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Government of the Islamic Republic of Afghanistan FIRST INTERCOUNTRY CONFEERENCE ON PSYCHOSOCIAL REHABILITATION

Hosted by the Ministry of Public Health And the Afghanistan Disability Support Programme

CONFERENCE REPORT Kabul Afghanistan: 14-15 December 2010

CONFERENCE REPORT First Inter-country Conference on Psychosocial Rehabilitation 2010


Introduction
On December 14, Afghanistans Ministry of Public Health (MOPH) and the Mine Action Coordination Center of Afghanistan jointly sponsored the First Inter-country Conference on Psychosocial Rehabilitation at Kabul Hotel in Kabul. Her Excellency Minister of Public Health Dr. Surya Dalil and Deputy Minister of Labor, Social Affairs, Martyrs and Disabled Mrs. Suryah Paikan welcomed the approximately 80 participants who attended the two-day Conference, including honorable guests from the neighboring country Tajikistan, Dr. Reykhan MUMINOVA and Mr. Zainiddin RASULOV from Tajikistan Mine Action Centre (TMAC), representative from Tajikistan Ministry of Labor and Social Protection Mrs. Soima MUHABBATOVA, professor of psychology from Tajik National University, Mr. DAVLATOV Mahmadullo, Dr. Zainiddin SAFAROV from National Research Institute of Rehabilitation for persons with disabilities and Mrs. Aydulan KHUJAMKULOVA from the Tajik Sport Federation for the persons with disabilities Paralympics. Doctors and other health professionals from the Afghanistan Mental Health Taskforce including Health Net-TPO (HNI), International Assistance Mission (IAM), Mental Health Hospital, Windows for Life (WFL), HOSA, Medical Mondial, and AADA. Disability stakeholders, Mine Action Centre for Afghanistan, Swedish Committee for Afghanistan, Handicap International (HI), SERVE, AABRAR, DAO, and Family Welfare Focus also attended the conference. On the second day of the conference after presentations and discussions of core elements of psychosocial rehabilitation, identification of gaps and needs in the services and coordination and cooperation between Afghanistan and Tajikistan on Psychosocial Rehabilitation, Dr. Sayed Azimi, MoPH Mental Health Advisor and one of the two psychiatrists in the country and Dr. Reykhan Muminova from Tajikistan played a vital role in shaping the conference agenda. The Mental Health and Drug Demand Reduction department of MoPH members including Dr. Alia Ibrahim Zai and Dr. Bashir Sarwari and Dr. Razi Khan Hamdard from Disability Unit of MOPH were critical to the success of the conference. The following provides a summary of each of the Conference sessions, as well as a transcription of the recommendations presented by participants at the end of the Conference. The full Conference agenda is available at Addendum B. The participant list (including registered participants only) is available at Addendum C

Tuesday 14th December 2010


Welcome and Introduction
The conference was started by recitation of verses from the Holy Quran by Mr. Zabiullah Haider. The the national anthem was played by a group of girls performing in sign language from Family Welfare Focus (FWF) Organization. Dr. Jameel Abdulmatten the conference announcer from WFL welcomed all the participants. Mrs. Frozan Esmati, Mental Health Consultant for MACCA welcomed the participants and reviewed the conference objectives as follows: 1. To share current situations of psycho-social problems, rehabilitation services and opportunities available for persons with disabilities, including landmine/ERW survivors in Tajikistan and Afghanistan. 2. To identify the gaps and needs for psycho-social rehabilitation services in Afghanistan and Tajikistan. 3. To create close coordination and cooperation between Afghanistan and Tajikistan Mental Health and Disability Departments, Victim Assistance Programs in regards to improve psycho-social rehabilitation services for persons with disabilities/landmine survivors. 4. To agree on the way forward/methods for collaboration between the two neighboring countries and the region for future consultations and development of psycho-social rehabilitation services for persons with disabilities, including landmine survivors. 5. Continue to identify and utilize opportunities to enhance bilateral exchanges between neighboring countries (Afghanistan and Tajikistan) and to share national experiences, training materials, good practices, and existing opportunities between two countries and build capacities to enhance VA-related activities. She then briefly reviewed the conference agenda for the two days. See Addendum A.

Speech by H.E. MINISTER SURAYA DALIL, Minister of Public Health


Her Excellency Dr. Suraya Dalil after officially opened the conference and after welcoming the participants she highlight the following points: Disability and mental health are interconnected phenomena that not only affects individuals but they also affect families and societies. She also mentioned that mental disorders are the most disabling disorders in the world and they are the are among the most reasons for years lost in disability .She further noted that depression is the most common especially among women. Dr. Suraya mentioned that the prevalence of symptoms of mental disorders in the country is high and they are much higher among people with disability. She ended her speech by asking more donors support to mental health and to mental health of individuals with disability. She also requested the

experts in the conference to come out with a plan for psychosocial rehabilitation that is cost effective and is practical. For Dr. Surya Dalils full speech please refer to Addendum B.

Speech by H.E. DEPUTY MINISTER SURAYA PAIKAN, Ministry of Labour, Social Affairs, Martyrs Families and Disability
H.E. Mrs. Paikan after welcoming the participants mentioned the following issues: Psychosocial rehabilitation is a very broad concept that needs cooperation of many ministries together and it cannot solely be done by ministry of public health. She also mentioned that a Survey is needed to be conducted in this area so that exact figures are obtained and hence policies are made accordingly. At the end she requested her Excellency Dr. Suraya Dalil acting minister of ministry of public health to pay more attention to this issue. For a copy of H.E. Mrs. Paikans speech please refer to Addendum A.

Speech by DR. RAZI KHAN HAMDARD, MACCA Advisor to the MoPH Disability and Rehabilitation Department
Dr. Razi Khan after welcoming the participants gave a brief speech on behalf of Mine Action Centre for Afghanistan. He mentioned MACCAs financial support to this conference.

