It is Saturday morning, and some 40 people on foot, bikes and rickshaws begin trickling into Kuklung village. They take a seat outside a single-storey building and wait to see the psychiatrist at a monthly treatment camp for people with mental health conditions.
The camp is providing a lifeline to this remote, impoverished community in Assam, in northeastern India.
Among those seated is Ayesha Ali*, 32, who was diagnosed with schizophrenia as a teenager. She has struggled to receive consistent treatment because her family has not always been able to pay for drugs or psychiatrists’ appointments. In the past, she sometimes had to travel 200km from her home in Kuklung, near the Bhutan border, to the state capital Guwahati for treatment.
That changed two years ago when the Ant (Action Northeast Trust), a rural development organisation, started the camp in her village. Now, every third Saturday of the month, Ali can meet with a psychiatrist and collect her medicine for 300 rupees (about £3) a time. That is a day’s wages for many people in the village, who are labourers or farmers, but it is 10 times less than the cost of a private consultation. The camp is the only route to low-cost, quality, consistent treatment in the area.
The human toll of non-communicable diseases (NCDs) is huge and rising. These illnesses end the lives of approximately 41 million of the 56 million people who die every year – and three quarters of them are in the developing world.
NCDs are simply that; unlike, say, a virus, you can’t catch them. Instead, they are caused by a combination of genetic, physiological, environmental and behavioural factors. The main types are cancers, chronic respiratory illnesses, diabetes and cardiovascular disease – heart attacks and stroke. Approximately 80% are preventable, and all are on the rise, spreading inexorably around the world as ageing populations and lifestyles pushed by economic growth and urbanisation make being unhealthy a global phenomenon.
NCDs, once seen as illnesses of the wealthy, now have a grip on the poor. Disease, disability and death are perfectly designed to create and widen inequality – and being poor makes it less likely you will be diagnosed accurately or treated.
Investment in tackling these common and chronic conditions that kill 71% of us is incredibly low, while the cost to families, economies and communities is staggeringly high.
In low-income countries NCDs – typically slow and debilitating illnesses – are seeing a fraction of the money needed being invested or donated. Attention remains focused on the threats from communicable diseases, yet cancer death rates have long sped past the death toll from malaria, TB and HIV/Aids combined.
'A common condition' is a Guardian series reporting on NCDs in the developing world: their prevalence, the solutions, the causes and consequences, telling the stories of people living with these illnesses.
Tracy McVeigh, editor
“She is much better now and no longer has psychotic episodes,” says her brother, Ahmed Ali*. “She is able to function independently.”
Sonali Sarkar*, 40, was diagnosed with severe depression and anxiety by a camp psychiatrist last year. She has been coming to the sessions because she felt low and had started neglecting her children. She now feels well. “I’m happy that I can now take care of my husband and children,” she says with a smile.
The latest National Mental Health Survey of India, from 2015-16, found that 15% of Indian adults require treatment for one or more mental health conditions. But there is a severe shortage of trained professionals across the country, and a lack of funding to improve the situation. Less than 1% of the 2022-23 national health budget is directly earmarked for mental health.
In Assam, India’s sixth poorest state and the poorest in the northeast, the authorities run a district mental health programme but it does not reach all 31 districts. Where it is running, it is plagued with problems, including shortage of staff, medicines and funding.
The Ant began monthly treatment camps at its base in Rowmari village, 25km from Kuklung, in 2007. Hundreds of patients came from across the state, queuing from early in the morning to see medics. The overwhelming response spurred the organisation to expand the programme in 2014. The non-profit now runs monthly camps in 25 locations throughout Assam with the help of local partners.
Camps are held on a fixed day each month and in the same place, so that “even if a patient stops coming for a while, she or he knows exactly when and where to find us,” says Dr Sunil Kaul, co-founder of the Ant.
“Nearly 50% of our patients need to remain on medications for life,” he adds. This makes access to regular and consistent treatment critical. The camps continued throughout the Covid pandemic, a time when mental illnesses increased dramatically.
The Ant enlists experienced psychiatrists who give up their weekends to work at highly discounted rates. It also sources quality generic drugs from a non-profit that manufactures essential medicines for charities.
Kaul estimates the Ant has treated more than 8,000 patients since 2007. “80% of our patients who complete at least the first three months of treatment get back to what they were doing before illness,” he says. “When a patient comes back to us on her or his own and is able to engage in conservation, we feel so happy.”
Dr Bharat Vatwani, one of India’s most respected psychiatrists, says the Ant’s treatment camps “are a lifeline for the mentally ill in these rural hinterlands of India, where mental health infrastructure is often poor”. He adds that the work of the organisation “also creates that much-needed dent in cultural myths and stigma which abound around mental illness”.
Kaul says the Ant plans to expand the programme in Assam and other states. “Our goal is to have mental health camps in all eight northeastern states within the next three years.”
* Names have been changed to protect identities
