Virtual psychotherapy - Chad

About me: I am a health psychologist living in Montreal, Canada and provide mental health services (psychotherapy) to N'Djamena, Chad through Skype.

Origins of the project: The idea has been circling in my mind for several years but the project is only a few months old. It has grown quickly and the service is in high demand.

About the project: The concept is simple. Every weekend I sit in front of my computer and talk to people on the other end.  I receive supervision by a trans-cultural psychiatrist when I need a consult for a patient. The project requires someone in N'Djamena to also offer services (an office, a computer, internet connection) which so far have gone unpaid. This person is also offering administrative services such as coordinating appointments between patients and me, accepting cancellations, follow-ups etc. I am also in touch with a physician in N'Djamena in case I need a patient to be seen by a doctor if there is a need for medication. Here, there is a physician who is temporarily volunteering as a medical advisor for my work. I go to her with questions about medication which I then pass on to the physician in Chad who finds an equivalent locally available medication to prescribe or recommend to patients if deemed necessary. Although I have not yet performed a formal evaluation of the work, the feedback is very positive. The therapy sessions are helpful and have made a difference.Challenges: The problems I've encountered so far are rather minor. The major one is when their electricity is cut-off in the middle of a session which happens frequently. The other problem is bad connection when voice is lost, delayed, difficult to hear, with frequent interruptions in the session. Other minor problems include lack of privacy for the patients who usually come with their family in tow including children and babies. Also heat waves which I'm told interfere with the WI FI connection. Another problem, likely cultural, is patients' lack of punctuality. None of these problems have been very serious and the work continues. There is something about care provided through distance that patients find special and resonating. It seems to offer something above and beyond the therapy itself and portray considerate care, concern, and empathy. I believe this adds to patients' potential for healing. I feel privileged to be able to provide this assistance, to have my patient's trust despite the cultural differences, and to be able to stand beside another human being along their journey to health.

Funding: This project is currently funded by me (personal funds). My work is pro bono. A few other professionals have shown interest in joining me to provide free psychotherapy services. I would like to find sources of funding to provide some compensation to those volunteering their time and equipment in Chad, and to cover, at least partially, their internet fees, and to provide some supplies.

Invitation:  If you are a French speaker and would like to work with me and provide psychotherapy to Chad I would welcome an email. If you are interested in establishing a virtual clinic to offer similar services I would be very happy to hear from you.

Request: If you know of sources of funding that could help with this work I would appreciate hearing from you.

Comments

Submitted by deen on 26 September 2013 - 2:31am.

I think we need therapists and there is need of mental therapists so we should give training to students for the prepration. I am also a therpists and now i want to do it online. I am still online here online therapist and have helped many people online. I wish i could help people arround world and in this time i am working to provide psychiatric help for those who do not know what is therapy.

deen

Submitted by nfaregh on 2 September 2013 - 8:47pm.

http://www.bbc.co.uk/news/world-africa-23901414

nfaregh

Submitted by Epiphane on 5 August 2013 - 7:30am.

Greetings my name is Epipane ADJADJI from Benin in West Africa. I read your work on virtual psychology to Chad. I’m interested in taking a course in psychosocial care  for children. But can’t get anywhere because of financial constraints.

I am a bilingual and interested  in helping in some way of the other with my bilingual skill and desire to learn about this field. I am working in a child-based NGO called BØRNEfonden a child and sponsor relation  assistant.  We do not do  have any  psychosocial care to children per se but  from time to time, I am called by Family Advisors on the field to provide counsel.

If you think I can be of any help. Thanks for  letting me know.


Epiphane

Cell: 229 97 47 06 83 or 94 96 44 10

Epiphane

Submitted by nfaregh on 21 July 2013 - 8:58pm.

For new updates see our new website:

www.virtual-psychology-Chad.com

nfaregh

Submitted by Flower Hart on 30 June 2013 - 3:37pm.

Hello,

I am a licensened and board-certified Creative Arts Therapist located in New York with 15 years of clinical experience working with children, adults and families with histories of abuse and trauma. I realize you need French speaking people and therefore could not use me as a therapist etc.. however I am writing to inquire if you have any other needs that could be supported by a virtual volunteer. I am currently out of work and am seeking to eventually return to work at a job that embraces global mental health. I will translate the above in French through google so that I am sure you understand this message.  I could offer you up to 20 hours a week in volunteer time depending on the assignment; I would prefer if there is some component within the volunteer work that would require the use of my clinical skills in some manner or the opportunity to learn a new skill etc. If that couldbe worked out, i could offer you 20 hours. Thank you for your time. I look forward to hearing from you.