General Situation of Mental Health and Psychosocial Rehabilitation in Afghanistan


DR. ALIA IBRAHIMZAI (MOPH) started her presentation by giving the summary of the result of researches which have been conducted on mental health in Afghanistan. She summarized that there are high prevalence of anxiety and depression among Afghan Population and even higher levels among people with disability. She then presented the current status of services in mental health in Afghanistan. She stated that (according to WHO atlas 2005) there are: 8 psychiatrist 20 psychologist 15 psychiatric nurses

Mental Services Mental Health Hospital Psychiatric wards Total MH Beds MH outpatient centers Day Care centers 1 3 180 9 1

She finalized her presentation by stating the following gaps in the current mental health services: Lack of human resources Lack of financial support to mental health Lack of public awareness on mental health and mental illnesses Lack of psychosocial rehabilitation services

Mrs. Frozan Esmati, MACCA Clinical Psychologist-Mental Health Advisor started her presentation by stating that there are very limited services which have been conducted on psychosocial rehabilitation services in Afghanistan. She briefly presented the Psychosocial Rehabilitation resource book which has been developed and the training which have been conducted so far. She stated that so far there are three training have been conducted in Afghanistan. One training was conducted for CBR staffs in Takhar province followed by another training for CBR staffs in Jalalabad and then a training of trainers in Kabul. However she finalized her presentation by the following statements: The trainings were not followed up due to lack of resources:

Lack of Human Resources Unavailability of Fund Lack of a structured program on Psychosocial Rehabilitation

Current Situation of Mental Health System in Tajikistan


Dr. Reykhan, PHD Medicine is a psychiatrist graduated from Tajik State Medical University with specialization in neurology and psychiatry. She worked as a psychiatrist for Tajikistans National Research Institute of Expertise and Rehabilitation of Persons with Disabilities where she started her research devoted to landmine survivors and their quality of life. She authored more than 20 scientific articles in different medical journals and research papers published in Tajikistan and abroad. She has worked for TMAC since May 2006, and has significantly contributed to its surveys and victim-assistance activities. Dr. Reykhan holds a PhD in psychiatry and medical-social expertise and rehabilitation of persons with disabilities. Dr. Reykhan started her presentation by introducing the status of mental health Policy and Legislative Framework in Tajikistan. She stated that, the law of the RT on Psychiatric Care was developed in 2002. However, there is no Strategy or Policy on mental health in Tajikistan and also there is no department on mental health in the Ministry of Health of RT. She also emphasized that there is lack of funding from international organizations towards mental health and of all the expenditures by the government health department only 1% of healthcare expenditures was spent on mental health, Of all the expenditures spent on mental health, 84% of them directed towards mental hospitals (Used source: WHO-AIMS Report on Mental Health System in the Republic of Tajikistan, Dushanbe, 2009): Dr. Reykhan also mentioned that mental health in Tajikistan is still institutionalized, mental health specialists are less paid and there is very weak awareness of society on mental health issues. On the current status of service provision she highlighted the following points: (Health of population and activities of health facilities in 2009, Dushanbe, 2010, Ministry of Health Republic of Tajikistan, Republican Center of statistics.) 53 outpatient mental health facilities 1Republican MH Centre for Children and Adolescents (out-patient services for 30 beds). Psychiatric cabinets exist within the district (not all the cabinets have psychiatrists). 15 centers for treatment of mental disorders, 12 of them have hospital 3 community-based psychiatric inpatient units available in the country for a total of 65 beds per 100,000 population

Total number of psychiatric beds was decreased from 1595 in 2008 to 1490 in 2009 25 beds for children and adolescents 25 beds for persons with mental disorders in forensic inpatient units 1060 beds in other residential facilities such as homes for persons with mental retardation, detoxification inpatient facilities, homes for the destitute, etc.. Number of psychiatrists-neurologists 172 Number of neurologists - 277 o Dr. Reykhan ended her presentation by proposing steps in strengthening mental health situation in Tajikistan: Development of the comprehensive policy, national strategy and plan of action for mental health Creation of community-based facilities Capacity building for mental health professionals Increasing the numbers of psycho-social staff Increasing the mental health system's links with other key sectors Development/improvement of the mental health information system

Trauma and Stress


Dr. Niko, Licensed Psychologist/psychotherapist, Kris och Traumacentrum, Sormland, Sweden shared his expereinces from working with Refugees in Sweden. He started by explaining what happens in the brain when a person is exposed to trauma and on that he explained the follwoings: The neocortex disconnects. (You cant play chess if youre afraid). The limbic system and the brainstem becomes activated and the Fight/Flight/Freeze mechanism occurs. First reaction is Flight; less risk of harm. The Freeze mechanism increases risk of PTSD. Fight and Flight reactions are normal reactions, Post Traumatic Stress. The sympathic nervous-system is activated, when the dangerous situation has passed, the parasympathic nervous-system calms down the body. During Freeze reaction both sympathic and parasympathic nervous-system is activated. The person looks calm on the outside, but is fully activated inside. In freeze the body will function as memory. Therefore, its important that trauma treatment integrates body focused therapy as well as psychotherapy. Otherwise it might not work. Neocortex doesnt remember trauma. The body remembers.

Dr. Niko also presented about psychosocial care and then he shared his experience from working with refuges from Bosnia and Iraq. Psychosocial Care: Goal; reduce symptoms of psychological stress below the treshold of developing pathology. Mankind is actually made for surviving trauma and difficult severe experiences, otherwise we wouldnt exist as a species. Psychosocial care from a Trauma-perspective KEY POINTS, how to adress traumatized patients? SIMPLICITY People in the western world always seems to complicate things in this matter SLOW DOWN.. Keep it simple, take it slow.

Just be there, be near, be with, listenknowing how to be quiet but be present, awakes your own anxiety. Holding , containing.. Main goal in trauma treatment; NORMALIZING

Psychosocial care at the hospital: What could this consist of? 1. Medical issues taken care of, stabilizing the patient 2. The psychological aspect..the simplicity principles.. Be there, be near, be with 3. Immediate inventory of patients resources.. 4. Social network, mobilizing groups, making it possible to talk about trauma or other psychological problems or issues. 5. Psycho-education about symptoms and mechanisms regarding the human body and brain when exposed to trauma. 6. Follow-ups, re-meetings with the group. Experience from post conflict countries: Bosnia, the Balkan war: Started from one day to anothergood friends and neighbors became enemies at once. Trauma treatment is difficult when there is ongoing trauma. When refugees from Bosnia came to Sweden we started a project, trying to find out what kind of therapy could be useful. Medication with anti-depressive and sedative drugs had poor effect. Best effect was achieved with group psychotherapy and psycho-education. Important to have knowledge about forensic medicine to understand the connection between physical injuries and psychological injuries. Necessary to get staying permit in Sweden before starting therapy, to create secure environment and remove threat that people might have to return.

Discussion and Question and Answer session from the above panel:
Dr. Alia was asked about the researches which have been conducted and was asked why the prevalence of depression why rate of depression is different among different studies? Dr. Alia responded by stating that in different research different instruments were used for different populations and hence the results are different. Mrs. Esmati was asked, what are the next steps for psychosocial rehabilitation services in Afghanistan? She responded that one of the goals of this conference is find what needs to be done in this area so after the workgroups tomorrow we all can come with a proposed plan. Dr. Alia was also asked to share the articles from the researches which have been conducted on mental health with disability taskforce. She promised that she will do accordingly.

Individual Psychology and Group Sessions for Landmine Survivors


Mr. Davaltov Mahmadullo, Psychologist from Tajik National University, professor of psychology in department of psychology. He has rich experience in practical psychology and authored more than 70 articles in different Tajik journals and magazines.

