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Fixing the World from the BBC World

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Fixing the World Welcome

0:42

to People Fixing the World from the BBC

0:44

World Service. I'm Myra Anubian.

0:46

Every week I tell you about

0:48

great ideas that are changing our

0:51

world for the better. Speaking about

0:53

change, today we're taking a step

0:55

back to find out how changing

0:57

our mindsets can make a difference.

1:00

We'll look at two very

1:02

different examples of how this

1:04

has helped with mental health

1:06

treatment and waste disposal. Now,

1:11

if there's one thing I've come to

1:13

realise on People Fixing the World, it's

1:16

that great solutions almost always start with

1:18

a change of opinion. But

1:20

that's not always easy to do,

1:22

especially with beliefs that have existed

1:24

for a long time. Take,

1:27

for example, mental health. In

1:29

many parts of the world, people's

1:31

perceptions about mental health have changed radically

1:33

over the last few years. But

1:36

there's still a lot of stigma around

1:38

it. And one of the reasons why

1:41

is lack of knowledge. In

1:43

parts of Africa, for example, I've

1:46

heard of cases of relatives being

1:48

kept in their rural homes or

1:50

people being called lazy or even

1:52

crazy for mentioning the fact that

1:54

they're struggling with their mental health.

1:57

But away from the stigma, another

1:59

big is the scarcity

2:01

of clinical help. Now,

2:03

Nigeria, for example, has the

2:05

largest population in Africa. However,

2:08

there are only about 300

2:10

registered psychiatrists for

2:13

over 200 million people, and

2:15

most of those are based in cities. Now,

2:19

this is where our first solution

2:21

today comes in. You

2:25

see, a lot of people in Nigeria prefer

2:27

to go to traditional healers, instead

2:31

of medical doctors, for help with

2:33

mental health problems. For many reasons,

2:35

actually. Maybe because of

2:37

cost, distance, and also because

2:39

they really trust them. So,

2:46

one research project used an

2:48

unorthodox approach to

2:50

get these two groups with very

2:52

opposed views, the medical

2:54

doctors and the traditional healers, to

2:56

work together to reduce the stigma

2:59

and improve the treatment

3:01

of mental health there. But

3:04

how do you get traditional healers

3:06

who often use strange and sometimes

3:08

harmful methods of treatment to

3:11

work with doctors using evidence-based

3:13

medicine? Well, our

3:15

reporter, Makochi Okafur, went

3:18

to the outskirts of Imadan, a city

3:20

in Nigeria, to find out more. It's

3:23

a bright and sunny morning, and right now

3:25

we are in a little suburb in

3:28

Imadan, Oyostit, the western part of

3:30

Nigeria, where outside the residence of

3:32

the traditional healers, I've been

3:35

told that he's been doing this for over

3:37

40 years, and lots

3:39

of people respect him. He's a chief,

3:41

and I don't know what to expect. I've

3:44

never been to a healer's home before. Nice

3:49

to meet you, sir. Healing

3:54

home. I'm

3:57

a little nervous after a contact from

3:59

the research team. introduces of

4:01

the chief mukola Yusuf. He's

4:03

a tall, intense looking man,

4:06

wearing a blue patterned long roof and

4:09

a traditional hand-woven hat. Some

4:11

people you have a pattern

4:13

of problems, some

4:15

people you have a witchcraft

4:18

problem. Chief Yusuf believes some mental

4:20

illness can have a spiritual or

4:22

supernatural cause. He uses incantations to

4:24

read a patient of what he

4:26

regards as a curse. Well led

4:28

into a small room, it's

4:41

painted blue and is fairly dingy with

4:43

just a single window. It's

4:46

where he first

4:48

meets his patients.

4:52

Scattered around me, I see dried

4:54

bones and animal skin plus bottles

4:56

of liquid and herbs which

4:58

he uses for his homemade

5:01

remedies. The traditional Gila has

5:03

explained to us how he administers

5:11

care for people who come to him. If

5:14

someone comes and their condition is

5:16

very strong or very severe, they're

5:18

sort of sinking in incantation and

5:21

they evoke the spirit and

5:23

then once you come, the nurse

5:25

or the healthcare worker can now

5:27

come and also administer sort of

5:30

a Western worker. So there's a

5:32

collaboration, exactly there's a collaboration. Good

5:35

afternoon Baba. Good afternoon Baba. I'm

5:38

fine. The

5:41

chief or Baba father as

5:43

is respectfully known had never

5:46

been involved with a clinical

5:48

evidence-based medicine but in 2012

5:51

he signed up to a

5:53

groundbreaking research project to collaborate

5:56

with medically trained healthcare workers.

