This is a brief follow up to the link I shared on the status of cancer care in Kenya….. Look at some of the activities being done for cancer care and also screening in a few parts of Kenya by this dedicated group:
curse, evil machinations, evil spirits, Frank Njenga, Human rights, Human rights based approach, John Kinuthia, Kenya, Locked up and forgotten, Lukoye Atwoli, Mental health, mental health act, mental health policy, Mental illness, post election violence, Poverty, Prejudice, Public financing, Robbin Hammond, Silent epidemic, Stereotypes, stigma, traditional healers, war
“Across Kenya, there’s a terrible secret, hidden from the world. People who barely exist. They live in darkened rooms, if you call it living…they’re Locked Up and Forgotten.” That is an excerpt from a 2011 CNN documentary showing the rot in Kenya’s mental health system. In it we see the inhumane ways in which Kenya’s mentally ill are treated and the degrading conditions in which they are housed. Inpatients at Mathari Hospital Kenya’s main psychiatric hospital were crammed in crowded wards, forcefully medicated and with complaints of sexual abuse from fellow patients going unaddressed. Outside of hospital, the documentary showed how Kenya’s poor struggle to access mental health services. With nowhere left to turn and in a country where stigma and discrimination against the mentally ill or disabled is deeply entrenched, these families result to chaining their ill and hiding them away from the eyes of a society that would rather pretend they don’t exist.
A PBS article; Mentally ill shackled and neglected in Africa’s crisis regions, featuring harrowing images from across Sub Saharan Africa by the photographer Robin Hammond; demonstrates that mistreatment of the mentally ill is widespread in Africa.
The pictures formed the basis of Hammond’s book published in 2014:CONDEMNED – Mental Health in African Countries in Crisis. In the book’s intro, Hammond notes that the mistreatment of the mentally ill in Africa, “was the worst assault on human dignity” he had witnessed in his 12 years of documenting the effects of war and conflict. He further articulates the harsh reality of the mentally ill especially in Africa’s war torn regions:
Abandoned by governments, forgotten by the aid community, neglected and abused by entire societies: Africans with mental illness in regions in crisis are resigned to the dark corners of churches, chained to rusted hospital beds, locked away to live behind the bars of filthy prisons. Some have suffered trauma leading to illness. Others were born with mental disability. In countries where infrastructure has collapsed and mental health professionals have fled, treatment is often the same – a life in chains.
In Africa, the assumption that infectious and parasitic disease constitute the biggest threat to health is erroneous. Poverty, conflict, war, displacement, diseases like HIV/AIDS and tragedies like famine which led Kenya’s psychiatrist Dr. Frank Njenga to call Africa the ‘traumatized continent’ make mental illness a serious concern. Kenya for instance has suffered many traumatic experiences from the Mau Mau concentration camps, post election violence that led to scores of internally displaced persons and several terror attacks like the 2001 bomb blast in the US Embassy in Nairobi and the recent Al Shabaab attack on the Westgate shopping mall.
Unfortunately, the majority of psychiatric problems remain undiagnosed and thus unmanaged in most of Africa. Experts have thus declared mental illness as the continent’s “silent epidemic.” In Kenya for example, mental health experts estimate that 1 in every 4 Kenyans may be suffering from a mental health problem. These range from common disorder like depression and anxiety; severe disorders like psychosis, schizophrenia and bipolar disorders; alcohol and substance abuse problems among others. See:Reforming Kenya’s ailing mental health system for details. Among these conditions, clinical depression is said to be the most prevalent with an estimated 4 million Kenyans suffering from it.