Mr. Davlatov started his speech by stating that he has started his cooperation with Tajikistan Mine Action Centre (TMAC) since 2006 in Summer Rehabilitation Camp and he has been cooperating with TMAC since then. He provides psychological support and consultation to mine survivors during summer camp. He added that the psychological study of mine victims revealed that their personalities encounter changes. Firstly, the self-concept of a victim changes and these changes are observed in different manners among the victims depending on the level of disability they received (degree of injury, loss of one or both hands, legs, eyes, etc). Commonly, a low level of self-concept is observed among the victims. Usually, they evaluate themselves at low level with poor dignities and tend to have excessive self-criticism. Such attitude cultivates loss of assurance and lack of efforts to improve their situation. The complicating situation and ascending difficulties are able to overcome and overwhelm the victims. Eventually, the preposition I would flee among the victims. The overwhelming difficulties create rooms for psychological rehabilitation for the victims. Beside changes in the self-concept of the victims, emotional changes are also observed among them. Firstly, they encounter emotional apathy with no attention to surroundings. They are constantly exhausted and fatigue, bashful, reticent, reserved, etc. If measures are not taken to prevent apathy then depression among the victims can occur. Excessive depression downs the attitude of the victims towards their personalities, surrounding people and future perspectives. In such cases, the psychological services are mainly responsible for restoring healthy attitude among the victims. He attended his presentation by forms of psychological services that he provides: The therapy is provided in both individual and group form during the last four summer rehabilitation camps organized by TMAC. Individual self-evaluation, Individual perspectives, Individual disposition, My five-years future plan, Accentuation of characteristics, Drawing methodic, Incomplete sentences questionnaires are used to assess individuals. In order to achieve the goals, we provided psycho-therapy and art-therapy for the victims during the summer camps. Psychological methods of relaxation, stress management, effective psychological consultation, drawings, emotions control, role-play You can do it! and other exercises were applied to reduce stress among the victims.

Community Based Rehabilitation in Afghanistan and its role in psychosocial rehabilitation


Dr. Razi Khan, Senior Physical Rehabilitation Advisor to the MoPH started his presentation by giving a very general idea of Community Based Rehabilitation (CBR). He described the concept of CBR followed by its principles and its origins. He then described CBR today which contained the following points: WHO 2007 survey: 92 countries had CBR projects and programs : 35 in Africa, 26 in Asia, 24 in Latin America and 7 in Europe (Khasnabis and Heinicke-Motsch, 2008) 4 successful CBR conferences in Africa 1st Asia Pacific CBR congress in 2009 with 700 delegates. Five regional CBR Conferences in South Asia 2004 Joint Position Paper (ILO, UNESCO, WHO) CBR Guidelines UN CRPD : Articles 19 and 26 Gradual change from medical alone to comprehensive, rights based approach Recognition that persons with disabilities have same rights, and need access to same services and opportunities, as others in their communities

Arguably the most significant development over the last thirty years for persons with disabilities, especially those living in rural areas in developing countries Well recognised, long-surviving brand name in the development sector

He then gave a brief history of CBR in Afghanistan along with CBR networks in Afghanistan followed by CBR and psychosocial rehabilitation which he noted the followings: Community processes, full participation, equal opportunities, social inclusion, gender sensitive, diversity and focus on rights are some of the key components of CBR which are no different from Community Mental Health The emerging trend away from vertical health programmes to integrated multipurpose models favor primary level services and community based strategies Continuity of care is more readily achieved when there is an existing CBR Sensitize people involved in CBR to be open to work with PLWPSD. Adequate inputs about Mental Health issues. Listening and dialogue is the life force: Respecting views and needs of PLWPSD.

Dr. Razi Khan concluded his presentation by: Inclusion of mental health issues in CBR is possible and cost effective The approach is rights based and people- centered Creating a favorable environment for promotion of good mental health

Psycho-social rehabilitation for persons with disabilities through MLSPP services


Mrs. Soima Muhabbatova, of the Ministry of Labor and Social Protection of Population, (MLSPP) Republic of Tajikistan is alumnus of Tajik National University 1989. She works in the field of social protection of population since 1996 to present. She started her employment with Dushanbe Social Welfare Department and was promoted to manage the Social Services Department at Tajikistan Ministry of Labor and Social Protection in 2007. Mrs. Soima is researching on her PhD thesis The structure of social protection organizations in Tajikistan. She compiled several publications on social protection and public services for persons with disabilities in Tajikistan. Mrs. Soima opened her speech by quoting from the excerpts of Appeal of His Excellency President Emomali Rahmon addressed to Tajikistan Parliament Majlisi Oli: I extend great care to the orphans, elderly, people with disabilities, victims and survivors of World War and take an ought that you will remain attended with caress, protection and sheltered. She then talked about social protection of elderly, orphans and people with disability by Tajikistan Government stating that social protection to elderly and children with disabilities are priority tasks of the government. The ongoing measures and social development programs assure that these groups of population remain at central focus of government agencies and local authorities. Mrs. Soima also emphasized that numerous measure have taken place by government to ensure social protection of the mentioned groups such as the Poverty Reduction Strategy, Action Plan for implementation of Social Protection Concept, the Law on Government Pension and Insurance in Tajikistan, and the Amended Law on Social Protection of People

with Disabilities, were approved for the benefits of these target groups. Additionally, new criteria for identification of poor families, provisions for compensation of electricity and gas utilization bills, memorandum on increase of pension and other measures were adopted that prove government protection of elderly and people with disabilities in Tajikistan. Meanwhile the government of Tajikistan has support from international organizations. Mrs. Soima further noted that in order to timely and effectively serving the needs and benefits of elderly and people with disabilities, there are five boarding homes for elderly and people with disabilities, two boarding homes for people with mental distortion, Chorbogh Center for medical rehabilitation of children and youth, National Orthopedic Centre in Dushanbe and its three regional Centres in Kulob, Khorug and Khujand oblasts, National Research Institute for Expertize and Rehabilitation of people with disabilities, four resorts and one boarding school for children with disabilities functioning in Tajikistan. The said institutions constitute complex structure of social services of the Ministry. Additionally, there are 45 social assistance departments with 748 employees operating in some towns and districts of the country that provide 30 types of assistance at homes of 5710 elderly and people with disabilities, including psychological, legal, social and medical assistances. It should be noted that 1504 elderly and people with disabilities live in the boarding homes. Another 14 regional Centres of social services, of which 8 are non-government centre, provide social services to 4482 needy people in Tajikistan. The regional Centres employ 326 social workers covered by the government. Provision of social assistance to people with disabilities is top priority for the government, including technical assistance. Mrs. Soima further added that for the purpose of improving the quality and quantity of social services, the Ministry continues to cooperate with UNICEF, European Commission, UNDP, Turkish International Cooperation Agency and dozens of other international organizations. With this cooperation, one of the buildings of Chorbogh Center for medical rehabilitation of children and youth was renovated in 2009 and is opened for medical rehabilitation of children with mental distortion, where 20 children with one of their parents or guardians stay for 21 days to receive medical rehabilitation course. This is the only Centre in the country, where children receive medical rehabilitation and parents get trainings on children nurture and recreate at the same times. The Centre provides services to 400 children with their parents per annum. Mrs. Soima finished her speech by stating that other government ministries and agencies in cooperation with public associations and non-government organizations hold significant roles in implementation of aforementioned activities and in improvement of social protection of elderly and people with disabilities in Tajikistan.