6:00

The idea was to make better use

6:02

of traditional hmulas. Many

6:04

people, especially in rural areas, appear

6:06

being seen going to a mental

6:09

health clinic, afraid they'll be

6:11

called names and their family will suffer

6:13

discrimination. Instead, they

6:15

visit someone they trust and are

6:18

familiar with, their local healer. We

6:20

are collaborating together to

6:22

achieve the same goal. Can you tell me

6:24

a bit of what you learned during this

6:26

training? Ah, we learned some. Many

6:29

things. Many

6:31

things. I'm quite a bit of a poor.

6:33

He tells me proudly that he feels enlightened

6:35

by what he's learned from the medical team.

6:38

He's been taught how to spot signs of

6:41

severe mental health problems, such

6:43

as hallucinations or a loss

6:45

of contact to reality, which often

6:47

indicate psychosis. If he

6:49

finds a patient suffering delusions, he

6:52

calls one of the community healthcare workers to

6:54

come check on them. We can

6:56

do together. We can do together.

6:58

So, you normally call

7:01

when you have a patient with

7:03

harm, he or her safe. Is

7:06

there any patient? Healthcare worker Ybikunle

7:08

Ybijola describes how they work

7:11

together. All of the treatment

7:13

is administered at the healer's house, where

7:16

patients sometimes stay for weeks on end. So,

7:18

when we come, we introduce

7:21

these patients to us. When

7:23

a patient needs medication or

7:26

seems to stop, Ybikunle Ybijola

7:28

takes over. Once the

7:30

patient is come, she hands back to the

7:32

traditional healer. Boneta, Baba will take over and

7:34

they will do it. Do you

7:36

see sort of collaboration? Yeah, that is

7:39

collaboration. Traditional healer, I used to fear

7:42

them. I believe they

7:45

usually destroy people. But

7:47

during the period that I close to them,

7:49

I can see they can help the people,

7:52

especially this Baba. Your

7:56

mind has changed. I have changed my

7:58

mind. they

8:01

are good to the people in the community too. She

8:03

believes that she and other healthcare workers

8:05

have a good impact on the healers

8:07

too, encouraging them not to

8:10

resort to harmful practices like physical

8:12

restraints such as handcuffs in

8:14

order to control patients. We correct

8:17

them that it's not uncomfortable

8:20

so medication out there will make

8:22

the patients calm down. The

8:25

mood changes to normal mood.

8:28

Chief Mikola Yousuf tells me that

8:30

he doesn't physically restrain or harm

8:33

his patients but the

8:35

training he's received has shown him that

8:37

there is actually no need to do

8:39

so. Before before I don't like to

8:42

frog better people or

8:44

to sting better people.

8:47

No. That training is

8:49

more as giving more more more more. Has

8:52

the the nurse and the

8:54

healthcare provider have they been helpful? Have

8:56

they helped you better than

8:58

before when you were not working with them? Ah.

9:01

You have to you have

9:04

too much. Chief Mikola Yousuf obviously sees

9:06

the benefits but before I left the

9:08

button I also spoke to a man

9:10

whose wife has been helped. She spent

9:13

16 years hidden away

9:15

at home suffering and without

9:17

treatment. He describes how

9:19

her illness began and how

9:22

she seemed to have forgotten who he was.

9:24

If I see her I call

9:26

her. You don't

9:28

know me I'm your husband. You

9:31

can't recognize me. For a couple of years

9:33

he had tried to help but nothing had

9:35

worked. He was cautious about going

9:37

to a traditional healer but in 2017

9:40

he found one who was collaborating

9:42

with a local clinic. They

9:45

was together so that

9:47

they hid her. His wife is

9:50

still in recovery but he wants

9:52

others to learn from his experience.

9:54

Begging them not to hide their loved ones

9:57

away. Don't hide them in the

9:59

house. Take care of them

10:02

before it's bad.