The situation is compounded by the pervasive culture of denial, silence and stigmatization that surrounds mental health issues: Anxiety disorders and depression are seen as Western constructs and therefore Un-African. At best, these are seen as a problem that only afflicts Africa’s middle class. In Africa, depression’s simply NOT A THING-and where it is, one is expected to simply, “snap out of it.” A satirical piece written in the wake of Robin Williams death in Kenya’s Standard newspaper; Depression Has Never Been An African Disease, eloquently captures the trivialization of depression by the Kenyan society. Says the author:
What disturbed me was news that the famed actor (Robin Williams) had committed suicide because he was suffering from depression. What is this depression thing? I accept it when a man hangs himself because his wife has left him, or he is jobless, or the neighbour has bewitched him or he is caught red-handed kissing his mother-in-law. But committing suicide because you are suffering from depression is simply not African.
As a Kenyan who watches NGOs tinkering with jiggered feet, I can’t wrap my mind around the fact that depression is an illness. We are stressed and depressed all the time! In fact, it is such a non-issue that African languages never bothered to create a word for it. Anybody who knows what they call depression in their mother tongue, please step forward.
Depression, I am told, does not have a single cause, but that “an upsetting or stressful life event – such as bereavement, divorce, illness, redundancy and job or money worries” could trigger it. To be honest, some diseases only strike wazungu (white people) or the middle class. Around here, when you are bereaved, you wail your head off, blame a neighbour, slaughter a cow for mourners, get inherited or replace the departed spouse and move on.
An article on the knowledge, attitude and practice (KAP) of mental illness among staff in general medical facilities in Kenya notes that in many African societies “psychiatric illness is seen as either the outcome of a familial defect or the ‘handiwork of evil machinations’ (demons, evil spirits).” The article notes that such beliefs leads to psychiatric patients being ostracized. The report further notes that “when such beliefs are combined with common stereotypes of the mentally ill as unpredictable and dangerous with a propensity for self harm, harm to others or property leads African societies to stigmatize, fear and shun the mentally ill.”
In the book ‘Mental illness in popular media: Essays on the Representation of Disorders’ the authors note that African communities ascribe mental illness to curses, evil spirits, or witchcraft, “even when mental illness arises from observable and verifiable causes such as drug abuse and sudden changes in lifestyle.” Furthermore, according to the KAP report, most view psychiatric patients as being responsible for their illness, especially when it is an alcohol and/or substance related problem. In Africa, the mentally ill are generally labelled “mad” and the frequent use of of the infamous African proverb “every market has a mad man” in popular media like in this article: Each market has a mad man but Luanda has one too many and the blog, Viva my village madman shows the extent to which society embraces their disdain.
The KAP report notes:
Mental illness stigmatization denies psychiatric patients the empathy and understanding traditionally bestowed on the sick in the African society.”
Ultimately, the silence, negativity and stigmatization that surrounds mental illness in Kenya and Africa at large impedes patients’ treatment. The belief that mental illness has supernatural causes leads many to seek ‘cures’ from the so called ‘witch doctors’ and traditional healers often delaying effective care. The shame attached to the illnesses also means that most would rather suffer in silence rather than seek treatment. Unfortunately, since medical professionals, legislators and policy makers are all drawn from the general population, they share the same prejudice and stigmatizing attitudes as the general public as the KAP article reports. Finally, since most patients are locked away, Hammond notes, “these people are unseen so their suffering is ignored” including by their own governments!
Constraints to the provision of mental health services in Kenya:
CNN’s Locked Up and Forgotten prompted a human rights audit of the mental health system in Kenya by the Kenya National Commission on Human Rights (KNCHR). The commission’s report: “Silenced Minds; The Systematic Neglect of the Mental Health System in Kenya,” released in November 2011 painted a grim picture of the sub-sector. The report noted that Kenya lacked an effective legal and policy framework for mental health: Kenya’s mental health act which was effected over 25 years ago in 1989 is narrowly focused on inpatient treatment and even then remained only partially enforced because the implementing board of mental health lacked an operational budget.The authors further noted that though a mental health policy was drafted in 2003 and revised in 2007, neither drafts were adopted. Effectively, Kenya has no mental health policy.
