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Hosted by the Ministry of Public Health And the Afghanistan Disability Support Programme
experts in the conference to come out with a plan for psychosocial rehabilitation that is cost effective and is practical. For Dr. Surya Dalils full speech please refer to Addendum B.
Speech by H.E. DEPUTY MINISTER SURAYA PAIKAN, Ministry of Labour, Social Affairs, Martyrs Families and Disability
H.E. Mrs. Paikan after welcoming the participants mentioned the following issues: Psychosocial rehabilitation is a very broad concept that needs cooperation of many ministries together and it cannot solely be done by ministry of public health. She also mentioned that a Survey is needed to be conducted in this area so that exact figures are obtained and hence policies are made accordingly. At the end she requested her Excellency Dr. Suraya Dalil acting minister of ministry of public health to pay more attention to this issue. For a copy of H.E. Mrs. Paikans speech please refer to Addendum A.
Speech by DR. RAZI KHAN HAMDARD, MACCA Advisor to the MoPH Disability and Rehabilitation Department
Dr. Razi Khan after welcoming the participants gave a brief speech on behalf of Mine Action Centre for Afghanistan. He mentioned MACCAs financial support to this conference.
Mental Services Mental Health Hospital Psychiatric wards Total MH Beds MH outpatient centers Day Care centers 1 3 180 9 1
She finalized her presentation by stating the following gaps in the current mental health services: Lack of human resources Lack of financial support to mental health Lack of public awareness on mental health and mental illnesses Lack of psychosocial rehabilitation services
Mrs. Frozan Esmati, MACCA Clinical Psychologist-Mental Health Advisor started her presentation by stating that there are very limited services which have been conducted on psychosocial rehabilitation services in Afghanistan. She briefly presented the Psychosocial Rehabilitation resource book which has been developed and the training which have been conducted so far. She stated that so far there are three training have been conducted in Afghanistan. One training was conducted for CBR staffs in Takhar province followed by another training for CBR staffs in Jalalabad and then a training of trainers in Kabul. However she finalized her presentation by the following statements: The trainings were not followed up due to lack of resources:
Lack of Human Resources Unavailability of Fund Lack of a structured program on Psychosocial Rehabilitation
Total number of psychiatric beds was decreased from 1595 in 2008 to 1490 in 2009 25 beds for children and adolescents 25 beds for persons with mental disorders in forensic inpatient units 1060 beds in other residential facilities such as homes for persons with mental retardation, detoxification inpatient facilities, homes for the destitute, etc.. Number of psychiatrists-neurologists 172 Number of neurologists - 277 o Dr. Reykhan ended her presentation by proposing steps in strengthening mental health situation in Tajikistan: Development of the comprehensive policy, national strategy and plan of action for mental health Creation of community-based facilities Capacity building for mental health professionals Increasing the numbers of psycho-social staff Increasing the mental health system's links with other key sectors Development/improvement of the mental health information system
Dr. Niko also presented about psychosocial care and then he shared his experience from working with refuges from Bosnia and Iraq. Psychosocial Care: Goal; reduce symptoms of psychological stress below the treshold of developing pathology. Mankind is actually made for surviving trauma and difficult severe experiences, otherwise we wouldnt exist as a species. Psychosocial care from a Trauma-perspective KEY POINTS, how to adress traumatized patients? SIMPLICITY People in the western world always seems to complicate things in this matter SLOW DOWN.. Keep it simple, take it slow.
Just be there, be near, be with, listenknowing how to be quiet but be present, awakes your own anxiety. Holding , containing.. Main goal in trauma treatment; NORMALIZING
Psychosocial care at the hospital: What could this consist of? 1. Medical issues taken care of, stabilizing the patient 2. The psychological aspect..the simplicity principles.. Be there, be near, be with 3. Immediate inventory of patients resources.. 4. Social network, mobilizing groups, making it possible to talk about trauma or other psychological problems or issues. 5. Psycho-education about symptoms and mechanisms regarding the human body and brain when exposed to trauma. 6. Follow-ups, re-meetings with the group. Experience from post conflict countries: Bosnia, the Balkan war: Started from one day to anothergood friends and neighbors became enemies at once. Trauma treatment is difficult when there is ongoing trauma. When refugees from Bosnia came to Sweden we started a project, trying to find out what kind of therapy could be useful. Medication with anti-depressive and sedative drugs had poor effect. Best effect was achieved with group psychotherapy and psycho-education. Important to have knowledge about forensic medicine to understand the connection between physical injuries and psychological injuries. Necessary to get staying permit in Sweden before starting therapy, to create secure environment and remove threat that people might have to return.
