Perspectives of the Sierra
Living with mental illnesses in rural communities of Chiapas, Mexico.
Photography as a means of self-exploration and empowerment.
Our mission is to fight against mental health related stigma
Stigma towards people suffering from mental health illness is a negative label that isolates and dehumanizes members of society. Stigma is also a major barrier to finding treatments, leaving those with mental health illnesses isolated from support networks and professional care, and thus worsening their condition.
The project
Perspectives of the Sierra is a collaboration between Compañeros en Salud/Partners in Health Mexico (CES/PIH), the London School of Hygiene and Tropical Medicine and an independent photographer. We seek to reduce stigma through the empowerment of people living with mental disorders in the rural communities of the Sierra Chiapaneca. To this end, we designed an intervention based on the Photovoice methodology to:
- Facilitate participants reflections about their positive and negative experiences of living with a mental illness.
- Support participants in the process of generating images to express their reflections and sharing them with peers and family members.
- Generate safe environments to have open discussions about experiences with mental illnesses mediated by these images.
- Evaluate the effect of the intervention on the perceptions and attitudes of participants and their families towards mental illnesses.
We value the perspective of each participant and provide platform for self-guided reflection, reconciliation and group dialogue.
The Communities
Chiapas is the poorest State in Mexico with 75% of its population living below the poverty line. This project was undertaken in four communities: Honduras, La Soledad, Capitán and Monterrey. All of them are located in the Sierra Madre of Chiapas, 7 hours away from the State capital. Each one has a population of between 1500 and 2000 inhabitants.
This region is located far from the tourist area of Chiapas and it is very difficult to access. People here mainly cultivate coffee, the economic pillar of the region. Beans, rice and tortillas make an essential part of the daily diet; the majority of men work the fields and the majority of the women do housework.
These are four of the ten communities in which the organization PIH/CES provides medical staff, medications and other support to local government health clinics. The most common conditions in these communities are infectious and chronic illnesses and mental disorders. It is estimated that the prevalence of depression in these communities reaches 7.8%, and it is among the ten primary reasons for consultation in the clinics. There are currently 288 patients receiving treatment for depression, 32 for schizophrenia and 56 for anxiety. Resources to address mental illnesses in the state are extremely limited. There are few psychologists, less than 1 psychiatrist per 100,000 people, one psychiatric hospital and one unit of outpatient services, all of which are at least 6 hours away from these communities.
The lack of support and services for patients with mental disorders, the rejection they suffer coupled with the impact of poverty mean that these group of patients are highly vulnerable. Therefore efforts to encourage dialogue and strengthen support networks have a particularly great impact.
The Workshop
The course had theoretical and practical sessions designed to provide the participants with the basic tools and knowledge to explore new creative processes and tell their own stories through a new language.
Each participant was given a camera (for the two week duration of the project) and instruction on how to use it and to develop a photography project.
“I had never used a camera before. I loved it. To take photos of nature, relatives, animals. I liked the attention you gave to us.” Participant, aged 62.
Week 1: One Group session per day
Session 1: Welcome
Session 2: Introduction to Photography
Session 3: Who am I? Exercises on self-awareness
Session 4: What is depression and anxiety?
Session 5: My photography project
Week 2: A daily visit at home for individual project development support
Week 3: Final presentations
Each participant presented their final project in front of the group and their families.
Fifty printed photographs were given to each participant on the final day.
“It was nice to use a camera and I never thought you could do all this with photos … Making a story with the photos and realizing that we do not all think the same about the disease.” Wendy G., aged 17.
The Results
- 70% of the participants had never used a camera before.
- Most patients changed their perceptions about mental health.
- At least one family member accompanied each of the participants in the final presentation. Relatives said that they learned something they did not know about their family member and now have a better understanding of their illness.
- All the participants said that they enjoyed using a camera and most would like to continue taking photos.
- The level of stigma decreased for 78% of participants.