The report noted that Kenya’s mental health sector lagged far behind physical health primarily due to gross underfunding by the government. In Kenya, mental health gets just 0.01% of the entire budget allocated to the ministry of health most of which is spent on administrative costs. As a result, Kenya, has approximately 77 consultant psychiatrists, 418 psychiatric nurses and 30 clinical psychologists to serve a population of 44 million. It is also reported that medical students generally frown upon psychiatry making it difficult to raise the number of professionals for the sub-sector.
Also tied to under funding, the report found the available services were of insufficient quality and facilities non conducive to recovery. Inpatient and outpatient services like rehabilitation services and halfway houses are almost unheard of and the supply of psychotropic drugs insufficient. Mental health services were found to be overly centralized with almost 70% of inpatient beds found in the capital Nairobi limiting accessibility. At the time of the audit, far flung areas like the North Eastern province were found to have neither a psychiatrist nor a psychiatric nurse. The report concluded that the legislative, policy, programmatic and budgetary steps the taken by the Kenyan government had been ineffective in realizing the right to mental health and in protecting the right of the mentally ill to have their dignity respected as provided by Kenya’s constitution.
Benefits of a human rights based approach to mental health care:
The KNCHR report concluded that anchoring Kenya’s mental health care in a system of rights would be greatly beneficial since this comes with corresponding state obligations. The report noted that this is important because putting obligations on the government in turn demands accountability; strengthens the ability of poor and vulnerable people to demand and use services and information; prohibits the discrimination and emphasizes equitable access to mental health services. The report was highly optimistic since at the time it was being crafted, Kenya had just promulgated a new constitution (2010).
The authors therefore felt that mental health reform in Kenya was particularly timely at especially since per the new constitution, previously centralized health services would be devolved to 47 newly created counties. Devolving health services should have made mental health access more equitable by making it easier to integrate mental health services in to primary health care and linking this to informal community based services and self care.
But in Kenya, more things change; the more they stay the same:
Why African governments should care about mental health:
As noted in the recent Declaration on mental health in Africa: moving to implementation by global mental health experts, there is urgent need for African governments to address the existing gaps in mental health provision as well as addressing the persisting stigma and social exclusion. Failure to address mental health problems exacerbates poverty because lowers the productivity of individuals and it also curtails the achievement of other health goals. Also as noted by the KNHCR report, “the systemic neglect and marginalization of the mental health sub-sector by governments amount to discrimination against the mentally ill on the grounds of health.” The KNCHR warned that without concrete and targeted reforms in the mental health sub-sector, countries will fail in creating a just, cohesive society with equitable social development.
Bridging the mental health gap is achievable even in low resource settings:
In Improving mental health in Africa, Prof. David Ndetei a leading psychiatrist in Kenya says where resources are a constraint, nations should embed mental health service delivery within preexisting community health delivery services. He notes that Kenya already has many operational community health centers that deliver nutritional interventions and immunizations. He notes that training community health workers working in such centers could improve mental illness screening, treatment and support at the community level. This strategy has been tried and tested in places like India as detailed in the talk: Mental health for all by involving all by Dr. Vikram Patel from the London School of Hygiene & Tropical Medicine. Dr. Patel believes we can improve mental health delivery in low-resource settings “by teaching ordinary people to deliver basic psychiatric services.”
I dedicate this song to you because at this point in time, I have no words of my own to express my anguish at what’s going on with you. Hopefully the political class and the perpetrators of the violence get their minds and hearts right to preserve your integrity. We love you always.
Time is wasted, we were meant to love each other
Separation, is the root of all our problems
If I hurt you then I hurt myself; Hate you then I hate myself
If I kill you – I kill me
But if I love you like I love me,
And if I treat you like I treat me
Oh what a world (what a world ) this would be
Oh what a world (what a world) when I see, YOU ARE ME!
We are dying, bodies lying in the street
From the silence unmarked graves are crying out for peace
If I turn my back and walk away say… that’s not me so I’m okay – I fail
Cos it goes on and on again
But if I love you like I love me,
And if I treat you like I treat me
Oh what a world (what a world ) this would be
Oh what a world (what a world), when I see….