10:05

Now and thank God

10:08

I'm enjoying with her and see

10:10

too enjoy with me. Makochi

10:13

Okafuro with that report. Now

10:16

this was a five-year research project funded

10:18

by the United States National Institute of

10:21

Mental Health and it ended back in

10:23

2017. During

10:25

that time more than 300 patients

10:28

were involved and the study

10:30

meant that one half received collaborative

10:32

care and the other half did

10:34

not. I was keen to

10:36

find out just how successful this had been

10:39

so I got on a call with Professor

10:41

Oye Gureje, the psychiatrist in charge of the

10:43

project. When they were

10:45

recruited into the study we would

10:48

do a baseline assessment that would

10:50

rate the severity of their psychotic

10:52

symptoms. And so we were

10:54

comparing the outcome of that at six

10:56

months between the two groups and

10:59

we found a significant improvement

11:02

in the arm receiving

11:05

collaboration and they were

11:07

more likely to have resumed work. And

11:10

the people in the intervention

11:12

arm also reported less experience

11:14

of self stigma. Stigma

11:16

they have experience from people

11:18

around them. So

11:21

Professor what you're saying is that in

11:23

many ways people would feel less

11:25

stigmatized going to traditional healers than

11:27

going to regular medical doctors

11:29

to seek help for mental health issues. Yes

11:32

and there are several reasons for

11:34

that. One is the expectation

11:36

that healers are more likely to be able

11:38

to get to the root cause of

11:40

the problem and get rid of it permanently.

11:44

While there might be the feeling

11:46

that biomedical service will only alleviate

11:48

the symptoms and the person might

11:50

still be carrying the illness. The

11:52

other reason of course is that

11:54

there is a more stigmatizing attitude

11:57

among biomedical health providers especially not

11:59

just medical health providers. non-specialists than

12:02

among healers. Healers often have

12:04

a shared meal, they live

12:07

under the same roof

12:09

with their patients and they do things

12:11

with them and in fact one of

12:13

the things that we have shown to

12:15

be effective in reducing stigma is contact.

12:18

When people make physical contact with people

12:20

with mental illness, they are less likely

12:22

to have stigmatising attitude to them. Now

12:25

in many ways, traditional healers

12:27

have also shaped the narrative

12:29

and stigma around mental health

12:32

because some of the treatments they use can

12:34

be very scary, stuff like prolonged

12:36

fasting, restraining and ritual

12:39

scarring. However, the

12:41

professor says this project helped

12:43

educate healers about better ways

12:45

to help their patients. We

12:47

enlighten them about some of these things,

12:50

about the risk of infection and because

12:52

the collaboration was going to take care

12:54

of some of their anxiety about absconding

12:56

or bowel lungs or aggression anyway, so

12:59

there will be no need for them

13:01

to use those approaches. So what's

13:03

the key here to making this

13:05

relationship work really well

13:08

between traditional healers and

13:10

other members of the medical practitioner

13:13

space? Well the

13:15

first thing is the awareness

13:17

that this is actually possible

13:20

and then of course the facilitation

13:22

of that by government. At

13:24

the moment, many of the countries struggle

13:26

because the healers don't want to be

13:28

registered but when this kind of approach

13:30

is on the table, they will probably

13:32

see the benefit of it and will

13:34

be more likely to accept being

13:37

registered. The

13:40

relationship between healers, healthcare workers

13:42

and patients is complex but

13:45

Professor Oye Gredje is hopeful

13:47

that the lessons learned in

13:49

this trial can build towards

13:51

a greater collaboration in community

13:53

healthcare, something the World

13:56

Health Organization is now pushing

13:58

for globally. You're

14:02

listening to People Fixing the World

14:04

from the BBC World Service and

14:06

today we're looking at how getting

14:08

people to change their mindsets or

14:10

perceptions can have a positive influence

14:12

in our world. We've

14:14

just heard about one project that's

14:16

helping change people's attitudes towards mental

14:19

health. However, our

14:21

next solution is looking at a completely

14:23

different problem. Each one

14:25

takes us to India to find out how

14:28

to make life better for a group of

14:30

people who are looked down upon because of

14:32

the work that they do. It's

14:39

a project that's all about removing

14:41

the disgust factor from waste pickers

14:43

in India by changing people's attitudes

14:46

towards those who deal with the

14:48

rubbish on a daily basis. So

14:55

we've just heard someone singing a

14:57

happy number. What does it mean?

