The Rwandan Approach to Depression - Community, nature and joy

Neha was feeling out of sorts. Exams were looming and the pressure was intensifying. The Iron Gate of the SLC (final school exams) seemed to get taller every day. Her will to go on had disappeared. I hated seeing her under this amount of pressure, wished I could do something. The Nepalis I spoke to said it was simply exam pressure and everyone had to go through it. But it was more than that. Her appetite had gone, she couldn’t sleep. She had started talking about suicide. Her soul was giving up. I sought advice in Australia. I was told she needed counselling and to be put on anti-depressants, that she was clinically depressed.

 

I returned to the psychiatrist in Kathmandu to ask his advice. “It’s normal exam pressure, but if you think it’s more, then here are some anti-depressants and sleeping tablets.” Um, no thanks. Sleeping tablets for a suicidal teenager didn’t seem logical. And counselling in Nepal generally consists of telling them to get over it and study harder.

 

All options seemed counterintuitive. Talking about what was making her stressed and drumming it further into her mind; medicating her so she wasn’t able to feel the stress; telling her to get over it; removing the stress entirely by telling her not to sit her final SLC exams, effectively limiting her future options. There had to be a better way; one which was more positive, which would build her resilience against future stress as well. Not one which seemed to compound the problem.

 

Then I came across this quote about the Rwandan approach to dealing with depression. It was an aha moment for me.  

 

"We had a lot of trouble with western mental health workers who came here immediately after the genocide and we had to ask some of them to leave. They came and their practice did not involve being outside in the sun where you begin to feel better. There was no music or drumming to get your blood flowing again. There was no sense that everyone had taken the day off so that the entire community could come together to try to lift you up and bring you back to joy. There was no acknowledgement of the depression as something invasive and external that could actually be cast out again. Instead they would take people one at a time into these dingy little rooms and have them sit around for an hour or so and talk about bad things that had happened to them. We had to ask them to leave."

 

As I reflected on this as well as the elements of wellbeing and the research surrounding resilience, I felt like we needed to inject some fun into Neha’s routine, some laughter and positive experiences. So we started with a “Love Bomb” – a burst of one on one attention doing something she enjoys. Often these have the effect of giving a boost of energy which enables the person to grab onto the first rung of the ladder to help them climb out of the pit of depression. We combined this with a number of other strategies – spending time in nature, allowing our bare feet to connect with the earth; hanging out with the kindergarten kids (there is something uplifting about enjoying the company of young children with few inhibitions and a wonderful curiosity for life); a crazy hour of dancing to all her favourite songs. We also taught Neha the impact that stress was having on her body, allowing her to identify the symptoms and giving her some tools (breathing exercises, mindfulness techniques) to minimise these. Then we added some memory boosting foods such as almonds and tuna.

 

Of course, the tension and pressure of exams continued. We can’t remove this. But by adopting the Rwandan way, giving her a package of positive boosters, we hoped to allow her to climb out of the depressive pit and to allow her to feel confident she could handle things herself in future.

 

As Neha’s final exams near, she is in a great place. Stressed and terrified, understandably yes; but no longer feeling hopeless and sad. Now she sees the opportunities to learn from the experience and is excited about her future. And her cheer squad is right here to give her boosts of fun and love along the way.

 

 

 

 

The power of perspective - from the worst year ever to a year of inspiration

I sat down to reflect on 2013 and concluded it was the worst year ever. Some horrific things happened which knocked me for six – possibly even further. Feeling rather disheartened by it all, I shifted my focus to thinking about the highlights of the year and a smile immediately appeared on my face as the list grew longer and longer. Here are just a few (in no particular order!): 

1)    Saraswoti, my daughter, obtaining 72% in her SLC (class 10) results. In a year in which only 38% of students passed, I am even more proud of her achievement.

2)    The enormous feedback from my op-ed piece in Nepal’s Republica newspaper titled “Nepal is not poor” gave me hope.

3)    Despite the circumstances, the opportunity to spend time with my brother, sister-in-law and my nephews in Adelaide was a gift.

4)    The passion and energy of the group of students from Charles Sturt University when they spent 3 weeks with us completing their practical teacher training was so much fun.

5)    Setting up our new hostel and the bravery of the kids who came with us inspired me and gave me reason to believe again.

