Are there natural risks in Ibadan Nigeria

Mentally ill in Nigeria: hiding in the dark corner

THEMES OF THE TIME

Only a few have the opportunity to come to the psychiatric department of the hospital in Ibadan for consultation hours. Photos: Dorothee Klecha
In Nigeria, the mentally ill, often mistreated by traditional healers, receive rudimentary care in the cities and not at all in the countryside. An association in Freiburg wants to help.

Going to a psychiatrist or going to a psychiatric bed in crisis situations - what we take for granted is almost completely unknown in Nigeria. According to the head of state Olusegum Obasanjo on the occasion of the World Health Day in June 2000, which was under the theme of "Mental Health", 30 to 40 million Nigerians suffer from mental problems (6). There are only 110 psychiatrists available for these people in Nigeria (11). With a population of 120 million, this means that there is only one psychiatrist and less than one psychologist for every one million people in Nigeria (5, 10). In comparison, there is one psychiatrist and three psychologists for every 15,000 inhabitants in Germany (10).
In Nigeria, the mentally ill are mostly cared for by the numerous traditional healers. Great power is attributed to these, as there is a belief that they are in contact with the world of spirits (4, 7, 8). Therefore, special skills are expected of them, for example a diagnosis without speaking to the patient - simply by the healer asking ghosts or oracles. Mental illness is generally thought to be caused by supernatural forces, such as evil spirits or bewitching.
The treatment is exhausted in necromancy and sacrifices, which are supposed to appease the gods, combined with the gift of herbs. Such healers often have their own unofficial "institutions" in which the sick
be held. A report
According to the British Broadcasting Corperation (BBC) (1998), patients would be brutally beaten on arrival and mistreated for the months that followed (1). The sick would be locked in hot, humid cells without light and chained to metal ankle cuffs for months. The rusting metal often leads to infections that go untreated. Often people left such dungeons with gangrene on their feet, some of which later make amputations necessary (1, 4). These methods are socially accepted because mental illnesses are highly stigmatized. Not only the sick person but also their family and everyone who has to do with them suffer from it (1, 7, 9, Gureje / personal communication). That is why relatives often hide their sick people in a dark corner of the house (9) or bring them to the "healers" themselves.
Even when those affected do not fall into the hands of such healers, Nigerians have to be on the lookout for help
for mental illnesses with
to fight insurmountable obstacles. Reason: The rural population often cannot walk the long way to the psychiatric facilities in the cities because of the lack of transport vehicles and routes, or the people cannot afford treatment.
In Nigeria, when hospitalized, patients have to pay for food, accommodation, medication and medical procedures out of their own pocket - a treatment that many cannot afford (10). Despite Nigeria's wealth in raw materials (especially oil deposits), estimates from the year 2000 estimate that around 45 percent of the population live below the poverty line (3). Professor Oye Gureje, the head of one of the few psychiatric departments, reports that around ten to 15 percent of the patients in the teaching hospital in Ibadan, which he runs, could not even afford the older drugs with more side effects, such as Haldol or imipramine. Although there is a small "Helpers’ Fund "financed by donations in his hospital, this money can only be used to pay for acute treatment - if at all. If patients are discharged, further treatment is unsecured. The use of newer drugs is a completely priceless desire. Despite special agreements with the manufacturers of Risperdal, a new antipsychotic, for example, a monthly treatment with 3 mg Risperdal per day costs as much as the monthly minimum wage. Since almost half of the population lives below the poverty line and those affected are often unable to work as a result of their illness, the majority of people have practically no access to modern medicines. This problem is exacerbated in that
Psychiatric drugs often have to be taken over a longer period of time, often for life, in order to stabilize the health of those affected.
In 1998, more than a tenth of the global disease burden was on psychological
chical disturbances (2). Why the supply of psy-
The poor health of the sick in developing countries is due to poverty, the lack of infrastructure and stable political conditions, as well as the lack of reliable statistics for estimating needs. In addition, serious health problems such as infections, malnutrition, contaminated drinking water and high maternal and child mortality lead to mental illnesses being neglected. In addition, mental illnesses are still considered incurable in many countries;
policy makers therefore do not invest in this sector. Another factor is the long-standing criterion of mortality as the only indicator of health problems. Only in recent years has a parameter been introduced that also includes the stresses caused by illnesses (the so-called disability adjusted life years) and thus shows the importance of mental illnesses as the cause of human suffering in terms of health policy.
Most of the mentally ill do not have access to necessary medication.
In order to help mentally ill people, a non-profit association “Seelische Gesund-heit Afrika e. V. “founded. He supports the psychiatrists working in Ibadan with donations of money and material to care for the poorest patients. The association collects drugs that are no longer needed in Germany in order to improve the drug treatment of patients in the psychiatric department of the hospital in Ibadan. In cooperation with the hospital, a project is planned to enable psychiatric care in the rural area of ​​Ibadan. Existing primary supply bases in the rural area, which are usually
star and nurses are manned, should be used to set up a mobile psychiatric outpatient clinic. These bases are to be visited by doctors from the clinic in Ibadan on certain days of the week. Mentally ill patients who would otherwise have no access to psychiatric care can be summoned to these appointments to work out a treatment concept. To set up this outpatient, mobile psychiatric team, an all-terrain car, two nurses, medication and equipment are required. There are costs of around 70,000 euros, for which the association collects donations.
By informing patients and their relatives about the nature of mental disorders in the context of rounds and the fact that mental illnesses can be treated, which is visible to all, the stigmatization of mentally ill and their relatives can also be counteracted.

