COSMA - The Clinic

COSMA
La Comisión de Salud Mental de Ayacucho


The front entrance to the clinic, it is hard to imagine from this unimposing entrance the extent of the facilities within.
What is the history and work of COSMA?
In addition to the predictable range of psychiatric disorders common in poor countries, Ayacucho was the epicentre of the Shining Path Guerrilla War of 1980’s and 90’s in which 70,000 were killed and thousands of others tortured and displaced from their land. The survivors are still traumatised.
These dire circumstances led to a psychiatric nurse, Sister Anne Carbon of the Missionary Sisters of St. Columban, to found a mental health clinic in 2003. The program began as Sister Anne treated the chronically mentally ill living in the streets of Ayacucho. In 2004, she was joined by a small group of U.S. mental health professionals associated with the Peruvian American Medical Society, PAMS, who assist with education, medication management, medicine donations and financial support.
The clinic has treated over 3,000 patients suffering from schizophrenia, depression, bipolar disorder, anxiety, post-traumatic stress disorder, substance abuse and family violence.
The clinic also runs a successful program for developmentally disabled children, a social rehabilitation program for people with schizophrenia and a pharmacy which provides free and low cost medicines to patients in need. COSMA is affiliated with the Peruvian American Medical Society and the Noguchi Psychiatric Hospital in Lima.
COSMA is entirely non-sectarian. It is funded solely by donations from individuals and organisations. There are no religious, political or philosophical orientations involved other than the highest medical standards.
The mission of COSMA is clearly stated as being committed to bringing free, full-service mental health care to the people of Ayacucho Province.
While its goals are four-fold.
Firstly, the treatment of mental illness, substance abuse and developmentally disabled children and teenagers.
Secondly, the education and training for local professionals and lay people in order to identify and assist those with mental illness.
Thirdly, research into the effectiveness of treatment as well as the progressive initiatives to develop and improve mental health treatment.
Finally, to expand the program to local healthcare providers and also develop outreach to outlying areas.

As of the beginning of 2011 the Missionary Sisters of St. Columban handed over the clinic to a Belgium Order, the Brothers of Charity. Sister Anne relinquished her role as the clinic’s Director and the Brothers of Charity have now assumed the directorship and subsequent administration and coordination.
The Brothers of Charity were founded in Belgium in 1807 by Canon Peter Joseph Triest with the aim to care for the poor and underprivileged, specifically the mentally ill.

As you can see from the photographs the building is a wonderful facility incorporating treatment rooms, consulting rooms, pharmacy, separate activity rooms for both the children and young adults, an auditorium, reception area, administration area and a small kitchen. In the latest development accommodation has also been added to the very top floor, affectionally referred to as “the penthouse”. It is even more incredible when you discover that this was originally a private residence and this house was built on quite a steep slope, again evidenced by some of the shots taken. Sister Anne did mention that the reception area was originally the garage!


The Reception area is on the immediate right as you look towards the front entrance. A permanent receptionist greets all the patients and visitors.

This the main Administration area, the shot also gives you a glimpse of the small kitchenette in the background.

The various four levels of treatment and consulting rooms as well as separate activity rooms for the children and young adults.

A small, internal recreation area for the use of the patients, or their visiting family and friends.


The very well equipped Auditorium; this is where we conduct our English lessons.

“The penthouse” is built on the third floor of this building and this was to cater for visiting medical personnel; consulting rooms are below and the Auditorium is at ground level. The use of the term “level” is a difficult concept to understand in this part of the world!