You know they gave us the phonenumbers of their relatives.
Speaker 1 (35:52):
So those are like some of the technical challenges
that we had yeah, yeah, wewe've experienced some of the
same technical challenges andand tracing people, and and
that's not uncommon in research,but it sounds like you guys did
a lot of work to make sure thatthis was well integrated into
the community.
Um, and that's not uncommon inresearch, but it sounds like you
guys did a lot of work to makesure that this was well
integrated into the communityand that you had community
(36:13):
support.
You weren't just coming in andenforcing it, but seeing what
already existed and buildingupon it.
Speaker 2 (36:21):
Yeah, sure.
Speaker 1 (36:25):
Great.
Speaker 2 (36:42):
Go ahead, structured format, you know.
And yeah, I think one of thethings that I'm looking forward
to is not to let them down andalso to scale it to other
communities after the randomizedcontrol study.
I'm going to say yes, man.
Speaker 1 (37:01):
Yeah, no, I love that .
I love that it's something thatthey love so much that they
want it to continue, and I hopethat it will as well.
And it would also be veryinteresting to see, over time,
if you're able to measure theimpact it has over many years
and many, many pregnant women.
Speaker 2 (37:21):
Sure, definitely, that's also something we'll be
looking forward to, and anotheraspect that we are also looking
forward to, and another aspectthat we are also looking forward
to into the future, is how bestwe can also be able to refer
some of these women to some ofthe services that they really
needed in terms of support.
You know, yeah.
Speaker 1 (37:48):
Services like.
Speaker 2 (37:51):
This is like like, for example, um, some of them we
are having uh, problems with,for example, like abuse, you
know how we can be able to linkthem, for example, like the, you
know, social support servicesto support them in some of these
problems that they'reexperiencing, which is unique,
(38:13):
you know, and which sometimes,as an intervention, the
intervention basically does nothave much to do in terms of,
like, supporting them throughthat pathway, you know.
So, linkages with services issomething also we are looking
forward to.
Speaker 1 (38:30):
Well, are there other areas?
You know it sounds like.
Your paper on the culturaladaptations of the language
that's used to describe anxietyand depression is being
published.
Your pilot study on thesemother-to-mother support groups
is being published.
What's next?
Speaker 2 (38:47):
Well, the next aspect is, as I said, looking for
grants and do like a randomizedcontrol study and see how best
we can scale it up to othercommunities and districts across
the country.
Speaker 1 (39:01):
Amazing.
Well, best of luck with thoseresearch grants in that way.
Is there anything else you'dlike our audience to know about
your research and work inperinatal mental health?
Speaker 2 (39:11):
We also have, like, two papers that I'm also working
on, which definitely will bepublished very soon.
One of them is looking at theprevalence and the risk factors
and the prevalence it willsurprise you to know that it's
about 50%, so meaning that oneout of every two pregnant women,
lactating mothers, isexperiencing psychological
(39:33):
distress.
And also the other paper islooking at the maternal child
health impact of thepsychological distress.
You know, because you can seeit clearly from the data we
collected, we are womendescribing that a particular
woman at the community, forexample, like Adama, experienced
(39:55):
miscarriage because of thedistress she was experiencing
from the partner, or sheexperienced stillbirth.
So all these at community level, you can see elderly women or
the pregnant or lactating motherlike describing that when the
woman is going through thepsychological distress, even the
baby in the womb is having like, so which in western constructs
(40:21):
we can in fact, as like in thetradition, you know.
So basically, at level, theycan describe it colloquially of
which we can extrapolate and seethe Western equivalent of it,
you know.
So we're also working towardspublishing those two papers as
well.
Speaker 1 (40:39):
It's amazing.
Well, we look forward toreading those as well.
You're not just taking yourwork and taking these Western
terms and forcing it on thesecommunities, but exploring it
within the community and sayinghow does this equivocate to
something that you know is inthe DSM?
Question that we ask all of ourguests is what are you
(40:59):
optimistic about?
Speaker 2 (41:02):
Well, I'm optimistic about the scaling up of this
intervention because I am very,very sure that if we can scale
up this intervention at nationallevel and have each and every
community havingmother-to-mother support groups
that are not only supportingwith the infant malnutrition
(41:23):
program but also supporting withthe psychological aspect of
pregnant women and lactatingmothers, I foresee that in the
long run, there will be adecline in things like cases of
eclampsia and preeclampsia,which has been directly linked
with psychological distress.
We can also see a decrease interms of infant malnutrition, of
(41:44):
which we have the evidencelinking them as well, and even
things like stillbirth, you know, and low birth weight, you know
, and all these indicatorsactually, which we are always
struggling with, you know, forme, which I consider to be
distal, you know, distal factorsso, of which we need to address
(42:05):
the proximal factors, which arelike the psychological
components, psychological aspectof pregnancy, when a lactating
mother is.
Speaker 1 (42:13):
Yeah, so it does come back to maternal and child
mortality as well.
Not just their mental healthand their morbidity and their
well-being, but even hasimplications for that as well.
Speaker 2 (42:28):
Yeah, definitely, yes , that as well.
Yeah, definitely, yasmin.
Speaker 1 (42:30):
Yeah Well, thank you so much for joining our episode
today.
It's been a pleasure talkingwith you and hearing about this
work and the way that you'reexploring how to help women and
children through this innovativeapproach.
Speaker 2 (42:46):
Thank you very much, Yasmin.
Speaker 3 (42:51):
Thanks for listening.
If you enjoyed this episode,please subscribe, share it with
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To catch all the latest from us, you can find us at Helping
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