Discussion and Question and Answer session from the above panel:
Dr. Alia was asked about the researches which have been conducted and was asked why the prevalence of depression why rate of depression is different among different studies? Dr. Alia responded by stating that in different research different instruments were used for different populations and hence the results are different. Mrs. Esmati was asked, what are the next steps for psychosocial rehabilitation services in Afghanistan? She responded that one of the goals of this conference is find what needs to be done in this area so after the workgroups tomorrow we all can come with a proposed plan. Dr. Alia was also asked to share the articles from the researches which have been conducted on mental health with disability taskforce. She promised that she will do accordingly.
Mr. Davlatov started his speech by stating that he has started his cooperation with Tajikistan Mine Action Centre (TMAC) since 2006 in Summer Rehabilitation Camp and he has been cooperating with TMAC since then. He provides psychological support and consultation to mine survivors during summer camp. He added that the psychological study of mine victims revealed that their personalities encounter changes. Firstly, the self-concept of a victim changes and these changes are observed in different manners among the victims depending on the level of disability they received (degree of injury, loss of one or both hands, legs, eyes, etc). Commonly, a low level of self-concept is observed among the victims. Usually, they evaluate themselves at low level with poor dignities and tend to have excessive self-criticism. Such attitude cultivates loss of assurance and lack of efforts to improve their situation. The complicating situation and ascending difficulties are able to overcome and overwhelm the victims. Eventually, the preposition I would flee among the victims. The overwhelming difficulties create rooms for psychological rehabilitation for the victims. Beside changes in the self-concept of the victims, emotional changes are also observed among them. Firstly, they encounter emotional apathy with no attention to surroundings. They are constantly exhausted and fatigue, bashful, reticent, reserved, etc. If measures are not taken to prevent apathy then depression among the victims can occur. Excessive depression downs the attitude of the victims towards their personalities, surrounding people and future perspectives. In such cases, the psychological services are mainly responsible for restoring healthy attitude among the victims. He attended his presentation by forms of psychological services that he provides: The therapy is provided in both individual and group form during the last four summer rehabilitation camps organized by TMAC. Individual self-evaluation, Individual perspectives, Individual disposition, My five-years future plan, Accentuation of characteristics, Drawing methodic, Incomplete sentences questionnaires are used to assess individuals. In order to achieve the goals, we provided psycho-therapy and art-therapy for the victims during the summer camps. Psychological methods of relaxation, stress management, effective psychological consultation, drawings, emotions control, role-play You can do it! and other exercises were applied to reduce stress among the victims.
Arguably the most significant development over the last thirty years for persons with disabilities, especially those living in rural areas in developing countries Well recognised, long-surviving brand name in the development sector
He then gave a brief history of CBR in Afghanistan along with CBR networks in Afghanistan followed by CBR and psychosocial rehabilitation which he noted the followings: Community processes, full participation, equal opportunities, social inclusion, gender sensitive, diversity and focus on rights are some of the key components of CBR which are no different from Community Mental Health The emerging trend away from vertical health programmes to integrated multipurpose models favor primary level services and community based strategies Continuity of care is more readily achieved when there is an existing CBR Sensitize people involved in CBR to be open to work with PLWPSD. Adequate inputs about Mental Health issues. Listening and dialogue is the life force: Respecting views and needs of PLWPSD.
