It was the end of April. Police had stopped transportation on the busy road leading to Savar; a stream of people walked along the hot, dusty road. We were all going to the same place: the site of the former Rana Plaza factory. Days before, on April 24, 2013, it had collapsed with over 3500 workers inside. Now, six days later, the rescue operation had dwindled to the recovery of the 1,116 bodies in the wreckage. Nonetheless, onlookers streamed to the site. Some protested or brought donations. Others just came to witness the worst industrial disaster in the history of Bangladesh.
Outside the factory, women holding pictures of missing loved ones wailed. As a rare foreigner, they targeted me for attention, begging me to do something. I hugged two, one under each arm – and when a camera crew noticed, I was suddenly on live TV. A journalist asked in English what I thought should be done. “These people need access to mental health care now,” I said.
I knew my words were in vain. I had come to Bangladesh months before as a Fulbright research fellow to study the mental health system – or, to phrase it more accurately, the lack thereof. Bangladesh is a nation of 163 million, of whom about one in seven have a diagnosable mental health condition at any given time. (This figure is on par with most nations.) Yet the country has just 123 psychiatrists and 40 clinical psychologists.
In some ways, the lack of mental healthcare is typical. Internationally, most mental healthcare is concentrated in wealthier countries. But Bangladesh is a particularly bad case. Its 123 psychiatrists are enough to serve just 1% of the 26 million Bangladeshis with mental health disorders – and not nearly enough to answer the need for popular education and the removal of public stigma. Per capita, it has less mental healthcare providers than Afghanistan.
Curiously, though, the interest in scaling up mental health systems in developing countries comes mostly after armed conflicts or disasters, like the collapse of Rana Plaza. (Perhaps it is because the cases of post-traumatic stress disorder some people will suffer after catastrophe are seen as an injustice requiring redress.) Across time and geography, the pattern is so clear the World Health Organization now suggests waiting for an atrocity to generate public interest in mental health system development.
Standing in front of Rana Plaza, I noticed many people acknowledged ongoing grief and trauma. Without knowing exactly what mental health care would offer, people expressed worry about the lonely women who stood near the ruin weeping. Institutional shortcomings aside, Bangladesh’s apathy towards mental health may have been cleared away with the rubble of the building.
It was a necessary awareness. The country’s main psychological research department predicted 1,000 cases of post-traumatic stress disorder (PTSD) among workers, rescuers, and families of the dead. Government officials wrote an action plan assuming only 200 PTSD cases will occur. With outreach remaining poor, it’s never been clear which was accurate.
Now, as the first anniversary of the atrocity approaches, many are well again. A Bangladeshi friend traced a typical pattern. He volunteered at the site for over a week in April. In August, he often told me about his irrational guilt, sleeplessness, and fixation on his own death. I worried over him. But by January, he was alright. For a significant portion of otherwise-healthy individuals with a reasonable level of support, PTSD sometimes remits within a year.
For those who have not sprung back, clinical care remains important. As the international corporations that sourced garments at Rana Plaza finally begin pay-outs to workers and their families, paying for mental healthcare has been overlooked. Remembering the sound of women crying in my arms last April, I know it shouldn’t be.
M. Sophia Newman, MPH, was a 2012-2013 Fulbright fellow to Bangladesh. See more of her writing at msophianewman.com.