«Avoiding» mental health in a country where siege and harassment prevail

Nicaragua has a single hospital specialized in psychiatric care, the José Dolores Fletes Psychosocial Hospital located in Managua, but there are also some spaces where you can get a free consultation

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The World Health Organization (WHO) defines mental health as a state of well-being in which the person fulfills their abilities and can cope with the normal stresses of life, work productively and contribute to their community. . In this positive sense, mental health is the foundation of individual well-being and the effective functioning of the community…nnnAfter the sociopolitical outbreak of April 2018, followed by the health crisis due to Covid-19, the economic situation that overwhelms the population, added to massive unemployment, many ills have taken over Nicaraguans, from stress, anxiety, fear, insecurity, violence, isolation, couple conflicts, as well as addictive behaviors to mention alcohol, tobacco and some drugs. Although it is not until now that mental health has been deteriorating in a country where poverty prevails.nDoña Estela, whom we will call this at the request of the interviewee, says that, after the death of her husband three years ago and all the political “whirlwind” that the country has experienced, stress and depression took hold of her without realizing it when pointing that in mid-2021 he began to develop white spots on his face, hands, and neck.nn“When my husband died, that great emptiness remained, even though I have my children, who accompany me and support me, loneliness is hard, plus all this, that we do not live in peace, the insecurity of our children and food rising every day… ”, confesses this lady with straight hair, who is dedicated to taking care of two children and cleaning, in a house in a capital neighborhood.nnIn addition to her vitiligo problem, 55-year-old ‘Estela’ has to deal with people’s discrimination, as she assures that when she goes to the sale and travels on the bus, people see her again as a ‘rare animal’ and some even separate her. “I have assimilated my disease, learned to live with these spots, I even eat spinach, I apply the creams, something that I did not do any of that, because I rejected my problem and it is something that does not happen, it is the same ignorance of the people ”, he adds and at the same time advises the population to take care of their health.

Take care of your health with an expert!

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World Mental Health Day is celebrated every October 10. According to the WHO-Nicaragua Facebook page, half of the mental illnesses begin before the age of 14, but most cases are neither detected nor treated.nnClinical psychologist and teacher Andrea Pomares explains that in Nicaragua there is no culture of mental health, a situation that has been changing in many aspects and from various actors. “That is, for example, the schools, the educational system, which now takes mental health care a little more seriously, the business side as well, and that is something that helps us modify that vision that we have regarding mental health, which in general should be preventive,” he says.nnLikewise, he refers to the popular belief that mental health or mental health care is only for “crazy people” and clarifies that the work of psychology is very broad, “I like to approach it preventively, mainly the work is psychoeducational if there is already a situation established, developed because obviously it is attention and intervention and a possible reintegration in case it is something quite deteriorating for the person”.nnHe mentions that there are two major areas in mental health: the area of ​​psychology and the area of ​​psychiatry. “Psychology work is eminently preventive, as it should be, to prevent mental disorders from developing. In mental health, there are three major levels of care, but ours should be preventive, the psychiatric part is merely intervention, focused on psychopharmacological intervention. I see enormous importance in psychology because psychology does the work to prevent the person from going further, developing something else, deteriorating even more and avoiding going on to a psychiatric intervention”, he points out.

Regarding mental health and the arrival of Covid in the country, he states that it affected people in different ways. “From the psychological part, it came to trigger many problems that people already had, and other situations such as isolation were added to that,” he highlights.nnAccording to the health expert, human beings are sociable beings, highly sensitive to this aspect (isolation), “if I am surrounded by people, with whom I feel well-loved, protected, rooted, obviously your mental health and therefore physics will be fine, but with this isolation and the feeling of fear, it was believed that the young would-be immune and that the most vulnerable would be the elderly and all this resulted in a separation of generations, which must have communication and this is very important because values ​​are taught by grandparents and by making this separation, this generational communication within families was greatly fractured and that is going to take its toll on us… it brought with it stress and anxiety to give away, just by watching the news, everything was tragic, deaths…”.nnIt should be noted that in Nicaragua there is only one hospital specializing in psychiatric care, the José Dolores Fletes Psychosocial Hospital, located in Managua.

