Give us some background on you and WHO.
I joined WHO’s Africa regional office in 1999 and served as deputy regional director, assistant regional director, director of non-communicable diseases, WHO representative for Malawi, and co-ordinator of the Inter-Country Support Team for South and East African countries. Before joining the WHO, I worked with UNAids as Team Leader of the Africa and Middle East Desk in Geneva (1997-1999). I also served as Unicef’s regional health advisor for East and Southern Africa; and with Botswana’s Ministry of Health as a clinician and public health specialist.
You have been vocal about the shrinking donor funding. How can African countries fill in the gaps and sustain progress in healthcare?
It was inevitable that we would get here. Countries are developing, their economies are growing. This means that as countries graduate into middle-income states, they need to smartly invest more of their resources in health. If donor funding is reducing, African countries need to be working on ways to improve their own revenue. While they are trying to seal the gap, they need to work better on areas that need emphasis. It is not as if the money is not there, it may not be getting into the public purse. Therefore, we need to talk about flight of capital and address cases of some international donors not paying taxes to the degree that they should.
At the same time, instead of lamenting and worrying about the flight of donor money, countries need to invest much more effort in getting their own revenue from areas like taxation. I should say, Botswana has done well over the years, government expenditure on health has increased substantially. It is one of the few African countries to have reached the Abuja Target, with 15% of total government expenditure allocated to healthcare.
With a continent that is heavily populated with young people, what is the involvement of youth in an agenda like Universal Health Coverage?
We need to deal with the awkwardness of having old and young people in the room to talk about health or at least engage young people where they are and bring their views and voice into decision-making. At the WHO, we are learning to do this. Our adolescent health programme has not been among the best funded or our strongest and we are deciding that it deserves this added emphasis because it deals with the biggest demographic in the region.
We are therefore recruiting young people to change how we are working and asking our adolescent health programme to work with all the other programmes, so that those working on HIV/Aids, sexual and reproductive health, non-communicable diseases, and health systems development take on board the needs of young people.
Talk about WHO’s renewed approach to dealing with health emergencies and outbreaks.
Lessons from the Ebola outbreak in West Africa revealed critical gaps in WHO’s emergency preparedness. We are therefore adjusting our programmes to have a smart technical focus in line with the region’s priorities, basing interventions on evidence and lessons learned from experience. We have now reformed our Health Emergencies Programme and are part of a global WHO approach of one emergency programme, one workforce, one budget and one line of accountability.
That means, for example, that my director, who is the team leader in Africa, does not need to get permission from me for everything he has to do. One of the big changes we have put in place is that this director can work directly with the executive director in Geneva and the WHO country representative to make decisions.
This is the approach we used to address recent disease outbreaks in Africa such as the yellow fever outbreak in Angola. We are also working with other partners in a structured way and co-ordinating the work that needs to be done between the three levels to provide better support.
How prepared are African countries to deal with emerging issues like antimicrobial resistance and disease outbreaks?
I genuinely think African countries (maybe not all of them) are better prepared on the whole than they were pre-Ebola outbreak.
But I also think we are not quite there yet. Health systems are still very weak. If you look at an objective tool like the International Health Regulations, there are very many gaps in African countries.
With data collected from about 12 of the 47 countries, we have more evidence-based information about the existing gaps and what needs to be done.
Countries have also begun putting together co-ordination mechanisms on the so called emergency operation centres, where you can deal with one of the key problems when something arises:
“How do I have an effective co-ordination nod which directs the actions from investigations, confirmation, response, surveillance and monitoring to see that an outbreak is being brought under control?”
That is one more step to being better prepared. We have also seen improvement in the laboratory capacity to quickly diagnose some of the organisms causing outbreaks. At the end of the day, what needs to happen is that if an outbreak is starting somewhere and the infected person goes to a clinic anywhere in a country, you need to have in the health worker diagnostic capacity to pick up that something unusual is happening, report that and trigger investigations that will conclude what is going on.
Research has not been explored especially when you focus on Africa’s role. How can we see more research by ‘Africa for Africa’?