6)    Winning the Rotary Inspirational Woman of the Year Award as well as the Edna Ryan Award for Mentoring humbled me.

7)    My parents, who supported me through a very dark time in ways they will never fully know.

8)    Working with Riviera again and the mentoring I receive from the principal, Prajwal.

9)    The incredible support of my daughter, Nimu, who gives me so much courage and strength every day.

10) A morning spent with Jo Fedler which reminded me of the power of conversations with amazing people.

11) On the same theme, the conversations had over the month she spent in Nepal with Niki Simpson challenged me to think and debate my views of development.

12) The challenges I faced throughout the year gave me opportunities to learn so many lessons and to really focus on what is important to me. This is a gift for which I am very grateful.

 

When I reached the 50^th highlight of the year, I felt like dancing. How could I have felt that 2013 was horrible with a list of 50 pieces of evidence to the contrary? There was so much to be grateful for, so much beauty in the chaos of the storm.
A simple change in my perspective, my focus, gave me confidence to face the new year with a new appreciation of the gifts 2013 had given me.

 

So what challenges are you facing at the moment? And how could a shift in perspective give you a boost in the right direction?

 

(Thanks to Sally Morgan for the amazing image).

What does "wellness" really mean?

“Wellness” has become a buzzword these days; it’s the new “happiness”. Over the last few weeks I have been reflecting on what it really means, how we measure it and how setting a “wellness plan” is different from just another list of things we have to do. Here are my thoughts:

Wellness is about life, living day to day. So is a plan for this somewhat counterproductive? Who is to say that if we increase in all the areas to a maximum, we’ll be well? What level should we be aiming for? So if Marnie has a bad week, she would “abandon any attempts at behavioural change during this time.” And Alison said she hoped to “get back on track” next week suggesting she had failed this week. And I described myself as having “fallen off the wellness wagon”.
 

But that’s life, right? We have those weeks. I have really been struggling with what makes a wellness plan different from a series of “new year’s resolutions”. So what if we don’t achieve goals – maybe we’re not interested in them and forcing ourselves to do them because we feel we should isn’t going to improve our subjective perception of our wellness which is what it is about after all. At what point does a goal become achieved and crossed off the list. When it’s habit? What does this mean? Isn’t a wellness plan more about creating new rituals, changing behaviour than ticking off a series of goals?

Our wellness “plans” need to be flexible – but that needs to be an accepted part of the process, not something we feel is the result of a failure or a challenge. Also we need to give ourselves permission to put some of our goals on hold during challenging times. They may be seasonal – for example, Kathmandu is very humid and disgusting in the monsoon season and so a lot of my movement goals become too challenging. Or my priorities may change? Or I may have set it because I felt I had to. If I try to force myself to do them, I get angry with the whole process and my overall wellness goes down. So I give myself permission not to think about it or feel pressure to achieve it for those months. Does that make me less well?

My conclusion: “wellness” is subjective, it’s constantly changing, it’s life. So don’t get too caught up on it, or on setting goals which you then beat yourself up for failing to meet. Create some rituals which reflect the wellness lifestyle you want to lead and then get on with living!

“I don’t have time” is a bulls**t excuse

“How are you?” her friend asked as they sat in their favourite coffee shop for their weekly debrief on life, work, husbands, the state of the world.

“Busy” came the standard reply. “Me too. Work has been insane, Mark’s away so I’ve got the kids on my own, Mum’s been unwell so I had to take her to the doctor . . . . .” The list went on.

“Oh, I know”, her friend leapt on a pause for breath, “we’ve got a big presentation coming up for a new client and John’s driving me mad with his constant requests. Talk about the client from hell. Does he think he is my only client, for God’s sake?”

Jane smiled to herself at the next table. She wondered when being “busy” had become a badge of honour; when it had changed so that unless you’re running doing a million things at once, when you’re not seen to be a high performer or someone who’s worth being friends with. You’re seen as someone who can’t possibly be happy because you haven’t rattled off a list of things you’re busy with. Or maybe it’ that we use it as an excuse, she pondered. “How can I have time to be happy, I am too busy . . . .” As she sipped her chai, she tuned her ears back into the conversation at the next table.

