Imagine this. You're a 15-year-old student in a remote village with maybe a couple of hundred residents, miles from the nearest town. There's no TV. Cellphone service is spotty. The dirt road to your village floods regularly. Your link to the outside world is the family wind-up radio.
You crank up the radio one afternoon to hear the latest music but instead catch the first chapter of a 5- to 7-minute soap opera. The lead character is a young woman, 16 years old. Over the course of 30 episodes, she gets pregnant and finds out her boyfriend is a drug user. She's ashamed by the pregnancy, her parents even more so. The stress and depression get so bad she thinks about suicide.
This soap, called Bahati (that's the main character's name) doesn't just tell the story. After each episode, a local host talks about how depression factors into the characters' lives and talks about what can be done to make things better.
Depression is little known and little understood in parts of east Africa, says psychiatrist Stan Kutcher of Dalhousie University in Halifax. He's worked with Canadian charity Farm Radio International, which for years has brought agricultural news to remote areas in Africa, to design the project, which is also supported by teenmentalhealth.org. The first show hit the airwaves in Malawi and Tanzania a year and a half ago.
According to the World Health Organization, depression is the leading cause of disability among adolescents around the world. In poor countries with little access to mental health services, it's particularly important to address this issue, says Kutcher: "We know that early identification and early effective treatment make a huge impact not only at the time of treatment but throughout the lifespan." Kutcher presented the details at a meeting on global mental health this week in Washington, D.C., sponsored by the World Bank and the World Health Organization.
The radio soap opera, with scripts authored by local writers and teenagers, deals with the stresses and strains faced by young people. There's usually a character or two battling depression and sometimes suicidal feelings as well. The episodes are often played at school-based radio listening clubs, where teens discuss the latest installment with each other and their teachers. The radio show hosts know what resources are available in the villages and towns where people listen. During and right after the segment, teens can text or call in questions.
Teens have written in wanting to know what to do about not being so sad they can't get out of bed. Or they've been raped and they've lost all interest in the things they used to enjoy.
All told, half a million teens and young adults live in the areas where the soap operas are carried, and, says Kutcher, "surveys show they're the most popular shows on the radio."
Depression is something people just don't talk about in these communities. In Malawi, there was no word for depression in the local language. The health providers and trainers who designed the project literally invented a term for depression — nkhawa — which basically means "disease of worries."
Kutcher and others involved in the project tested local knowledge before the programs started airing a year and a half ago. At the beginning, "few knew what depression was or knew about the concepts of mental health and mental illness," he says. People often thought symptoms of depression or other illnesses were caused by spells cast on them; many believed that nothing could help.
In the post-soap opera discussions, listeners learn there are ways they can help themselves. Get enough sleep. Exercise. Talk to a sympathetic family member or friend. They learn about talk therapy and where it might be available. And they hear about medications that can treat depression. The project includes training for health care workers to recognize and treat depression and it also works with the governments in both countries to make medications available to youth who need them.
The project developers did a mobile phone survey of 4,000 young people in Malawi and Tanzania before the radio shows started and repeated the survey after the soap operas had been on the air. More teens understood at least something about depression and said they'd seek help if they felt depressed.
And the teens? Project manager Heather Gilberds says many of them have said they didn't realize that it was okay to talk about the thoughts in their heads, and they hadn't realized that anything could be done about the pain.