In Mozambique, this scenario is worsened by the shortage of specialists and the enormous distances between rural communities and health centers. But what if the answer to closing this gap was not just in large hospitals, but in the knowledge that circulates in villages and on the community floor?

In the Entrepares project, the partnership between Brazil and Mozambique (through Eduardo Mondlane University) seeks to build Participatory Mental Health that values ​​those on the front line. To understand how this is possible, we dive into Dirceu Mabunda's research, which brings fundamental lessons about care in Mozambican lands.

APEs: The Heart of Rural Care

Since 1978, Mozambique has had Elementary Polyvalent Agents (APEs). They are residents of their own communities, trained to promote health where doctors often cannot reach. Although the initial focus was on diseases such as malaria and diarrhea, Mabunda's research reveals that APEs have a positive attitude and readiness to take on mental health care, provided they receive adequate support.

The Science of Adaptation: Speaking the “Language of Life”

One of Mabunda's greatest contributions is his defense of cultural adaptation. It is not enough to “import” models from the Global North; interventions need to make sense for those who live in the territory. He highlights essential elements for this translation:

• Language and Metaphors: It is essential to use local terms, such as the concept of kufungisisa (thinking too much), to describe mental suffering in a way that the community understands and identifies with.
• Concepts and Context: the intervention must consider the interdependence between individuals and economic factors, such as the high cost of transport that prevents families from seeking treatment centers in Magude or Maputo.
• People and Partnerships: the success of care depends on horizontal alliances between health professionals, families and traditional healers.

Overcoming Barriers

For change to happen, Mabunda reinforces what holds back and what drives mental health:

• Capacity: the biggest barrier is the lack of specific mental health training for local agents.
• Opportunity: The stigma and myths that associate psychosis only with witchcraft can lead to isolation or abuse of patients by their own family. Agents can be facilitators for families to find a path to care and assistance, in addition to offering community support.
• Motivation: despite difficulties and poverty, community workers feel motivated by the sense of belonging to the community and able to spark interest in the community and among families to increase knowledge about psychosis: “This person belongs to the community, he is someone like us”.

The Future: Task-shifting and Technology

Participatory research proposes what we call task-shifting: the transfer of specific tasks from experts to trained community workers. According to Mabunda, involving local agents not only in the execution, but in defining the applicability of the research, is what guarantees that it is sustainable.

Furthermore, the use of mobile technologies (mHealth) appears as a promising tool for training and supervising these agents in remote areas.

Building a Popular Science in Mozambique means recognizing that the technical knowledge of the university only gains strength when it is combined with the life experience of APEs and families. By turning suffering into a tool for activism and social change, we are decolonizing care and ensuring that no one is left behind.

Related articles:

Decolonizing the Look: Why does mental health in the Global South need a popular science? When the community takes control of mental health. Mental Health and Decoloniality: For an Anti-Manicolonial Struggle in Brazil.