Dr. Razi Khan concluded his presentation by: Inclusion of mental health issues in CBR is possible and cost effective The approach is rights based and people- centered Creating a favorable environment for promotion of good mental health
with Disabilities, were approved for the benefits of these target groups. Additionally, new criteria for identification of poor families, provisions for compensation of electricity and gas utilization bills, memorandum on increase of pension and other measures were adopted that prove government protection of elderly and people with disabilities in Tajikistan. Meanwhile the government of Tajikistan has support from international organizations. Mrs. Soima further noted that in order to timely and effectively serving the needs and benefits of elderly and people with disabilities, there are five boarding homes for elderly and people with disabilities, two boarding homes for people with mental distortion, Chorbogh Center for medical rehabilitation of children and youth, National Orthopedic Centre in Dushanbe and its three regional Centres in Kulob, Khorug and Khujand oblasts, National Research Institute for Expertize and Rehabilitation of people with disabilities, four resorts and one boarding school for children with disabilities functioning in Tajikistan. The said institutions constitute complex structure of social services of the Ministry. Additionally, there are 45 social assistance departments with 748 employees operating in some towns and districts of the country that provide 30 types of assistance at homes of 5710 elderly and people with disabilities, including psychological, legal, social and medical assistances. It should be noted that 1504 elderly and people with disabilities live in the boarding homes. Another 14 regional Centres of social services, of which 8 are non-government centre, provide social services to 4482 needy people in Tajikistan. The regional Centres employ 326 social workers covered by the government. Provision of social assistance to people with disabilities is top priority for the government, including technical assistance. Mrs. Soima further added that for the purpose of improving the quality and quantity of social services, the Ministry continues to cooperate with UNICEF, European Commission, UNDP, Turkish International Cooperation Agency and dozens of other international organizations. With this cooperation, one of the buildings of Chorbogh Center for medical rehabilitation of children and youth was renovated in 2009 and is opened for medical rehabilitation of children with mental distortion, where 20 children with one of their parents or guardians stay for 21 days to receive medical rehabilitation course. This is the only Centre in the country, where children receive medical rehabilitation and parents get trainings on children nurture and recreate at the same times. The Centre provides services to 400 children with their parents per annum. Mrs. Soima finished her speech by stating that other government ministries and agencies in cooperation with public associations and non-government organizations hold significant roles in implementation of aforementioned activities and in improvement of social protection of elderly and people with disabilities in Tajikistan.
epilepsy is higher compared to physical and sensorial disability. And in terms of gender the prevalence of symptoms were much higher among woman compared to men. Apart from the mental disorders symptoms, these studies have also found that the behavioural problems such as isolation, sadness, fear and violence are high among people with disability. The results have shown that these behavioural problems are at least three times higher among people with disability compared to non-disabled. Among the behavioural problems that are common among people with disability regardless of the type of disability are: finding the way to expressing their need (23.5 % compared to 2.8 %), difficulty in feeling comfortable with people (25.5% compared to 3.3%), keeping calm, staying in one place (17.8% compared to 2.6%), difficulty in going out of the house because of fear and because of people staring (20% compared to 2.6%). The highest behavioural problem was feeling sad, crying without a specific reason which was 41% compared to 4.1% for people with disability and non-disabled respectively. Further breaking different types of disability itself and comparing the difficult behavioural health problems that are common among them the results showed that person with speech impairment were the highest proportion (84.1%) showing inability to express their needs to others and people with physical disabilities showed the lowest proportion (29.7%). Regarding different types of mental disability and the behavioural problems that were faced by each type, the findings showed that feeling sad, crying without reason are the highest among people with social/communicational disability followed by psychological and learning disabilities. Other problems such as difficulty expressing needs, feeling uncomfortable with others, difficulty keeping calm, not going out because of fear or scared of being stared by people and repetitive body movements are very common high among all types of mental disability compared to epilepsy and seizures. Moreover from a gender based perspective, comparing male and female respondents who are disabled in terms of behavioural problems the finding showed that compared to men the prevalence of these problems are higher among women. Apart from the mentioned behavioural difficulties reacting violently to outside surroundings are also very high among people with disabilities. In the same national disability survey that we mentioned above it has been found that violent behaviours occur within 14.3% to 19.6% of persons with disability. In this particular survey violent behaviour was measures in terms of physical violence towards others, verbal violence towards others, self-violence, fainting/passing out and episodes of fits. The results showed that compared to the non-disabled persons the proportion of these behaviours among people with disability are ten times higher compared to non-disabled. And comparing the rate of these behaviours among different types of disability the prevalence of violent behaviours are the highest among persons with mental disability, epilepsy or some other types of seizures compared to people with physical and sensorial disability. Considering the prevalence of violent behaviour among person with mental illnesses and intellectual disability it was found that for person having learning disability, less than one third experience a type of violent behaviour in the six months prior to the interview. On the other hand, person having psychological or social disability are the ones who experience a high level of
violent actions. More than 55% of them have verbally violent episodes towards others. A majority of person having social/communication disability also have physically violent behaviours towards other people and more than 45% towards themselves. The proportion is a little less for person having psychological disability. A majority of both groups experience episodes of fainting. Moreover, these symptoms were much higher among women compared to men. Persons with disability also have problems in communication. More than one quarter of persons with disability have communicational difficulties such as remembering things, talking to others, understanding what people say, making oneself understood, hearing clearly someone calling you in the house, seeing someone clearly in front of you. Moreover, the prevalence of these behavioural problems was much higher among people with mental disabilities and those with associated disability especially with regard to memory. 85.1% of persons with mental disabilities and 71.9% person with associated disability have problems with memory.
