Afghanistan, Iraq: SAMHSA Supports
Mental Health Efforts
When Nahid Aziz, Psy.D., returned to her native Afghanistan
this past May for the first time since she fled the Russian
invasion at age 12, the most moving moment came during
a visit to the reconstructed School of Medicine at Kabul
She well remembered her many childhood visits there
with her late father, a professor of medicine and one
of Afghanistan's first Western-trained physicians. The
school had since been heavily damaged, and in the Taliban
era, women had been excluded.
But this spring, nearly half the students on the rebuilt
campus were women. A class of 300 new physicians was
about to graduate. In the auditorium stands a commemorative
wall listing the pioneers of modern medical care in Afghanistan.
With deep emotion, Dr. Aziz saw among them the name of
her father, Dr. Mohammad Hossein Nasrat.
But her return to Kabul was no mere sentimental journey.
Dr. Aziz, a clinical psychologist and associate professor
at Argosy University in Washington, DC, regards it as
continuing her family's tradition of working for better
health care for the Afghan people.
She traveled there as a member of SAMHSA's delegation
to an international conference, cosponsored by Afghanistan's
Ministry of Public Health and SAMHSA. The conference
focused on the continuing process of planning for the
reconstruction of the nation's mental health system.
SAMHSA cosponsored two such conferences this spring.
In addition to the one in Kabul, SAMHSA convened a meeting
in Cairo for Iraqi health professionals. Other participants
at that meeting included colleagues from Egypt's Ministry
of Health and representatives from the World Health Organization
The WHO has played a significant role in the mental
health training provided to Iraqis over the last several
The Cairo conference tracked the progress made since
last year's similar, smaller meeting on Iraq in Amman,
SAMHSA News, May/June 2005). All the meetings
underscore SAMHSA's commitment to support the expansion
of mental health services in both Iraq and Afghanistan.
||At the only mental
health hospital in all of Afghanistan, SAMHSA Administrator
Charles G. Curie visited the kindergarten/day care
center established for the children of employees.
Some of the children are wearing traditional tribal
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"Mental health is crucial to fostering a constructive
relationship between health and development," Afghanistan's
Minister of Public Health, S. Mohammad Amin Fatamie,
M.D., told the more than 70 mental health professionals
who gathered in Kabul from around the country.
The 3-day meeting provided an opportunity to gather
together representatives of several ministries of the
Afghan government; international agencies including USAID,
the WHO, and the United Nations; and the non-governmental
organizations (NGOs) involved in providing mental health
"The Afghans are really looking at a time when
the NGOs will [leave] and the Afghans will be providing
services," said Winnie Mitchell, M.P.A., International
Officer at SAMHSA. Much of the discussion in Kabul, therefore,
centered on how the NGOs could train community health
workers and staff, and also, in the longer term, on the
curriculum and education needed at the Kabul medical
Training emerged as a crucial need of Afghanistan's
mental health system because of the country's severe
lack of mental health personnel, including, for example,
"not one practicing psychiatrist," said Hussain
Tuma, Ph.D., a consultant to SAMHSA who attended both
the Kabul and Cairo conferences.
Of the two qualified psychiatrists in the country, one
works at a ministry and the other with an NGO. "The
top people that we met are first rate," Dr. Tuma
said, but far too few Afghans have had the opportunity
to receive mental health training.
Formal presentations in Kabul focused on mental health
services, substance abuse programs and—probably
most significant—capacity building for mental health
A major accomplishment of the conference, and of the
breakout groups that did the work, was prioritizing the
strategies within Afghanistan's National Mental Health
Plan and discussing specific next steps.
Participants emphasized that the entire Afghan population
has been exposed to violence but that women and children
are most vulnerable.
They also identified a need to develop screening methods
for mental health and substance abuse problems and to
define quality standards for psychosocial interventions.
Despite these challenges, participants emphasized that
Afghan society possesses significant strengths in regard
to mental health, especially the nation's strong faith
and close-knit families.