National Disability Survey of Afghanistan (NDSA)


Mr. Qasim from Handicap International presented brief findings from the National Disability Survey of Afghanistan conducted by Handicap International in 2005. He briefly presented the results as follows: In this study symptoms of anxiety and depression were measured. The results showed that around 4050% of these person showed four major symptoms of depression and anxiety: feeling of sadness (42%), the thinking in isolation (41%), the feeling of oppression (43.5%) and the feeling of suffocation (51.2%). Relating to the prevalence of these symptoms among different types of disabilities the findings showed that the prevalence of these symptoms among people with mental disability, associated disabilities and

epilepsy is higher compared to physical and sensorial disability. And in terms of gender the prevalence of symptoms were much higher among woman compared to men. Apart from the mental disorders symptoms, these studies have also found that the behavioural problems such as isolation, sadness, fear and violence are high among people with disability. The results have shown that these behavioural problems are at least three times higher among people with disability compared to non-disabled. Among the behavioural problems that are common among people with disability regardless of the type of disability are: finding the way to expressing their need (23.5 % compared to 2.8 %), difficulty in feeling comfortable with people (25.5% compared to 3.3%), keeping calm, staying in one place (17.8% compared to 2.6%), difficulty in going out of the house because of fear and because of people staring (20% compared to 2.6%). The highest behavioural problem was feeling sad, crying without a specific reason which was 41% compared to 4.1% for people with disability and non-disabled respectively. Further breaking different types of disability itself and comparing the difficult behavioural health problems that are common among them the results showed that person with speech impairment were the highest proportion (84.1%) showing inability to express their needs to others and people with physical disabilities showed the lowest proportion (29.7%). Regarding different types of mental disability and the behavioural problems that were faced by each type, the findings showed that feeling sad, crying without reason are the highest among people with social/communicational disability followed by psychological and learning disabilities. Other problems such as difficulty expressing needs, feeling uncomfortable with others, difficulty keeping calm, not going out because of fear or scared of being stared by people and repetitive body movements are very common high among all types of mental disability compared to epilepsy and seizures. Moreover from a gender based perspective, comparing male and female respondents who are disabled in terms of behavioural problems the finding showed that compared to men the prevalence of these problems are higher among women. Apart from the mentioned behavioural difficulties reacting violently to outside surroundings are also very high among people with disabilities. In the same national disability survey that we mentioned above it has been found that violent behaviours occur within 14.3% to 19.6% of persons with disability. In this particular survey violent behaviour was measures in terms of physical violence towards others, verbal violence towards others, self-violence, fainting/passing out and episodes of fits. The results showed that compared to the non-disabled persons the proportion of these behaviours among people with disability are ten times higher compared to non-disabled. And comparing the rate of these behaviours among different types of disability the prevalence of violent behaviours are the highest among persons with mental disability, epilepsy or some other types of seizures compared to people with physical and sensorial disability. Considering the prevalence of violent behaviour among person with mental illnesses and intellectual disability it was found that for person having learning disability, less than one third experience a type of violent behaviour in the six months prior to the interview. On the other hand, person having psychological or social disability are the ones who experience a high level of

violent actions. More than 55% of them have verbally violent episodes towards others. A majority of person having social/communication disability also have physically violent behaviours towards other people and more than 45% towards themselves. The proportion is a little less for person having psychological disability. A majority of both groups experience episodes of fainting. Moreover, these symptoms were much higher among women compared to men. Persons with disability also have problems in communication. More than one quarter of persons with disability have communicational difficulties such as remembering things, talking to others, understanding what people say, making oneself understood, hearing clearly someone calling you in the house, seeing someone clearly in front of you. Moreover, the prevalence of these behavioural problems was much higher among people with mental disabilities and those with associated disability especially with regard to memory. 85.1% of persons with mental disabilities and 71.9% person with associated disability have problems with memory.

Discussion and Question and Answer session from the above panel:
There was a not a specific question, however, it was suggested by participants that many technical terms are used in the presentations that are not familiar for them and it would be good if presenters define the terms while they are presenting.

Summary of the first day was briefly stated by Mrs. Esmati highlighting the points below:
There are high prevalence of mental health disorders symptoms among people with disability Mental health services in general are very weak in the country Psychosocial rehabilitation needs to be paid especial attention as not much has been done in this regard.

Wednesday 15th December 2010


Role of art-therapy and sport activities during Summer Camps in psycho-social rehabilitation of landmine survivors
Dr. Reykhan Muminoval, PHD Medicine, Tajikistan Mine Action Centre started her speech by stating the fact that survivors have reduced emotional well-being due to depression, anxiety, fear, anger, dependence on others and isolation due to shame and discrimination. Impaired social abilities lead to a reduced capacity to communicate, as well as other emotional conditions. She further added that for mine victims to become Survivors, in addition to medical care and prosthetic devices, they need psychology rehabilitation. Nonetheless, in Tajikistan, like in many other post-conflict countries, health care facilities have no trained specialists in psychological support in the hospitals and clinics that could treat landmine survivors. Hence, there are no existing peer-to-peer support groups in the country. Regarding psychological rehabilitation to landmine survivors she mentioned that TMAC in cooperation with partners conducts Summer Camps for survivors. For the past six years (2005-2010), a total of 160 landmine/ERW survivors (every year one group of up to 25 survivors of different ages) enjoy two-weeks

time at Summer Rehabilitation Camps held in sanatoriums and resorts located in the picturesque Romit and Varzob valleys, in Dushanbe vicinity. The summer camps create impacts on survivors general health conditions by bringing together physiotherapy and adaptive sport in friendly and warming atmosphere, and enhance their communication and social integration ties. The summer camps provide psychological rehabilitation through art-therapy, individual and group psychological discussions. They help to enhance self-confidence and self- esteem among survivors. Dr. Reykhan also added that throughout the summer camps, TMAC used adaptive sport activities supervised by professional trainer and doctor. We had daily morning exercises with all survivors before breakfast. After breakfast we used walking and hiking around the resort area if weather conditions allowed. Group games included table tennis, chess, volleyball, basketball etc. In the afternoons survivors were busy with competitions - race, arm-sport, table tennis, swimming etc. In the evenings survivors enjoyed dancing, singing songs and watching movies at the back yard. Sport activities resulted in improved physical and psychological conditions of survivors, increased efficacy and stability of survivors. A professional coach from the Paralympics Tajikistan supervised all sport activities. Art-therapy was very effective and impressed the survivors. It helped to reduce aggression, anxiety and fatigability among the survivors, and facilitated non-verbal release of negative emotions. Art-therapy helped to improve the following among the survivors: ability expressing feelings; establishment of positive and friendly emotional mood identification of sources for future development development of creative self-expression and individuals capacity improvement of communication between survivors and team building

Dr. Reykhan finalized her presentation by stating that We can compare art-therapy as a window through which survivors could find out so many inner things using pencil and colours, which they wouldnt be able to express it to everyone. The process of art-therapy itself brings a lot of pleasure, while patients get to express their feelings. Art-therapy can be used independently as main therapy or as part of general or group psychotherapy. We proved that art-therapy could be used not only in the hospitals, but also in other rehabilitation facilities, such as summer camps.