Discussion and Question and Answer session from the above panel:
There was a not a specific question, however, it was suggested by participants that many technical terms are used in the presentations that are not familiar for them and it would be good if presenters define the terms while they are presenting.
Summary of the first day was briefly stated by Mrs. Esmati highlighting the points below:
There are high prevalence of mental health disorders symptoms among people with disability Mental health services in general are very weak in the country Psychosocial rehabilitation needs to be paid especial attention as not much has been done in this regard.
time at Summer Rehabilitation Camps held in sanatoriums and resorts located in the picturesque Romit and Varzob valleys, in Dushanbe vicinity. The summer camps create impacts on survivors general health conditions by bringing together physiotherapy and adaptive sport in friendly and warming atmosphere, and enhance their communication and social integration ties. The summer camps provide psychological rehabilitation through art-therapy, individual and group psychological discussions. They help to enhance self-confidence and self- esteem among survivors. Dr. Reykhan also added that throughout the summer camps, TMAC used adaptive sport activities supervised by professional trainer and doctor. We had daily morning exercises with all survivors before breakfast. After breakfast we used walking and hiking around the resort area if weather conditions allowed. Group games included table tennis, chess, volleyball, basketball etc. In the afternoons survivors were busy with competitions - race, arm-sport, table tennis, swimming etc. In the evenings survivors enjoyed dancing, singing songs and watching movies at the back yard. Sport activities resulted in improved physical and psychological conditions of survivors, increased efficacy and stability of survivors. A professional coach from the Paralympics Tajikistan supervised all sport activities. Art-therapy was very effective and impressed the survivors. It helped to reduce aggression, anxiety and fatigability among the survivors, and facilitated non-verbal release of negative emotions. Art-therapy helped to improve the following among the survivors: ability expressing feelings; establishment of positive and friendly emotional mood identification of sources for future development development of creative self-expression and individuals capacity improvement of communication between survivors and team building
Dr. Reykhan finalized her presentation by stating that We can compare art-therapy as a window through which survivors could find out so many inner things using pencil and colours, which they wouldnt be able to express it to everyone. The process of art-therapy itself brings a lot of pleasure, while patients get to express their feelings. Art-therapy can be used independently as main therapy or as part of general or group psychotherapy. We proved that art-therapy could be used not only in the hospitals, but also in other rehabilitation facilities, such as summer camps.
3 days: identification of MH problems 2. MH training for health staff Doctors (2wks): common psychiatric illnesses: emphasis on diagnosis and treatment (including psychopharmacology) Nurses/midwives (2 wks): emphasis on diagnosis, communications and psycho-education 3. MH activities in general hospitals OPD, IPD and Liaison Psychiatry: introducing multidisciplinary approach 4. Training of trainers (TOT) (two months)( provincial focal points) Basic mental health training course (2 weeks) Basic training methodology (2 weeks) Clinical training in a Postgraduate Medical Institute in Pakistan (2 weeks) Training under supervision (2 weeks) 5. Psychotropic drugs supply According to BPHS Essential Drug List 6. Supervision & monitoring of HFs and of provincial teams 7. Development of training, M & E tools and IEC materials 8. Technical support to NGOs implementing BPHS (EC funded provinces) 9. Support to MH department MoPH Dr. Ajmal also explained the community based approach of health-net TPO stating that The Psychosocial Program focuses on community based psychosocial services within the community. And this is done by: Mapping the communities to explore the needs, constrains and resources which are different in the different communities of the provinces; these mapping reports enable us to implement tailor made services for the population in need. Community mobilization (finding the right entry point, iidentification of key figures, focus group discussions) Capacity building of key influential figures (community leaders, Mullahs, CHWS and teachers) to raise the awareness about the Psychosocial problems and how to reduce these problems among people Group interventions; Discussion groups, Support groups, Self help groups, Specific group interventions for children (There will never be enough psychologists, counselors and psychiatrists to help everyone on an individual basis, due to lack of funds, lack of time and lack of training) Individual/family case management (if needed; Providing psycho education, family mediation, Referral to more specialized care Use of media to heighten public awareness Awareness raising among Ministries & other stakeholders (Coordination meetings and workshops) Development of guidelines & Best Practices Finally he briefly mentioned that HNTPO is planning to extend their program to other provinces and especial attention will be paid to woman empowerment.
