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    South Africa: Music – medicine a doctor can't prescribe

    Music – medicine a doctor can't prescribe

    On 11-13 April, severe flooding and landslides caused by heavy rainfall affected southern and south-eastern South Africa, particularly the provinces of KwaZulu-Natal and Eastern Cape. According to national authorities, more than 450 people lost their lives and over 40,000 were left homeless. A large number of displaced people are still sheltering in community halls, schools and churches.

    Doctors Without Borders began providing medical services and water and sanitation solutions to more than 30 shelters shortly after the catastrophic flash-flooding. During our team’s first community visits, it became apparent that many traumatised people were reeling from the loss of family members and their homes and were in need of counselling.

    Registered counsellors working for Doctors Without Borders, as well as several Doctors Without Borders doctors and nurses, joined the Department of Health’s outreach response and provide counselling and coping skills to the shelter residents and members of the surrounding communities, but the need for mental health support remains unmet.

    Our counsellors have found that people try to find their own ways to cope as best as they can. One way in which they do this is through song. Most of the residents in these shelters belong to the Zulu people and share the same language and culture, which extends to their musical background. In some shelters, everyone, from grandmothers to small children, are often awake and singing way into the night.
    Sean Christie, Emergency Team Coord.

    In May, a serendipitous meeting between Sean Christie and Menzi Mngoma, a self-taught opera singer from KwaZulu-Natal, planted the seed of an innovative music intervention as part of Doctors Without Borders' broader medical and mental health strategy to address the immediate healthcare needs of shelter residents. 

    “I was getting an Uber back from one of the shelters and the Uber driver asked if I did not want some live entertainment. He proceeded to sing and had the most extraordinary opera voice. We then began talking about the role of music in his life and in Zulu culture, especially the central role of music in times of bereavement,” says Sean Christie.

    Shortly before COVID-19, Menzi Mngoma had sung for another passenger who asked if she could record him. The video went viral and he began performing internationally, but the pandemic soon put paid to his rising opera career and he went back to driving an Uber.

    As luck would have it, one of Doctors Without Borders' own drivers in the area, Themba Mncube, is also a talented keyboard player. He, Menzi Mngoma, and one of Doctors Without Borders' counsellors, Nokuthula Shandu, got together to explore ways to design a musical programme. 

    “The programme was co-developed with the shelter residents, they shaped the structure of the program and came with suggestions for songs to be included. Overnight, many people had gone from having work and being self-sufficient to staying in the shelters and depending on others for almost everything. One rationale of the intervention was to give them back some control,” says Sean Christie.

    The first iteration of the programme was at the InterZuma shelter where Sean Christie and Menzi Mgoma first met. The programme is now being rolled out to six other shelters and Doctors Without Borders is also in discussions with the Department of Health about them possibly taking over the programme and extending it to more shelters.

    “Music helps people take their mind off their current situation for a brief moment and process their feelings. Music also stimulates the mind. We were glad to see how shelter residents built in other forms of creative art into the programme, some wrote a poem and others performed short skits,” says Dr Mani Thandrayen, Doctors Without Borders Medical Team Leader in Durban, adding that the programme was especially appreciated by the children.

    A high number of children are living in the shelters, and early in the response, both their parents and Doctors Without Borders' counsellors raised concerns that it is very little for them to do there. In addition to the music, Doctors Without Borders has also organized football matches and provided toys for the children.

    Climate change is expected to worsen the frequency, intensity, and impacts of some types of extreme weather events, including floodings. These events pose a rising threat to mental health and psychosocial well-being.

    We need to factor in the mental health consequences of natural disasters into our emergency planning – this is an area where innovation is needed. In many places, there are not enough trained counsellors to provide individual support to people and meet growing mental health needs. In these settings, in particular, there is increasingly going to be a need for innovative approaches that help to provide some relief.
    Sean Christie, Emergency Team Coord.