Late one evening, Dixon Chibanda, a psychiatrist in Harare, Zimbabwe, received a call from a doctor in an emergency room. A 26-year-old woman named Erica who Chibanda had treated months before had attempted suicide. The doctor said he needed Chibanda’s help to make sure Erica didn’t try it again.
Erica was at a hospital more than 100 miles (160km) away, however, so Chibanda and her mother came up with a plan by phone. As soon as Erica was released from the hospital she and her mother would come see Chibanda to reevaluate her treatment plan.
A week passed, and then two more, with no word from Erica. Finally, Chibanda received a call from her mother. Erica, she told him, had killed herself three days before.
“Why didn’t you come to Harare?” Chibanda asked. “We had agreed that as soon as she’s released, you will come to me!”
“We didn’t have the $15 bus fare to come to Harare,” her mother replied.
The response left him speechless. In the months that followed, Chibanda found himself haunted by the case. He also knew that Erica’s inability to access care due to distance and cost was not exceptional but, in many countries, in fact was the norm.
Globally, more than 300 million people suffer from depression, according to the World Health Organization. Depression is the world’s leading cause of disability and it contributes to 800,000 suicides per year, the majority of which occur in developing countries.
No one knows how many Zimbabweans suffer from kufungisisa, the local word for depression (literally, “thinking too much” in Shona). But Chibanda is certain the number is high. “In Zimbabwe, we like to say that we have four generations of psychological trauma,” he says, citing the Rhodesian Bush War, the Matabeleland massacre and other atrocities.
Yet those suffering from depression have few options due to a dearth of mental health professionals. Chibanda, who is director of the African Mental Health Research Initiative and an associate professor of psychiatry at the University of Zimbabwe and the London School of Hygiene and Tropical Medicine, is one of just 12 psychiatrists practising in Zimbabwe – a country of over 16 million. Such grim statistics are typical in Sub-Saharan Africa, where the ratio of psychiatrists and psychologists to citizens is one for every 1.5 million. “Some countries don’t even have a single psychiatrist,” Chibanda says.