Peer Support Group and Findings from the Research on Effects of Disability on Mental Health
ALSO
Mr. Nasem Khan Aliyar from ALSO and Abass Panyanda Nik from (FPRO) briefed that ALSO organization for the first time provided peer support services in Afghanistan.. And currently the services are in Kabul and Mazar-e-Sharif. Until now more than 1500 individuals with disabilities have received peer support counseling and have been referred to other organizations for rehabilitation. He further defined that peer support services are provided for persons with disabilities by persons with disabilities. . He also mentioned that one of the objectives of the peer support is to enhance selfesteem of persons with disabilities and raise wareness of their families about the rights and needs of persons with disabilities to include them in society. Mr Aliyar also briefly mentioned about the methodology of their work. Initially ALSO recognize and identify persons with disabilities and with psychosocial problems at homes,hospitals and community , then a counseling is provided, followed by referral to rehabilitant centers based on their needs and demand for type of services. Finally he ended his presentation by mentioning the challenges that are present in their program as follows: 1. Absence of a standard program or policy on psychosocial services; 2. Lack of financial support for psychosocial program; 3. Lack of experts on mental health; 4. Lack of trained experts and peer supporters for peer support program ; 5. Limited number of research centers on psychosocial issues. Mr Payanda Nik shared the results of a research that he has conducted on effects of disability on mental health of persons with disabilities. The research has been conducted by FPRO and ALSO with the financial support of ICBL. According to Mr. Payanda Nik the objectives of his research as follows: Assessing the effect of disability on the mental health of individuals with disabilities; Assessing disability as a cause of deterioration of mental health; Comparison of mental health of individuals with disability with persons without without disabilities; Identification of common mental health disorders among individuals with disability About the instruments used for this research Mr. Payanda Nik mentioned that SCL-90 was used to assess the symptoms. Among the findings he mentioned the followings: The higher the age of persons with disability, the better their mental health; Persons with disabilities have poorer mental health compared with persons without disabilities; Mental health of women with disabilities are poorer compared with males.
The most common mental health disorders among persons with disabilities are depression, anxiety, low self-esteem, phobias and poor social skills.
rehabilitation of persons with disabilities operates since 1992. Staff at the Institute includes specialists in physical medicine and rehabilitation. There are 11 doctors and 10 nurses at the NRIRDP. The MLSP provided 9 Somoni (approx.US$2) per bed per night for treatment and feeding this is not enough. He then briefly mentioned his experience on: Audiology assessment of survivors Removing of Fragmentations Ultra sound examination
GROUP WORK
Group 1:
OBJECTIVE:
To identify the gaps and needs for psycho-social rehabilitation services in Afghanistan and Tajikistan 1. There is a need for technical research on psychosocial rehabilitation as there are very limited researches. 2. Lack of budget on psychosocial rehabilitation. 3. Limited number of technical staffs on psychosocial rehabilitation especially medical psychologists. 4. Limited donors support on psychosocial issues. 5. Absence of standards on psychosocial rehabilitation services. 6. Absence of proper attention from governmental organization to psychosocial rehabilitation. 7. Absence of implementation of policy and strategy by government 8. Lack of primary health care workers knowledge on mental health and disability. 9. Limitation of BPHS and EPHS implementers attention on mental health. 10. Lack of societys awareness on psychosocial rehabilitation. 11. Absence of a center that can train psychosocial counselors. 12. Absence of a system that can coordinate organizations who are working in the mental health field. 13. Absence of programs to increase public awareness on psychosocial rehabilitation through massmedia. 14. Necessity of inclusion of psychosocial rehabilitation in the university curriculum. 15. Absence of a proper monitoring and evaluation on the trainings which has been conducted.