Experience of Ms Aydulan Khujamkulova


Ms. Aydulan graduated from the special boarding school for children with disabilities in Hissor district in 1993. During 2001-2003 she worked as physiotherapist at National Research Institute for rehabilitation of persons with disabilities. She joined the Sport Federation for the persons with disabilities Paralympics in 2003. She is a multi-champion of Asian and Para-Olympic championships on armwrestling. She won two golden medals in 2006 in Dushanbe and 2009 Tashkent Arm-wrestling Championships. Ms. Aydulan shared her experience on how her success in her education, learning multiple languages, being expert in Sports has helped her to overcome the problems in her life. She mentioned that she did not believe that one day she will reach at this stage with disability. She continued that she excelled herself in different kinds of sports, such as swimming, running and gymnasium. She said she is alive with sport, it gives her energy, beauty and it makes her alive.

Primary Mental Health Project (PMHP) in Western Region of Afghanistan


International Assistance Mission (IAM)
Dr. Khalil Rasooly, Medical Coordinator for IAM-PMHP started his presentation by giving a brief history of PMHP stating that, the Primary Mental Health Project started in 1996 as a response to the high suicide rate among the women of the Western region of Afghanistan. The purpose of PMHP is to enable all medical professionals in the primary health care sector as well as community health workers of the western region in Afghanistan to provide primary mental health care and to raise awareness on important mental health issues through trainings. PMHP currently holds activities on the followings: 1. Community Team: At the community level the trainings are conducted for CHS, Mullahs, community leaders and teachers. Also, mental health Magazine is published quarterly. At this level, the mental health advocacy days in the western region provinces are also held. 2. Medical Team doctors and nurses: Mental health trainings are conducted for BPHS staffs and referral system is held between BPHS health facilities and CRC. Also quarterly mental health magazine for health staffs are published. 3. Mental Health Clinic-Resource Centre 4. Residency Training Dr. Rasooly also mentioned that PHMP since the year 2007 have trained several doctors and other health staffs. He also mentioned about PHMP Clinic Resource Centre where services are provided for the patients and families and also it is a practical training centre for health staffs. According to Dr. Rasooly PMHP also provides counseling service. The counseling is provided by trained nurses and Cognitive Behavior Therapy is used in treating the patients. Dr. Rasooly ended his presentation by stating that PMHP currently has sent one of the doctors to Malaysia to specialize in Psychiatry.

Mental Health and Psychosocial Program


Health Net TPO
Dr. Ajmal stated that Health-net TPO has activities on the following area: Community Based Psychosocial multi-sector approach: rehabilitation and community mobilization, mental health integration in Primary Health Care: BPHS, Mental Health in General Hospitals: EPHS. He further noted that the main mental health activities of Health-Net TPO are the following: 1. MH raining for CHWs

3 days: identification of MH problems 2. MH training for health staff Doctors (2wks): common psychiatric illnesses: emphasis on diagnosis and treatment (including psychopharmacology) Nurses/midwives (2 wks): emphasis on diagnosis, communications and psycho-education 3. MH activities in general hospitals OPD, IPD and Liaison Psychiatry: introducing multidisciplinary approach 4. Training of trainers (TOT) (two months)( provincial focal points) Basic mental health training course (2 weeks) Basic training methodology (2 weeks) Clinical training in a Postgraduate Medical Institute in Pakistan (2 weeks) Training under supervision (2 weeks) 5. Psychotropic drugs supply According to BPHS Essential Drug List 6. Supervision & monitoring of HFs and of provincial teams 7. Development of training, M & E tools and IEC materials 8. Technical support to NGOs implementing BPHS (EC funded provinces) 9. Support to MH department MoPH Dr. Ajmal also explained the community based approach of health-net TPO stating that The Psychosocial Program focuses on community based psychosocial services within the community. And this is done by: Mapping the communities to explore the needs, constrains and resources which are different in the different communities of the provinces; these mapping reports enable us to implement tailor made services for the population in need. Community mobilization (finding the right entry point, iidentification of key figures, focus group discussions) Capacity building of key influential figures (community leaders, Mullahs, CHWS and teachers) to raise the awareness about the Psychosocial problems and how to reduce these problems among people Group interventions; Discussion groups, Support groups, Self help groups, Specific group interventions for children (There will never be enough psychologists, counselors and psychiatrists to help everyone on an individual basis, due to lack of funds, lack of time and lack of training) Individual/family case management (if needed; Providing psycho education, family mediation, Referral to more specialized care Use of media to heighten public awareness Awareness raising among Ministries & other stakeholders (Coordination meetings and workshops) Development of guidelines & Best Practices Finally he briefly mentioned that HNTPO is planning to extend their program to other provinces and especial attention will be paid to woman empowerment.

Peer Support Group and Findings from the Research on Effects of Disability on Mental Health
ALSO
Mr. Nasem Khan Aliyar from ALSO and Abass Panyanda Nik from (FPRO) briefed that ALSO organization for the first time provided peer support services in Afghanistan.. And currently the services are in Kabul and Mazar-e-Sharif. Until now more than 1500 individuals with disabilities have received peer support counseling and have been referred to other organizations for rehabilitation. He further defined that peer support services are provided for persons with disabilities by persons with disabilities. . He also mentioned that one of the objectives of the peer support is to enhance selfesteem of persons with disabilities and raise wareness of their families about the rights and needs of persons with disabilities to include them in society. Mr Aliyar also briefly mentioned about the methodology of their work. Initially ALSO recognize and identify persons with disabilities and with psychosocial problems at homes,hospitals and community , then a counseling is provided, followed by referral to rehabilitant centers based on their needs and demand for type of services. Finally he ended his presentation by mentioning the challenges that are present in their program as follows: 1. Absence of a standard program or policy on psychosocial services; 2. Lack of financial support for psychosocial program; 3. Lack of experts on mental health; 4. Lack of trained experts and peer supporters for peer support program ; 5. Limited number of research centers on psychosocial issues. Mr Payanda Nik shared the results of a research that he has conducted on effects of disability on mental health of persons with disabilities. The research has been conducted by FPRO and ALSO with the financial support of ICBL. According to Mr. Payanda Nik the objectives of his research as follows: Assessing the effect of disability on the mental health of individuals with disabilities; Assessing disability as a cause of deterioration of mental health; Comparison of mental health of individuals with disability with persons without without disabilities; Identification of common mental health disorders among individuals with disability About the instruments used for this research Mr. Payanda Nik mentioned that SCL-90 was used to assess the symptoms. Among the findings he mentioned the followings: The higher the age of persons with disability, the better their mental health; Persons with disabilities have poorer mental health compared with persons without disabilities; Mental health of women with disabilities are poorer compared with males.

