When Dr. Etheldreda Nakimuli-Mpungu graduated from medical school, her mother told her, "OK, good. But you know it's not good to just be a doctor."
"She, said, 'There's some doctors you go to and they don't make you better. I want you to be one of the doctors that really makes people better,' " Mpungu recalls. "And I thought, 'Oh, no. What does she mean now?' "
Mpungu went on to work in a surgical ward. And then with children. She was helping people — but couldn't say she was really living up to her mother's high expectations.
Then Mpungu started working at a mental hospital in Kampala, Uganda, and she noticed something strange.
"We were getting tremendous number of patients living with HIV/AIDS being admitted with severe mental problems," she says. "And at the time, no one knew how to help them or what to do with them."
Doctors had pretty much given up on these patients. "Sometimes they were not even being prescribed the proper medications for their HIV," Mpungu says. "There was this idea in the medical community that these people were beyond help."
Mpungu pored over medical texts, looking for guidance on the best ways to care for patients with both HIV and depression. "But at that time, I couldn't find anything."
Here was an opportunity for her to step up — to be one of those doctors who really make people feel better — by developing programs to help HIV-positive patients with mental health issues. That was 15 years ago.
Now Mpungu, 41, is helping implement a group therapy program she developed for patients with HIV throughout northern Uganda, with major funding from the Canadian government. Her first study evaluating the effectiveness of the program was published in The Lancet HIV last May. And this month, Mpungu was named one of the winners of the Elsevier Foundation Award for female scientists in the developing world.
She has produced an entire body of research on the relationship between HIV and depression in sub-Saharan Africa, from scratch.
"I had to start by building the evidence that this was important," she says. There had been some studies done in high-income countries, demonstrating that people with HIV are more likely to suffer from depression, and vice versa. But no one had done such research in a developing country like Uganda.
Her research confirmed that people with HIV are more likely to feel depressed — owing to stigma and hopelessness about their condition. What's more, they're less likely to take care of themselves and take the medication necessary to keep the HIV at bay. On the other side, "depression impairs people's judgment," Mpungu says. Research shows that people with depression are more likely to take big risks, abuse drugs and have unprotected sex — and contract HIV in the process.
"So it's this vicious cycle," Mpungu says. "Once we showed that, doctors asked, 'OK, so what [should we] do about it?'"
Most medical centers lacked the money, training and staff to provide any sort of mental health care. So she needed to develop an approach that didn't require too many resources.
"Given how few trained mental health providers there are in Uganda, one-on-one therapy just wouldn't be practical," she says. "So I had the idea to have a group therapy intervention."
She began by consulting with patients in the Kitgum district in northern Uganda, where she was based at the time, and asked what would motivate them to attend a group therapy session.
The eight-week program that Mpungu designed included opportunities for group members to share their painful experiences. The program also taught coping skills and — at the request of the attendees — added some job training sessions as well.
To test out the program, Mpungu recruited a group of 150 people who had both HIV and depression. She and her colleagues randomly assigned some to group therapy and others to standard HIV information sessions at a clinic. Over time, depression declined — at least slightly — in all the patients. But depression among those who went to therapy continued to decline even six months after completing the program. And many of those who attended group therapy stayed in touch with the group members. Inspired by their job training seminars, some group members started projects or businesses together.
"We were surprised because we had thought maybe people wouldn't want to come, or maybe they wouldn't want to be seen with each other due to stigma," she says. "But they actually wanted something like this — so badly."