“I used to love Fridays with the weekend looming large, but now the weekends are even busier. Jess has to go to netball, James has a sleepover. It’s Mark’s mother’s birthday so we have to do the family thing. Shit. I have to get her a present too. She’s always judging me because I don’t have time to get her a present.” “Why doesn’t Mark get it, it’s his mother?” her friend ventured. “Oh apparently he’s too busy. Like, I’m not,” she scoffed. “He should try working at my job, raising the kids . . . .”

I don't believe in the "I don't have time excuse". We all have the same number of hours in the day; if we don't have time for something, it means we chose not to make it a priority to do it. That's fine but own the decision instead of trying to justify it away with the old "I don't have time" excuse. I challenge you next time you catch yourself using it to really question why. If it's something that's not important, take it off the To Do list and free your mind from it. If it is important, question why you didn't make it a priority today.

As the Zen saying goes, "You should sit in meditation for 20 minutes a day, unless you're too busy; then you should sit for an hour."

So take some time out for yourself today, and don’t feel guilty about it. Own the decision and enjoy it.

  

What does an "empowered woman" look like?

Sarita, one of the girls we support, asked me the other day, “Bec, how do you empower women?” Great question, where did it come from, I asked her. Her principal had asked her what her plans are for when she finishes class 10 in April. She said she wanted to work to empower women and the principal had nodded her head approvingly. This an accepted answer in Nepal and the catch cry of so many NGOs and INGOs. But, Sarita, continued, although she had used this phrase hundreds of times in school essays and exams, she wanted to know exactly what it meant.

We brainstormed what an “empowered woman” would look like, what would she do, how would she behave. Then looked at what skills they need and what support they may need on that journey. Finally, we broke down how organisations are approaching this task today.

Our conclusions:

1)    CONTEXTUAL SKILLS - Empowerment is about providing practical tools and skills to women to enable them to grab their opportunities within their context. It is about inspiring them to act or to change their behaviour;

2)    AWARENESS v ACTION - Most organisations focus on awareness only, on educating women as to their rights, nutrition, literacy etc. But they fail to focus on changing behaviours, on creating new rituals and behaviours in the women. The measurements of success for most organisations is numbers based – how many women were trained, how many received microloans. That is missing the point – it is not measuring behaviours that showcase empowered women;

3)    JARGON - Empowerment is a buzzword. There are so many of them used in development circles. But do people really understand what they mean? Do they consider what “success” looks like in these programs? In my experience, rarely.

Mitrataa has fallen into this trap sometimes too. We have explored before how to measure whether the girls we work with have really embraced the life skills we teach them. Empowered women fall into the same category. What does it mean and why are we aiming for it?

The development industry, in my experience, has got too caught up in jargon and patting themselves on the back for achieving numbers. But how about measuring what really matters – not to us, but to the people we have the privilege of supporting.

Thanks, Sarita, for making me really think. I am so happy to hear your future will involve empowering women. Nepal is lucky to count you as a future leader!

Energy Vampires v Cheer Squads

I had a few visits from energy vampires this week. You know the ones – those people in your life who have the uncanny ability to suck the energy out of you with their words or actions. Recognising their impact is a first step, but going from that to taking away the impact of their energy drain is a step I often struggle with!

Since I cannot just avoid these people, I decided to balance their energy with the positive energy that I feel when members of my Cheer Squad are around. These are people who believe in our dreams unconditionally, the ones who always manage to inspire us and remind us why we are on this path, the ones with whom a single conversation can send us soaring with ideas again.

I am so incredibly lucky to have some amazing people in my life who inspire me so after some bumpy moments with energy vampires, I managed to rediscover my confidence and try again.

Identifying the energy vampires in our lives and working out strategies to minimise their impact (which may include avoiding them if possible) is important. But even more so is identifying the members of our Cheer Squads – there will be different members you turn to at different times: some for a cuddle or a cup of tea, some for a “bitch session” to let you get it out of your system (although not too much before encouraging you to move on!), some for a debate on the issue and others for offering advice. Each is important and knowing who in your Cheer Squad will help replenish your energy and confidence when you need it will make it easier when those energy vampires come visiting.

However, as one of my Cheer Squad reminded me this week, sometimes it us who needs to change our perspective of these energy vampires and view them with compassion. What are they facing in their lives which is making them in need of energy? Or are they trying to teach us a lesson we need to learn . . . patience, perhaps? Changing the lens through which we view them can limit their ability to drain our energy.

