Argentina Outreach 2001
- To promote the development and maintenance of family support organizations.
- To join with families, consumers, and mental health professionals in the promotion of best practice in mental health service delivery, based on evidence from reputable research.
To present WFSAD programs and aims at the Annual Conference of the Argentine Psychiatric Association. To meet with the executives and members of several family associations affiliated with APEF, to further the family movement and to encourage partnerships between families and professionals in Argentina. To conduct sessions to further educate and inform families.
Professor Julian Leff, Dr. Edgardo Engelmann (psychiatric conference); WFSAD Executives: Jim Crowe (president) Martha Piatigorsky, (V-P) and Diane Froggatt (Executive director, Secretary); session chairman: Diana Trumper.
Prof. Julian Leff (back row, middle) with happy volunteers and WFSAD personnel, after the symposium at the XVII International Congress of Psychiatry in Mar del Plata, Argentina, April 28, 2001.
We would like to thank Martha Piatigorsky for making all the arrangements to facilitate our visits to the four centres in Argentina and to say how much we enjoyed her company and the fruits of her efforts. We also thank Diana and Leiva Trumper for entertaining us on several occasions. It is obvious that the success of our visit depended quite heavily on the work of a dedicated group of volunteers and we would like to thank all of these for their commitment to the cause. We also thank Prof. Leff , Dr. Engelmann and Diana Trumper for their contributions at the conference. We also greatly appreciate the enthusiasm and commitment of our family organization hosts in Bs. As. Cordoba, Mar del Plata and Mendoza. It goes without saying that a special thanks is in order to Pfizer Inc. for providing the educational grant which enabled this project.
APEF HEADQUARTERS BS.AS.
Our first visit was to the offices of APEF (email@example.com) where we met with current president Diana Trumper and several APEF volunteers. The weekly session of a group of patients who come to work on art and other projects and to socialize, was in progress. Through Martha Piatigorsky's interpretation, Jim Crowe was able to converse with the group and add a touch of humour. We provided our latest materials to Diana for translation and use in whatever way seems best. We exchanged the signed copies of the agreement between WFSAD and APEF to conduct the Hispanic Outreach through our first initiative: the newsletter.
Upon our return from Mar del Plata we were privileged to address APEF Buenos Aires members at the offices of Janssen-Cilag. The meeting lasted around three hours, during which many issues faced by families were addressed and an interchange of ideas took place. Translation was provided by a new APEF member. We hope that our presence will encourage a growing membership in Bs. As. and a boost to family empowerment.
ARGENTINE PSYCHIATRIC CONFERENCE:
MODERN TREATMENT OF SCHIZOPHRENIA
Over two hundred delegates attended this WFSAD symposium which was very well received according to people polled by our volunteers. Given that 70% of Argentine psychiatrists are psychoanalysts and psychosis often goes improperly diagnosed, we were very pleased at the interest generated by the session. Diane spoke first on the contribution that families and family organizations can make to the recovery of patients and to changes in societal attitudes. Her slides were in Spanish to ensure proper understanding (simultaneous translation was operating). Prof. Julian Leff gave a brief history of work that includes families as members of the treatment team. He spoke of the damage done to the family by hostile attitudes and the need to respect families and ensure their partnership through training and education. He described his work training people to work with families and the current work of training families to work with families. Jim Crowe gave an overview of WFSAD work and showed the extent of our membership. He emphases the importance of treating the patient as a person. Jim Crowe also spoke about the strength in having families as partners in care. Strong emphasis was put on the need for including families from the first presentation. Dr. Edgardo Engelmann proposed a new sensitivity should surround the treatment of the patient, taking into account his/her needs and desires and giving the opportunity of rebuilding self esteem. He spoke of the value of psycho-education and of treating the person not the illness. Because the previous session had run overtime, the time keepers insisted we keep to the original time frame which meant that Dr. Engelmann could not give his talk in its entirety, a considerable loss to the delegates who were hearing an enlightened presentation.
It was a shame that Pfizer Argentina was unaware that Pfizer Inc. in New York were sponsoring this symposium. Had communication been what it should have been, Pfizer Argentina would have been very happy to foot some of the immediate expenses surrounding the advertising of the session. As it was Janssen-Cilag sponsored the advertisement and Pfizer provided handouts for our audience from the material provided. APEF volunteers did an amazing job of selling the session to delegates and it was useful that the session was on the second day as it gave them the time to do this. We sincerely thank Joan and Juanita and their colleagues.
It was unfortunate that the conference organisms omitted Professor Leffs name from the special guest list in the program. In addition there was a spelling error of our name! When informed, the conference chairman was very apologetic and invited us to the presidential suite in the conference hotel for introductions. While we were waiting, Gabriela Navarra, the health reporter from Argentinas national newspaper La Nacion, arrived and upon finding out who we were she interviewed us for about 20 minutes and took pictures. A week later a quarter page article appeared in the paper. As a result of this article, which gave email addresses, APEF has received a large number of calls from interested persons and persons needing support. A copy of the article, for those who read Spanish, is available upon request. A particular issue which Navarra addresses is the widespread habit of restricting the visits of family when a person is admitted to hospital.
At conference end we all enjoyed a sumptuous buffet dinner at a local restaurant!
MAR DEL PLATA GROUP MEETING
We were very pleased to be able to take part in a family group session in Mar del Plata. At first families directed all their questions to Dr. Leff, but as the meeting progressed, the true spirit of self help emerged as members of the group gave their experiences and made suggestions or gave advice to others. There were people present with some very difficult situations. Resolving a multitude of problems takes time and fortunately the group is now thoroughly established thanks to a local social workers perseverance and enthusiasm. Home made hot pastries and wine prepared by the volunteers were served afterwards to the delight of the participants.