15:00

Well, to find out more, I'm now

15:02

joined by Claire Booze. And Claire, start

15:04

by telling us what is it that

15:06

we've just heard. Yeah,

15:08

that happy number, let's have it

15:10

one more time, 38325, not not not not. That

15:15

is 383,250,000 kilograms. And

15:22

that refers to the huge

15:24

pile of rubbish that waste

15:26

pickers prevent from reaching landfill

15:28

each year in the Indian city

15:31

of Bengaluru. That's the city previously

15:33

known as Bangalore. So

15:36

it's this huge pile of

15:38

stuff which people have thrown away

15:40

thinking that there's no more use

15:42

for it. But in actual fact,

15:44

the waste pickers sort through it

15:46

and find the bits that can

15:48

be sold or recycled. And

15:51

that is a lot of waste. In fact,

15:53

as of last year, India has the biggest

15:55

population in the world. So there's going to

15:58

be a lot more rubbish to make. And

16:00

Claire, it's sad because many of the

16:03

people managing it, they're doing it without

16:05

any protective clothing or equipment. It's a

16:07

really hard job. Yeah,

16:10

Myra. Although there is a

16:12

formal refuse collection service across

16:14

India and those people are

16:17

equipped correctly, India

16:19

does rely on the informal sector

16:21

to deal with a much less

16:24

happy number. And that's the 62

16:26

million tonnes of solid waste which

16:28

is generated in India

16:30

every year. And this

16:33

job is mostly done by

16:35

families belonging to a particular caste

16:37

and that's people like Indira. I

16:40

am Indira and I live

16:42

in Bangalore. Indira's family are

16:44

all waste pickers and age 10

16:47

she joined them too on the streets

16:49

picking through the waste. She

16:51

says it's amazing what people in

16:54

India's technology capital throw away. I

16:58

find copper wires and old mobile

17:00

phones that are disposed as waste.

17:03

People usually don't know how to sell

17:05

their old mobile phones. But

17:07

these phones are collected and

17:09

can be sold for anywhere between 500 rupees up

17:11

to 3000 rupees. I

17:15

look at these earnings as a gift from God. But

17:19

people like Indira are not

17:21

widely valued in Indian society.

17:23

Instead, they often experience discrimination

17:26

with people regarding them as

17:28

both dirty and untrustworthy. People

17:32

looked at us and treated us very badly

17:34

in the past. They say hurtful

17:36

things about us and they don't even allow

17:38

the bags that we carry to touch them.

17:41

There have been times where people were ready

17:43

to hit me just because my back touched

17:46

them. Claire,

17:48

I can't even begin to imagine how this

17:50

would feel. But let's talk about

17:52

the solution now because there are people trying

17:54

to reduce the stigma. That's

17:56

right. There's a huge campaign going

17:59

on in the city. of Bengaluru

18:01

at the moment and that 10

18:03

different organisations are involved. They're looking

18:05

at all aspects of waste picker's

18:07

lives, but we're looking at what

18:09

one organisation, BBC Media Action, is

18:11

doing. You'll note from

18:13

the name, they are connected to

18:15

the BBC, but they're a charity

18:18

which is independently funded. And

18:21

I spoke to Radharani Mitra,

18:23

whose global creative advisor there,

18:25

and she told me the

18:27

priority for them was to

18:29

try to reframe the role

18:31

of waste pickers and to remove

18:33

the distrust and disgust factor. There's

18:36

definitely been a shift amongst the

18:38

general population of Bengaluru and

18:40

the fact that they now see that

18:42

these people are not just

18:44

waste pickers, but they are recyclers, they

18:46

are entrepreneurs. That, I think, has been

18:48

the biggest gain for the campaign. So

18:51

as well as composing the Happy Numbers

18:53

song, they also conducted a social experiment

18:55

on Facebook, and this was

18:57

to connect the general public with waste

18:59

pickers. So

19:04

they could understand what their lives

19:06

were actually like. The early starts

19:08

in all weather, working

19:10

without protective clothing, sometimes picking

19:13

through stuff which is dangerous to handle.

