In Tena and Chontapunta, Ecuador, in the Amazon river basin, our partner organization Sumak Kawsay Wasi, the social branch of the provincial government. Partnership with local services like this offer the greatest opportunity for a lasting impact on the communities in which we work through supporting the efforts and expertise of local actors.
Dr. Liliana Pacheco works at the Sumak as a psychologist and is a passionate advocate for mental health care. She is dedicated to improving situations of mental illness, domestic abuse, family dysfunction, and relational problems through therapy and counseling for parents and families in rural communities.
This is a growing challenge in global health. The World Health Organization now estimates that 14% of the global disease burden is related to mental illness and psychological disorders, but that the majority of the population suffering do not have adequate access to the complex, ongoing care they need. In low-income countries, 75% of those with mental illnesses lack access to any care, either because of lack of existence of mental health professionals in local health systems or because of complex economic and sociocultural barriers (WHO 2019).
In our many years seeing families at Timmy clinics in such communities, we’ve found it very difficult to convince patients to follow through on their referrals to see Dr. Liliana due to high stigma around mental health, as well as the daunting requirement to overcome the economic and geographic barriers to getting to therapy in the city on a repeated basis.
However, Segundo Cambo, a patient who was recently referred for debilitating anxiety due to relational problems with his immediate family, was different. Segundo lives outside of Los Ríos, a very remote community more than three hours from Tena, where Dr. Liliana works at the Sumak. In order inform Segundo of his counseling appointments, our community health promoter had to send a handwritten note home from school with one of Segundo’s children, a daily walk of several miles for them. Segundo then only made the long trip to Tena because of Timmy’s promise to reimburse his $5.00 bus fare, which he had to borrow from a neighbor for his first appointment.
During one of Segundo’s sessions, Dr. Liliana discovered that he was illiterate. In addition to continued counseling, Dr. Liliana started giving him homework for him to practice writing his own name, seeing this as important for building his self-confidence. After a little over a month of sessions Segundo reports he is already feeling much better and has been able to put into practice what he’s learned in his time with Dr. Liliana. Dr. Liliana plans to continue follow-up sessions with Segundo and his family, committed to making the difficult travel to his community despite her high workload and recent loss of her husband.
However, the great difficulties our indigenous patients face in traveling long distances to appointments, overcoming cultural stigma, and communicating with her in Spanish don’t stop Dr. Liliana, but rather seem to encourage her hard work and dedication to providing mental health care and alleviating the problems of family violence and dysfunction associated with poverty, stress, lack of opportunity, and depression. When told that Timmy wanted to share her story, Dr. Liliana was excited — not for the personal praise, but for more people to learn the importance of mental health and holistic care in improving community well-being.
As the World Health Organization describes, “Mental health is a state of well-being in which an individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and is able to make a contribution to his or her community” (WHO 2018). Through her commitment to helping remote individuals and families overcome barriers to treatment and realize full mental health, Dr. Liliana exemplifies the kind of compassionate and comprehensive care that will make a lasting impact for not just Segundo, but his family and community, and we are grateful for the opportunity to learn from and work alongside her.
World Health Organization (WHO). 2018. Mental health: strengthening our response. Web: https://www.who.int/en/news-room/fact-sheets/detail/mental-health-strengthening-our-response. Accessed 24 June 2019.
World Health Organization (WHO). 2019. WHO Mental Health Gap Action Program. Web: https://www.who.int/mental_health/mhgap/en/. Accessed 24 June 2019.