We were met at the airport by Dr. Raimundo Muscellini, who spearheads the group ACAPEF (Asociacion Cordobesa de Ayuda a la Persona Portadora de Esquizofrenia y su Familia; firstname.lastname@example.org or email@example.com).
Cordoba has a population of 1 million. There are 9 hospitals. There are 800 beds in the Oliva psychiatric hospital and 500 beds in the Santa Maria psychiatric hospital. There are 200 beds for the mentally retarded in Belleville.
We understood that there were 1,000 members of ACAPEF. Because Cordoba is centrally located many people come from the surrounding rural areas. The groups meet every Saturday. They are pursuing early psychosis interventions. Dr. Mouscellini and his wife Maria Contreras have written a book: Calidad de Vida en Patientes Esquizofrenicos which espouses the work of many of the worlds leading psychiatrists. The psychiatric group has completely up to date modern ideas about treatment.
There are 900 psychiatrists. Over 50% (600) are psychoanalysts. "We are all neurotic; no one has psychosis", said Dr. Muscellini. Patients with Schizophrenia are often treated by psychoanalysts, sometimes going 3 times a week for treatment. The School of Psychologists are all Freudian.
Maria Contreras is working as a psychologist in clubhouse with rehabilitation. Colleagues cannot understand why she is not working in a hospital with schizophrenia patients. When she mentioned the Anderson tests for positive and negative symptoms her teacher did not know what that was.
We ran into a Canadian State Visit by the Governor General of Canada and had a chance to drop a note off to the GG (Her Excellency Adrienne Clarkson) and to talk to some of the delegation. There was no time to meet with her because of the tight schedule (both hers and ours). We did, however, meet her husband, the author John Ralston Saul, who spoke about the psychoanalytical framework of mental health in Argentina and wished us luck!
The public meeting at which we presented took place at a local auditorium where we were on the platform and flanked by Dr. Muscellini and the president of ACAPEF. Over 100 persons attended. We provided three WFSAD pamphlets in Spanish: How to Behave; Schizophrenia: the myths, signs and statistics and Maintaining your own health for families. We were presented with copies of the first newsletter of the group.
Crowe and Froggatt gave short introductory presentations and invited questions from the audience. Piatigorsky translated as did an ACAPEF volunteer, Beatriz Romero.
It is clear that no government help is given in the provision of housing or clubhouses and that families do not know their rights as regards disability. We encouraged them to research this area and not to be discouraged because government was not listening; a lot could be done simply by the will of the families. The eternal question of what to do when someone doesnt realize they are ill and/or will not take the medication was raised. While we made suggestions, we pointed out that this was a question that had no definite solution. That the family may not be able to pay for continuation of the newer medications once the patient is out of hospital was another issued. We did not go into insurance issues or the other many problems, but urged families that they were their relatives best advocates as a group.
ACAPEF is extremely well developed. After the public meeting, we met with the founding president Patricio Ortiz, Gerardo Bergoglio and other executive members of the group during an unbelievable Argentine barbecue where six courses of beef were served! The barbecue was held in ACAPEF offices which are used as a clubhouse and were therefore ample for the 60 people having dinner. Many of the patients/ consumer members of this group were receiving treatment from Dr. Muscellini or his colleagues.
Mendoza is further west and south than Cordoba in the foothills of the Andes. Santiago, Chile is just over the Andes from Mendoza.
The Mendoza group has been going since around 1994 with Ema Fagale at the head. Recently Ema suffered some ill health, which has made her aware of the need to delegate authority and the need to build a strong executive. Ema was not able to give us any statistical information about her region, so we are not able to give you any local statistics of care. However, we did learn that there were several housing initiatives in Mendoza which was encouraging.
The meeting was in two parts and lasted all afternoon. We began, as is usual, with Jim and I giving brief introductory talks followed by question and answer sessions. In the second session we fully discussed the issue of building and developing the group and exchanged ideas with the members on ways to do this. While most of the people at the meeting (about 75 people) were families, there was a social worker family member and a woman psychiatrist, who we feel will be helpful for the future of the group. In addition, two or three well informed members made their views known and we feel that we were a catalyst for progress. The following day we received a letter from Ema thanking us for the leadership we had provided and looking forward to adopting some of our suggestionse.g. separating support group from executive group so that those who wish to be advocates or to do projects can do them outside the support framework.
HOUSING INITIATIVE, BUENOS AIRES: APROA
On separate occasions during our stay Jim and I visited APROA, the residence for 10 people with mental illness run by Martha Piatigorsky and her husband Teo, who is Executive Director (firstname.lastname@example.org) The house operates out of two, four-bedroom apartments on adjacent floors in an apartment building. The kitchen and dining room for all the residents is in one apartment while the laundry facilities are contained in the other. Some of the residents share their rooms, while others have the smaller single bedrooms. We met the cook and several of the residents who seem very comfortable in their accommodation. The landlord of the apartment building is so pleased with his tenants that he has offered APROA another apartment! The apartment building is well situated in the embassy section of Buenos Aires with parks and monuments surrounding. This initiative has no funding source other than that of the rent paid by the residents families.
Footnote: Later in 2001 we had an opportunity to sponsor a return visit to Buenos Aires and APEF for Professor Julian Leff. He gave workshops to packed meeting rooms of family members during November 2001.
Jim Crowe President
Diane Froggatt Executive Director, Secretary