When the problem is the opportunity

Dixon Chibandi is one of only 12 psychiatrists in Zimbabwe.

But Zimbabwe is a country of 14 million, so this makes the ratio one psychiatrist to every one million people. Obviously this doesn’t work very well. Several years back, Dixon got a phone call from a village 200km away – a young woman needing psychiatric help. He told her to come to his practice in Harare to see him. A few weeks later, her mother called to say the young woman had committed suicide. Dixon asked why she hadn’t come to see him. The mother said they couldn’t afford the $15 bus fare. That’s when he realised the problem needed a creative solution.

The medical term is generalised anxiety disorder (or GAD), defined as: “Six months or more of chronic, exaggerated, unfounded worry and tension””

Young women were suffering in villages all over Zimbabwe.

So Dixon did what creative people do: he turned the problem into an opportunity.

Because there was something else in all those villages: grandmothers.

Grandmothers who all wanted someone to talk to, as well as young women who needed someone to listen to them.

Dixon began training grandmothers very broadly in cognitive behavioural therapy, where the patient and the practitioner solve the problem together. He describes it as “evidence-based talk therapy”. The Zimbabwean word for depression is “kufungisisa”, which literally means “thinking too much”.

The main thing the grandmothers had to learn was listening. Dixon’s brilliant innovation was the “friendship bench”. An open-air wooden bench, where a young woman could talk to a grandmother.

It was cheap and easy to construct in villages all over Zimbabwe.

And the informality made it more accessible, much less intimidating, to the young women.

Dixon now has 70 friendship benches in different communities across Zimbabwe.

Typically, a treatment will consist of six one-to- one sessions, with a week between each.

Hundreds of grandmothers have treated 70,000 patients, and the young women are five times less likely to have suicidal thoughts as a result.

The grandmothers are more effective at treating depression than doctors are, and the young women remain symptom-free six months after treatment.

The results of the clinical trial have been published in The Journal of the American Medical Association.

After six months, depression in the control group was 50% – but among friendship bench users, it was 14%.

Depression among those receiving standard care was 48% – but among friendship bench users, it was 12%.

Suicidal thoughts were 12% among those receiving standard care – but among friendship bench users, it was 2%.

Dixon says the grandmothers are “supported and networked through digital platforms”.

Which just means Zimbabwe’s 12 trained psychiatrists can use mobile phones to confer with grandmothers in any village, however remote.

Dixon says there are currently 600 million grandmothers worldwide aged over 65, who would love to feel useful and needed.

At the same time, they could be helping to solve the problems of young women in poor and underdeveloped societies who don’t have access to psychiatrists.

Putting two problems together to create a solution is what creative people do.