Few township residents have ever met a psychiatrist. But in two Khayelitsha clinics, three women are reaching out to mothers and babies in need of psychological support.
Nomfundo* is convinced that she fell pregnant because she was bewitched. Three days before she gave birth, she still denied that she was pregnant. Her baby is now four weeks old. But she still says that her aunt bewitched her.
Sitting in a small room in Mdlezana Clinic in Khayelitsha, psychiatrist Dr Astrid Berg tries to navigate her way through Nomfundo’s story to uncover what is making the 28-year-old woman deny her pregnancy so vehemently.
“Ask her whether she accepts that this is her baby,” Berg says to her assistant, Nosisana Nama.
Nama then speaks to Nomfundo with great patience. Slowly, slowly her story comes out. It turns out that Nomfundo went to a traditional healer after the death of her husband. This healer is the father of her baby.
“She connects the baby with the boyfriend, this healer,” reports Nama, “and he has accepted that he is the father of this child. But she is still having this feeling that she got pregnant because her aunt bewitched her.”
Now, Nomfundo no longer goes to the healer that made her pregnant, but to another healer. “This new healer told her that she needs to be cleansed of evil spirits, so she is not breastfeeding because she fears that the evil spirits will go into the baby,” says Nama. “She is taking muti from this second healer and he says he needs to perform a cleansing ceremony at her home.”
Berg’s immediate concern is Nomfundo’s baby, a tiny boy with the intense stare of the very young. He is being fed mainly on gripe water and tap water. Nomfundo, sensing the anxiety in the room, proceeds to breastfeed him briefly. But he sucks listlessly. There seems to be little milk, and he’s whipped off the breast before he gets going.
Berg is a child psychiatrist, based at the Red Cross Child and Family Unit. Her expertise lies in working with children between birth and the age of three. Much of her work rests on trying to improve the relationship between mothers and their babies.
She started working in Khayelitsha in 1995, after meeting Nama and her other assistant, Nokwanda Mtoto. Nama and Mtoto get a small stipend from a parent-infant fund which Berg has set up using money from patients on medical aid, who to see her at the Red Cross.
The women work one morning a week in the township, alternating between Mdlezana and Nolungile Clinics.
Sometimes Berg, Nama and Mtoto are simply translators in the bewildering world of medicine, explaining physical problems and referring mothers to other experts where needed.
From time to time, they chance upon someone like Nomfundo who clearly needs psychological help.
“Most of the babies I see in Khayelitsha have developmental delays,” says Berg. “Usually, all the investigations [on the baby] have been done at the Red Cross [hospital], but the mothers don’t understand a problem. I can then get their folders from the hospital and we can explain the problem. I saw a mother with a Downs Baby a while back. It was written in the folder but no one had ever told her.”
The sisters in charge of the two clinics also refer babies who are not picking up weight to Berg and her team “as there is often an emotional side to this”.
Nama and Mtoto also give speeches to clinic waiting rooms, explaining that if a mother is unhappy, she can’t interact well with her baby and that if mothers feel they cannot cope, they can speak to Berg and her team.
The “therapy sessions” are very far from the lie-on-the-couch, Western stereotype. Outside the flimsy door, babies cry and mother talk. Inside, there are three people plus the mother and child.
Questions to mothers are often negotiated between Berg, Nama and Mtoto, issues delicately balanced between what is culturally acceptable and clinically important. “No, Astrid. She is not ready to answer that one yet,” Nama tells Berg at one stage during discussions with Nomfundo.
After the consultation, the mother is given food for her baby and, if necessary, taxi money to return in two weeks’ time.
Nama says mothers are not put off by the to-and-fro between herself, Mtoto and Berg.
“They are used to it. Whenever they go to hospital, it is like this with the [white] doctor and the nurses.”
“I think they also have a sense that we are really listening and trying to help,” adds Berg, who says that she always asks the mother to speak in isiXhosa so that her child understands the problem too.
“In Khayelitsha, there is so much physical deprivation and the emotional is closely linked to that,” says Berg. “Many women are depressed because they have been left by the father. We try to separate out the baby and the father, and say that she might not have the father any more but she does have a baby.”
Later, the three discuss Nomfundo’s story. Mtoto, who came across Nomfundo while doing house visits to publicise the therapy sessions, reveals that Nomfundo’s mother “wants her to have a full medical examination because she has had some mental problems in the past”.
“So maybe her idea that she is bewitched is a delusional thing, not a cultural thing,” says Berg.
Berg is completely candid about her dependence on Nama and Mtoto, both of whom have a natural empathy and are motivated by a desire to help their community. “I couldn’t work in Khayelitsha without them,” she says.
And by working with her, Nama is now inspired to study psychology.
The combined effort of one middle-class professional and two dedicated community volunteers is contributing to improving the lives of a few overburdened mothers in a township that has never heard of psychiatry. ‘ health-e, the online health news service.
* Not her real name.