Concord Times (Freetown)
Ibrahim Jaffa Condeh and Kevin Hill
29 April 2008
Consultant psychiatrist has revealed in Freetown that apart from inmates at the Sierra Leone psychiatric hospital in Kissy some 10% of Sierra Leoneans would require psychiatric care, meaning 400,000 have some form of mental disorder in the country.
Dr. Edward Nahim is worried because the nation has only 67 qualified doctors to take care of the entire nation and further disclosed that he was the only psychiatric specialist in the mental health field.
He said the psychiatric hospital, formerly the Kissy Mental Home, is the only mental health facility in the country. He complained that when it comes to allocation of the few resources that the country has, mental health is all but forgotten.
"It is a system that is marked by too many people chasing too few facilities," he observed.
The mental health system in Sierra Leone faces many challenges including stigma, discrimination, lack of qualified personnel, insufficient infrastructure and poor funding. Another, more immediate challenge, is simply feeding the patients.
For the past month patients at the hospital has not been receiving food as part of its daily care. This places a heavy burden on family and staff taking care of patients at the mental hospital.
Upon entering the wards patients immediately begin asking visitors for food. Many of these patients are chained to their beds. The heavy, naked chains keep those wearing them from moving around. These patients cannot be allowed to leave the hospital, as they may go looking for food.
The government usually provides three meals per day at no charge to the patients. This, according to Dr.
Edward Nahim is a supplement to, or is to compliment, the food that families of patients are supposed to provide.
Families are expected to provide food for their relatives. Most patients do have families who can take care of them, but many do not. Those patients who are alone, or who have been abandoned, rely on the charity of staff members to survive.
Nurses working at the psychiatric hospital told Concord Times that they provide a small amount of food to patients who have no other alternative source.
"There is a lot of hard work, as compared to the salary we get. So the ministry should raise our salaries. We get paid a salary of Le150, 000 per month. From our salary we give the patients gari and sugar when there is no food for them to eat. We do not want them to go to bed hungry." Dr. Nahim said that he also donates some of his own money to cover the cost of basic sustenance for some of his patients. "Those who are abandoned, we take care of them. Sometimes I donate money from my own pocket." "Everybody is being fed, no one goes hungry," said Dr. Nahim.
Meanwhile, the contract of the company in charge of providing food to all hospitals across the country expired in March of this year. A new tender process is underway to choose a new contractor to take over the job. Until that happens, the burden falls on the caregivers.
When asked to address the issue of patient's having access to food, Dr. Nahim responded "That's their problem. The whole nation suffers from this problem.
All hospitals are affected." The heavy chains that are used to restrain patients are the only appropriate patient care in Sierra Leone.
According to Dr. Nahim, "this is what we have. In other countries patients are kept in high security facilities like prisons for long periods of time. Here they are chained for up to one week, until they are no longer dangerous. Some of these patients are very violent. They need to be restrained." Leah, a psychiatric patient, was brought to the hospital by her husband about 6 weeks ago. "I have been restrained by a chain and there is no food," she said. She would prefer to leave the hospital instead of staying where one can go to bed without food.
Dr. Nahim doesn't want his patients to become institutionalized. Patients are kept in the psychiatric hospital for only three months for treatment and then released back into the community.
He points to community based traditional methods of mental health care as the most effective solution for most psychiatric patients in Sierra Leone. He divides mental health care into two distinct groups: the medical model of mental health and the traditional model.
Many mental problems are caused by a strong belief in witchcraft, curses by juju men or bad people within the family. The first point of contact for most people in Sierra Leone is the local traditional healer. For this reason 90% of mental health patients in Sierra Leone are treated with traditional methods, instead of Western medical model methods. Culturally speaking, many Sierra Leoneans believe mental illness is a curse from God.
James, a resident of the psychiatric hospital, said he has been coming to the hospital intermittently since 1980, suffering from frustration, depression and influence by juju men. He described the juju men as a major cause of mental trouble in Africa, being made worse by the actions of our own family due to jealousy and hatred. He is in the hospital seeking asylum from these enemies, and the love and sympathy from the staff. He usually receives food three times a day, but only recently has there been a lack of food.
The majority of mental health work is being done at community level. In order to address this situation the ministry of health and sanitation has begun pilot projects in Kailahun and Magburaka Towns. Here community mental health teams are working at grassroots level to deliver mental health care. The success of these pilot projects may provide a feasible level of care delivery for those 90% of Sierra Leoneans seeking care in the villages in non-traditional means.
According to deputy minister of health and sanitation Sheiku Tejan Koroma efforts are being made to revive mental health policy in Sierra Leone, though he acknowledged that the country does not currently have a national health policy plan that includes mental health. "I want to reassure Dr. Nahim that the minister and I take the issue of mental health very seriously," he said.
"We all know how difficult it is to treat those with mental illness. It takes courage, determination and commitment. Patients need patience, love, compassion and respect," Koroma added. But is this what patients currently residing in the Sierra Leone Psychiatric Hospital can expect? We will continue to make follow ups.
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