Sylvia's Journal

I spent most of the day at the ministry. Only one of the three meetings I had planned to attend actually materialized. So much for getting things clarified, straightened out and organized before I go off for a fortnight. Still, it is good to hang out at the ministry because you meet people and hear things one would not back at our office.

In the morning I attended a presentation by the private sector (for profit) office that has sketched out a plan for bringing them on board to work alongside the ministry towards better health services and products for Afghans.

It is a complicated undertaking because (1) there is a general mistrust of the private-for-profit sector’s motives (perceived as ‘make as much money as you can, no matter what the quality of the product or service is’), and (2) the for profit health sector is not organized making it hard to invite ‘representatives’ to the table.

The plan was a heroic attempt to bring some order in all this, and a strategy for action. Yet how this is going to be funded is unclear. This was also true for the next presentation about Afghanistan’s mental health strategy; maybe an even more complex and more costly undertaking.

Everyone agrees there is a huge problem but the boundaries of what constitute ‘illness’ and what is the result of cultural practices that some of us would call domestic abuse are fluid.

The strategy development process was long and arduous and full of disagreements and conflict. The proponents of the need for action fought many battles and lost often to primary health care advocates. All sides claimed that their investments pay off. But the investments will have to come from outside as the government cannot pull this cart on its own. Someone is calculating the cost. It will stun people no doubt.

That women are anxious, throw themselves in wells, burn themselves or are seriously depressed is not because they are mentally ill (although one could argue they become that way – ill from worry). Afghanistan, especially the rural areas, is not a healthy place for women.

One of today’s ANSO reports (the organization that reports faithfully on the multiple ‘security incidents’ each day) illustrates this all too well: the bodies of two women were brought to the capital city of Helmand province this morning. They were, allegedly, members of a women’s tailoring cooperative – funded through the US government which made them, in the eyes of the insurgents, ‘collaborators,’ a death sentence that was swiftly executed. Or may be it was simply a family feud – such reckoning goes mostly unpunished.

There are safe houses for women who escape, but they are well hidden and thus not easy to find. The women who make it there need psycho social support yet there are few professionals who are trained to provide this and no government services or legal recourse to help them. The mental health strategy tries to insert some services so that women who come to the health center can find an attentive ear rather than a man to escort them back to their tormentors (husbands, brothers, uncles as well as mothers-in-law).

One of the people who spent much energy on this mental health strategy is Inge Missmahl. She attended the meeting as one of the architects of the strategy. She and her ministry counterpart must have been very happy to hear the words ‘strategy accepted,’ at the conclusion of the meeting, coming out of the mouth of a senior government official.

My friend Charles had sent this link that shows Inge speaking on TED. I felt privileged to meet her in person.