The most common mental health disorders among persons with disabilities are depression, anxiety, low self-esteem, phobias and poor social skills.

Windows for Life (WFL


Dr. Mateen of Windows for Life mentioned that WFL is a national NGO that works on psychosocial counseling. WFL counselors have completed a comprehensive training period that was offered by CARITAS Germany and have more than three years of experience in this area. The counselors are certified by the ministry of public health. Also, WFL works in close cooperation with the emergency mental health cases. Dr. Jamel mentioned that both individual counseling and group counseling are offered. Individual counseling usually takes between 30-45 minutes and group counseling usually takes between 45-90 minutes. Finally among the therapy methods that are used he mentioned the followings: 1. 2. 3. 4. Cognitive Therapy Behavior therapy Cognitive Behavior therapy Group Therapy

Psychosocial Aid Project-HOSA


HOSA Dr. Fereshta briefly stated that HOSAs overall objectives are to support social development of Afghanistan according to the MDGs by strengthening the Afghan health system. She addresses HOSAs achievements as follows: Completion of three and half months intensive training (23 PSCs: 9 from Herat, 9 from Balkh and 5 from Bamyan) Opening of 10 counseling centers (4 in Herat, 4 in Balkh and 2 in Bamyan) Starting offering individual and group counseling services Conducting awareness raising seminars on psychosocial issues Conducting trainings for health staff of the 3 provinces on integrative approach in MH care

Rehabilitation Is Our Daily Activities


National Research Institute for Expertise and Rehabilitation of Persons with Disabilities
Dr. Zainiddin Safarov from the National Research Institute for Expertise and Rehabilitation of persons with disabilities, graduated from Tajik State Medical University in 1999. He is working under his PhD devoted to the problem of comprehensive rehabilitation of persons with hearing impairments in the result of mine explosion. He authored more than 10 articles in the different journals and magazines. He is head of department of rehabilitation. Dr. Zainiddin introduced the National Research institute as MLSPP established the 70-bed National Research Institute for Expertise and Rehabilitation of People with disabilities (in Dushanbe which conducts research on disability issues and provides physical rehabilitation. The Research Institute for

rehabilitation of persons with disabilities operates since 1992. Staff at the Institute includes specialists in physical medicine and rehabilitation. There are 11 doctors and 10 nurses at the NRIRDP. The MLSP provided 9 Somoni (approx.US$2) per bed per night for treatment and feeding this is not enough. He then briefly mentioned his experience on: Audiology assessment of survivors Removing of Fragmentations Ultra sound examination

Persons with Vision Impairment Organization


Mr. Ghulam Rasool from Persons with vision Impairment Organization shared his experience in working with persons with vision impairments. He who has lost his vision 15 years ago believes that working with people with vision impairment needs special psychology to work with and that needs separate training.

Mental Health and Psychosocial Project


AADA
Dr. Farhmand introduced AADA as a non-political, non- profit and independent Afghan registered organization founded in September 2005. AADAs multidisciplinary team has extensive experience of health, research and development, capacity building and communication projects at national and international level. AADA is a BPHS implementer with special emphasis on psychosocial issues working mostly in the provinces of Bamyan, Ghazni, Faryab and Khost. Dr. Farahmand briefly mentioned AADAs achievements as follows: 26 trainings conducted on psychosocial support counseling to health workers 102 Doctors trained in mental health and psychosocial support counseling 312 health workers (Midwives, Vaccinator ,Nurses, community health supervisors ) trained in mental health and psychosocial support counseling 206 community health workers trained in psychosocial support counseling 26 trainings conducted on psychosocial support counseling to health workers 102 Doctors trained in mental health and psychosocial support counseling 312 health workers (Midwives, Vaccinator ,Nurses, community health supervisors ) trained in mental health and psychosocial support counseling 206 community health workers trained in psychosocial support counseling 148 group support counseling provided at health facilities by community health supervisors

Mental Health and Psychosocial Reporting Tools and IEC Materials


Mental Health and psychosocial reporting tools ( register books, patient card, tally sheets, monthly activity report, CHWs pictorial tally sheet and report developed and supplied to all health facilities of Bamyan and Faryab after approval of mental health task force and mental health directorate of MoPH. Mental health and psychosocial IEC material developed and disseminated to all health facilities of Bamyan and Faryab.

GROUP WORK
Group 1:
OBJECTIVE:
To identify the gaps and needs for psycho-social rehabilitation services in Afghanistan and Tajikistan 1. There is a need for technical research on psychosocial rehabilitation as there are very limited researches. 2. Lack of budget on psychosocial rehabilitation. 3. Limited number of technical staffs on psychosocial rehabilitation especially medical psychologists. 4. Limited donors support on psychosocial issues. 5. Absence of standards on psychosocial rehabilitation services. 6. Absence of proper attention from governmental organization to psychosocial rehabilitation. 7. Absence of implementation of policy and strategy by government 8. Lack of primary health care workers knowledge on mental health and disability. 9. Limitation of BPHS and EPHS implementers attention on mental health. 10. Lack of societys awareness on psychosocial rehabilitation. 11. Absence of a center that can train psychosocial counselors. 12. Absence of a system that can coordinate organizations who are working in the mental health field. 13. Absence of programs to increase public awareness on psychosocial rehabilitation through massmedia. 14. Necessity of inclusion of psychosocial rehabilitation in the university curriculum. 15. Absence of a proper monitoring and evaluation on the trainings which has been conducted.

Group 2:
OBJECTIVE:
To create close coordination and cooperation between Afghanistan and Tajikistan Mental Health and Disability Departments, Victim Assistance Programs in regards to improve psycho-social rehabilitation services for persons with disabilities/landmine survivors 1. Establishment of a working group which consists from organizations working in mental health and disability departments who can work solely for psychosocial rehabilitation. 2. Conducting inter-country conference in order to coordinate organizations activity and get updated about the activities of each organization with regard to psychosocial rehabilitation. 3. Development of a directory which contains a directory of organizations which are working on mental health and all disability stakeholders with their addresses and their activities. 4. Involvement of Ministry of Higher Education/Ministry of Education in psychosocial rehabilitation activities. 5. Coordination of activities with regard to psycho-social rehabilitation between ministry of public health and Ministry of Higher Education/Ministry of Education.

6. Development of a concise term of reference for the working group that is supposed to work on psychosocial activities. The working group should be able to work on the rights of person with disabling mental illnesses.

