Mental illness the ignored catastrophe in Africa

Mental illness in Uganda has not received the same attention as HIV/Aids or malaria, but is just as serious. A consultant psychiatrist, Sarah Nalule at Butabika hospital, Uganda's national referral mental hospital, said that 35% of Ugandans, about 11.5 million people, suffer from some form of mental illness, with depression being one of the most common. But barely half of these people seek medical attention from health centers in a country where people only associate mental illness with advanced and possessed psychosis.

According to Tina Ntulo, Africa director of Basic Needs, Mental health organization, not much money has been invested in fully functioning mental health units in district hospitals. It has been undermined by planners and decision makers with just meager budget allocations.

‘Whilst there is newly constructed mental health infrastructure in Hoima district, there is no infrastructure for mental health at all in Masindi and Sembabule districts and only a very small unit in Masaka district and this is the same with the Eastern region,” she added.

Ntulo stressed the point that there are only thirteen practicing psychiatrists in the country. Twelve of them are practicing in Butabika hospital in the capital, Kampala. This means that it is virtually impossible for people living in rural areas to easily access a psychiatrist and get the help they need unless they travel long distances, which can be very expensive.

Some drugs are only allowed to be dispensed at major Health Centers. If there is demand for such drugs at lower levels, these patients should be referred to bigger hospitals for better management. However, the distances and access to these major hospitals coupled with the poverty that mentally ill people face makes referral difficult.

What is mental health?
Mental health is how we think, feel and act as we cope with life. It also helps determine how we handle stress, relate to others and make choices. Like physical health, mental health is important at every stage of life, says

Dr. Sheila Ndyanabangi, principal medical officer at the Ministry of Health said that mental illness is an illness that affects or is manifested in a person's brain. It may impact on the way a person thinks, behaves, and interacts with other people.

“The term "mental illness" actually encompasses numerous psychiatric disorders, and just like illnesses that affect other parts of the body, they can vary in severity. Many people suffering from mental illness may not look as though they are ill or that something is wrong, while others may appear to be confused, agitated, or withdrawn,” she added.

Warning signs of Mental Illness
A person with one or more of the following symptoms should be evaluated by a psychiatrist or other physician immediately: Marked personality change, inability to cope with problems and daily activities, strange ideas and excessive anxiety, prolonged depression, change in eating or sleeping patterns, extreme highs and lows, abuse of alcohol or drugs, excessive anger, hostility, or violent behavior, suicidal tendencies

Post Traumatic Stress Disorder (PTSD), the most common mental ailment in war affected areas like the northern Uganda; it is a result of events that cause horror. These include war, accidents, loss of loved ones and sexual abuse like rape.

Dr. Seggane Musisi, a lecturer of psychiatry at the Faculty of Medicine, Makerere University says that mental illnesses are common but many times, the patients do not get treatment. Disorders which include depression and irrational fear should not be ignored. Fortunately, they are often treatable. Prescriptions and therapy can improve the life of most people with mental illnesses.

He also noted that more than a third of the individuals surveyed (67%) had signs of depression. A person who is depressed feels irritable, persistently sad, unnecessarily tired, anxious, guilty, lack of sleep and worthless.

“One also loses interest in pleasurable activities like sex or may fail to concentrate on tasks and usually has problems remembering details. One’s appetite may also rise or decline,” he added.

Link between mental health and poverty

Uganda has come a long way in its recognition and treatment of mental health problems, but stigma and a misunderstanding about conditions remain unsolved.
Lukwago Godfrey, a Programme Officer at Mental Health Uganda says that in Uganda there is a close association between mental illness and chronic poverty. Although statistics on mental health are scanty, there is an increase in cases of mental disorder.

“Many people in rural areas turn to traditional healers or faith healers to cure their illnesses. Whilst these healers are successful in treating some mental illnesses by using counseling methods in their treatments, often their methods are inappropriate and ineffective,” he added.

He stressed that there is a massive dearth in trained staff, which is why Mental Health Organisations rely a lot on local volunteers from within the communities we work in to help us reach out to people with mental health problems.

Lack of adequate treatment

Lukwago also stressed that effective treatment is a vital first step in giving mentally ill people the chance at a new life. Through effective treatment we show that mentally ill people can return to a normal state and this is an essential part removing the stigma from family and community that mentally ill people face.

“The most important thing that mentally ill people need is care that they can access in their communities however the little health care available is often found in psychiatric hospitals in cities. That means that people who live in very remote rural areas have to travel long journeys to get treatment. The transport is not free and many people cannot afford it,” Lukwago added.

