We were lucky to catch up with Pavel Reppo recently and have shared our conversation below.

Hi Pavel, thanks for joining us today. Let’s kick things off with your mission – what is it and what’s the story behind why it’s your mission?

I emigrated from Belarus to the United States in 1996 at the tender age of 5. My parents lived through the break-up of the Soviet Union, forced to ration food tokens for purchasing salt and bread. By coming to the United States, we had made it. I could be anything I wanted to be. And for a while, I wanted to be an Aerospace Engineer. However, when I was 13 years old I found myself standing face to face with the bathroom mirror. I began to wash my hands, and I couldn’t stop. I would wash them for 30-40 minutes several times a day and for weeks at a time. They began to crack and bleed, and they resembled the leathery exterior of a used football. This was my first encounter with Obsessive-Compulsive Disorder.
I have had days where I was bedridden, completely paralyzed by fear and anxiety. I remember feeling out of sorts and out of control – thinking that OCD was a reprieve for control. And still on some days, after brushing my teeth and enjoying my morning eggs, I am close to being triggered into full-body depression. I’ve not “overcome” it; instead, I am only okay because I live in the United States. I’ve been fortunate to have supportive friends and family, a wonderful therapist, an OCD coach, recovery literature to gorge on, and access to support groups. I have money to afford all of the abovementioned resources. I recognize that because of my privilege, I have many resources at my disposal that have made my journey with OCD manageable.

My mission to work in mental health began when I had the opportunity to volunteer at a summer camp for kids and adults with intellectual disabilities. Working at this camp brought me a sense of wholeness and a sense of purpose. In search of tools to deepen my work, I attended the Leadership in Mental Health Course in Goa, India. Before leaving, I stumbled upon Vikram Patel and his inspiring take on utilizing community health workers to bridge the astonishing treatment gap. I was hooked. How do I help? He urged me to attend the course to learn the skills to develop and scale-up mental health interventions, and strategies to overcome barriers in resource-constrained settings. There were 50 of us who attended – a motley crew of service providers, teachers, entrepreneurs, and students sprawling from the Global South. I was bolt-struck; the interventions taking root in India, Nepal, Kenya, and South Sudan were culturally sensitive, adaptive, and community-oriented.

I first visited Uganda in 2013; it was the beginning of a tenacious and compelling relationship. The people of Uganda greet you with smiles (you know this because their eyes light up), offer food and other provisions because you are their guest, respond with grace, understanding, and passion, and believe that they deserve more and better. For one of my visits, I was volunteering at a health center during a mental health clinic day, accompanying a doctor and listening to the patients’ stories while he advised them and dispensed medication. We heard stories of struggle and pain, difficulty finding work, challenges connecting with family, and disempowering self-doubt. I felt a deep resonance with my own personal struggles with mental health, and a yearning to help. This pushed me to take a closer look at my experience from Goa and to ponder how to adapt the model to meet the needs of mental health in Uganda. Thus began my calling to address the mental health crisis in Uganda. My purpose is to offer mental health treatment to anyone, irrespective of race, location, language, socioeconomic status, and beliefs. Finemind was born.

Pavel, love having you share your insights with us. Before we ask you more questions, maybe you can take a moment to introduce yourself to our readers who might have missed our earlier conversations?

Finemind offers free, widespread mental healthcare in Northern Uganda where the residents suffer from extensive intergenerational trauma and scant psychological resources. Finemind trains and monitors local community health workers (CHW) with knowledge and skills to deliver streamlined and effective counseling, a method that has been documented through evidence-based research to be an effective approach. The peer-to-peer counseling is offered in progressive steps of treatment, known as “stepped care”. At each step, patients are counseled, evaluated and either discharged or referred to the next step where the treatment is intensified and more specialized. Finemind’s adjacent programs address the barriers of stigma and social determinants such as poverty that are tied to mental healthcare.
In order to understand our theory of change, it is essential to first describe the context of our work. The center of Finemind’s efforts has been the Agago District in Uganda. It is an area that has suffered from years of civil war, genocide, refugee migration, humanitarian crisis and the AIDS epidemic, which has resulted in deep inter-generational trauma. All these circumstances are linked in a vicious cycle with issues of poverty, poor education, inadequate healthcare and broken family structures. The people of Agago are continuing to face difficulties due to insufficient basic services and limited support. Finemind operates from the premise that rebuilding community-wide mental health will lead to greater agency in the community, i.e. stronger, more capable individuals and families and eventually prosperous, thriving communities.

We’d love to hear a story of resilience from your journey.

My intention is to not glorify struggle and in doing so, inadvertently place the limelight on pushing through as a way to vindicate hard work and success. In hindsight, I should have acted sooner and sought help. I have a hard-headedness that can be self-injurious. I do not condone resilience in the face of suicidal ideation or for that matter, impaired mental health.

At any rate, here is my story.

In the early days of Finemind, I placed undue stress on myself to lead a successful pilot program in order to illustrate the effectiveness of our approach. The work was never ending and the results were modest. In order to get more eyeballs on our work, I chose to partner with a local ethics review board to garner additional credibility. I had no idea what I was doing, and I was overwhelmed. The curriculum was untested in Uganda. We didn’t have a team or health workers to offer counseling services. I was running around Uganda, often on fumes. I was stretched thin, lonely, out of my comfort zone, and unwell.

I worked 15 hour days while juggling multiple balls at the same time. I attempted to console myself, but was unsuccessful. I started to loathe waking up in the mornings and resented time spent by myself. Depression found me quickly and suicidal ideation wasn’t far behind. I started to imagine different ways I could take my life – daydreaming about peace and rest. I was afraid of myself and despite this growing concern, I felt obliged to keep the work going.

Thankfully, I reached out to a Ugandan psychiatrist. I reached out to my family and friends and spoke candidly about my struggles. My US-based therapist offered his time, and we set up a loose structure to make it through the next 2 weeks. I pressed on, and I finished my time in Uganda without heading home early.

Resilience demands attention – equal amounts of care and love. What this instance taught me is that I neglected its demands and prioritized accomplishment above health. Resilience should not be the silver lining of suffering.

Do you have any insights you can share related to maintaining high team morale?

My role isn’t to be the loudest or the smartest person in the room. My role is to enable the right combination of factors, to engage the proper levers to prepare our team to perform at their best. On certain days, this may look like Pavel, the cheerleader – rooting on a teammate with zeal and passion, while other times this may look like Pavel, the mentor – offering critical insight and input for refinement and clarity.

Our team is now 36 people large and based in Uganda. Remote leadership serves up its own dish of challenges. Mostly, it’s reminding myself over and over to not control how the work should be done. Through experience I have learned the importance of maintaining a guest mentality and the subsequent value of not having all of the answers. Listening to the needs of the community, and incorporating their expertise, opinions and insights often leads to the best fit solution. The local community knows best.

Contact Info:

• Website: https://afinemind.org/
• Instagram: https://www.instagram.com/finemindorg/
• Facebook: https://www.facebook.com/finemindorg/
• Linkedin: https://www.linkedin.com/company/finemind/
• Youtube: https://www.youtube.com/channel/UCUksR0G-64Pq5j5LxdXqQYQ