By Sr Anne Carbon SSC

Sister Anne, a psychiatric nurse by profession, is a Columban Sister form Cagayan de Oro. Misyon has featured a number of her articles about her missionary work in Peru. 

On 10 October 2008, World Mental Health Day, the Commission on Mental Health of Ayacucho celebrated its fifth anniversary. Looking back on those five years, I cannot but thank God for the many advances that have made it possible for us to initiate and carry forward different programs at our clinic.

The Ayacucho Mental Health clinic represents an effort to address the striking absence of mental healthcare in rural areas of the less–developed world. According to a recent report of the World Health Organization (WHO), between 76.3% and 85.4% of the seriously mentally ill in developing countries had received no treatment in the twelve months prior to its survey. In another document WHO reported that the majority of the world’s 450 million suffering from neuropsychiatric disorders live in developing countries and that fewer than ten percent have access to psychiatric treatment.

The mountainous farming region of southern Peru where people tend small plots of land or herd alpacas and sheep was the epicentre of brutal violence between Maoist insurgents and the military in the 1980s and early 1990s. The Truth and Reconciliation Commission set up in 2001 estimated that 69,000 people died in the violence. Most were poor, Quechua-speaking peasant farmers in Ayacucho and neighbouring regions. 

The survivors have been left to deal with having witnessed the murder of spouses, parents, children and neighbors, seeing their farms and belongings burned, or searching fruitlessly for loved ones taken away by soldiers or Maoist insurgents.

Data gathered in 2002 showed high rates of mental illness in highland areas that had been affected by political violence, with problems ranging from alcoholism, depression, post-traumatic stress disorder and anxiety to schizophrenic and suicide. Often all are related to high levels of domestic violence.

The Commission on Truth and Reconciliation recommended that education and mental health care be provided to people affected by the violence, and it took up the cause later in 2003.

The Clinic

After spending a year working in Instituto Especializado de Salud Mental ‘Honorio  Delgado-Hideyo Noguchi’, Noguchi Psychiatric Hospital, in Lima, I opened a psychiatric clinic in Ayacucho in October 2003. This was done in coordination with local religious and lay groups. We began with minimal supplies, a volunteer nursing staff and a volunteer psychiatrist from Lima. 

The clinic provides a mental health service to an area of the Peruvian Andes that, like most of the rural developing world, has never had access to such. The clinic, operated in a non-denominational manner, is supported by volunteer psychiatrists from Lima and US psychiatrists associated with the Peruvian-American Medical Society, which also provides technical and some financial support. The clinic serves more than 2,000 patients in Ayacucho and neighboring provinces, providing psychiatric evaluation, treatment and rehabilitation. Treatment includes pharmacology, individual and group psychotherapy, an alcohol- and substance-abuse program, a program for mentally-challenged children and adolescents. 

A schizophrenic rehabilitation program includes individual, group, family and multifamily therapy sessions, occupational training and other activities, including weaving, manual work, jewellery-making, carpentry and computer training. The aim is to help the participants recover capabilities that they have lost and reinsert themselves in society. Every small step forward by a patient is a cause for celebration. 

Within the city of Huamanga, we serve individuals who are able to come to the clinic, as well as residents of the local nursing home, the orphanage and the prison. We also make home visits to mentally ill individuals who are unable to come to the clinic. 

When a new patient arrives, a team member visits the person`s home and talks with family members to gain their commitment to help and support him or her. This is a condition for treatment. We don’t have a place for patients to stay. Eighty percent of recovery depends on the family, ten percent on the rehabilitation and ten percent on medication.

However, relatives are often the first to deny there`s a problem. Acute cases sometimes require hospitalization. But the local hospital, where a psychiatric ward is still on the drawing board, often turns patients away or insists that a nurse from the Commission stay with the patient overnight. While this puts one more demand on an already overburdened team, the young nurses, all of whom speak Quechua, are from Ayacucho, and were children when the political violence was at its peak, take it in stride.

Some of the people who seek help have been wandering the streets of Ayacucho. A few have been brought by bus from distant villages by family members who tied or chained their hands and feet to control them during the trip. Most people would be afraid of these patients, but not so here at the clinic. We treat them as we would any other human being and restore their functional and social abilities.

When we started, mental health was a taboo topic and that is one of the reasons that we face the dual challenge of trying to raise awareness about the problem and at the same time provide treatment. We give presentations on mental health awareness in local schools, at fairs and to groups of parents. With the commitment of local professionals and religious groups we are able to make a large part of the population aware of the importance of good mental health. We believe that without mental health, there is no health.

I would like to express my heartfelt gratitude to the many generous people who have helped us all these years. Without your support, we would not be able to achieve and improve the quality of life of many people here in Ayacucho.

You may email Sister Anne at