47-year-old Ali: "I was ready to let go of life, but then there was a loud knock on the door..."

»I was ready to let go
of life, but then there
was a loud knock on the door…«

»I was ready to let go of life, but then there was a loud knock on the door…«

KENYA

It’s about listening, asking, and recognizing that things may not be quite right and that they can change. In Nakuru, Kenya, Community Health Promoters trained in Psychological First Aid (PFA) and low-level psychological interventions are making a world of difference in a context where traumas are lining up and psychologists are few.

Meet some of the people who are helping Kenya’s most vulnerable.

KENYA

Meet some of them who are helping Kenya’s most vulnerable.

Text and Photo: Marie Torp Christensen

April 22th 2024

There is a loud knock on the door.

The vendor from whom Ali usually buys his tomatoes is standing outside. She keeps on knocking because she knows that her tomatoes are the ones he likes best. Inside the dark house, Ali has a rope around his neck.

He must decide whether or not to open the door for the woman with the tomatoes – and with that decision, the fate of his life.

»When there was a knock on the door, I realized what I was doing. I removed the rope and opened the door,« says Ali, who has since thought that maybe it was a sign from above that she arrived at that exact moment.

It's hard to talk about the difficult problems

Ali is a tall man who sits upright and talks about how he has moved from the darkest part of his mind to rise again, with a new appetite for life.

We met him on the outskirts of the informal settlement area Bondeni, home to 35,000 people and integrated into the city of Nakuru. This is where he grew up and lived, surrounded by narrow fields between tin-roofed houses and free-range goats bleating under the warm sun rays.

HOME. Ali’s familiarity with the Bondeni area stems from his upbringing here.

»Fatuma made me realize that my life matters – to my family, my friends and myself«

It is here that the biggest crisis of his life has played out – but it is also a member of the local community in Bondeni, Fatuma, a Community Health Promoter, and the tomato seller who has brought him here today.

»Fatuma came to visit me after my tomato vendor reached out to her and told her about my situation. Fatuma listened to me when I spoke and I felt like she understood me and my pain,« says Ali, who had fallen into a black hole after his wife cheated on him.

»Fatuma made me realize that my life matters – to my family, my friends and myself.«

Fatuma is one of those who has been trained in Psychological First Aid by the organization MIDRIFT HURINET, DIGNITY’s partner in Kenya. The knowledge and skills have given her the tools to help the residents of Bondeni to breathe, calm down, and – together with her support – assess what the ‘next steps’ should be.

Traumas are everywhere here

Gangs, robberies, poverty, alcohol abuse, drugs and violence. These are some of the words that MIDRIFT HURINET psychologist Millie Rono mentions when describing the problems with which the people living in slums like Bondeni struggle.

DRUGS. Psychologist Millie Rono highlights that many young people cope with their challenges by resorting to drug use and alcohol consumption, often resulting in neighborhood conflicts.

Nakuru, Kenya’s fourth largest city, is home to over 505,000 people, while the entire Nakuru region is home to around 2.4 million people.

»Trauma. It’s everywhere in these areas,« says the psychologist, who works for the organization MIDRIFT HURINET, which has trained 45 local health workers like Fatuma to perform Psychological First Aid.

»We teach them basic skills that enable them to help a person in crisis to breathe and calm down«

»Children in Kenya are taught how to manage their physical health and take care of their physical hygiene from a young age but they are often not taught how to deal with their emotions and life’s adversities,« says Millie, as one reason why many young people, in particular, deal with their problems by taking drugs and drinking alcohol.

These are just a few of the many reasons why there is a need for training in the skills that MIDRIFT HURINET, with support from DIGNITY, can provide to local health promoters. It is estimated that in the entire Nakuru region, 26.2 percent of people live with mental challenges. Each month, those trained in psychological first aid speak with around 250 clients in total in the local areas.

»We teach them basic skills that enable them to help a person in crisis to breathe and calm down. It’s not psychological treatment, just like regular first aid is not surgery,« Millie explains and lights up as she explains the next part:

»The beauty of psychological first aid is that it allows the health workers to assess whether that one session was enough or whether they should be referred to more sessions or to the psychiatric ward at Nakuru hospital, where we are able to help financially in case of an emergency.«

FACTS

Five sessions that makes a difference

Problem Management Plus (or simply ‘PM+’), as the program is called, was developed by the World Health Organization (WHO) and consists of five sessions which are used to teach a number of different strategies to clients. By learning, and regularly practicing, such strategies, many clients learn to understand and manage their challenges more effectively.

All PM+ helpers like Mary receive ongoing supervision from a PM+ Supervisor, who gathers the helpers in small groups where they can share their experiences and learn from each other. And all PM+ supervisors are supervised by one of DIGNITY’s psychologists, who is a PM+ expert.

In Nakuru, MIDRIFT HURINET together with DIGNITY has successfully trained 48 local PM+ helpers and 10 PM+ Supervisors, all of whom know the local area and the people living there. In addition, DIGNITY has trained three MIDRIFT HURINET employees, along with staff from he Nakuru County Mental Health and Psychosocial Support coordinator in PM+ strategies.

