MCF currently operates in three regions of West and Central Africa: Around Bouaké in central Côte d’Ivoire, around Piéla in Burkina Faso and in Cameroon in a district south-east of the capital Yaoundé. We are also working on a project on the Lesser Sunda Island of Flores, which belongs to the Indonesian province of East Nusa Tenggara.
All four projects are featured below.
Ivory Coast
In the surroundings of Bouaké, the second largest city in Côte d’Ivoire, we support the SAMENTACOM project, in collaboration with the local university and the National Program for Psychiatry.
For the current state of affairs read the activity report for the years 2019/2020
It is led by a dedicated psychiatry professor, Prof. Asseman Médard Koua, and aims to establish a care network for people with mental and epileptic illnesses and psychosocial disabilities in the surrounding rural regions. Central to the concept is the outpatient psychiatric work in cooperation with the existing health stations, which are at the forefront but are not yet equipped for the treatment of this patient group. For this reason, nurses and other helpers are trained in the rural health stations and trained to diagnose and treat these diseases.
Staff of the health posts, which mediate contact between the health centers and the villages (Agents de Santé), but have only little training themselves, are to be trained to visit people with mental illnesses and epilepsy in the villages, offer them treatment and continue to accompany them. In addition, the information and counselling of relatives and village communities is important in order to enable a different view of these diseases and to promote the integration of the patients into their familiar social environment. Self-help groups are also initiated and supported within the framework of this project.
The SAMENTACOM project is to be gradually extended to the entire Ivory Coast, which will certainly take many years. Regular contacts are therefore maintained with the local and regional health authorities and the national health ministry, which will also be kept informed of the progress of the project. On the one hand, we would like to show that psychiatric help is also possible with limited resources. On the other hand, we would like to try to draw the attention of the Ivorian state to its responsibility for mental health and the observance of human rights.
In preparation for this project, MCF members were already in Bouaké and the surrounding rural areas in 2018, where they saw the plight of the sick, isolated in the village communities and often living outside in so-called Camps de Prière (CdP)-prayer camps. The prayer camps are villages with religious offerings, which usually accept mentally and epileptically ill people for payment, mostly for long periods of time, even against their will concerned at the request of their relatives. Mental illnesses and epilepsy are here interpreted religiously as obsession by evil spirits, and so the treatment consists of prayers and sometimes also of torture to which the sick are subjected in order to drive the evil spirits out of them. To force the patients not to run away or cause damage they are often chained to trees in the open air, in many cases for years. The path of the patients usually leads via healers who practice traditional medicine to the prayer camps, which are mostly evangelically oriented, with traditional religious elements playing a more or less important role. In view of the helplessness of many relatives in dealing with mental illnesses, the accommodation of the sick in prayer camps often seems to them to be the only possible solution. The Camps de Prière are therefore of central importance, and the development of constructive cooperation with them is an opportunity for the development of psychiatric care in West Africa. We are convinced that the superstition and exclusion of the mentally ill will diminish as good help becomes visible and tangible.
A pilot study covered a total of 71 Camps de Prière in the Bouaké area, 40 of which were studied. This was documented. In a further step, all Camps de Prière in Côte d’Ivoire will be recorded and selectively investigated.
The project is working with the national pharmaceutical authority to develop the supply of medicine to the centers.
Our last project visit took place in March 2024.
Burkina Faso
All over West Africa (and not only there) psychologically ill people are excluded and locked away. This also is happening daily in Burkina Faso. The pastor and musician Tankpari Guitanga has watched the misery for a long time and then decided to help himself. In May 2015, he founded the aid organization Yenfaabima e.V., and began his work in a small rented house in the community of Piéla in the east of Burkina Faso.
Initially, 40 people came for monthly psychiatric consultations, but the centers‘ offer is spreading quickly and was broadcasted on the radio. There are several hundred mentally ill people who often find their way to Piéla from afar every month and are treated there. The nurses who treated the mentally ill, who held the monthly consultation hours lasting several days, have so far travelled from the capital Ouagadougou and from Ouahiguya, 360 kilometers away. With our financial support, one of the nurses — Timothée Tindano — was offered the opportunity to work directly in Piela, so that he no longer has to travel hundreds of kilometers. He has gladly accepted this offer and will use part of his work to contact the surrounding health centers and train the local nurses and agents de Santé. He is also supposed to inform the local authorities about the situation of mentally ill people, visit Camps de Prière and motivate them to cooperate.
Read case reports and more of the work of Yenfaabima here.
Cameroon: Hand on Heart
Hand on Heart Cameroon (HoH) is a non-profit organization dedicated to improving mental health care and raising awareness about mental health in Cameroon. The organization was founded by Sandrine Tchouamou Magwa, inspired by her personal experience with mental health challenges in her family.
The situation in Cameroon: severe lack of treatment and counseling for those affected and their families
Cameroon is located in Central Africa, with an area of 475,442 km² (Germany: 357,588 km²) and a population of around 28 million. On the Human Development Index, Cameroon ranks 151st out of 193 countries (Côte d’Ivoire 166th, Burkina Faso 185th, Indonesia 112th)¹. The state only spends around 1% of the total health budget on mental health² (Germany: 13.1%)³.
