Prodjut Roy, 29, is a mental health supervisor with Doctors Without Borders/Médecins Sans Frontières (MSF). Since June, he has worked in the primary health center (PHC) in the Nayapara refugee camp in Teknaf, Bangladesh, where tens of thousands of ethnic Rohingya refugees have settled after fleeing targeted violence and persecution in Myanmar. During his time in the camp, Roy has seen first-hand the stigma associated with mental health in the Rohingya community—but also the calm that many patients find through the services of “shanti khana,” which means a place of peace.
“Sometimes they come secretly. They do not want to share that they have some problems,” said Roy. “They know their information will be kept confidential, but when we ask if they know of other people who have similar problems, they don’t want to discuss the issue. They’re keeping the problem within the family, and they’re not going to expose the problem to others.”
When a patient registers at an MSF health center, they receive an outpatient card showing the type of medical assistance sought. In a recent case at the Unchiprang primary health center, a patient’s card showed they were visiting for mental health services. The crowd-controller managing patient flow invited her to come to the mental health counseling room. Roy noticed that this made the patient extremely upset.
“The patient explained that in their community ‘mental’ means insane, ‘mental’ means crazy, ‘mental’ means mad,” said Roy. “I shared this experience with my team and asked them to not use the word ‘mental’ in the facility or the community.”
Breaking down the stigma of mental health
Staff and volunteers now use the term “shanti khana” for the counseling room. “Shanti means peace,” said Roy. “The Rohingya ... don’t like psychology, they don’t know mental health, but they like shanti khana.”
Health promotion and psychology education activities carried out by volunteers in the community have started to ease the stigma around mental health. The Nayapara primary health center has seen the number of patients seeking mental health services almost double in the last few months.
Immense mental health needs
Patients present with a mix of symptoms. The violence they experienced and witnessed has left its mark. Many suffer from post-traumatic stress disorder or acute depression. This is compounded by the daily difficulties of living in a refugee camp and uncertainty about their future.
“They have flashbacks,” said Roy. “They can’t sleep. Sometimes they experience psychosis. They can’t differentiate between the present and future. When the flashbacks come, their bodies are shivering. When they see the army of Bangladesh, they can’t differentiate it from the army of [Myanmar], so they run."
Roy remembers the particularly difficult case of a young women who was suicidal. Unfortunately, she was in the early stages of pregnancy, so was not able to take the medication that normally might have helped her. Roy and another specialist worked with her over several months to provide support and slowly saw her improve. Eventually, once it was safe to do so, the MSF psychiatrist was able to prescribe psychiatric medication to support her recovery.
“Every day we see the same patients,” said Roy. “They’re coming for a problem. They’re coming for a follow-up. And one day they’re getting better. That day is very special for us.”
All portraits in this article were taken by photographer and activist Robin Hammond as part of a six-day workshop conducted with MSF in Kutupalong refugee camp, in Bangladesh's Cox's Bazar district. Rohingya refugees were encouraged to share their stories as part of the In My World campaign to document the lives of people with mental health conditions and expand access to care.
Since August 2017, MSF has provided more than 16,000 individual mental health consultations and 18,000 group mental health sessions in Bangladesh. All MSF health facilities provide mental health services and both psychological and psychiatric services are available at all inpatient and some primary health centers. The limited availability of mental health services and particularly more advanced mental health services, including psychiatric care, in this area of Bangladesh remains a serious concern for MSF.