Group 2:
OBJECTIVE:
To create close coordination and cooperation between Afghanistan and Tajikistan Mental Health and Disability Departments, Victim Assistance Programs in regards to improve psycho-social rehabilitation services for persons with disabilities/landmine survivors 1. Establishment of a working group which consists from organizations working in mental health and disability departments who can work solely for psychosocial rehabilitation. 2. Conducting inter-country conference in order to coordinate organizations activity and get updated about the activities of each organization with regard to psychosocial rehabilitation. 3. Development of a directory which contains a directory of organizations which are working on mental health and all disability stakeholders with their addresses and their activities. 4. Involvement of Ministry of Higher Education/Ministry of Education in psychosocial rehabilitation activities. 5. Coordination of activities with regard to psycho-social rehabilitation between ministry of public health and Ministry of Higher Education/Ministry of Education.
6. Development of a concise term of reference for the working group that is supposed to work on psychosocial activities. The working group should be able to work on the rights of person with disabling mental illnesses.
Group 3:
OBECTIVE
To continue to identify and utilize opportunities to enhance bilateral exchanges between neighboring countries (Afghanistan and Tajikistan) and to share national experiences, training materials, good practices, and existing opportunities between two countries and build capacities to enhance VArelated activities. 1. Exchange of experiences on several areas: a. Exchange of training materials b. Organizing of workshops and seminars with regard to psychosocial rehabilitation. 2. Giving an opportunity for Afghan disability organization to see the summer camps in Tajikistan. 3. Sharing of experiences on psychotherapy. 4. Development of common projects on research or any issues related to psychosocial rehabilitation between two countries. 5. Conducting scientific research between two countries on mental health of persons with disability. 6. Sharing of strategy on disability and mental health strategy between two countries. 7. Conducting of Paralympics games between two countries. 8. Conducting of inter-country and regional conference on psychosocial rehabilitation every year. 9. Development of a network between two countries with regard to psychosocial rehabilitation. 10. Opportunity to learn experiences from Tajikistan with regard to Art-therapy, Music therapy etc.
Dr. Razikhan Hamdard ended the conference with Mrs. Soima Muhabbatova from Tajikistan. They both agreed that the next conference on psychosocial rehabilitation should be conducted in Tajikistan.
Addendum A
MINISTER OF PUBLIC HEALTH SPEECH DR SURAYA DALIL FIRST INTERCOUNTRY CONFERENCE ON PSYCHOSOCIAL REHABILIATION
In the name of Allah the most merciful Assalamalikum and good morning. Respected Deputy Minister Mrs. Suraya Paikan, respected guests from the country that we share common language and common culture, Tajikistan, representatives of UN organizations, donors and relieve organizations and dear colleagues! As the acting minister of ministry of public health I would like to welcome your participants in this conference that is held under the title 1st Inter-country Conference on Psychosocial Rehabilitation. Disability and mental health problems are interrelated and interconnected phenomena that in interaction with socio-cultural factors create a much more complex figure. The one who is mostly affected is the person with disability, but the disability will affect his/her family and hence it will affect the society. When we accept that human beings are from the same nature, can we leave a person with disability with his own condition? If yesterday supporting these individuals were only a moral obligation based on cultural believes today it is a social need based on needs of society. Based on the World Health Organization statistics on the Global Burden of Disease report on the year 2004, around three percent of world population was suffering severe disability, and another twelve percent were suffering from chronic mild disabilities. Though, there are no up to date and exact data on disability figures in our country but roughly one out of each five household has a person with disability. Mental Disorders are amongst the most common disabilities. Again, based on WHO figures, mental disorders are among the most reasons for years lost in disability and depression is the most common especially among women. Some studies report that more than 60 percent of Afghans are suffering from symptoms of mental illness and social problems. In a survey in the country in year 2002, around 60 percent of men and 73 percent of women had symptoms of depression. Prevalence of mental disorders among disabled are much more. And study in 2004 showed that depression symptoms among people with no physical disability were around 68 percent while 71 percent of people with physical disability were suffering from depression symptom. Furthermore, 85% of people with physical disability showed symptoms of anxiety. Although, these figures are not certain; but can show the depth of disaster in the country.
