For weeks Sadir has felt unwell. Pale-faced and short of breath, she coughs frequently. Her sister, Afra, does most of the talking and explains that the medication for hypertension is making Sadir sick. Asking Sadir questions about her life while examining her, Dr. Wesam Awamla realizes that his patient’s complaints are more likely caused by living circumstances than by high blood pressure.
As a student many years ago, Dr. Wesam, a general practitioner, had a few weeks training in psychology and psychiatry. But these days he routinely encounters patients like Sadir: Iraqis living in Jordan whose physical symptoms are caused by mental health problems. He is one of 25 medical doctors currently receiving training from International Medical Corps in Jordan as part of a larger project that reaches out to communities and incorporates mental health into primary health care services. “The course helps me to refresh my memory and to better recognize the symptoms of depression, anxiety, and other mental health problems,” Dr. Wesam says. “It helps me to help my patients.”
Sadir fled her Iraqi home town of Babil in 2005 when sectarian violence became unbearable. Now her family of seven is sharing one room in eastern Amman, the Jordanian capital, where hundreds of thousands of Iraqis have settled over the last years.
“The men smoke the whole day,” says her sister Afra, “they have nothing else to do.” Nobody in the family is working and they live from handouts and rapidly dwindling savings. “When we ask them to smoke outside, our men yell at us.”
Frustration, anger, family quarrels, qualms over money and an uncertain future in a foreign country have taken their toll on Sadir’s mental health. When her oldest son returned to Iraq things only got worse. “I fear for his life. I cry all the time. I cannot do anything,” Sadir says quietly. Her sister tries to take her for walks in the street but Sadir spends her days paralyzed and worrying.
Up to 40 patients – most of them Iraqis – come every day to the clinic, run by the Jordan Red Crescent. Consultations, treatment, and medication are free. “We support local NGOs that provide health care for Iraqis through training of health professionals. It is very important that mental health becomes fully integrated into the primary health they provide,” says Boris Budosan, International Medical Corps Advisor for Mental Health.
Every Saturday International Medical Corps trainers run lectures on mental health issues ranging from trauma to anxiety disorders, depression, substance abuse, and child mental health. The training takes 12 weeks and includes role plays and case studies. Later, International Medical Corps will observe how the physicians implement their knowledge with patients.
Professor Abdul Monaf Al-Jadiry, Chairman of the Psychiatric Department at the University of Jordan and now an International Medical Corps consultant believes that the program, funded by UNHCR, will not only make mental health care available for displaced Iraqis but will improve access to these services for Jordanians as well. “Because of these courses we will be able to raise awareness on mental health problems in general. Most of our doctors approach patients in a purely medical way.”
Diagnosing patients is just the first step. Doctors are also being trained to provide psychotherapeutic techniques, such as anxiety management, interpersonal therapy, psycho-education of patients and their families, and problem-solving skills. Finally, they refer patients as needed for specialized care or community activities. Dr. Wesam asks Sadir to walk outside as much as possible and talk to her sister. “Your problems don’t come from the medicine but the stress and troubles in your life,” he tells her.
“I will see her again in a week and will slowly start to offer her help through a psychiatrist,” Dr. Wesam says. “I recognize signs of depression, but I know she will not easily accept my suggestions. There is a large stigma in the Arab world about mental health and we have to be careful.”