Africa has paradoxically been quite involved in global health research but much of this has been invested in by outside entities and the agenda of this research has been determined by the funders of the research.
We need our own domestic investment in research which will enable the countries to define their own research priorities and, most importantly, to work with the outcomes of those researches to inform policy and service delivery.
I have seen the private sector becoming more and more engaged in playing its role in healthcare.
And we must admit that there are a lot of opportunities to harness the resources, skills and experiences of private sector. However, I think it needs to be done within a framework of clear alignment with national priorities and for us, because this is the Sustainable Development Goals era, clear alignment with the idea of driving towards equity, better quality services access but also emphasising affordability.
Forgiveness is a virtue
It’s hard to get through life without experiencing some resentment. Executive Director – Phronesis International College (PIC) and Counselling and Psychotherapist, Peacebuilding and Life Skills Education Specialist Dr Thelma Kgakgamatso Tlhaselo-Majela discusses forgiveness and why letting go is good for you.
Forgiveness is a process that positions one on a healing path by choice in an attempt to resolve the psychological stress and trauma one could be experiencing. These pains and emotional injuries may stagnate one into feelings of anger, bitterness and resentment and in worse cases depression, anxiety and post-traumatic stress disorders. If left for long, protracted unresolved psychological distress and or trauma could deepen one more into multiple losses.
It may generate hatred and desire to cause harm on the other and this can throw one into revenge and or vengeance. Forgiveness then starts from the cognitive ability to choose letting go of the emotional and cognitive baggage thus granting the self or inner being power to constructively open portals of intrapersonal empowerment. Moreover, a well-integrated process of forgiveness could shift one into an empathetic and compassionate psychological space filled with virtue and psycho-sociological attributes of restoration that accentuate positive benefits of healing.
In your experience,what are the common issues that need forgiveness?
Life by nature is riddled with so many issues and challenges characterised by diversity and complexity hence appropriate understanding is very important. People are social beings that co-exist through healthy connectedness and this may happen at the physical, personal, socio-cultural, psychological, financial, spiritual; political level to mention a few.
We all need a deepened awareness on how the intra-personal (within self), inter-personal (with others), inter-group (within groups) and international (nation to nation) relational connections play out in life. These healthy relationships deserve to be developed, nurtured and protected lest they become dysfunctional and corrosive.
The common issues for forgiveness are varied and highly individualised. One person may look at what another is struggling with and may consciously or unconsciously belittle it because for them it appears an easy or small matter but people are unique and this deserves respect. The relational betrayals, emotional injuries, corrosive conflicts and intractable may result in residual emotions that can cause people to drift into anger and bitterness. In such accounts, people may find themselves responding through avoidance or seeking revenge which has the potential to cycle one back into deeper pain.
The complexity of forgiveness may originate from the nature and quality of the relationship one had, the nature of the wrong committed with the cognitive interpretations one ascribes to the event. This includes significant others such as spouses (couples), children, family relatives, colleagues, bosses and subordinates in the work place.
Sometimes, it may be people we do not know that have hurt us such as a murderer, rapist or an abuser and may not even acknowledge that they have done anything wrong to us. It may also be about the symbolic losses where the people and or situations to forgive do not physically exist such as a dead person or a geographic disconnection. In such cases, the existential reality of the phenomenon remains true, real and alive in the psyche of the emotionally injured person and requires a healing process.
Is it possible to forgive when one is still angry and can you forgive someone who does not think they have done anything wrong?
Forgiveness is a process that one does by choice for oneself and not for the perpetrator because one understands that the pain and suffering one is experiencing has a direct injurious effect on one’s life. Similarly, revenge and vengeance which for long has been one of the rudimentary human responses can only promote increased pain as it stagnates one into more hurt and pain.
It often cycles one back into psychological trauma hence one needs to perceive value addition in engaging in forgiveness because it can be logically and rationally incomprehensible when one is caught up in this quagmire. A bitter-angry person may grapple with cognitive dissonance which is an internal struggle to understand why they have to release someone who according to them deserves a punishment or better still refuses to acknowledge that they have done anything wrong.
