Community care on wheels
In Senegal, mental health remains a low priority in national health policies. Mental health centers, as well as specialized staff, are scarce throughout the country. Of the seven existing mental health centers, half are concentrated near Dakar, the capital, even though more than half of the country's 16.7 million inhabitants live in rural areas.
For over 20 years, the Hospitaller Order of Saint John of God has been providing mental health care through its centers in Fatick and Thiès. These two centers, twinned with the Sant Joan de Déu Health Park , are called Dalal-Xel, which in Wolof (the most widely spoken language in Senegal) means "to calm the spirit." Each year, these facilities treat approximately 27,000 adult and young men and women with mental health problems. They serve people daily from all over Senegal, and even from neighboring countries such as Mauritania and Mali.
One of the biggest challenges in this country is facilitating access to mental health services in rural areas . People with mental health problems often have to travel 800 kilometers to receive quality care and cover the costs of travel and accommodation. Can anyone imagine what it would mean, for example, to have to travel frequently from Barcelona to Oviedo to receive this care?
A pioneering project in community mental health
To try to alleviate this situation, which is especially difficult for the most vulnerable, the Dalal-Xel centers launched a pioneering community mental health project in 2020. Every week, teams specializing in primary care, social work, and psychiatry travel to strategic locations in rural areas to bring mental health care to hundreds of people. Schools and other facilities in the area host the teams for a full day, becoming community-based mental health centers.
This project has facilitated access to health and adherence to treatment, because the people served no longer have to face long journeys, but can do so closer to home and with the help of specialized multidisciplinary teams.
Furthermore, these sessions are used to conduct talks and workshops to raise awareness among the local population about the importance of prevention, early detection, and mental health care, as well as the crucial role of families and their communities in supporting individuals with mental health disorders. It is important to note that, in addition to the challenges of detecting and treating mental health problems in the country, there are serious issues such as stigma and human rights violations.
Since the project began five years ago, more than 25,000 people from thirteen rural communities have been served.
People like Fatou and Aliou are two of the protagonists of the three-part miniseries " On the Road for Mental Health," which explains this project. The documentary series was produced by photojournalist Pablo Tosco (World Press Photo 2021), in collaboration with Juan Ciudad ONGD , the international cooperation organization of San Juan de Dios.
The series' central theme is precisely the testimonies of those receiving care and professionals from the community mental health project teams. Each episode explains, from a different perspective, the importance of this community intervention, which aims to address the needs of people in Senegal with mental health problems who lack access to specialized services. "Since I was diagnosed with the disorder, it's been difficult," Fatou explains, "because sometimes I didn't have the money to travel from my village."
The videos also highlight the coexistence in Senegal of the two types of medicine that exist today: traditional and modern medicine . This is a reality familiar to the healthcare professionals of the St. John of God teams who travel weekly to rural areas, where mental health is a taboo subject and most families choose to first consult a marabout (traditional healer) or hide the person with mental health problems, given the ongoing stigma. For this reason, and because of the trust many people place in traditional medicine, it is important that healthcare professionals understand and respect that a person may continue to visit the marabout if they so choose, while also receiving care from specialized teams.
“We treat people with respect for their culture, customs, and religion. Because it’s an important part of the person and can also help them recover,” says Suzane Niuki, coordinator of the community mental health program at the Dalal Xel Center in Thiès. And, in the end, “when the person we’re treating is stable, everyone is at peace.”
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