Team cares for mental health in Peru highlands

As Reynaldo Cuba Medina's fingers skipped nimbly over the weft of a large loom, a pattern of colorful Inca figures emerged from threads.

"I learned to do this from a neighbor a long time ago, when I was well," he said.

That was before Cuba, 22, shut himself up in his family's house, fearing that everyone was watching him. "For a whole year I didn't leave my room. I felt that the walls had eyes," he said.

The first person who managed to break through his shell was Columban Sr. Antonnette Carbon, who visited at his mother's invitation.

"I agreed to talk to her, but in the dark," Cuba said.

At Carbon's encouragement, he finally agreed to go with his mother to the Ayacucho archdiocese's mental health office.

Sr. Victoria Leano of the Missionary Dominicans of the Rosary, who works as an adviser at the office, said she remembers the day Cuba arrived, a baseball cap pulled down over his eyes, still not convinced that his fears were due to an illness that could be controlled.

Now, after two and a half years of treatment for schizophrenia, Cuba is in charge of the weaving workshop in the group therapy office.

The mountainous farming region in southern Peru, where people tend small plots of land or herd alpacas and sheep, was the epicenter of brutal violence between Maoist insurgents and the military in the 1980s and early '90s. The Truth and Reconciliation Commission set up in 2001 estimated that 69,000 people died in the violence. Most were poor, Quechua-speaking peasant farmers in Ayacucho and neighboring regions.

The survivors have been left to deal with witnessing the murder of spouses, parents, children and neighbors, seeing their farms and belongings burned, or searching fruitlessly for loved ones taken away by soldiers or Maoist insurgents.

Data gathered in 2002 showed high rates of mental illness in highland areas that had been affected by political violence, with problems ranging from alcoholism, depression and anxiety to schizophrenia and suicide--often all are related to high levels of domestic violence.

The commission recommended that mental health care be provided to people affected by the violence, and the archdiocese took up the cause in 2003.

"When we started, mental health was a taboo topic," said Ruth Moises Rios, a nurse who heads the mental health team, which faces the dual challenge of raising awareness about the problem and providing treatment.

Gradually, people like Cuba's mother began seeking them out, lining up outside the makeshift office a few blocks from Ayacucho's main plaza to talk with Leano, a team member or the psychiatrists who visit once a month from Lima, the capital.

When a new patient arrives, a team member visits the person's home and talks with family members to gain their commitment to help and support the patient.

"That's a condition for treatment," Moises said. "We don't have a place for patients to stay. Eighty percent of recovery is going to depend on [the family], 10 percent on us and 10 percent on medications."

However, "relatives are often the first to deny there's a problem," said Dunia Quintanilla Calderon, a psychologist.

Acute cases sometimes require hospitalization. But the local hospital, where a psychiatric ward is still on the drawing board, often turns patients away or insists that a nurse from the archdiocesan team stay with the person overnight.

While that puts one more demand on an already overburdened team, the young nurses--all of whom speak Quechua, are from Ayacucho, and who were children when the political violence was at its peak--take it in stride.

"We have more empathy with [the patients] because we are from Ayacucho and have lived through the same things," Leano said.

Since 2003, the 10 nurses and one psychologist on the team, who have special training from a mental health institute in Lima, have treated 2,526 patients. About 43 percent of them have been treated for depression, 6.5 percent for schizophrenia, 3.6 percent for posttraumatic stress disorder, and nearly 6 percent suffered from anxiety.

Some of the people who seek help have been wandering the streets of Ayacucho. A few have been brought by bus from distant villages by family members who tied or chained their hands and feet to control them during the trip.

"Most people would be afraid of these patients, but that's not what happens here," Moises said."'We take their hands; we give them a hug."

Individual, group, family and multifamily therapy sessions, occupational training and other rehabilitation activities, including weaving and computer training, are held in the team's cramped offices.

"The idea is help them recover the capabilities that they have lost," Moises said.

The staff is frustrated at times that they are reaching only a small fraction--less than 5 percent, by Moises' estimate--of the people who need them. Although they provide treatment in two outlying districts and the city, they must set limits on the number of patients they can treat.