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|Dr. Geetha Jayaram|
Just how much people have problems of the human condition in common is an eye-opener. In rural India, for example, a few hours’ drive on an unpaved road from the cosmopolitan city of Bangalore, village life is simple. Houses are one-roomed with cattle at one end and human occupants living at the other. The agricultural life there is fixed to the seasons, to weather.
“You’d think, in such a place, that people would have few mental health problems,” says Geetha Jayaram, M.D., “but that’s not the case. Their lives are simpler, but certainly not stress-free.” Jayaram, a community psychiatrist well-versed in the mental health needs of inner-city poor, sees parallels between East Baltimore and rural Bangalore, and recently her expertise in the problems of both, plus an exceptional drive to make a difference, has begun helping in India as it has here.
For more than a decade, Jayaram has directed or been a clinician with Hopkins’ community psychiatry clinic and has been a force behind its being a national model for innovative care. Currently, with Jeffrey Janofsky, M.D., she directs a short-stay program serving severely mentally ill living near Hopkins hospital.
But though she’s been in this country longer than in her native India, the problems of India’s rural poor aren’t far from her mind. “It’s surprising, really, how similar the two populations are,” she says. “The top two illnesses we see in our clinic, major depression I and alcohol dependence II, are the same, followed by anxiety disorders. Stresses in the poor seem to be universal, though the specifics may differ.” It may be monsoons failing or unscrupulous village moneylenders, but it’s still stress.
Yet, unlike those in the Hopkins vicinity, India’s rural poor lack mental health services. Poverty—villagers make less than $10 a month—keeps them from visiting physicians in Bangalore. And psychiatric problems are widespread.
So in 1997, when Jayaram was “back home” during summer vacation, she reached a decision. As a longtime Rotary member, she knew of matching humanitarian grants through Rotary International that could help make a start. Applying wasn’t easy. It meant convincing her local club in Columbia, Md., to raise funds, with assurance of cooperation from a partner club in Bangalore. A banner sum of $25,000 was collected. Then, several hundred e-mails and phone calls to India let Jayaram set up a partnership between St John’s Medical College in Bangalore—her alma mater—and a Rotary club there.
The results? They include donation of a roadworthy van, the hiring and training of case workers who fanned out into villages to assess need, registration of 600 potential patients, identification and treatment of 200 with major depression, half of whom are now well, a working partnership with St. John’s that includes education for villagers. “That they now stop us to ask about bejaar kayile, depressive illness, is heartening," says Jayaram. “If only we can keep the support up, we can lock things in place and effect real change.”