But irrespective of the reason, holding on to anger, bitterness and resentfulness within the inner self can only grant one false gratification that they are holding the perpetrator to ransom. Needless to say, we have no control on how the other person thinks and feels and we may actually be subjecting ourselves to increased injury and punishment from the very issue we are contending with.
Seeking professional help will assist one to work through the psychological defence mechanisms such as denial, repression, rationalisation, reaction formation, regression to mention a few that may promote dysfunctional tendencies in un/forgiveness processes. Notwithstanding, people need to be assisted with respect for human dignity within them and never be forced and or coerced into forgiveness when they are not ready to do so. Given that anger will consume the person already holding the pain and hurt whether it is perceived or real, working on forgiveness can be a desirable option to open the healing process.
Can you discuss the rewards or benefits of forgiveness?
As can be seen, it often pays to work through forgiveness hence the concept of working it out because people respond to pain and trauma differently. The rewards and benefits shared in this context are not by any means exhaustive because there are several psycho-social models for assisting people to process forgiveness issues and this requires well trained service providers.
*People who are angry and bitter are often not desirable in social contexts because they may consciously or unconsciously spill this negative energy on other people and this tends to repel instead of attract social connections. At intra-personal level, we are likely not to find our inner life peaceful and enjoyable if we are ever stuck psychosocially on anger and bitterness because it may promote self-hate, poor self-concept and negative self-esteem. So it pays to be gentle to love yourself enough to desire good emotions about and towards other people for that will rub corrosively on your personal well-being. The benefits of forgiveness include enabling one to circumvent these psychological pains and trauma that can affect quality of life with self and others which may compound stress levels.
In extreme cases people may sink into depression and anxiety which could ripple into other areas of life such as sexual dysfunction, eating disorders, substance use and abuse, relational conflicts and psychosomatic illness. Forgiveness builds a healthy mindset and that attracts a healthy personality which consequently leads to healthy social and physical well-being. Forgiveness fills the inner space with good attributes and this is shared with others. We then by addressing forgiveness issues reduce on maladaptive tendencies and lift on psychosocial protection thus leading to safeguarding the intra-personal, familial, corporate and societal communities from effects such as divorce and relational stressors.
At corporate and industrial level, a socio-psychological space that is riddled with un/forgiveness is a breeding ground for visible and invisible costs. For instance, a huge cost can emanate from a collective environment that is unproductive because of collective stress and restlessness. A workplace where people are transparent and honest and regard others with respect to deserve forgiveness often tends to promote healing communities where others feel safe and do not fear hence they can work to the optimum level of their potential.
We also benefit as a nation when we are characterised by forgiveness because we have a strategic desire to promote a knowledge-based community as the foundation for transformational change. Botswana considers people as a reservoir for knowledge and wisdom to lead as change agents and if we are a community that is unable to work through issues of forgiveness, we may create or nurture a psycho-sociological space that disempowers collective construct for healing communities.
A Motswana who is able to forgive is likely to live with people from other backgrounds and has a healthy and broader capacity of dealing with diversity and differences with virtue and competencies for the 21st century to advance the nation at local, regional and international level.
Rabiya Mahomed-McGeoff: Talking Marriage and Family Therapy
Increased mental health awareness is leading to demand for therapists to serve couples and families. Licensed Marriage and Family Therapist, Lead Clinician, Rabiya Mahomed-McGeoff talks to SunHealth about being one of the most important confidants a person or family can have.
What is a Marriage and family Therapist?
A Marriage and Family Therapist is a mental health professional trained in psychotherapy and family system, and licensed to diagnose and treat mental and emotional disorders within the context of marriage, couple and family system. A Marriage and Family Therapist treats a wide range of serious clinical problems including adult schizophrenia, depression, marital problems, anxiety, individual psychological problems and child parent problems.
How did you become a couple and family therapist?
When I did my undergraduate studies in Psychology, one of my professors was a Marriage and Family Therapist.
He introduced systems theories and they made sense to me. So I decided to pursue marriage and family therapy.I did my Bachelors in Psychology with a minor in Women Studies at University of Massachusetts. I did my Masters in Marriage and Family Therapy at Alliant International University in the US. After completing my Masters, I did clinical experience for two years, completing 3000 hours of direct client contact (which is a requirement in the State of California before one can seat for the licensing exams.)