Particularly in times of trauma and loss, Dr. Aziz told
SAMHSA News, Afghanistan's tradition of close
and vigorous extended families provides bereaved or traumatized
individuals far more emotional and practical support
than is typically available elsewhere. The strength of
this support has been a major element in the people's
resilience over years of violence and oppression, she
click to view larger image
|In this Afghan
government antidrug poster, poppies growing in a
field are mowed down by a tractor. Because heroin
and opium are derived from poppies, they are portrayed
under a "devil" image with horns, claws,
and black clothing.
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The effects of violence and trauma in Iraq were evident
at the Cairo conference, participants told SAMHSA
News. One could sense "hopelessness among the
Iraqis at the beginning of the conference because of
the challenges they are facing," said Husam Alathari,
M.D., staff psychiatrist at the Northern Virginia Mental
Health Institute in Falls Church, VA.
An expatriate Iraqi, Dr. Alathari attended the conference
as part of the SAMHSA delegation. "You can really
sense that the Iraqis are very stressed out. On top of
this, physicians have been a target for the insurgents."
But as the week progressed, "everyone was very impressed
by the amount of energy that was generated by the conference.
There is a lot determination. They are not losing hope."
The keynote address by Iraq's National Advisor for Mental
Health Sabah Sadik, MBCHB, FRCPsych, DPM, opened with
a report on services, training, and research and policy
accomplishments during the previous 12 to 18 months.
These included finalizing Iraq's National Strategy for
Mental Health; drafting and submitting to the government
a much-needed national mental health law; aiding the
establishment of a Child Mental Health Association; establishing
a number of mental health clinics; arranging for the
return to professional work of numerous experienced psychiatrists,
psychologists, and social workers who had for a variety
of reasons stopped working; and conducting a course for
trainers of nurses in mental health, 1 of more than 50
training events involving more than 2,000 individuals.
"It was very impressive to see what people had
achieved," Dr. Alathari told SAMHSA News.
"Absolutely, progress had been made [that] was beyond
our expectations." These accomplishments, he added,
are "even more impressive given all these challenges"
that Iraqi health professionals face.
Dr. Sadik's talk enumerated some of the challenges,
including the need to encourage greater teamwork, re-establish
professional and service standards, develop collaboration
with institutions of higher learning that will enhance
competence in the mental health professions, develop
leadership training, and build an effective information
system. "Sadly," he observed, the need to function
in a poor security situation has "hindered"
international support and contributions.
Nonetheless, optimism about the future of mental health
care was high among the Iraqis present, said Dr. Alathari,
who was last in Iraq in the early 1990s. At the conference,
he spoke with a number of former colleagues and classmates
from the days when he was receiving his education there.
"They said, ‘Fortunately, we have the best
opportunity of any health system in the world. We can
look at all the models, and we can design our own, starting
from scratch.' At the same time, they have the opportunity
to look at all the other challenges that other health
systems have gone through and not repeat the mistakes."
After "15 years of intellectual isolation, they
want to catch up," Dr. Alathari continued. They
relished "the opportunity to attend an international
conference and interact with professional organizations."
"It was very evident that [the Iraqi participants]
have a clear idea of how to re-establish mental health
services in Iraq," Ms. Mitchell added.
Once the security situation improves, Dr. Tuma believes,
progress on rebuilding Iraq's mental health system will
In support of that process, "the conference has
been very effective in enhancing team work, partnership,
and collaboration," Dr. Sadik told SAMHSA News.
"Delegates were relaxed, participated actively,
and felt valued as colleagues and contributors. I am
confident that the skills they acquired and the networking
they established will make a significant impact in the
short and long term."
Spending time in safety among supportive international
colleagues proved a "sanctuary" for the Iraqi
health professionals and provided them tremendous emotional
support, said Dr. Tuma. "When you're working under
stress, you don't know whether you want to go on. . .
. But what these doctors and mental health professionals
are doing in Iraq is important. As a group, we wanted
to let them know that."
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