Wednesday, April 23, 2008
Mental Health Care at Sierra Leone Psychiatric Hospital
By Kevin Hill and Ibrahim Jaffa Condeh
The mental health system in Sierra Leone faces many challenges including stigma, discrimination, a 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 Sierra Leone Psychiatric Hospital have not been receiving food as a part of their daily care, placing a heavy burden on family and staff of the hospital.
Upon entering the wards patients immediately begin asking visitors for food. Many of these patients are chained to their bed. 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 patient. This, according to Dr. Edward Nahim, Consultant Psychiatrist at the Sierra Leone Psychiatric Hospital in Kissy, 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, must rely on the charity of staff members to survive.
Nurses working at the psychiatric hospital told the Concord Times that they provide a small amount of food to the patients who have no alternative. “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 ($50). From our salary we give the patients gari (ground cassava) 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.
The contract to provide food to all hospitals across Sierra Leon expired in March of this year. A new tender process is underway to choose a 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 appropriate patient care in Sierra Leon. 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 resident of the hospital, was brought in 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.
Patients are kept in the psychiatric hospital for only three months for treatment and then released back into the community. Dr. Nahim doesn’t want his patients to become institutionalized. 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 in Sierra Leone 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 approximately 90% of mental health patients in Sierra Leone are treated by traditional methods. 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. He is suffering from frustration, depression and influence by juju men. James describes the juju men as a major cause of mental trouble in Africa, “being made worse by the actions of our own families due to jealousy and hatred.” He is in hospital seeking asylum from these enemies, and for what he calls the love and sympathy of the staff. He said that he usually receives food three times a day. Only recently has there been a lack of food.
The majority of mental health work is done at the community level, so the Ministry of Health and Sanitation has begun pilot projects in Kailahun and Magburaka Towns to begin to reach these people. If successful, these pilot projects might prove to be a model of care delivery for some of those 90% of Sierra Leoneans seeking traditional help.
According to Dr. Nahim 10 % of Sierra Leoneans require psychiatric care, meaning 400,000 have some form of mental disorder in the country. After a decade long war marked by numerous atrocities, Sierra Leone needs help.
The nation has only 67 doctors in total. In the mental health field, Sierra Leone has only 1 doctor, Consultant Psychiatrist Dr. Edward Nahim. Sierra Leone Psychiatric Hospital, formerly the Kissy Mental Home, is the only psychiatric facility in the country. When it comes to allocation of the few resources that the country has, mental health is all but forgotten. It is a system where there are “too many people chasing too few facilities”.
According to Deputy Minister of Health and Sanitation, Sheiku Tejan Koroma, efforts are being made to revive mental health policy in Sierra Leone. The minister does, however, acknowledge 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 mental health 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.” Mr. Koroma added. But are patients getting what they need at the Sierra Leone Psychiatric Hospital?