A sick person at home

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Dealing with a sick person at home is another matter to deal with. Ana and Carlos had a very nice relationship that stole the looks of neighbors and relatives. This young couple had plans for a house, a car, and a long future ahead of them with their little daughter, until one day, everything changed and those plans were blown away.nnWhile she had just gotten a job, her husband was putting the resignation letter in his job, news that took her by surprise, since she did not consult him about anything as she did before, without imagining that months later, she would have in her hands her husband’s diagnosis, drawn up by a psychiatrist.nnWork stress affected his health. In the medical opinion, it is read that the nature of the disease is “Acute psychotic episode” due to occupational risk and in her assessment, the psychiatrist summarizes that the patient has: Acute psychotic episode, borderline disorder, and secondary depression. Despite the support of the family and his wife, all these changes and manifestations in the patient, over the years, led to family separation.nnIt is for this reason that Pomares advises the population to visit a psychologist, not to wait until things happen, “it’s like when you do a preventive checkup on the vehicle, you don’t do it when there is already something wrong, but to avoid it,” adds the specialist, who points out that there are no clear statistics on how many people with mental problems there are in the country because many do not come for treatment and remain on the sidelines.nn“You have to understand that when we have a family member with a type of mental disorder and we have to take care of them, the caregiver must also have assistance, not only to know how to deal with the patient but also how you are going to take care of yourself, so the advice goes aimed at the issue of self-care, which is very important, because we return to the same thing, which is of a preventive nature and comes to favor the support that you are giving to your relatives and that there is not a single caregiver so that the care of the person rotates, so as not to burn the person, so as not to overload them, overexpose them…”, he points out.nHe points out that there is something called “caregiver’s disorder”, but it is physical and psychological situations, also of an emotional nature, that happen to caregivers of patients with mental disorders, due to wear and tear.

Main signs

Among the main signs for which to go to a mental health expert, are the cognitive ones. He mentions mental exhaustion, which is when people forget things a lot, “perhaps they are daily forgetfulness, it may be that he could not pay attention, he could not concentrate, I think, I think about something and I cannot go on to something else, I it makes learning difficult… on an emotional level, a variety of signs can occur, for example, feeling sad for no apparent reason or feeling a very specific emotion, such as anger, sadness, apathy, it can be melancholy, disgust, displeasure, a sign that all people or most people at some point we feel, but we do not give it that due importance, that is, I am surrounded by people, but I do not feel that human connection…”, says the specialist.

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Pomares calls to avoid fatigue. “Unfortunately it goes quite unnoticed, under the radar, why? because of the pace of life, we ​​lead, but in general, the patient can tell me: I sleep, but I feel like I don’t rest, I sleep and I feel like I wake up just as tired the next day, this could be due to many situations, it could be due to mental fatigue or it could be due to physical fatigue, but the origin is emotional…”.

Free consultations, something positive

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In Nicaragua, through the Nicaraguan Red Cross, the population that feels vulnerable or is experiencing a problem that requires psychological care, this institution has a free care service available, ideal for those who do not have the resources to pay for a psychologist, through the National Center for Psychosocial Support, who has allocated an area equipped to develop therapies and care for minors.

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The procedure that is carried out to receive care is to go to the National Center for Psychosocial Support, in the admissions area. After this, the patient will receive a user code, and a note will be given at the time and on the day the appointment is scheduled.

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This center is open from Monday to Friday from 8:00 a.m. to 5:00 p.m. 5:00 p.m. Here they provide free medical and psychological care. Likewise, they attend in the teleassistance modality to people who cannot appear, they can be attended to through a call, which would be made by the doctor or the specialist in psychology and in person who would have to appear at the center.

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Heal Nicaragua, an independent initiative, published the first edition “Techniques to heal Nicaragua” two years ago, an idea that emerged from a group of psychologists who came together with the same objective “to help heal the emotional wounds with which society Nicaraguan carries the product of its history and unresolved duels.”

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The collective published the basic, key, and free manual to deal with situations such as grief, sadness, uncertainty, and depression. On the Sanar website, there are self-containment techniques and exercises, a suicide management booklet, a library called Meetings in Resistance, and audio and video support material. All free.

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They also put at his disposal the helpline to receive counseling: 8327-8079. This space has stood out for providing free psychological support and creating freely distributed psychoeducational content.

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On April 22, the site posted on its Facebook page: “It is with grief that we announce that we are pausing our psychological support work indefinitely. At the moment we do not have sufficient resources to ensure the sustainability of therapists. We believe that mental health deserves to be taken care of by the community and we need your contribution to resume this access space that is so necessary. Contribute from $1 on Paypal. me/Sanarni, share this information or give away a product from our barter house”.

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Likewise, several universities in the country have a department of psychology where they can speak, most private schools offer their counseling space to students and on a personal level, some psychologists give talks and consultations for free or with symbolic payments.

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For her part, the Child and Adolescent psychologist Paola Marchena, who is also an emotional intelligence coach, works with children of single mothers daily. Last December, she invited single mothers to join her Super Moms club, a free self-help space where patients have the opportunity to discuss the challenges of single motherhood with other women in similar situations to yours.

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“If you want to receive emotional support, advice, and guidance from other mothers, click on this link, and ask me to add you to the club: https://wa.link/jbdgpk”, she posted on Facebook. Last January, she shared tips for parents on YouTube about the first day of school.

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