Group 3:
OBECTIVE
To continue to identify and utilize opportunities to enhance bilateral exchanges between neighboring countries (Afghanistan and Tajikistan) and to share national experiences, training materials, good practices, and existing opportunities between two countries and build capacities to enhance VArelated activities. 1. Exchange of experiences on several areas: a. Exchange of training materials b. Organizing of workshops and seminars with regard to psychosocial rehabilitation. 2. Giving an opportunity for Afghan disability organization to see the summer camps in Tajikistan. 3. Sharing of experiences on psychotherapy. 4. Development of common projects on research or any issues related to psychosocial rehabilitation between two countries. 5. Conducting scientific research between two countries on mental health of persons with disability. 6. Sharing of strategy on disability and mental health strategy between two countries. 7. Conducting of Paralympics games between two countries. 8. Conducting of inter-country and regional conference on psychosocial rehabilitation every year. 9. Development of a network between two countries with regard to psychosocial rehabilitation. 10. Opportunity to learn experiences from Tajikistan with regard to Art-therapy, Music therapy etc.

The conference ended by the following outcomes:


There is great need for development of psychosocial rehabilitation services in Afghanistan and Tajikistan Limited Donors support to mental health in general and to psychosocial rehabilitation in particular There is a need for research on issues related to psychosocial rehabilitation and mental health of persons with disabilities There is a need for a proper standard program on psychosocial rehabilitation in Afghanistan and Tajikistan so that all organizations can implement it. There is a need to increase publics and health staffs awareness on mental health A monitoring and evaluation of the trainings devoted to mental health that have been done and the trainings that are going to be conducted. Establishment of a working group that can work and follow up activities on psychosocial rehabilitation. Exchange of training materials and experiences between Afghanistan and Tajikistan on psychosocial rehabilitation. Conducting research on using of psychotherapy and other psychosocial related activities between Tajikistan and Afghanistan.

Dr. Razikhan Hamdard ended the conference with Mrs. Soima Muhabbatova from Tajikistan. They both agreed that the next conference on psychosocial rehabilitation should be conducted in Tajikistan.

Addendum A
MINISTER OF PUBLIC HEALTH SPEECH DR SURAYA DALIL FIRST INTERCOUNTRY CONFERENCE ON PSYCHOSOCIAL REHABILIATION
In the name of Allah the most merciful Assalamalikum and good morning. Respected Deputy Minister Mrs. Suraya Paikan, respected guests from the country that we share common language and common culture, Tajikistan, representatives of UN organizations, donors and relieve organizations and dear colleagues! As the acting minister of ministry of public health I would like to welcome your participants in this conference that is held under the title 1st Inter-country Conference on Psychosocial Rehabilitation. Disability and mental health problems are interrelated and interconnected phenomena that in interaction with socio-cultural factors create a much more complex figure. The one who is mostly affected is the person with disability, but the disability will affect his/her family and hence it will affect the society. When we accept that human beings are from the same nature, can we leave a person with disability with his own condition? If yesterday supporting these individuals were only a moral obligation based on cultural believes today it is a social need based on needs of society. Based on the World Health Organization statistics on the Global Burden of Disease report on the year 2004, around three percent of world population was suffering severe disability, and another twelve percent were suffering from chronic mild disabilities. Though, there are no up to date and exact data on disability figures in our country but roughly one out of each five household has a person with disability. Mental Disorders are amongst the most common disabilities. Again, based on WHO figures, mental disorders are among the most reasons for years lost in disability and depression is the most common especially among women. Some studies report that more than 60 percent of Afghans are suffering from symptoms of mental illness and social problems. In a survey in the country in year 2002, around 60 percent of men and 73 percent of women had symptoms of depression. Prevalence of mental disorders among disabled are much more. And study in 2004 showed that depression symptoms among people with no physical disability were around 68 percent while 71 percent of people with physical disability were suffering from depression symptom. Furthermore, 85% of people with physical disability showed symptoms of anxiety. Although, these figures are not certain; but can show the depth of disaster in the country.

My expectations from the experts in this conference is to come out with methods for obtaining more accurate information on rate of disability and main causes of it as well as methods of rehabilitation of persons with disability with low cost and especially psychosocial rehabilitation of these individuals with respect to resources available in the country, using the knowledge of our Tajik colleagues and attending experts in this conference. Hereby I want to ask further attention of our donors to the importance of mental health problems in the country. We have the support of our international organizations on physical problems but surprisingly with all these shocking figures we cannot obtain necessary supports for improvement of mental health condition in the country. Socio cultural problems of disabled and handicaps should be addressed as well. As an example even among our health professionals we dont have proper words to address these individuals. When we call someone as Maklul or Makyob, we add to his disability and paving the way for his rejection from work and social life. As a conclusion, I expect that this conference will end up with precise propositions for improving the psychosocial rehabilitation of persons with disability as well as methods for improving mental health services and ways to get more support for this important issue. As the wise knowledge of our predecessors which have told: tell less to be used more, I would like to officially open this conference and wish you success.

DEPUTY MINISTER SURAYA PAIKAN (MOLSAMD) FIRST INTERCOUNTRY CONFERENCE ON PSYCHOSOCIAL REHABILATION
Assalaamalaikum and good morning, I would like to welcome our especial guests from the neighboring country Tajikistan, participants from different provinces of Afghanistan, national and international organizations working with persons with disability. I am extremely happy that an important scientific conference is taking place in Kabul with the participation of the participants from a country that we have so many common traditions. Psychosocial rehabilitation is a very important concept and there is a serious need for this in the country. It is a very technical matter that can not solely be solved with ministry of health; it needs to collaboration of all of us, all the sectors. There is a need for a precise survey to be conducted in order to find the causes of disability and mental health. We as policy makers should be aware of the causes, although we know some of the causes such as war, financial problems but still there is a need for a survey to be done. Although many meetings are conducted and issues are shared between MOSLSAMD, Ministry of Public Health, and Ministry of Education however, psychosocial rehabilitation should be mentioned in future meetings so that new intervention methods are found. I would like to request her Excellency minister of public health Dr. Suraya Dalil to order all her secondary units to take this matter seriously.

At the end I would like to thank all the individuals who are responsible for conducting this conference and I wish all of you success.

Addendum A
Inter-country Psychosocial Rehabilitation Conference Conference Program 14-15th December 2010 Kabul Hotel, Kabul Afghanistan
Goal
To assist landmine survivors and persons with physical and psychiatric disabilities, including women and children, to resume their role in the community by helping them to cope and adjust to life challenges through psychological and social supports that assist in regaining and/or maintaining a healthy and positive outlook on life.