Sincerely,

Stacy Jones MA ATR-BC LCAT

Bonjour,

Je suis un thérapeute Creative Arts licensened et conseil certifié situé à New York avec 15 ans d'expérience clinique auprès des enfants, des adultes et des familles avec des antécédents de violence et des traumatismes. Je sais que vous avez besoin de personnes qui parlent français et ne pouvait donc pas se servir de moi comme un thérapeute, etc. cependant je vous écris pour vous demander si vous avez d'autres besoins qui pourraient être soutenues par un bénévole virtuel. Je suis actuellement sans emploi et je cherche à finalement retourner au travail à un emploi qui englobe la santé mentale dans le monde. Je traduis ce qui précède en français grâce à google de sorte que je suis sûr que vous comprenez ce message. Je pourrais vous offrir jusqu'à 20 heures par semaine en temps de bénévolat selon l'affectation, je préférerais s'il ya une composante dans le travail bénévole qui exigerait l'utilisation de mes compétences cliniques d'une manière ou l'opportunité d'apprendre une nouvelle compétence etc Si couldbe élaboré, je pourrais vous offrir 20 heures. Merci pour votre temps. J'ai hâte de vous entendre.

Stacy Jones MA ATR-BC LCAT

Flower Hart

Submitted by Doris Potter on 27 May 2013 - 9:52am.

Your initiative is for a social cause and its good to read people are joining in. I wish all the best for Chad.

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Doris Potter

Submitted by nfaregh on 21 July 2013 - 9:00pm.

Here is an update on the services we have been providing in Chad. What follows is a summary.

You can also contact me at nedafaregh@gmail.com

The virtual psychotherapy project in Chad has been running for a year. Services are free of charge. Project staff continue to work pro bono publico. Our services are currently offered on a small scale and reach very few people. Although we have have the ability to incrase the service from Montreal, our capacity for accomodating service users in N'Djamena is limited and currently is the "bottle-neck".

Project staff: The project is supported by four individuals providing services.  I provide psychological services including psycho-education to patients in N’Djamena. An internist working at the Montreal General Hospital offers medical consultations to the project when and if needed. In N’Djamena, a locally trained surgeon is available for medical consultations and assistance if needed to address suicide risk. The location in N'Djamena is managed by a coordinator who also offers office space and a computer/internet usage.

Service users: Our selection of service users is currently very biased. Service users are primarily known to and enrolled by the coordinator, and are either self-selected or selected based on the coordinator's recommendation. Female patients often arrive to their appointment accompanied by their families. So far there have been 4 female service users out of a total of 7.

Operation: To date, seven patients received initial assessment and follow-up services for a total of 60 hours. Not all available service days and hours could be used due to technical difficulties, electric outages, cancellations without prior notice, and weather. The remaining available service time was spent at virtual meetings for administrative and project planning.

Themes:  topics of discussion in sessions and the proportion of times the topics were discussed are shown below.

  • Psycheducation - 89%;
  • Work life balance -76%
  • Couple and marital problems -73%
  • physical health problems - 50%
  • Extended family problems 46%
  • Boundaries (lack of)- 37.5%
  • Expressions of male superiroty - 33.3%
  • financial problems- 33%
  • Intimacy and sex -13%
  • Alcohol abuse- 13%
  • Witchcraft/sorcery - 12%
  • Improvement since last session (spontaneous expressions) - 50%

Lessons learned:

- Privacy: The set up offered little privacy for service users, which did not seem to present a problem for service users who often arrived as a group with other family members.

-Technical difficulties: For the majority of time the Skype connection was poor. Downtime and outages, including electrical outages, were common. The connection was through voice only because the available internet bandwidth cannot support video. We need to find funding to pay for better internet connection with adequate bandwidth and more reliable service. We also need to find a way to provide a part-time salary for the coordinator.

-Weather: The temperatures reached 47 oC at the end of the dry season and affected patients’ mood, punctuality, and proneness to frustration. Patient’s ability to travel to the project office in the afternoon heat was also impacted. Sandstorms and rain (downpours that can continue for several days) also contributed to service interruptions.

-Cultural consideration: Most issues related to culture were non-significant, for example the service provider did not always appreciate the effect of heat on the environment. Issues with moderate impact were related to service users unfamiliarity with service provider's expectation for punctualtiy, or cancellation with prior notice. More difficult problems encountered were related to service users' personal beliefs about sorcery and witchcraft. The coordinator in N'Djamena played a crucial role as a cultural mediators and his services were invaluable in that regard.

Resistance: There was a remarkable abscence of therapeutic resistance. We wondered if this was due to service users' unfamiliarity with the therapeutic process and giving more credence to the service provider than should have been there. To counteract this, service provider routinely reminded service users about the purpose of the sessions (role as consultant, suggestive nature of recommendations, certain questions are to provoke thought).

nfaregh