Always remember to share your gratitude with your Cheer Squad too and be there when they need you to return the favour. And don’t turn into an energy vampire yourself for members of your Cheer Squad!

Thanks so much to my amazing Cheer Squad for helping me to replenish my energy this week. You are all wonderful and I am so lucky to have you in my life.

 

“When there is room for doubt, fill the gap with hope.”

Diya smiled at me with her big, soft eyes. “Bec mamu, things will get better. I always have hope for a better future. It can’t be worse than this.” This tiny girl who had experienced more pain and loss in her short life than most people do in a lifetime, continued to have hope, to believe in a better future, even with the odds stacked against her.

Hope is a wonderfully powerful concept. “High hopers” have been shown to embrace a goal with more emotional zeal and energy and to demonstrate a greater ability to develop alternatives when faced with challenges. I wondered whether hope had the same power on a national level as on an individual one when I was struck by the headline in The Economist’s Special Report on Emerging Africa in March 2013 - “A hopeful continent”.

I reflected on the power of hope, the motivation which springs from it as I read the on: “African lives have already greatly improved over the past decade. The next 10 years will be even better.” I smiled at the image this created, inspired by the optimism and celebration of success so far, “a picture at odds with the Western images of Africa.” The media-driven images of controlling dictators, war, and poverty while definitely an accurate depiction in some respects, only told part of the story. These things have become rarer. The report acknowledges that “[p]eople still struggle to make ends meet, just as they do in China and India. They don’t always have enough to eat, they may lack education, they despair at daily injustices and some want to emigrate. But most Africans no longer fear a violent or premature end and can hope to see their children do well. . . . . The biggest reason to be hopeful is that it takes time for results from past investments to come through, and many such benefits have yet to materialise.”

I wished something similar could be said about Nepal, my adopted homeland, a wonderful country with so much to offer the world, but so little hope. Years of civil war, followed by years of ineffective and self-obsessed government had drained these patient and fatalistic people of their belief in the possibilities of a better future.

 

Travelling back to Nepal after a few weeks in Australia, the Straits Times hailed a cry of hope from the Singaporean prime minister – “PM: A bright future for S’pore’s babies. He urges citizens to work with the Government to keep the country a good place to raise children.” For a spirit of national hope to thrive, it needs to be led by the government, inspired by the government and communicated by the media. Singapore seemed to have found a way to share its inspiration. Nepal’s media on the other hand, was communicating a message from its government which had a very different approach.

“Consensus again eludes big four” shouted one headline. “Differences delay new gov’t. Leaders disagree on army rank, TRC, voter registration” proclaimed another. “NBA opposes CJ-led government. Threatens protests if parties go ahead.” And finally “After days of dilly-dallying, CJ accepts PM offer. SC statement says Regmi not guided by personal interest”.

The “big four” had been arguing for months and still hadn’t managed to pass the new constitution. A few months later in August and the November election date has just been abandoned because some parties are refusing to participate because they don’t think they have the numbers yet – um, so let them not contest it! But no, the country remains in a downward spiral while the politicians fight for power. Is it any wonder the Nepali people have lost hope?

Bhutan, known for its innovative Gross National Happiness, also recently made a decision to issue condoms to monks. Even though monks are supposed to be celibate, the government was concerned that sexually transmitted diseases were being reported and so decided to tackle the issue head on rather than ignoring it and allowing it to get bigger. This is the kind of proactive, unafraid, committed government Nepal needs in order to inspire its people to rediscover their hope.

The story in Nepal needs to change from the “Nepal is a poor country which needs lots of help” narrative that they are taught in schools and which is reinforced by the amount of aid coming in and by the government’s disorganised self-obsessed mismanagement to one of hope. Maybe Diya is right, it can’t get worse so we have to hope it will get better. Perhaps Nepal needs to develop a new form of national measurement, inspired by Bhutan’s Gross National Happiness – Gross National Hope.

Imagine what could be achieved if Nepal was a country of “high hopers” with the passion and energy to achieve their dreams. Imagine if The Economist’s headline was about Nepal – “a country of hope”.

“When there is room for doubt, fill the gap with hope.”