My expectations from the experts in this conference is to come out with methods for obtaining more accurate information on rate of disability and main causes of it as well as methods of rehabilitation of persons with disability with low cost and especially psychosocial rehabilitation of these individuals with respect to resources available in the country, using the knowledge of our Tajik colleagues and attending experts in this conference. Hereby I want to ask further attention of our donors to the importance of mental health problems in the country. We have the support of our international organizations on physical problems but surprisingly with all these shocking figures we cannot obtain necessary supports for improvement of mental health condition in the country. Socio cultural problems of disabled and handicaps should be addressed as well. As an example even among our health professionals we dont have proper words to address these individuals. When we call someone as Maklul or Makyob, we add to his disability and paving the way for his rejection from work and social life. As a conclusion, I expect that this conference will end up with precise propositions for improving the psychosocial rehabilitation of persons with disability as well as methods for improving mental health services and ways to get more support for this important issue. As the wise knowledge of our predecessors which have told: tell less to be used more, I would like to officially open this conference and wish you success.
DEPUTY MINISTER SURAYA PAIKAN (MOLSAMD) FIRST INTERCOUNTRY CONFERENCE ON PSYCHOSOCIAL REHABILATION
Assalaamalaikum and good morning, I would like to welcome our especial guests from the neighboring country Tajikistan, participants from different provinces of Afghanistan, national and international organizations working with persons with disability. I am extremely happy that an important scientific conference is taking place in Kabul with the participation of the participants from a country that we have so many common traditions. Psychosocial rehabilitation is a very important concept and there is a serious need for this in the country. It is a very technical matter that can not solely be solved with ministry of health; it needs to collaboration of all of us, all the sectors. There is a need for a precise survey to be conducted in order to find the causes of disability and mental health. We as policy makers should be aware of the causes, although we know some of the causes such as war, financial problems but still there is a need for a survey to be done. Although many meetings are conducted and issues are shared between MOSLSAMD, Ministry of Public Health, and Ministry of Education however, psychosocial rehabilitation should be mentioned in future meetings so that new intervention methods are found. I would like to request her Excellency minister of public health Dr. Suraya Dalil to order all her secondary units to take this matter seriously.
At the end I would like to thank all the individuals who are responsible for conducting this conference and I wish all of you success.
Addendum A
Inter-country Psychosocial Rehabilitation Conference Conference Program 14-15th December 2010 Kabul Hotel, Kabul Afghanistan
Goal
To assist landmine survivors and persons with physical and psychiatric disabilities, including women and children, to resume their role in the community by helping them to cope and adjust to life challenges through psychological and social supports that assist in regaining and/or maintaining a healthy and positive outlook on life.
Objectives
1. To share current situations of psycho-social problems, rehabilitation services and opportunities available for persons with disabilities, including landmine/ERW survivors in Tajikistan and Afghanistan. 2. To identify the gaps and needs for psycho-social rehabilitation services in Afghanistan and Tajikistan. 3. To create close coordination and cooperation between Afghanistan and Tajikistan Mental Health and Disability Departments, Victim Assistance Programs in regards to improve psycho-social rehabilitation services for persons with disabilities/landmine survivors. 4. To agree on the way forward/methods for collaboration between the two neighboring countries and the region for future consultations and development of psycho-social rehabilitation services for persons with disabilities, including landmine survivors. 5. Continue to identify and utilize opportunities to enhance bilateral exchanges between neighboring countries (Afghanistan and Tajikistan) and to share national experiences, training materials, good practices, and existing opportunities between two countries and build capacities to enhance VArelated activities.
Category of Participants:
Around 100 participants from Ministry of Public Health (MoPH), Ministry of Labor, Social Affaire and Martyrs and Disabled (MoLSAMD, Ministry of Education (MoE), MACCA, Tajikistan Mine Action Centre, Ministry of Labour and social protection of population RT, National Research Institute for Rehabilitation of persons with disabilities of RT, National University of RT, relevant UN Agencies, National Organizations, International organizations.
