A couple of weeks ago, I wrote a story about why mental health is one of the most neglected problems in the developing world.
In the article, I highlighted the work of Strongminds, a charitable organization that is treating depression at scale in Uganda, focusing particularly on women.
Inspired by the inventiveness of their solution, I reached out to Strongminds founder Sean Mayberry and program director Kari Frame. I wanted to know more about their approach to mental health and how they’re disrupting depression in Africa.
We started with a general introduction of Strongminds’ work, then they explained why they decided to dedicate two brand new programs to targeting adolescents and refugees, and finally, I asked them why, after Uganda, they’re now extending their operations to Zambia.
Kinder World: Sean, you founded Strongminds in early 2013. Why? What did you want to achieve?
Sean Mayberry: Our mission was and is to improve the mental health of women and girls in Africa by focusing on depression, the most pervasive and debilitating mental illness in the world.
So far, we’ve treated over 43,000 women of all ages, but our goal is to treat 2 million women by the year 2025.
Given the extreme scarcity of mental health professionals in Africa, to even dream of achieving such a goal we can’t afford to employ a model that relies on doctors and nurses.
So, we perfected a depression intervention based on Group Interpersonal Psychotherapy. A cycle of group therapy consists of a 12-week period of 60-90-minute sessions and, in the end, we encourage women who complete it to run their own peer therapy group, making the process scalable and low-cost.
Keep in mind that there are at least 66 million women in Africa who suffer from depression and, according to the World Health Organization, approximately 85 percent of them have no access to treatment
This is a gigantic problem that needs effective, scalable solutions.
Mental health should be a priority for international aid. It should really be at the top of the list. Take the case of refugees, for example. Before you could think of other interventions like a training program, you need to get the refugee back to good mental health.
If you don’t follow this order, the illness will be a blockage, nullifying the effects of other aid measures.
In this regard, I know that you’ve recently started to develop a new program tailored to refugees’ needs. Why did you think it was important to do it?
Kari Frame: In Uganda, the refugee population is huge. Over one million people have been welcomed there in the past years.
The reason is that it’s one of the most liberal and receptive environments in Africa when it comes to allowing refugees to settle, to work, and in general to rebuild their lives.
So there’s this huge population that is migrating there carrying the typical mental health challenges that come with displacement and conflict. That’s why we’re interested in developing a therapy that caters to their distinctive needs.
We’ve been researching this topic for a while now. Interestingly, there are quite a number of scientific studies demonstrating that to address refugees mental health you don’t have necessarily to focus on the trauma or the PTSD.
Depression and the challenges of the “here and now” are sometimes even more important. And these are the problems our therapy is particularly well suited to address.
In fact, data reveal that a traumatic event like a war is more likely to trigger a depressive episode than to trigger PTSD.
In addition to refugees, you’ve also decided to dedicate a new program to adolescents. The question is the same: why did you think it was important to do so?
Kari Frame: Adolescence is the cradle of depression. That’s when most people who experience depression have the onset of their illness.
If you treat depression, the risk of relapse over time will be drastically reduced, so a focus on depressed adolescents, epidemiologically, makes sense.
However, adolescents are a difficult target group. They have a lot of different competing priorities, like boyfriends or girlfriends. It’s then important to be flexible with certain parameters like the length of the treatment.
We also know that the important people in an adolescent’s life - such as her friends or partner - can either support or put off her engagement in therapy, so we also need to find ways to engage with these other people and make sure they understand the treatment’s importance.
Interpersonal Group Therapy is usually considered very effective for adolescents, even though it has not been widely studied in the context of Sub-Saharan Africa. But that’s what we’re set out to do this year.
This really is our typical Strongminds approach. There’s a lot of experimentation involved, of figuring out what we don’t know yet, testing it, and ultimately being able to develop a state-of-the-art, replicable model.
For example, at the moment, we’re looking into how we can package our therapy in a way that is more appealing for adolescents.
We suspect that technology and specifically social media might play a role since they are the important currencies in an adolescent’s life.
You’re not just expanding your treatment’s reach to new target groups. You’re also expanding geographically. I’m referring to your decision to start up a new Strongminds chapter in Zambia. Why did you pick this country?
Sean Mayberry: Of course, geographical expansion is part of our plans to scale.
When we had to decide where to go next, we looked at everything, from demographics to safety, but the single most important factor that brought us to Zambia is that we have received the greatest proactive stance from its Minister of Health, who directly asked us to partner up and deliver our service as part of the existing national health infrastructure. And being involved in larger partnerships is one of the ways we want to scale our solution.