Tuberculosis is a killer disease

What is TB?

Tuberculosis is an infectious bacterial disease caused by Mycobacterium tuberculosis, a germ that commonly affects the lungs. This germ that causes the TB disease (TB Bacillus) was discovered by Dr. Robert Koch in 1882. It is transmitted from one person to another through the air as droplets from the throat and lungs of people with TB. If not treated, each person with active TB infects on average 10 to 15 people every year.

When do we suspect TB in a person?

We suspect TB in anybody, who presents with cough for two weeks or more, with or without blood or cough for two or more associated with other symptoms such as chest pain, weight loss, evening fevers and night sweats, patients with lymph node swellings in the neck, axilla and other areas not associated with any trauma.

Before HIV era, 1 in 10 TB infected persons would become sick with TB disease in their lifetime. However today because of HIV, once infected with TB an HIV positive patient has the chance of developing TB disease increased five to ten times per year and up to 20 to 50 times in lifetime.

How has TB affected the world of today and where is it?

TB disease is a global pandemic ravaging the mainly poor countries and Uganda is not spared. TB is a disease of the poverty ( it affects the poor and also leads to poverty) affects mostly young adults in their most productive years. The vast majority of TB deaths are in the developing parts of the world mainly in Asia and Africa. Today TB remains the leading cause of illness and death worldwide. TB disease is the single greatest killer of people living with HIV.

Let’s Create a Tobacco Smoke Free Environment

Why we should promote a smoke free environment

Every Ugandan needs a tobacco smoke-free environment because second hand tobacco smoke kills and causes serious illness.

100 percent smoke free environments are conducive, promote the workers health and prevent serious harmful effects of tobacco smoke.

Everyone has a right to clean air, free from tobacco smoke. Smoke free environments are conducive for business, as families with children and most non smokers often prefer to go to smoke free places.

Smoke free environments provide the many smokers who want to quit with a strong incentive to cut down or stop smoking altogether.

Smoke free environments help prevent people especially the young from starting to smoke.

Useful tips on how to create a tobacco smoke free environment.

• Reduce on the number of cigarettes you smoke per day gradually.
• Stop buying any more cigarettes
• Aviod enticing environment like bars and frantic sports that could lead to smoking
• Reject smoking offers
• Keep busy with constructive work
• Exercise your body
• Use chewing gum when you feel the urge to smoke
• Emphasise personal hygiene, clean your teeth and wear clean clothes ( with out cigarette holes on your clothes.)

Health Dangers of smoking Tobacco

·         Smoking tobacco is a major threat to our health today. Over 5 Million people die every year due to tobacco smoking. Approximately one person is killed by tobacco every 6.5 seconds. This loss of lives which is entirely preventable costs an individual, family, nation and the world at large far much more than anyone can imagine.

·         Mothers who smoke have a higher risk of miscarriage. They usually bear underweight babies which contribute to poor growth of their children.

·         Smoking causes lung cancer, skin cancer, uterine cancer, heart diseases and chest problems like bronchitis, asthma, importance in men, stomach ulcers, skin wrinkling, hearing loss and hair loss.

·         Non smokers, who inhale smoke from those who smoke near them, suffer similar risks as smokers. Usually, children born to parents who smoke have a higher rate of respiratory illness such as pneumonia, colds and bronchitis and or sudden infant death syndrome.

·         Smoking not only destroys our health, but is a major cause of environmental, industry and house hold fire damage.

Economical consequences of tobacco use

• Tobacco as a crop is responsible for damage to forests, soil depletion and pollution from pestcides, fertilizers and cutting tree to dry tobacco.
• Tobacco tends to be consumed by the poor, in turn it contributes to poverty through loss of productivity, diseases and death. Money spent on tobacco deprives families from purchasing the basic necesities such as food, shelter, eduaction and health care.
• Poor health of the smoking bread winner may mean less income for the family with increased medical expenses worsening the family's economic situation.
• Tobacco farmers often find themselves in a debt trap to tobacco companies caught between low crop prices, discrinatory grading systems and escalating farm input costs; they always work at a loss.
• Tobacco cultivation and curing process exposes the farmer to health hazards and thus increasing the poverty.
• At the national level, the country suffers huge economical loses as a result of high health care costs as well as lost productivity due to tobacco related illness and pre mature death od its citzens.