How this article is cited:
Dtsch Arztebl 2003; 100: A 1662–1663 [Issue 24]

The numbers in brackets refer to the bibliography, which is available on the Internet at www.aerzteblatt. de / lit2403 is available.

Addresses of the authors:
Dr. med. Antonia Barke
Institute for Psychology, Department of General Psychology, Johann Wolfgang Goethe University Frankfurt
Mertonstrasse 17, P.O. Box 11 19 32
60054 Frankfurt / Main
Email: [email protected]

Dr. med. Dorothee Klecha
Department of Psychiatry and Psychotherapy with Polyclinic, University Clinic for Psychiatry and Psychosomatics of the Albert-Ludwigs-University, Hauptstraße 5
79104 Freiburg
Email: [email protected]


Call for help
The association "Seelische Gesundheit Afrika e.V." is looking for more members. The membership fee is 15 euros per year. Association members receive regular information on the progress of the projects.
For the planned establishment of the outpatient psychiatric service and the dispatch of the medication, donations are primarily required. Donation receipts can be issued.
Practice owners and clinicians can ask their patients to hand in psychiatric medication they no longer need. The medication must be stable for at least a year. In this way, in Freiburg, for example, it was possible to collect medication donations worth more than 23,000 euros within four months. The association provides information for doctors and patients.
In the context of the association's activities, there are many tasks, such as letters from potential donors, public relations and other things. Cooperation is welcome.

Mental Health Africa e.V.
c / o Dr. Dorothee Klecha
Black Forest Clinic - Neurology
In the Sinnighofen 1
79189 Bad Krozingen
Telephone: 0 76 33/93 18 20
Email: [email protected]
Internet: www.seelische-gesundheit-afrika.de

Donation account:
Mental Health Africa e.V.,
BLZ: 680 900 00,
Account number: 16 736 503
Volksbank Freiburg
BBC Newsitem 76130 (04/10/1998). February 6, 2002 http://news.bbc.co.uk/1/hi/world/africa/76130.stm.
Brundtland GH: Mental health in the 21st century. Bulletin of the World Health Organization 2000; 78: 411.
Central Intelligence Agency (CIA): The world factbook: Nigeria. 03/12/02 http://www.cia.gov./cia/publications/factbook/geos/ni.html.
Erinosho Olayiwola A: The evolution of modern psychiatric care in Nigeria. Am J Psychiatry 1979; 136: 1572-1575. MEDLINE
Nigerian Government, Federal Ministry of Information and National Orientation, 2001, Fact File. March 13, 2002 http://www.nigeria.gov.ng/aboutnigeria/factfile.htm
Obasanjo O: Address on World Mental Health Day 2000. WHO website in Nigeria. March 11, 2002 http://www.who-nigeria.org/quarter/million.html.
Obejide AO, Olatawura MO, Sanda AO, Oyeneye AO: Traditional healers and mental illness in the city of Ibadan. J Black Stud 1978; 9: 195-205.
Prince R: Some Notes on Yoruba Native Doctors and their Management of Mental Illness. In: Lambo TA (ed) First Pan-African Psychiatric Conference in Abeokuta (Nigeria). Government Printer, Ibadan, 1961.
Sartorius N: Fighting for mental health: a personal view. Cambridge University Press, Cambridge 2002.
World Health Organization: Atlas: mental health resources in the world. Geneva 2001.
World Psychiatric Association on-line: Association of Psychiatrists in Nigeria. March 16, 2002 http://www.wpanet.org/generalinfo/member5.html.
1.BBC Newsitem 76130 (04/10/1998). February 6, 2002 http://news.bbc.co.uk/1/hi/world/africa/76130.stm.
2. Brundtland GH: Mental health in the 21st century. Bulletin of the World Health Organization 2000; 78: 411.
3. Central Intelligence Agency (CIA): The world factbook: Nigeria. 03/12/02 http://www.cia.gov./cia/publications/factbook/geos/ni.html.
4. Erinosho Olayiwola A: The evolution of modern psychiatric care in Nigeria. Am J Psychiatry 1979; 136: 1572-1575. MEDLINE
5. Nigerian Government, Federal Ministry of Information and National Orientation, 2001, Fact File. March 13, 2002 http://www.nigeria.gov.ng/aboutnigeria/factfile.htm
6. Obasanjo O: Address on World Mental Health Day 2000. WHO website in Nigeria. March 11, 2002 http://www.who-nigeria.org/quarter/million.html.
7. Obejide AO, Olatawura MO, Sanda AO, Oyeneye AO: Traditional healers and mental illness in the city of Ibadan. J Black Stud 1978; 9: 195-205.
8. Prince R: Some Notes on Yoruba Native Doctors and their Management of Mental Illness. In: Lambo TA (ed) First Pan-African Psychiatric Conference in Abeokuta (Nigeria). Government Printer, Ibadan, 1961.
9. Sartorius N: Fighting for mental health: a personal view. Cambridge University Press, Cambridge 2002.
10. World Health Organization: Atlas: mental health resources in the world. Geneva 2001.
11. World Psychiatric Association on-line: Association of Psychiatrists in Nigeria. March 16, 2002 http://www.wpanet.org/generalinfo/member5.html.
Mentally ill in Nigeria: hiding in the dark corner

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