October 01, 2007 – Ramtau Sabun Village, Indonesia – For 15 years Rosmawati knew she was ill but she didn’t know with what. The 35-year-old woman would become unconscious and fall down without notice, seizing three to four times a day. “We thought that it was a congenital disease,” said Rosmawati.

PHOTO: Stephanie Bowen Rosmawati's village is very remote, making it difficult to access consistent care.

“Usually when she had an attack, we would take her to the traditional healer in the village,” recalled her husband Ilyas. They also took her to the hospital in Banda Aceh three times, but the medication they put her on didn’t seem to help.

The mystery of Rosmawati’s illness began to unravel when she visited International Medical Corps’ mobile clinic. The diagnosis: epilepsy. The medication the hospital had administered had not worked because it hadn’t been given to her continuously. Generally, epilepsy medication must be given for at least one year to be effective. Because she lived in a small village where access to continuous care was non-existent, Rosmawati and her family had virtually no options. International Medical Corps works to integrate mental health services into primary care, even in the most remote communities, making it possible for people to get the help they need.

“When I first met Rosmawati she was very skinny. She didn’t go to the market, she never left her house because she was afraid of a sudden attack,” said Muis, the IMC-trained mental health nurse who cared for Rosmawati. A neurological disorder, epilepsy has severe physical risks, but it also has significant behavioral and cognitive consequences.

Rosmawati’s condition was hard on her and the rest of her family. “I felt very sad when I saw my mother sick,” said her teenage daughter Izawati. “I used to help her cook and would often just start crying.”

“In the United States, if you have epilepsy, you would be referred to a neurologist. The U.S. is a country where medicine is highly specialized, and resources are available,” said Lynne Jones, International Medical Corps’ technical adviser in mental health. “In Indonesia epilepsy is a widely unaddressed need. It is regarded by the population as a mental illness, and most often treated by traditional healers, or general practitioners or psychiatrists.”

The reason many go to traditional healers is that in Indonesia, as in many poor countries, the mentally ill and epileptics are often seen as bewitched, or suffering from evil spirits. Stigma is as big an obstacle for implementing mental health care services as are limited resources and a lack of skilled personnel. International Medical Corps not only treats the patient, but also educates the community and local health workers. “When I’ve been working with traditional healers, it is a great opportunity for me to show them that we can treat these conditions with medication,” Jones continued.

PHOTO: Stephanie Bowen International Medical Corps mental health nurse with Rosmawati and husband Ilyas.

Rosmawati had her last seizure ten days after International Medical Corps started her on medication. She has been seizure-free for more than six months. Her life has changed dramatically. “I can go out now and do my normal activities. I can accept invitations and socialize with others.” Things she was unable to do for fifteen years.

Muis visited her once a week, checking on her physical and emotional state, but also educating the family about her illness. That was just the beginning.

“Because the society is not educated, they were afraid of her disease,” said Ilyas, her husband. “They were afraid of her because they thought she was contagious.” Izarwati’s classmates also asked a lot of questions.

Muis was one of many mental health nurses chosen by the community to be trained by IMC, not to treat illness, but to be a contact person for their village. They were given the skills to recognize symptoms as well as focus on preventative measures. They then took what they learned to the larger community.

PHOTO: Stephanie Bowen This woman found out about IMC after her neighbor Rosmawati was treated by International Medical Corps. Her epilepsy is now under control.

Teachers and parents learned about things like childhood development and depression from International Medical Corps-trained mental health nurses. They also explained disorders like epilepsy, taking away the mystery and the fear.

“We give special education,” said Muis. “And now the community understands the disease better.” So much so that others have come out of the shadows for treatment. One 60-year-old woman had seizures for ten years, and a six year old boy had symptoms for four years. Both have received treatment through International Medical Corps and are doing well.