19:15

And ultimately, to understand

19:17

that they do all this and

19:20

it's super beneficial for the city. And

19:22

this really seems to have struck home. I had a

19:24

lump in my throat because my

19:26

heart goes out to these people who are doing things that none

19:29

of us want to do. They

19:31

also introduced the glam factor. I'm a

19:39

with a series of filmed coffee

19:41

dates with celebrities. Now here's Indra,

19:43

who we met earlier, chatting with

19:46

a famous Indian actress called Bhoomi

19:48

Shetty. And

19:54

Indra says in her everyday life

19:56

now, she's already noticed a change

19:58

in the way people treat her

20:01

on the social media. street. In

20:03

the past people used to look at us and

20:05

move away from us even

20:08

policemen and government officials. Now

20:11

the situation has changed. Today

20:13

I am invited to places and

20:16

offer the seat and some water or

20:18

tea. There is definitely a

20:20

shift in the way people see me which

20:22

makes me happy. Oh

20:28

that sounds really good. Now Claire I know

20:30

that there's a lot of investments in this

20:32

project but it's only happening in one city

20:35

in India and for a limited amount of

20:37

time. Yes although

20:39

they've just secured funding for

20:41

a further three years in

20:43

Bengaluru itself. Now when

20:45

I spoke to Radharani Mitra she said

20:48

she thinks the project would be easy

20:50

to replicate elsewhere with funding of course.

20:52

Right but so how do we measure

20:54

the impact of this? Hmm good

20:57

point. So they have a panel of 1,900 social

21:00

media users and these are aged between 18 and

21:02

45 all recruited

21:05

at random and then survey a

21:08

subset of this panel regularly to

21:10

gauge the impact of the work.

21:12

So they measure for several things

21:15

including awareness of the waste pickers

21:17

and this covers kind of an

21:19

understanding of the waste pickers lives

21:21

and their challenges and they

21:24

also measured for things like empathy

21:26

whether people were more sympathetic towards them

21:29

and they say that has risen from

21:31

33% to 46%. But Claire

21:35

that's just a panel of people

21:37

on social media and arguably

21:40

more inclined towards change but there's

21:42

a much more entrenched attitude about

21:45

the caste system there and the

21:47

idea that people of a lower

21:49

caste do these kinds of jobs

21:53

and this cannot really fix that.

21:55

Hmm yes caste is a huge

21:58

issue and obviously these projects,

22:00

these social media projects, they've introduced

22:02

a lot of glamour. These particular

22:04

waste pickers have had a lot

22:07

of attention and that's all been

22:09

very lovely. But beneath it all

22:11

is the question of caste and

22:14

that was a question I put to

22:16

Rudarani Mitra of BBC Media Action.

22:18

We are not even going there because

22:20

that's just too rooted and too big

22:23

an issue. That's not part of our

22:25

communication objectives and it would

22:27

be foolish and very presumptuous of

22:29

us to imagine that we could

22:31

make a difference. And it's also

22:34

something that India herself talked about.

22:39

Yes, caste discrimination is still

22:41

there. People still differentiate

22:43

between upper and lower caste but

22:46

aren't we people first? There should not

22:48

be a caste system and we must

22:51

all treat each other as people

22:53

first. And that's really it. At

22:56

the end of the day we

22:58

just have to treat each other

23:00

as people first. So thank you

23:02

for what we've heard today Claire.

23:04

Thanks Myra. That brings us

23:07

to the end of today's programme

23:09

but have you come across any

23:11

other ideas that are changing people's

23:13

opinions and changing our

23:15

world? Go ahead

23:17

and send us an email

23:20

about them to peoplefixingtheworld at

23:22

bbc.co.uk and join me again

23:25

next week for more great

23:27

solutions. Until then, thanks

23:30

for listening. Who

23:34

were the Black 14? 14

23:36

football players who were at University of Wyoming in

23:38

1969. 14

23:40

student athletes who paid a heavy price

23:43

for planning a show of support against

23:45

racism. It hit the campus like

23:47

wildfire. Some of it was getting death threats.

23:49

Amazing sports stories from the BBC

23:51

World Service tells their stories. Amazing

24:00

Sports Stories, wherever you get your

24:02

BBC podcasts.