In Cameroon, people with mental illness and their families face considerable challenges. There is widespread stigmatization and a serious lack of counselling, psychiatric and psychotherapeutic services. Primary mental health care in the country is provided by only a handful of specialized facilities and qualified professionals, most of them concentrated in the two largest cities, Yaoundé and Douala.
This alarming situation underlines the need for active mental health initiatives and awareness campaigns in Cameroon.
Hand on Heart Cameroon helps through treatment, education and destigmatization
HoH’s main activities include educational and awareness campaigns to inform the public about mental health and well-being. HoH organizes events such as World Mental Health Day to raise awareness in the community. In addition, HoH works to establish help-centers for people in need of mental health support and to improve access to affordable mental health care, including counseling and medication.
Training mental health professionals and networking with research institutions in the country
Another central concern of HoH is the networking, training and support of professionals in the field of mental health. By training new professionals and providing workshops and resources for existing professionals, HoH aims to improve the quality of mental health care in Cameroon.
In addition, HoH plans to collaborate with local universities and research institutions to collect comprehensive data on mental health and diseases in Cameroon. This data will be used to call for better policy frameworks and appropriate resource allocation.
Pilot 2024: New mental health unit in rural district hospital
In collaboration with the Mindful Change Foundation, HoH is establishing a six-month pilot project in Mfou, a rural district in Cameroon southeast of the capital Yaoundé, until the end of 2024.
With a total financial volume of EUR 11,500, this project aims to expand the local public district hospital to include a mental health department. This department not only provides direct patient care, but also serves as a training center for local healthcare staff and as a basis for awareness campaigns in the surrounding villages.
This pilot programme is expected to see around 500 patients by the end of the year. The project is led by Jules Gomina, the clinical psychologist of the HoH team, and involves another clinical psychologist, a mental health nurse, a project manager for awareness campaigns and the staff of the hospital as well as the local Red Cross, who will be trained accordingly as part of this project.
After completion, the project will be evaluated to determine the extent to which a follow-up model can be developed for similar collaborations with rural hospitals in other regions of Cameroon.
Together with the Mindful Change Foundation, the aim of Hand on Heart Cameroon is not only to provide immediate help, but also to work in the long term to improve the framework conditions for the mental health of the population in the country.
¹ United Nations Development Programme (UNDP) 2024
² World Health Organization (WHO) 2020
³ World Health Organization (WHO) 2020
Indonesia: Flores
On the island of Flores, part of the Indonesian province of East Nusa Tenggara (NTT), people with mental illness and their families face enormous challenges due to widespread stigmatization and limited access to mental health care. The island covers an area of approximately 13,540 km² and is home to around two million people. Mental health care is mainly accessible in larger cities, while it is almost non-existent in rural areas. In 2024, there are three psychiatrists working in two cities (Maumere, Labuan Bajo), while the nearest psychiatric hospitals are located on the neighboring islands (Bali or West Timor).
Serious shortcomings in mental health care
In Indonesia, shackling people with mental illnesses with clamps or locking them in confined spaces is known as “pasung” — a method that is the last resort for many families and communities. This occurs due to the difficulty of accessing mental health services, pressure from family and society, and the widespread misconception that this is the only way to restrain aggressive behavior.¹
This belief is deeply ingrained in family members and community leaders who have limited or no knowledge of mental illnesses and disorders and often believe that they are caused by demonic influences. These culturally-held beliefs often lead to a preference for traditional cures over medical treatments, reinforcing stigma and making access to appropriate care more difficult. Despite the urgent need, the Indonesian government invests less than 1% of its health budget in mental health, reflecting broader socio-economic challenges.² Indonesia ranks 112th out of 193 countries on the Human Development Index, highlighting the significant socio-economic barriers that contribute to inadequate care for those affected.
The alarming situation on Flores underscores the urgent need for targeted interventions in the area of mental health care and prompted the Mindful Change Foundation to launch a comprehensive program.
Community-based training in the field of mental health
Given the relevance of local knowledge and community support in Flores, the program together with the Mindful Change Foundation includes specialized training for lay people. A key focus is to provide basic mental health knowledge to those without the appropriate training to improve their understanding and response. These individuals, who are often the first contact persons for people with mental health problems, are equipped with essential skills to provide basic psychological support, recognize symptoms of mental illness and guide them to appropriate treatment. This training not only strengthens the community’s ability to respond to mental health needs, but also creates a more supportive environment for those affected.
Empowerment and securing livelihoods through pig farming
A unique feature of the program is to integrate livelihood measures as a form of self-empowerment. Pigs, which are a valuable resource on Flores, are given to former Pasung patients who can raise them and use them to improve their economic situation. This initiative aims to reduce the stigma that often accompanies mental health problems by providing economic stability to those affected and their families. The pigs are symbolic of a sustainable approach to mental health care that combines well-being with economic growth and community development.
¹ I. Irwanto, A. Parawita, A. Boeckenfoerde, et al.; 1 March 2020; The Lancet Psychiatry; Volume: 7 (3), E11,
² Australian National University (ANU) 2021
³ Federal Ministry for Economic Cooperation and Development (BMZ) 2024