- Participants reported that: they felt less anxious about telling people they received psychological treatment, they felt less lonely, they would be more willing to say they had mental health problems when applying for a job, and they now feel stronger for having mental health problems.
“I see my depression in a more relaxed way.” Francisca C., aged 42.
See the stories of our participants:
Click here to GO TO HONDURAS
Click here to GO TO SOLEDAD
Click here to GO TO CAPITAN
Click here to GO TO MONTERREY
Our Team
From left to right:
Fátima Rodríguez is a general doctor graduated from the Faculty of Medicine of the National University of Mexico. She worked for 3 years as a Histology Instructor at the Department of Cellular and Tissue Biology at the same university. From a very young age she got involved in medical brigades and visits to marginalized communities in the country where she approached a reality where access to health and resources were limited. These facts led her to make her year of social service in rural communities of Chiapas in collaboration with Partners in Health Mexico. A little more than a year ago she started working for this same organization where she is the current Coordinator of the Mental Health department and one of the Clinical Supervisors.
Her objectives are to get more training to improve its clinical, diagnostic and therapeutic skills and contribute to deliver quality medical care, especially to people living with mental illness, regardless of their context of precariousness. Her interest is to continue making Global Health a way of life, in Mexico and in other parts of the world.
Coordinator of the Mental Health Program, Partners in Health, Contact: fatimarodriguez@pih.org
Camila Jurado, is a graduate of the BA on Media and Communications at Goldsmiths University of London and has a Master’s Degree in History and Theory of Photography from Sotheby’s Institute of Art London. Being both a historian and a photographer, her work has become not only the production of images but also the production of content towards the reflection, interpretation and investigation of the photographic image and the place it occupies in contemporary culture.
Her personal work is primarily documentary photography and has focused on various social and cultural issues around the world. Her passion is to use photography as a vehicle to tell stories, engage in conversations between outer and inner worlds, a tool for making connections, asking questions and generate emotions.
Contact: camilajurado@me.com
Georgina Miguel Esponda, studied psychology at the Universidad Iberoamericana and later completed a master’s degree in Global Mental Health at the London School of Hygiene and Tropical Medicine, where she is currently completing a PhD in Epidemiology and Population Health. She has collaborated in research projects and mental health promotion projects in different NGOs and government institutions in New York, Mexico City and Chiapas.
Currently, her main interest is the improvement of access to quality mental health services, especially in areas where there is a high need for specialists and where the prevalence of mental illness is high due to the impact of poverty and other social problems. As a person who has suffered from depression herself, the fight against stigma is a professional passion but mainly personal, which she hopes to keep sharing with many people around the world.
Contact: georgina.miguel-esponda@lshtm.ac.uk
Sarah Hartman is a volunteer in Partners in Health Mexico working on the evaluation and implementation of mental health programs. She studied Anthropology and Public Health at Tufts University in Massachusetts, U.S.A. After college she spent a year with the Jesuit Volunteer Corps on the low-income mental health program in Washington DC, facilitating therapeutic courses. She also has experience with culture and mental health research with Clark University. She earned a Master’s degree in Global Mental Health from the London School of Hygiene and Tropical Medicine and King’s College.
She learned about Partners In Health as a volunteer in Haiti during high school and college. She was always struck by their mission of equity in global health and social justice. She is very grateful to be working with PIH.
Contact: shartman@companerosensalud.mx
Special thanks
Thanks to Partners in Health for supporting us both with their local knowledge and logistics.
Thanks to the Public Engagement Grants Programme of the London School of Hygiene and Tropical Medicine for their support to make this project possible.
Thanks to Harvey Aspeling-Jones for his support and research.
Thanks to Sara Evans-Lacko for her support and advice on the design of this project.
A special thanks to Rubén Balcázar Zepeda, Jesús León Reyes, Zugary Lima Tellez, Edgar Morales Cortes, Nicolás Pedroza Mendoza y Omar Rodríguez Juárez for facilitating the workshops in the communities of Capitán and Monterrey.
