It’s Saturday morning and about 40 people start flowing into the village of Kukling on foot, bike and rickshaw. They sit in front of a one-story building and wait to see a psychiatrist at a monthly treatment camp for people with mental health problems.
The camp provides a lifeline to this remote, impoverished community in Assam, northeast India.
Among those seated is Ayesha Ali*, 32, who was diagnosed with schizophrenia as a teenager. He has trouble getting consistent treatment because his family can’t always afford drugs or psychiatrist appointments. In the past, he sometimes had to go to the provincial capital, Guwahati, 200km from his home in Kukling, near the Bhutan border, for treatment.
I am happy that I can now take care of my husband and children.
Depressed Sonali Sarkar
That changed two years ago when Ant (Action Northeast Trust), a rural development organization, started the camp in his village. Now, on the third Saturday of every month, Ali can see a psychiatrist and get his medicine for 300 rupees (about £3) each time. This is a daily wage for many people who are workers or farmers in the village, but 10 times less than a special consultation fee. Camping is the only route to low-cost, quality and consistent treatment in the region.
The number of people with noncommunicable diseases (NCDs) is huge and growing. These diseases kill about 41 million of the 56 million people who die each year, three-quarters of them in developing countries.
NCDs are simply that; Let’s say unlike a virus, you can’t catch them. Instead, they result from a combination of genetic, physiological, environmental and behavioral factors. The main types are cancers, chronic respiratory diseases, diabetes and cardiovascular diseases – heart attack and stroke. Nearly 80% are preventable and all are on the rise, spreading relentlessly around the world as aging populations and lifestyles driven by economic growth and urbanization make unhealthy a global phenomenon.
Non-communicable diseases, once seen as a disease of the rich, now affect the poor. Disease, disability, and death are perfectly designed to create and widen inequality, and being poor makes you less likely to be properly diagnosed or treated.
While the investment in tackling these common and chronic conditions that kill 71 percent of us is incredibly low, the cost to families, economies and communities is surprisingly high.
In low-income countries NCDs – typically slow and debilitating diseases – are seen as an investment or donation of some of the money needed. Attention has focused on threats from communicable diseases, but death rates from cancer have long surpassed those from malaria, TB, and HIV/AIDS combined.
‘A common case’ is a Guardian series that reports on noncommunicable diseases in the developing world: their prevalence, solutions, causes and consequences, telling the stories of people living with these diseases.
Tracy McVeigh, editor
“He’s much better now and no longer has psychotic episodes,” says his older brother, Ahmed Ali*. “Can work independently.”
Sonali Sarkar, 40, was diagnosed with severe depression and anxiety last year by a psychiatrist at the camp. She came to the sessions because she felt bad and started neglecting her children. She feels good now, she. “I’m happy now that I can take care of my husband and kids,” she says with a smile.
The most recent Indian National Mental Health Survey from 2015-16 found that 15% of Indian adults need treatment for one or more mental health conditions. But there is a severe shortage of trained professionals across the country and a lack of funds to improve the situation. Less than 1% of the 2022-23 national health budget is devoted directly to mental health.
In Assam, India’s sixth-poorest state and the northeast’s poorest state, authorities run a district mental health program, but the program does not reach all 31 districts. Where he works, he struggles with a lack of staff, medicine, and funding.
The ant started monthly treatment camps at its base in Rowmari village, 25 km from Kuklung, in 2007. Hundreds of patients from across the state lined up to see paramedics in the early hours of the morning. The overwhelming response prompted the organization to expand the program in 2014. The non-profit organization currently organizes monthly camps at 25 locations across Assam with the help of local partners.
Camps are held on a specific day and at the same location each month, so “even if a patient doesn’t show up for a while, they know exactly when and where to find us,” says Dr. ant.
“About 50% of our patients require lifelong medication,” he adds. This makes access to regular and consistent treatment critical. The camps continued throughout the Covid pandemic, a time when mental illness has increased dramatically.
Ant hires experienced psychiatrists who leave their weekends to work at heavily discounted rates. It also procures quality generic drugs from a nonprofit that manufactures essential drugs for charities.
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Kaul estimates that Ant has treated more than 8,000 patients since 2007. “80% of our patients who complete at least the first three months of treatment return to their pre-disease state,” he says. “We feel very happy when a patient comes to us on their own and is able to undergo containment.”
One of India’s most respected psychiatrists, Dr. Bharat Vatwani says Ant’s treatment camps are “a lifeline for the mentally ill in this rural hinterland of India, where mental health infrastructure is often weak.” He adds that the organization’s work “also creates that much-needed dent in the cultural myths and stigma that abound around mental illness.”
Kaul says Ant plans to expand the program in Assam and other states. “Our goal is to have mental health camps in all eight northeastern states within the next three years.”
* Names changed to protect identities