On last New Year’s Day, the president of Zambia visited the local mental health hospital and pretty much said that mental health will be a top priority for the government.
It’s gonna take a lot of work. When I was there in October, I was told that in the country there are just around eight psychiatrists. That’s for a population of over 16 million people. For us, it’s not a shock. This is pretty much the standard ratio of mental health professionals in Sub-Saharan Africa.
And so we go back to why our community-based model is designed to work without trained doctors and nurses.
I have one final consideration: I certainly don’t want to make a “ranking” of mental diseases but depression seems relatively less debilitating than schizophrenia. And I guess that people in the schizophrenia spectrum have an even stronger stigma attached to them.
I was just wondering what could be the fate of someone suffering from it in a country like Uganda or Zambia, also in light of the radical lack of mental health professionals you mentioned.
Sean Mayberry: We focus on depression because it’s the number one problem there at the moment. It’s also a matter of percentages: depression affects around 30 percent of the population while schizophrenia has an incidence of around one percent.
But, granted, someone with schizophrenia is living a horrible life, also because it outwardly presents the signs most associated with the mental illness stigma.
On top of that, access to medication here is a real issue.
So yes, it’s an extremely difficult situation. In Sub-Saharan Africa, mental illnesses are often not recognized as such, so people might think it’s a curse or their own personal weakness.
Then, there’s the social decay that happens with it. Many of the people that we have found to be depressed, they were thrown out of their social networks, and they were isolated for months or years.
The strength of the Strongminds group therapy approach is that it pulls depressed people out of isolation, encouraging them to share their feelings and experiences with other women so that they understand they are not alone. In doing so, it removes the stigma of mental illness, which is a source of shame for sufferers and confusion for their loved ones.
© header image: Strongminds
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Join us for the second of our Kinder Conversations - the Sky has a Limit.
Following our investigation into the Future of Meat in February, we've turned our attention to the sky. We'll be talking about whether air travel can be more sustainable, and how.
We're delighted to be hosting this event in collaboration with our friends at TQ, the Amsterdam tech hub where we're based.
📅 When Monday 17 June 18:30 - 20:30
📭 Where TQ, Singel 542, Amsterdam
🎯 Why should I fly Kinder? To hear about the latest research and technology making air travel more sustainable. To find out what you can do to reduce the impact your flights are having. To share a drink with like-minded travelers, and sample some of our vegan snacks (including beloved Professor Grunschnabel ice cream, as seen at the Future of Meat event)
Here at Kinder, we believe that greener travel is one of the key ways in which we can tackle the climate crisis. Travelling green can mean a lot of things, but right now we’re concerned about the aviation industry.
If aviation were a country, it’d be a top 10 polluter - and C02 emissions from air travel are growing many times faster than any other form. We’re already in a very dangerous position, and although there are many potential solutions, we sometimes feel overwhelmed and uncertain about what to do about it.
That’s where Kinder Conversations comes in.
Kinder Conversations is a series of events which delve into the biggest issues facing the world.
At the Sky has a Limit, we’ll be bringing together representatives from research and technology, the aviation industry and the not-for-profit sector to talk about sustainable air travel. We’ll hear more about the problem, and a lot more about the solutions.
Plus, there’ll be time to get a drink from TQ’s bar (buying a drink helps our friends from TQ support more events like this), try some vegan ice cream, and chat to fellow travellers about the steps you can take to travel greener.
✈️ Are you ready to #flykinder? Then secure your boarding pass here.
I don't have a driving license and when pressed about getting one by friends tired of chauffeuring me around I usually say I will only get one if I can drive something cool, like the Batmobile or a flying car. Unfortunately, I might have to honour that promise as it seems that flying cars are finally taking off (alas, no commercial Batmobiles in sight).
Indeed, several promising startups around the world are working to deliver the "car of the future" over the next few years. Like the Dutch company PAL-V that showed off a limited edition of its flying car at the Geneva Auto Show in Switzerland.
The PAL-V is a hybrid between a car and a helicopter (or more precisely, a gyrocopter), able to reach a top speed of 160 km/h on the tarmac but also get airborne in just 5 minutes, hitting airspeeds of 180 km/h over a range of up to 500 km. But since buying a PAL-V will set you back around € 350,000 I might have to pass on this one. Moreover, flying this beauty requires not just a driving license but also (understandably) a license to fly, and that's just too much for me.
Thankfully, other companies are developing vehicles that need no driver at all. Aerospace manufacturer Bell Helicopter, for example, is working on Nexus, an air taxi capable of taking off and landing in the middle of a city (whereas the PAL-V still needs a runway, albeit short, to get airborne).
