Opening up about one’s mental health challenges can be among the hardest thing to do in life, but Sarah Mashaba (34), a community health worker (CHW) based at Thomo Clinic, Giyani, believes that talking can not only improve one’s mental health, but save lives.

She is proud of the fact that discussing mental health is not taboo where she lives.

“The people in my community discuss their mental health problems freely. This is because we teach them about mental health whenever we visit them at their homes. We tell them that not speaking about things can result in depression and, ultimately, death. So people here understand the importance of speaking about their mental health. Our [Grow Great Champions] clubs at the clinics also discuss mental health regularly,” says Mashaba.

The advice is not reserved for her clients only; Mashaba lives by her words. Getting things off her chest has always been her preferred way of dealing with work stress or problems at home.

“Whenever I’m stressed about something, I share it with my colleagues. I do the same at home with my husband and children. Talking helps, we need to tell our partners and children about the problems we have,” says the mother of a girl and two boys.

Despite her best efforts at encouraging people to talk and her community’s generally positive approach towards mental health, there are some who are not comfortable discussing it.

“Sometimes, people are too afraid to disclose their mental health problems and I’m not sure how to encourage them to open up. This ends up affecting their physical health. For example, I always encourage my pregnant clients to book early [for antenatal care] at the clinic and I’ll offer to go with them, but they sometimes make excuses when it’s time to go. Some women have said to me they’ll make a booking with a general practitioner, while some said they’ll go for antenatal care after 6 months.”

Poor mental health can affect the health of unborn babies and Mashaba takes every opportunity she can to educate pregnant women and learners in her community about the importance of maintaining good mental health.

“We [CHWs] give health talks at our clients’ homes. We also teach other and ask each other questions until we find solutions to certain problems. We also have school campaigns and community dialogues where we talk about mental health.”

It was during one of her school campaigns that Mashaba encountered one of her most difficult challenges in her 17 years as a CHW: assisting a pregnant 14-year-old who was battling depression.

“I had arranged a session where I would speak with pregnant learners about the issue of early antenatal care bookings and then screen them for any mental health problems they were facing. Afterwards, a 14-year-old girl approached me, saying that she was pregnant and had no idea how far along she was.

“I visited her home and spoke with her mother who said her daughter was five months pregnant. I was shocked and decided that I should make a booking for her at the clinic. After receiving permission from her mother and the school, we went to the clinic, where she was given a maternity book, which she took home. In it, I made a referral for her so she could finally be booked for antenatal care.

“I followed up with her and her mother the day after the visit. They said everything had gone well and that she would go for her next appointment – she is fine now.”

The girl was in a bad space before meeting Mashaba, however, and the CHW said that there were several specific factors that led to her being depressed.

“Firstly, she is a minor – only fourteen years old. Secondly, she had stopped going to school. She also ran away from home, this was the third issue. When I first accompanied her to the clinic, she was nervous when questioned by the social worker and started crying.

“When I screened her, I asked if she knew who the father [of her unborn baby] was; she said yes but seemed uncertain. I believe this was the fourth factor that led to her being depressed. The fifth was that she didn’t know how many months pregnant she was – she just was not prepared for the pregnancy.

“I didn’t feel good about the whole situation: she was really depressed and so were her parents, in my view. But I had to be strong and focus on helping them and doing my job. I referred her for counselling and now she is fine. I am happy that she is.”

Mashaba says that she would like to see a reduction in teenage pregnancies in Thomo as well as zero stunting by 2030. The work that she and her colleagues do brings hope that this can be achieved, which is why we are proud to have her as one of our Grow Great Champions.