Beware Cervical cancer kills

It was such a great relief to learn that KCC dispensary offers free breast and cervical cancer tests. Not knowing your health status can be such a great burden to carry. For a long time I had been contemplating on when and where to go for a cervical cancer test. Cervical cancer test is also known as Pap test or Pap smear. I had tried visiting gynecological clinics but the costs of getting the tests done in a private clinic are quite high. They range between Uganda shillings 30,000 to 50, 000. I had previously visited two clinics one in Wandegeya and the other on Kampala road.

Luckily enough I was informed just in time that Kampala City Council dispensary on Nkrumah road did the tests and also offered the treatment for free. The services are available from Monday to Friday between 8:00 am and 5:00 pm. The Uganda Women’s Health Initiative collaborating with UCL funded by the UK is the angel behind this service.

It was last week that I decided to go for a cervical and breast cancer test; it was not an easy decision to make. I was escorted by a friend, Jocelyn Nabire who also wanted to get the tests done. When we reached, we had to first go through counseling by Sr Annet Nabakka. She informed us about the dangers of cervical cancer, how one can get it and the importance of detecting it early.

The medical personnel at KCC are very friendly, they will speak to you in any local language you feel comfortable communicating in, and they also make sure that you feel at home so as to trust them with your body. It is only women in this section so that gives you confidence to go on with the test.

Sr Nabakka explained that the cervix is part of a woman's reproductive system. It's in the pelvis. The cervix is the lower, narrow part of the uterus (womb). It is a passageway because it connects the uterus to the vagina. During a menstrual period, blood flows from the uterus through the cervix into the vagina. The vagina leads to the outside of the body.

“This is a voluntary test, it is up to you to take it or leave it, and you should test every after three years and for those with HIV/AIDS should test after one year” she said.

Sr Annet Nabakka also said that taking it is necessary to take this test and know your status. If cervical cancer is detected early enough, then they can free the virus and you will be cured. She also said that 80% of women with cancer have cervical cancer.

“Do not wait for the pain to start before coming for a checkup, because by then it might be too late, sometimes we may find other sexually transmitted diseases like gonorrhea, syphilis and treat them,” advised Sr Rose Izimba.

Sr Izimba also said advised that us to take the test every three years just to be sure that we are fine. Lack of regular Pap tests: Cervical cancer is more common among women who don't have regular pap tests. The Pap test helps doctors find abnormal cells.

“If you are found with cervical cancer, we remove or kills the abnormal cells,” said Izimba.

She also noted that while undergoing treatment one is advised to abstain from having sex for at least four weeks and then go for another test after six months.

Infection with HPV (human papilloma virus) is the main cause of cervical cancer. HPV infection and other risk factors may act together to increase the risk even more.

HPV infections are very common. These viruses are passed from person to person through sexual contact. Most adults have been infected with HPV at some time in their lives, but most infections clear up on their own.

 “Women who have had many sexual partners have a higher risk of developing cervical cancer. Also, a woman who has had sex with a man who has had many sexual partners may be at higher risk of developing cervical cancer. In both cases, the risk of developing cervical cancer is higher because these women have a higher risk of HPV infection,” she added.

Sr Nabakka also informed us that we had to undress before the tests can be done. The dispensary provides wrappers for one to use.

After all the counseling session which took us about ten minutes, we were asked to wait outside in order of who came first. People were given an option of testing for only breast cancer, just in case they did not feel comfortable undressing. In other words the decision was up to us to decide whether to have both tests done or get just one or even leave it all.

I had a one on one discussion with Sr Nabakka, she asked me when I first had sex, if I had ever given birth, if I had ever had a miscourage or if I had ever had any Sexually Transmitted Disease. Basing on my answers I almost lost the chance of getting the test done on me because of my age, but I insisted that I wanted to know where I stand and it done. It was such an embarrassing situation to undress and lie down on that hospital bed as the nurse was looking at me.

 We started with the breast cancer test and to my relief the results were negative. I was examined by Sister Izimba who was wearing gloves on her hands, she checked my breasts using the touch and feel method.

Then we proceeded to the Pap smear, it did not take us even five minutes before it was done. She told me, that I did not have anything wrong with my uterus.

My friend Jocelyn was afraid to do the Pap smear, she only got the breast cancer test done.

Afterwards, we introduced our selves to the nurses that we were journalist and wanted to write about our experience. They welcomed the idea of spreading the gospel. They said that will be grateful if more women’s lives were saved from dying of cervical cancer. It is my humble request to whoever reads this article please pass on this information on to all the women you can come across. Tell your sister, mother, girlfriend, grandmother, and friend’s friends to go for the checkup. Let’s save lives while we still can. Life is precious once lost can never be regained.  The tests are done free of charge and treatment is also given for free.

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