Called VTOLs (short for Vertical Take Off and Landing), these aircraft aim to become sort of an Uber of urban air travel, bringing customers to the opposite part of the city or even to a nearby city in a matter of few minutes.
If you're at JFK airport in New York, for example, and have a meeting in Manhattan, instead of embarking on a 1-hour, Cosmopolis-style taxi ride, you could just hail a flying car and be downtown in 5 minutes.
Futuristic as it may sound, concrete plans to make it come true are underway. Earlier this month, German startup Lilium successfully completed the first test of its new five-seater Lilium Jet, an electric vehicle that, according to the company, will have a range of 300 km and a top speed of 300 km/h.
The reason electric flight is such an exciting area of research is not just because flying taxis will allow a handful of high rollers to drastically cut on their commuting time. Electric flying cars might be really good for the environment too.
A recent study published by Nature highlighted that, in some cases, flying cars could eventually be greener than even electric road cars, cutting emissions while reducing traffic on increasingly busy roads.
Moreover, developments in the field of flying cars could also boost the research on electric flight at large, including long haul electric flights, sort of the Holy Grail of aviation. And, as known, the civil aviation industry needs to find effective ways to lower its carbon emissions as soon as possible.
However, as explained by Hugh Hunt in an article on The Conversation that we republished here on Kinder World, "gaps in necessary technology and practical uncertainties beyond the cars’ promising physics mean that they may not arrive in time to be a large-scale solution to the energy crisis and congestion."
Let's get this one thing straight: most people prefer flying to other modes of transport, and we seem to do it more and more often. The airline industry is booming and 4.1 billion passengers have been transported last year. Almost every figure one looks at shows the impressive increase in flights over the last two decades.
Alexandre de Juniac, head of the International Association for Flight Transport proclaims: “In 2000, the average citizen flew just once every 43 months. In 2017, the figure was once every 22 months. Flying has never been more accessible. And this is liberating people to explore more of our planet for work, leisure, and education. Aviation is the business of freedom."
However, this ‘business of freedom’ runs on fossil energy carriers as planes still almost exclusively fly on kerosene. Kerosene is a fuel produced by oil refining and carbon dioxide (CO2) is the major product of burning kerosene. The 2-5% of all global CO2 emissions the aviation industry emits is caused by its fuel consumption (and choice). And unlike other fuels like diesel or gasoline, airlines don't pay taxes on kerosene in most countries — making cheap air travel possible.
In 2018 Europe’s biggest airline Ryanair became number 9 in the list of Europe’s biggest CO2 emitters and still claims to be the ‘greenest and cleanest airline’. Andrew Murphy – the aviation manager at the European Federation for Transport and Environment — argues that Ryanair the new coal when it comes to climate pollution. Ryanair CEO Michael O’Leary, on the other hand, dismisses such claims by saying the claims are ‘’complete and utter rubbish’’.
Other airlines, like KLM who partly uses renewable jet-fuel, are acknowledging the problem but they aren't too far behind Ryanair on the list of emitters.
The growth of the industry is not expected to slow down. India and China are the biggest growth markets, the latter alone is building 200 new commercial airports in the next ten years. Moreover, industry forecasts suggest that emissions will rise by 700% until 2050 which amounts to more than 4% of the world’s remaining carbon budget.
If we want to reach the goals of the Paris Agreement, every the average earthling has a quota of two tons of CO2 per annum but just a return trip between New York and Amsterdam generates three tons already.
Compared to other modes of transport planes are the biggest CO2 emitters per travelled kilometre followed by cars, buses and finally trains which are the least polluting. The CO2 emissions, however, are only one half of the medal. The impact of flying on global warming is different than most other transport as it happens in the air high above the ground where the processes that cause or reduce global warming happen. These include CO2 and nitrogen oxide emission but also cloud formation, ozone and soot as well as methane reduction.
The climate impact of the emitted greenhouse gases in the stratosphere are three times higher than on the ground. Flying also causes condensation trails and fog clouds in certain weather conditions. Such clouds can have a warming or a cooling effect on the climate. One way to improve the climate effect of flying would be planning better routes where warming clouds are avoided and the formation of cooling clouds is favoured — our current routes have an overall warming effect.
So, hypothetically, some flights with clever flight-route planning might even reduce global warming. However, as we don't have time to hypothesise, we need to find and urgently implement other ways to bring down the impact of flying, like using better fuels or even better planes.
This article was written by Eric Schuler for Kinder World. Schuler is a PhD candidate at the University of Amsterdam and works on new industrial sustainable chemistries to turn captured CO2 into useful things such as plastics or fuel. He's also a photojournalist with an interest in climate and land-use change.