Objectives
1. To share current situations of psycho-social problems, rehabilitation services and opportunities available for persons with disabilities, including landmine/ERW survivors in Tajikistan and Afghanistan. 2. To identify the gaps and needs for psycho-social rehabilitation services in Afghanistan and Tajikistan. 3. To create close coordination and cooperation between Afghanistan and Tajikistan Mental Health and Disability Departments, Victim Assistance Programs in regards to improve psycho-social rehabilitation services for persons with disabilities/landmine survivors. 4. To agree on the way forward/methods for collaboration between the two neighboring countries and the region for future consultations and development of psycho-social rehabilitation services for persons with disabilities, including landmine survivors. 5. Continue to identify and utilize opportunities to enhance bilateral exchanges between neighboring countries (Afghanistan and Tajikistan) and to share national experiences, training materials, good practices, and existing opportunities between two countries and build capacities to enhance VArelated activities.

Category of Participants:
Around 100 participants from Ministry of Public Health (MoPH), Ministry of Labor, Social Affaire and Martyrs and Disabled (MoLSAMD, Ministry of Education (MoE), MACCA, Tajikistan Mine Action Centre, Ministry of Labour and social protection of population RT, National Research Institute for Rehabilitation of persons with disabilities of RT, National University of RT, relevant UN Agencies, National Organizations, International organizations.

AGENDA
Tuesday 14th December 2010 Time 08:00 09.00 09.00- 09:15 Topic Registration of delegates Welcome and start of the conference Recitation of the Holy Quran Introduction of Conference Goal, objectives, outcomes and brief agenda Welcome speeches 1. 2. 3. 4. 5. MoPH MoLSAMD MoE MACCA WHO Tea Break Mental health general situation in Afghanistan Presentation from Tajikistan Current situation of Mental Health System Mental Health Department Dr Alia Plenary Presenter Facilitators Methodology

09.16 09:30

Plenary

09.30 10:30

Plenary

10.30-10.45 10.45-11.00

11.00-11.15

TMAC

Dr.Reykhan Muminova (PhD Medicine) Frozan Plenary

11:15 11:30

Psycho-social approach and Rehabilitation in Afghanistan.

Mental Health Department

11.30-11.45

Psychology Individual and Group sessions for survivors Penal Discussion and Question and Answer Session

Davlatov Mahmadullo, psychologist The above presenters

11.45-12.45

12:45 13:45 13.45 14.00

Lunch and pray Break Community Based Rehabilitation in Afghanistan and its role in psychosocial rehabilitation Presentation from Tajikistan Psycho-social rehabilitation for Persons with disabilitiess through MLSPP services Disability and Rehabilitation Department, MoPH Dr Razikhan Plenary

14.00-14.15

MLSPP, Soima Muhabbatova

14.15-14.30 14:30 15.00

Disability National Survey Presentation from Tajikistan Role of art-therapy and sport activities during Summer Camps in psycho-social rehabilitation of landmine survivors"

HI TMAC, Dr.Reykhan Muminova Plenary

15.00-15.15 15.15 - 16.00 Plenary Discussion and Question and Answer Conclusion of day and closure

Tea Break Above Presenters Plenary

16 .00 16:30

MOPH

Frozan

Plenary

Second Day Wednesday 15th December 2010 Time Topic Presenter Facilitators Methodology

8:30 9.00 9.00- 9:15

Registration of delegates Welcome and review of first day Frozan Plenary

9.15 -10:30

Presentation of Organizations working in mental health in Afghanistan

PMHP-IAM Healthnet-TPO ALSO

WFL HOSA 10:30 11:00 11.00-12.30 Group Works Tea Break G.1. Discuss 2nd Objective of the conference (Gaps and needs for psycho-social rehab) G.2. Discuss 3rd Objective (Cooperation) of the conference G.3:Objective 4 of the conference. Dr. Azimi from Afghanistan Plenary

Dr.Reykhan Muminova from Tajikistan Davlatov Mahmadulo

12:30 13.30 13:30 14:30 15.00 16.00 16:00 17.00

Lunch and Pray break Group work presentation and discussion General Discussion on developing mutual cooperation Conclusion of the conference and agreement on the 2nd conference Each group representative

Sharing expertise, resources and opportunities

17:00 17.30

Addendum B
First Inter-country Conference On Psychosocial Rehabilitation December, 14 &15 2010 Kabul, Afghanistan Participant List
Dr. Suraya Dalil, Minister of Public Health Dr. Suraya Paikan, Deputy Minister of Martyrs Families and Disability Directorate, MoLSAMD Dr. Sayed Azimi-Mental Health Advisor, MoPH Dr. Alia Ibrahim Zai-Mental Health Director, MoPH Mrs. Frozan Esmati-Mental Health Consultant, MACCA Dr. Gualai Disability and Rehabilitation Department, MoPH Dr. Razi Khan Hamdard Advisor, Disability and Rehabilitation Department, MoPH Sadiq Mohibi Advocacy and Awareness Advisor to the MoLSAMD, MACCA Haji M. Nader-DAO Dr. Noordudin Muradi-HOSA M. Iqbal-DAO Vida Faizi-Medical Mondial Kabul Zarghona Ahmadzai-Medical Mondial Kabul Dr. Ajmal Healthnet-TPO Najmuddin-ICRC Khada Bakhsh-HNTPO Amir jan-ICRC Akhtar Mohammad-FWF Hashmatullah-FWF Najibullah-FWF Muzghan-FWF Ahmadzai-FWF Wasim_FWF Fariah-FWF Atiqullah-Kahistani-CCD Ayesha Afzalzada-ICRC Rahilah-KOO Marie Anne-HI Mohumad Samad-HI Fatimah Abdullah-MOE

Abbas Payndajo-MOE Nabillah-CCD Haji Ahmadshah-CCD Dr. Sohaila Zia MOPH/RHD Dr. Samad Hami-AADA Ghulam Mustafa-ICRC Taiba Alokozai-Mental Health Hospital Salima-Mental Health Hospital Dr. Sharifah- Mental Health Hospital Dr. Temorshah Musamem-Mental Health Hospital Dr. A. Wasi Ashaa-MOPH Hashmatullah-FWF Najibullah-FWF Nasem Khan Aliyar-ALSO Azizudin-AAPT Said Kabir-PTI Habiburahman-PTI Dr. S. Nakibullah-MOPH Yusuf Ali-Mental Health Hospital Ibrahim Alokozai-ALSO Mohad Ja-SERVE Dr. Essa Ebrahimi-MOPH Dr. Khalil Ahmad Rahmani-PMHP-IAM Dr. Khalil Ahmad Rasuly-PMHP-IAM

Naqibullah-AABRAR Kohistani-MOLSAMD Sayed Karim-AOAD ZarAlem-AABRAR Zakirullah-AABRAR Dr. Khesraw Ariah-HSSP Dr. Temorshah-MOPH Mirwais Haleem-UNFPA Dr. Jamshid Omar-BRAC Dr. Shafiullah-BRAC Dr. Wais-WFL Dr. Jameel-WFL Mohammad Aziz Rasa-MOLSAMD Agha Shireen-SERVE Dr. Ehsanullah Gulban-MOPH Abdullah Subhan