AGENDA
Tuesday 14th December 2010 Time 08:00 09.00 09.00- 09:15 Topic Registration of delegates Welcome and start of the conference Recitation of the Holy Quran Introduction of Conference Goal, objectives, outcomes and brief agenda Welcome speeches 1. 2. 3. 4. 5. MoPH MoLSAMD MoE MACCA WHO Tea Break Mental health general situation in Afghanistan Presentation from Tajikistan Current situation of Mental Health System Mental Health Department Dr Alia Plenary Presenter Facilitators Methodology
09.16 09:30
Plenary
09.30 10:30
Plenary
10.30-10.45 10.45-11.00
11.00-11.15
TMAC
11:15 11:30
11.30-11.45
Psychology Individual and Group sessions for survivors Penal Discussion and Question and Answer Session
11.45-12.45
Lunch and pray Break Community Based Rehabilitation in Afghanistan and its role in psychosocial rehabilitation Presentation from Tajikistan Psycho-social rehabilitation for Persons with disabilitiess through MLSPP services Disability and Rehabilitation Department, MoPH Dr Razikhan Plenary
14.00-14.15
Disability National Survey Presentation from Tajikistan Role of art-therapy and sport activities during Summer Camps in psycho-social rehabilitation of landmine survivors"
15.00-15.15 15.15 - 16.00 Plenary Discussion and Question and Answer Conclusion of day and closure
16 .00 16:30
MOPH
Frozan
Plenary
Second Day Wednesday 15th December 2010 Time Topic Presenter Facilitators Methodology
9.15 -10:30
WFL HOSA 10:30 11:00 11.00-12.30 Group Works Tea Break G.1. Discuss 2nd Objective of the conference (Gaps and needs for psycho-social rehab) G.2. Discuss 3rd Objective (Cooperation) of the conference G.3:Objective 4 of the conference. Dr. Azimi from Afghanistan Plenary
Lunch and Pray break Group work presentation and discussion General Discussion on developing mutual cooperation Conclusion of the conference and agreement on the 2nd conference Each group representative
17:00 17.30
Addendum B
First Inter-country Conference On Psychosocial Rehabilitation December, 14 &15 2010 Kabul, Afghanistan Participant List
Dr. Suraya Dalil, Minister of Public Health Dr. Suraya Paikan, Deputy Minister of Martyrs Families and Disability Directorate, MoLSAMD Dr. Sayed Azimi-Mental Health Advisor, MoPH Dr. Alia Ibrahim Zai-Mental Health Director, MoPH Mrs. Frozan Esmati-Mental Health Consultant, MACCA Dr. Gualai Disability and Rehabilitation Department, MoPH Dr. Razi Khan Hamdard Advisor, Disability and Rehabilitation Department, MoPH Sadiq Mohibi Advocacy and Awareness Advisor to the MoLSAMD, MACCA Haji M. Nader-DAO Dr. Noordudin Muradi-HOSA M. Iqbal-DAO Vida Faizi-Medical Mondial Kabul Zarghona Ahmadzai-Medical Mondial Kabul Dr. Ajmal Healthnet-TPO Najmuddin-ICRC Khada Bakhsh-HNTPO Amir jan-ICRC Akhtar Mohammad-FWF Hashmatullah-FWF Najibullah-FWF Muzghan-FWF Ahmadzai-FWF Wasim_FWF Fariah-FWF Atiqullah-Kahistani-CCD Ayesha Afzalzada-ICRC Rahilah-KOO Marie Anne-HI Mohumad Samad-HI Fatimah Abdullah-MOE
Abbas Payndajo-MOE Nabillah-CCD Haji Ahmadshah-CCD Dr. Sohaila Zia MOPH/RHD Dr. Samad Hami-AADA Ghulam Mustafa-ICRC Taiba Alokozai-Mental Health Hospital Salima-Mental Health Hospital Dr. Sharifah- Mental Health Hospital Dr. Temorshah Musamem-Mental Health Hospital Dr. A. Wasi Ashaa-MOPH Hashmatullah-FWF Najibullah-FWF Nasem Khan Aliyar-ALSO Azizudin-AAPT Said Kabir-PTI Habiburahman-PTI Dr. S. Nakibullah-MOPH Yusuf Ali-Mental Health Hospital Ibrahim Alokozai-ALSO Mohad Ja-SERVE Dr. Essa Ebrahimi-MOPH Dr. Khalil Ahmad Rahmani-PMHP-IAM Dr. Khalil Ahmad Rasuly-PMHP-IAM
Naqibullah-AABRAR Kohistani-MOLSAMD Sayed Karim-AOAD ZarAlem-AABRAR Zakirullah-AABRAR Dr. Khesraw Ariah-HSSP Dr. Temorshah-MOPH Mirwais Haleem-UNFPA Dr. Jamshid Omar-BRAC Dr. Shafiullah-BRAC Dr. Wais-WFL Dr. Jameel-WFL Mohammad Aziz Rasa-MOLSAMD Agha Shireen-SERVE Dr. Ehsanullah Gulban-MOPH Abdullah Subhan