Sierra Leone has suffered one of the most terrible civil wars in all of Africa. The 11-year conflict resulted in 50,000 people dead at its end in 2002. Just this year, the former Liberian President was sentenced in The Hague to 50 years in prison for “aiding and abetting” war crimes in the conflict.
After the war came to a close, a mental-health survey by the World Health Organization (WHO) estimated that 400,000 Sierra Leoneans were stricken with mental illnesses such as depression and post-traumatic stress disorder. Less than one percent are receiving treatment.
Those numbers are certainly frightening, but they aren’t necessarily surprising given that the country only has one trained psychologist, and he’s retired.
Dr. Edward Nahim is 67 years old, and even though he is technically retired, Nahim works full time for the government, treating ex-combatants and hospital patients. There are only two qualified psychiatric nurses.
Donald Bash-Taqi, director of training, noncommunicable diseases, and research at Sierra Leone’s Ministry of Health told Clair MacDougall from Newsweek Magazine, “We are extremely concerned about having one psychiatrist who is retired. We are a country that has come from a brutal civil war with a rising youth involvement in drugs. It is not enough.”
One psychiatrist would hardly be enough for most countries without the history Sierra Leone has, yet Nahim works steadily from a psyciatric hospital in Kissy, a poor eastern side of Freetown. The area was occupied during the cival war by the Revolutionary United Front (RUF), a rebel group infamous for its use of child soldiers and acting out mass amputations.
The building was partially destroyed during the conflict, and Nahim and his staff, as well as the patients, were forced to leave. The original structure was the first mental-health clinic in all of Africa.
Sadly, the lack of trained staff to observe the patients results in some more volatile patients spending periods shackled to bedframes. “Here, we can’t keep them in the wards, so they can go out anytime they want to. The only way we can restrain them is to chain them for a short time,” Nahim said.
There is one other facility called the City of Rest, where 40 patients are barely crammed in. This facility uses Christian prayer, singing, and counseling. Nahim visits every week to offer brief amounts of counseling and prescriptions for those that need it.
Drug addicts make up the largest portion of Sierra Leone’s mental health issues, with over 80 percent of the hospital’s admissions being young males. They also played a large part in the war. The country was so disrupted, much of the youth population was unemployed and on drugs, so they were easily recruited.
Throughout all of sub-Saharan Africa, it is estimated only one psychiatrist is available for every 5 million patients. The continent as a whole is still trying to improve serious issues of high infant mortality rates, and wide-spread infectious disease. Mental health gets pushed to the backburner, especially when it comes to funding.
Outside of funding struggles, there is also a wide-spread, cultural stigma against those with mental illnesses. “You still have a very widespread supernatural belief in the causation of mental illness,” said Progessor Oye Gureje. Gureje is the president of the African Association of Psychiatrists and Allied Professionals. “People with mental illness may sometimes be seen as being deserving of it.”
The stigma also puts patients at risk of harassment and neglect.
Policy changes are slowly happening, but it is clear that these countries are still lacking. They are facing too many issues at once, and unfortunately mental health is often seen as not an immediate focus. None the less, Vikram Patel, professor and senior research fellow at the London School of Hygiene and Topical Medicine says “There have been significant changes in the last five years and we have seen developing countries.”