I sat for the two exams and passed. I got licensed as Marriage and Family Therapist in California, USA.
What do you most enjoy about your work?
Giving clients hope, a voice, walking them through transitions and seasons in their lives and seeing them gain insight on their issues.
What is the most challenging thing about marriage and family counseling work?
The most challenging thing is when I work with teenagers where parents don’t want to get involved.
They just drop their children and expect me to fix their children. In most situations you find that parents are the ones with problems and are the ones who need therapy not the children.
What is the biggest myth about therapy?
That you only go to therapy when you have problems. That is not the case; therapy empowers and helps to facilitate personal growth in one’s life. For couples, therapy helps with tune in and awareness of issues before there is a problem.
It strengthens the family and the marriage bond. And also the assumption that therapy is free. I still get amazed by my educated friends who get shocked that therapy is a paid profession.
In general, what do specialists in this practice offer?
We offer couples therapy, individual therapy, child therapy, and group therapy on different issues; grieve therapy, premarital counseling, divorce mediation and recovery.
We consult for organisations on different issues including restructuring, retrenchment and workplace communication.
How do you stay detached from your counselling work? Is it even possible?
I have been practicing for more that 10 years now, throughout the years I have created some rituals that help me to transition from work to family life.
I have learned to set clear boundaries. At the end of my work day I put my phone on a silent mode for 30 minutes. I write down things that I have accomplished on that day and one thing that I am thankful for. I do basic breathing exercises. When I close my office door that’s the end of work – when I get in the car I listen to music until I get home.
What experiences are most useful for people becoming counsellors?
You need to be passionate, enjoy working with people and be willing to learn from your clients.
What seems to be the biggest obstacle for clients in therapy?
Not taking responsibility for the choices one has made over the years.
Mental health problems seem to be skyrocketing in our society lately? What are the reasons for this and what can be done about it?
I don’t think mental health issues are skyrocketing. Mental health issues have always been there. It is only that in our culture when we don’t understand something we find a way to label it. Mental health was often labeled as “botsenwa, mopakwane or boloi.”
There was a stigma for a person suffering mental health problem and their family. Often times they were ridiculed and treated as outcasts and shame to their families. Now people are beginning to be open about mental illness and it seems like it is skyrocketing because of the increased awareness.
We need to educate people more about mental health so that they can be aware and be sensitised on mental health issues.
That is a step to destigmatising mental health and learning the importance of early intervention, which can make a difference in one’s life.
If there is one thing you wished your clients or patients knew about treatment or mental illness, what would it be?
Mental health is a real illness. It’s not a character defect and it is okay to live with mental illness.
I have heard that after a couple has a child, which is notably one of the happiest times in anyone’s life that the satisfaction and overall happiness in the marriage can dramatically decrease. Is this true, and why is this? What can couples do to sustain their marital happiness after children?
Having a child is a transitional time in a couple’s life. The reason why it feels like a couple’s happiness has decreased is that the couple did not prepare for the transitional period and therefore they don’t know how to behave, or support each other with the introduction of this new person in their lives.
It is important for the couple to prepare for this period. This is another time in a couple’s life where couple’s therapy is necessary to help process and explore different ways of preparing for the anticipated additional member of the family.
The challenging thing in this transitional stage is that one partner takes a back seat while the other one is the driver of all things baby.
It is a normal transitional challenge and with preparation and awareness it can be handled better to ensure that the fire keeps burning.
What do you do to personally cope with stress in your life?
I pray, read, exercise, spend time with the people I love, balance family life and work life.
If you had your schooling and career choice to do all over again, would you choose the same professional path? If not, what would you do differently and why?
I will do it all over again. I feel honoured and humbled when people come to my office and choose to trust me with their inner fears. It often gives me joy to see them walking away with a smile.
As a therapist I make a difference in people’s lives.
What is the best advice you can offer to readers on leading a meaningful life?
Be true to who you are as a person.
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