You are me and I am you: One blood, one spirit,
One world we are living and we could be the change we need
If I love you like I love me
And if I treat you like I treat me
Ohhh what a world…what a world …what a
world this would be
Kenya no one has more faith in you than I. Lets fix this, I know we can fix this. #NotOneMore life lost to senseless violence. This should be our unified message to the ruling elite.
411, Africa, African Technology Policy, Bar, British Council, Café Scientifique, Casablanca, cervical cancer, Child health, Circumcision, Communications, Contraceptives, Cysts, engage, Fibroids, Health, hormone replacement therapy, Hot flashes, Hurlingham, Infertility, Information, International Women's History Month, KEMRI Wellcome Trust, Kenya, Kenya AIDS Vaccine Initiative, Malaria vaccine, menopause, Movement, Nairobi, Networking, Pap Smear, Research, Science, Science cafe, Stereotype, Technology, University of Nairobi, Women's Health
The women who streamed into the Casablanca Bar in Hurlingham on March 24th were not looking for a frosty drink or a hot party. Instead, they came for cold, hard knowledge about health issues that could literally save their lives.
After kicking off their shoes or flopping on to cushioned stools in the bar with its low lighting, brightly coloured couches, and other vivid Moroccan furnishings, these patrons weren’t gathering to complain about work or gossip about men. They wanted the “411” on topics like hot flashes, contraceptives and cervical cancer.
Ranging in age from 19 to 49, these women were part of a growing worldwide movement that brings sciences to the masses known as Café Scientifique or the Science Cafe. Started in Leeds, England in 1998 by scientist Duncan Dallas, Kenya is only the fifth African country to join the movement.
Knowledge is power; “for the price of a cup of coffee or a glass of wine, people can meet and discuss the latest ideas of science and technology.”
Dallas, who has a Chemistry degree from Oxford University and also produced features for the BBC, was inspired by the philosopher Mark Sautet who founded Café Philosophiques in France. He says the reason for his project was simple; “too often science gets stereotyped in the general public as dull, remote, complicated, incomprehensible – or all the above.” But Dallas believes that when it comes to the impact that research can have on the quality of life, knowledge is power. And what better venue for empowerment than a place where people already gather as a matter of habit? Hence the marriage between the scientists and the Café. “This is a place where for the price of a cup of coffee or a glass of wine, people can meet and discuss the latest ideas of science and technology which are changing our lives,” he says.
Also, if the the image of science has received a bad rap through the years, the scientist has fared even worse. Many are labelled as eccentric or even downright mad. Stereotypes aside however, scientists themselves often acknowledge being so immersed in the technical aspects of their work that they are unable to explain it to the very people they’re trying to serve- the public.
But rather than ask the average citizen to attend scientific seminars to learn about issues, Dallas opted for a more realistic route- the Science Café. “The audience does not come for self improvement or to be lectured to. It comes to participate. The public wants to be informed, but also wants to discuss the consequences.”
Because March was International Women’s History Month, the two young women who brought the Science Café concept to Kenya selected Women’s Health as the theme for a women’s only Café. Consultant Ruth Wanjala, a former communications assistant for the African Technology Policy Studies Network was introduced to the Science Café concept in 2006 when she won an essay competition at a Café organized by the British Council in South Africa.
In April 2008, Wanjala and a young scientist friend, Ms. Juliet Mutheu hosted the first Kenyan Science Café. Mutheu a scientist with the KEMRI Wellcome Trust is also an external relations manager. The first Kenyan Science Café topic focussed on the Kenya AIDS Vaccine Initiative (KAVI). Ensuing topics included Child Health, the Malaria Vaccine and Male Circumcision.
