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“Talking Books” Help Improve Health Care in Rural South Africa

In South Africa, as in much of the world, millions of people suffer from depression and other mental disorders. For example, 10 percent of all teenage deaths in the country are due to suicide, while nearly half of those diagnosed with HIV / AIDS suffer from depression or other emotional illnesses. Health experts say it’s especially tough in rural areas, where there’s a stigma surrounding mental illness, and many suffer in silence. But one organization that’s fighting to educate the public on mental health issues, the South Africa Depression and Anxiety Group, is using a simple technology to reach those who can not read: "talking books." From Washington, reporter William Eagle has the story.

Their pages are big, bright and full of colorful drawings. They have a panel of buttons along the sides of their covers. In the West, these animated books are designed for young children and often carry the voices of popular cartoon characters, like Winnie The Pooh.

In South Africa, these so-called “talking books” also entertain and cater to those who cannot read. But unlike their Western counterparts, they carry social messages about health care for both children and adults. By pressing one of 16 buttons on the cover, the listener can activate a 30 second audio message that follows the text of each page of the book. Often, the messages are recorded by celebrities.

One book, called “Understanding Mental Health,” is available in English and the local Xhosa language. It counters a once-popular notion that blacks did not suffer from mental health problems, including depression. Other audio books deal with teen-age depression or how to live with tuberculosis.

Another is called “Caring for Child-Headed Households.” It’s funded by Africare and the US government’s PEPFAR program – and is geared to children in South Africa’s Eastern Cape who’ve lost their parents to AIDS. The text and audio explain the childrens’ rights, how to approach government for support, how to go to school, and also how to report abuse.

Among the books planned for the North American market is one called “Healthy Families – Watch Us Grow.” It will be distributed by the Academy for Educational Development to children in Hispanic and American Indian communities in an effort to fight obesity and diabetes.

Zane Wilson, the founder of the South Africa Depression and Anxiety Group in Johannesburg, gives another book to thousands of rural women trained to care for those with HIV / AIDS. It’s called “Living With HIV / AIDS Doesn’t Mean Living with Depression.”

The accompanying audio is read by popular South African soap opera star “Sister” Rosie Motene. [ed note: Ms. Motene is not a nun]. Home caregivers are encouraged to leave the book with patients who don’t read well and who often live in areas with no electricity. Research by Wilson’s NGO shows that each book is often circulated among up to 27 people.

Wilson said questions of the women caregivers show that the books – and their social messages – are reaching a much more diverse audience than first thought:

She said, "One of the questions we ask is how many people did you show it to, how many people saw it? … They go to shopping centers, clinics, churches, taxi ranks, bottle stores [liquor stores], shebeens [pubs, informal bars], savings clubs."

"One woman wrote," she continued, "that she took them to shebeens, where she says men hang out. She said the caregivers try to encourage [the use of condoms], and she walks by and pushes the buttons and they hear Sister Rosie. So they have a woman walking by a shabeen and they hear Rosie Motene’s voice."

It is important to tell family and food friends about your HIV / AIDS status, and how your depression is making you feel….. Considering going to a local support group. You can discuss your fears, concerns and worries with others in similar situations. They will not judge you, be critical or laugh at you.

Wilson notes that in South Africa, depression and trauma are among the leading mental illnesses in rural areas. She says there are many contributing factors besides HIV / AIDS.

Ten percent of all teen deaths in the country are suicides linked to depression. South Africa has one of the world’s highest murder rates – up to 50 per day; also, one in four women – often young women – are vulnerable to rape. The country also has a high rate of road accidents and fires – sometimes because of sub-standard housing, which are made of materials that catch fire easily.

Wilson said while the social factors that contribute to these problems may be hard to solve, at least the accompanying depression can be treated. Her goal is to encourage those affected by the illness to speak out and to get help as soon as possible.

The South African Depression and Anxiety Group includes over 100 patient-led support groups, a Suicide Crisis Line and a Mental Health Information and Counseling Helpline. It has also created several radio campaigns to educate the public on depression, including one effort aimed at reaching men. In addition to its work in South Africa, the group has helped other mental health NGOs in Kenya, Nambia, Zimbabwe and Swaziland.