Left alone far from her family

About an hour’s drive from Nakuru is Naivasha sub-county, the informal settlement of Karagita, where Pauline lives. Her hair is freshly braided and she sits with her gray hoodie on. It’s no coincidence that her outside appearance is in order, even though she has struggled with her inner self and finding the motivation to move outside her home.

»My husband’s family didn’t like me. Eventually, he left me,« says Pauline, looking at her hands. Raised far from Karagita, she left her friends and family behind to move in with the man who has now left her.

»I felt completely alone. I had no one to talk to. As a result, I was sad and found it difficult to be part of the community.«

HELP. After her husband left her, Pauline isolated herself. Fortunately, Pauline found support from a PM+ helper.

Fortunately, Pauline was not alone. Her friend recognized signs in Pauline that she herself had experienced – and had received help to address from a local health promoter, Mary. Through MIDRIFT HURINET, along with help from DIGNITY’s psychologist, Mary was trained to provide psychological first aid and be a Problem Management Plus (PM+) helper.

»Fortunately, I decided to open up and let her in. She has helped change my life«

Therefore, Pauline’s friend suggested that Mary should also contact her. But it wasn’t just the friend who had been worried about Pauline not letting anyone in. Pauline was already on Mary’s radar because she knew the locals well.

»At first I was scared to tell my story to Mary. I had never met her before. I didn’t trust her,« says Pauline. »Fortunately, I decided to open up and let her in. She has helped change my life.«

It was the conversations, the guidance, and Mary’s steady support that brought the joy of life back to Pauline. Among other things, they talked about hobbies. Pauline said she loves hair, and fashion, and had been trained by her aunt to braid. Mary helped her find a place at a hairdresser and picked Pauline up the first few times to make sure she actually went. Today, Pauline still works as a hairdresser and has a small business selling clothes alongside her job.

»I love braiding hair and styling.«

It's about both people and systems

Back in Bondeni, Ali carries around a small speaker. He makes music and writes poems about life and his love for the neighborhood.

»A lot of social change starts with people being brave and daring to open up about what is vulnerable and difficult«

But it’s not every day that heartbreak and mental health issues are the topic of conversation in the area, which is home to 35,000 people.

»There’s a lot of stigma associated with talking about mental health issues, especially when it comes to men,« says Millie Rono, explaining that there can be prejudice against seeking help when you’re in pain. Many fear that people will think they are crazy, so it is often kept within the four walls of the home.

»A lot of people have the same problems I had. But it can be difficult to know because not many people share their problems, even if you are family or good friends,« says Ali, who uses the techniques he learned from Fatuma and his PM+ helper to help others in Bondeni.

»A lot of social change starts with people being brave and daring to open up about what is vulnerable and difficult,« Millie Rono points out.

That’s why it’s also of great benefit for clients, such as Pauline and Ali, to share their experiences with friends, family, and the local community. It’s the first step in changing the perception that you’re not crazy if you have mental challenges or just need to talk to someone, says Millie Rono, emphasizing the importance of their efforts being backed by political action and funding to help even more people and refer to psychiatric wards when needed.

»It is a victory that we are in a dialogue with both the Nakuru County Government and the state politicians to ensure that in the future there will be a budget for mental health,« Millie Rono concludes.

»In my eyes, it shows how far we have come. It’s worth fighting for every day.«

For both Ali and Pauline, there is no doubt. For them, meeting Fatuma and Mary has meant the difference between darkness and light.

»I have succeeded, I am successful. I have a job, a good salary and I can take care of my family,« Ali smiles and says that he has just planted flowers on his plot.

If you have thoughts of suicide find helpline services here →

Meet Fatuma and Mary here

IMPACT. In Nakuru, community health workers like Fatuma, who are trained in psycological first aid, assists 250 clients monthly in coping with everyday challenges.

SUPPORT. It was the conversations, the guidance, and Mary’s steady support that brought back the joy of life to Pauline.

TIP:

How to get better at psychological first aid

The method that Mary and Fatuma are trained in can also be applied in your everyday life. Psychological first aid has three basic principles:

LOOK: Look for safety for both the affected person and you and observe what the affected person needs according to how they react. Perhaps they are cold, scared, or thirsty. Make sure the situation allows for calm and “privacy” as much as possible.

LISTEN: Introduce yourself and ask if you can help. Never pressure the affected person to tell you what they have experienced but listen carefully to what they say and ask about the concerns and needs they have right here and now.

LINK: Help the affected person get the help they need. For example, they may need to go to the hospital, borrow a phone, or contact the police. You can also help the affected person by calming them for example through breathing exercises or by talking about something nice.

How DIGNITY and MIDRIFT HURINET help

In Nakuru, DIGNITY collaborates with the organization MIDRIFT HURINET to prevent violence in the local communities, train local health workers in psychological first aid and PM+, and build trust between citizens and authorities to promote local leadership.

DIGNITY has been working with MIDRIFT HURINET in Kenya since 2014. The work is supported by the Danish Ministry of Foreign Affairs.