Asked why she wanted to bring the Science Café to Kenya, Wanjala says: “Having worked in a communications department, I realized that the scientific output we were producing- the brochures, journals, articles- were rather out of touch with what the scientists were doing.” Wanjala continues, “the research message wasn’t really getting out. Whenever we would go for conferences, the sessions were long and too technical. People often fell asleep.”
She adds, “during the lunch break however, I noticed the public would engage with the scientists to ask questions or simply discuss. I thought an informal setting might encourage greater engagement between the public and the scientists.”
At the recent Café, the featured speaker was Dr. Carol Odula Obonyo a University of Nairobi obstetrician and gynaecologist who also operates her own practice. She was joined by her colleague Catherine Musyoka who is a nurse. The two specialists drew on their experiences to answer questions in layman’s language. Areas covered ranged from menopause, diet, exercise, infertility, hormone replacement therapy, fibroids, contraceptives, cervical cancer and the HPV virus, pap smears and sexually transmitted diseases.
Dr. Obonyo thinks the Science Café could be an important venue for spreading health information for women. “Men have over time perfected the art of bar networking, but this now encompasses more purposes than just business,” she says, “it is fairly common to find men sharing with their mates about issues affecting them, be it their health, their kids or their marriages.”
Obonyo contrasts, “today’s woman in her quest to be super woman- mother, sister, wife, a professional- often gets stuck in a rut with very little time for herself and the matters that directly affect her.” This she believes makes the Science Café a really important concept, “we can forget the diapers, the formulas, jobs, and just talk,” she says, “we can catch up and discuss our health and nothing’s more important because a woman is the backbone of her family, when she is well she can give more support,” she concludes.
At Casablanca Bar, the questions were as varied as the topics and they ranged from the sobering to the hilarious. There were frequent gasps of shocked realization and sometimes even horror after learning the possible cost of one’s ignorance.
For example, one woman said she came to the Café to get information for her neighbour whom had been plagued by ovarian cysts and couldn’t get pregnant. At the same time however, she had been afraid to seek treatment for the condition. Besides warning that the neighbour’s cysts could signal serious health problems, Dr. Obonyo also suggested that the husband also be checked for infertility.
Another woman wanted to know her chances of conceiving at age 42 while she also had fibroids. In this case, Dr. Obonyo advised that it depended on where the fibroids were located in the uterus. She said conception was next to impossible if a fibroid is close to the fallopian tubes for instance. She however urged the woman to get tests since in some instances, it is still possible to conceive.
Obonyo also noted the potential of such Cafés in preventive health. “Why should we rush when we fall sick to seek a cure when all we needed was the right information to protect ourselves from disease even if that means getting free medical advice in a bar or Café?” she asked.
So far, only six Kenya Science Cafés have been held. Last year, funding was a problem. But the Café organizers recently won a grant from the International Engagement Award of the Wellcome Trust and will now host the event monthly. Even with minimal advertisement for the events, the turnout has been laudable. Most of the advertisement has been through simple word of mouth. And of course these days if it’s cool and involves the public you can find it on Facebook. The group’s name is Kenya Science Café.
Kenya Science Cafés are currently just being held in Nairobi but there are plans to take the concept to Mombasa and Kisumu. The organizers also plan to vary the settings to reach people of all socio-economic backgrounds. But wherever they are held, the Science Café organizers believe they can make a long term contribution to better health in Kenya.
For example, many women who attended the recent event vowed to get their pap smears and mammograms done as quickly as possible. The events can also help put scientists more in touch with public needs. Last but not least, “the public will also understand science related public policies,” Wanjala says, “we won’t have people thinking; I need to get a vaccine because my local district officer told me to, they will know precisely why it is important.
Note: This was actually my first publication for the Daily Nation prior to which I had written for the ‘rival’ newspaper The Standard. This piece was published on the 31st of March in 2009.
I hope the that the Kenya Science Cafés are still going strong! It is a great concept for science dissemination.
If anyone’s interested in the seeing the article as it appeared in the paper please see attached pdf and please forgive the rather unfortunate title!
Newspaper editors sometimes huh.