November 11, 2019
Merle received an email update from Karyn G. Gershon, the Executive Director of Project Kesher:
I know that you were disappointed in the way our joint project unfolded but I think you would have been blown away with what happened today in Moscow… and it would not have happened if we hadn’t come over together last year to kick off the health initiative.
Dr. Shari Lusskin presented a lecture entitled “Improving the Treatment of Perinatal Depression: Pharmacotherapy in Pregnant and Breastfeeding Women.” 150 doctors, medical students, and doulas from four countries participated. People flew in from Siberia, Kyrgyzstan, Belarus, and Ukraine for the three-hour program. Entire departments of psychiatrists at hospitals in Volgograd and Astrakhan watched the program together on live YouTube and submitted questions. One year after our visit, Project Kesher has developed an extensive network of healthcare professionals in this region, begun to build trust and saw the outcome of this community building.
This year, we learned that the standard protocol in this region is to discourage women with mental illness from getting pregnant, or to take them off all medication during their pregnancy and breastfeeding and then, be surprised when they have bad outcomes. Shari shared research that showed that medication and/or therapy are essential to the outcome for a woman with mental illness and her child and the risk to the fetus, in most cases, is minimal. She emphasized that substance abuse (tobacco, alcohol, drugs) and domestic violence are among the most dangerous stressors for pregnant women and that anti-depressants, etc., when properly administered can be lifesavers. Shari was bombarded with questions, asked to speak at four medical schools/universities, asked to advise on new protocols for Kyrgyzstan and asked, by several doctors, to serve as a consultant on tough cases.
Shari emphasized the importance of giving women choices. For instance, when one young (male) doctor asked how he should respond to a husband who inquires about institutionalizing his pregnant wife during the duration of her pregnancy because she once had a history of depression, Shari asked the doctor to step back and not see the question through the eyes of the husband. She suggested that his radar go up in this situation. She suggested that he question why this man would want to control his wife in this manner. Shari advised that this doctor focus on the needs of the pregnant woman, assess her mental health, determine what support he could provide through medication and/or talk therapy, and get a sense of her stressors. She suggested that he work with the woman to create a support system during her pregnancy and the months following pregnancy, actively engaging her family and friends to achieve a positive outcome.
One of the most powerful moments was when a young, woman, surgeon who specializes in breast cancer treatment and reconstruction came up and hugged me. She said that she operates in isolation. She treats cancer but not the whole woman. She does not understand mental illness and she does not understand women’s souls. She feels at a loss and today, for the first time, she felt like she had a community of like-minded people who want to do better.
There is so much more to report but I’m absolutely beat. I just wanted you to know that you planted a seed and it is growing.
Karyn G. Gershon
729 Seventh Avenue
New York, NY 10019