bipolar disorder in africa

Molweni apha. It’s time for another bipolar linkdump, but this time the links aren’t solely South African, there are some from the rest of Africa too.

I went through a tribal exorcism in Senegal that involved a great deal of ram’s blood and that I’m not going to detail right now, but a few years afterwards I was in Rwanda, working on a different project, and I happened to describe my experience to someone, and he said, “Well, that’s West Africa, and we’re in East Africa, and our rituals are in some ways very different, but we do have some rituals that have something in common with what you’re describing.” And he said, “But we’ve had a lot of trouble with Western mental health workers, especially the ones who came right after the genocide.” I said, “What kind of trouble did you have?” And he said, “Well, they would do this bizarre thing. They didn’t take people out in the sunshine where you begin to feel better. They didn’t include drumming or music to get people’s blood going. They didn’t involve the whole community. They didn’t externalize the depression as an invasive spirit. Instead what they did was they took people one at a time into dingy little rooms and had them talk for an hour about bad things that had happened to them.” (Laughter) (Applause) He said, “We had to ask them to leave the country.” Andrew Solomon

Mental Health Care in Sub-Saharan Africa: Challenges and Opportunities:
Moreover, the stigma tied to mental disorders is also an obstacle to care. In the sub-Saharan region, this reaction is deeply rooted in cultural beliefs and associations that some communities make between mental disorders and witchcraft.
Freelance photographer Robin Hammond has put a human face on mental health challenges in Africa. In his award-winning photo book “Condemned,” he documents the absence of mental health care in conflict-affected African countries. His photographs show the deplorable conditions under which the seriously mentally ill must struggle, and the absence of help or infrastructure to address their special needs. Unfortunately, governments there have used incarceration as a solution to ostensibly prevent the mentally ill from injuring themselves and also protect the public.
The AFrica Focus on Intervention Research for Mental Health (AFFIRM) hub is a research and capacity development hub, established in 6 countries: Ethiopia, Ghana, Malawi, South Africa, Uganda and Zimbabwe.

South Africa

Psychiatry in distress: How far has South Africa progressed in supporting mental health? The trouble in South Africa is that although its mental healthcare policies are progressive, these are not filtering down. For instance, the department of health has reported that 53% of hospitals have been listed to provide 72-hour assessments of psychiatric emergencies, in keeping with the provisions of the Mental Health Care Act. However, reports the South African Depression and Anxiety Group (SADAG), these hospitals frequently don’t have the staff or capacity to provide the care required. Patients end up being admitted to general wards, which adds to the stigma of their illness. Sometimes suicidal patients are turned away due to a lack of space.
Flying high and sinking low: bipolar disorder: When Charlene, 23, goes to her bedroom, opens her cupboard and takes out the green stockings and orange mini dress with huge circles all over it these days, she knows she is in trouble. She feels reckless and free – in fact she feels great – but at the same time she knows she is heading for a manic period which could last anywhere from a few hours to a week.  “When I’m manic I have no inhibitions and I’m likely to give away half my possessions – sometimes to virtual strangers.”
In a state of neurosis: tens of thousands of government employees suffer from chronic mental illnesses such as depression, schizophrenia and bipolar disorder, but are too reluctant to disclose their conditions.
Coping with depression in the workplace: As a South African employer, there are proactive steps that you can take to manage depression in your organisation and provide support for your employees.
The Girl From Human Street (text and audio): A Memoir Of A Family’s Diaspora, And A Mother’s Depression
The South African Health News Service: (Mental Health  archives). Bipolar archives.

Imam & patients in Dakka, Senegal

Rwanda: who is safe from mental illness? “Due to lack of awareness, most people still think that mental illness is an ancestral curse or punishment for wrongdoing or disobedience from God.”

And if there’s one country that deserves the chance to heal, it’s Rwanda.

RE: “Who is safe from mental illness?” People do not inherit mental illness or mental disorders. True, mental disorders have a genetic basis for their occurrence or “inheritance”; however, people inherit the possibility or likelihood that they will at some time in their lives suffer from mental disorder. source

Kenya: Visceral – an Exhibition on the Workings of a Bipolar Mind: “One point in time, I was very depressed and was trying to come up with ideas. I got so angry I kept stabbing the paper with a pen and then fell asleep. Woke up afterwards and looked at the image and it was exactly what I was feeling, so decided to go with the dots,” Mwini says.

South Sudan & Uganda: Q&A: The impact of war on mental health. (audio)

Ghana:

“I am fine” – Ms Ada according to her clinical psychologist is suffering from a bipolar disorder. The YFM presenter, Adaeze Onyinyechie Ayoka aka Ms Ada, who allegedly staged her own kidnap and gang-rape has finally made her first public appearance and statement to the media.
Cultural Aspects of Manic-Depression in West Africa

Nigeria & Ethiopia: Abstract: Epidemiology and burden of bipolar disorder in Africa: a systematic review of data from Africa. (Soc Psychiatry Psychiatr Epidemiol. 2015 Jul 9. [Epub ahead of print])
BACKGROUND: Bipolar disorder impacts negatively on the patient, the family, as well as the society. It taxes the health care services due to a combination of the illness with associated medical and psychiatric comorbidities. In Africa, unfortunately, knowledge of the epidemiology and burden of bipolar disorder is based mainly on studies from the USA and Europe. In this systematic review of literature from Africa, we highlight the epidemiology and burden of bipolar disorder.
METHODS: A systematic review of publications from Africa relating to the epidemiology and burden of bipolar disorder was conducted.
RESULT: Data from community surveys conducted in Nigeria and Ethiopia indicated a lifetime prevalence estimate of 0.1 % to 1.83 for bipolar disorder. Missed diagnosis rate of bipolar disorder was up to 36.2 %. In one study, 8.1 % of the males and 5.4 % of the females reported a previous suicide attempt. A study showed that up to 60 % of patients with bipolar disorder had at least one comorbidity. There were no reports on all-cause mortality and cost of illness.
CONCLUSION: Bipolar disorder is a major mental health problem in Africa. Scientific findings on bipolar disorder from Africa are consistent with the existing literature from other parts of the world. There still exists a dearth of high quality studies addressing the epidemiological, clinical, social, and economic burden of the disorder.

For me, the most interesting conclusion drawn is, “Scientific findings on bipolar disorder from Africa are consistent with the existing literature from other parts of the world.” Who’d have thunk it?

Ethiopia

“When there is an effective service and people start to use it, that also has an effect on stigma. People become more accepting of people with mental illness because there is more hope.” Abebaw Fekadu, Butajira Hospital

Major mental disorders in Addis Ababa, Ethiopia. II. Affective disorders
Socio-demographic correlates of bipolar disorder in Butajira, rural Ethiopia
Prevalence and clinical characteristics of bipolar I disorder in Butajira, Ethiopia: A community-based study

This is the one that fascinated me completely:

Bipolar disorder among an isolated island community in Ethiopia
Background: Psychiatric data on population groups of geographic and social isolates are rare, but can potentially give insights into factors of aetiological importance. The Zeway islanders have lived in geographic and cultural isolation for over three centuries.
Aim: To determine the prevalence of major psychiatric disorders among the adult population of Zeway islands.
Methods: A three stage screening design that included the use of structured interview instruments (CIDI and SCAN), key informants, and clinical assessment by psychiatrists was employed for case identification.
Results: Prevalence of bipolar disorders among the adult population (n=1691) was 1.83% (n=31) with 66% of the cases originating from one of the islands that constitutes only 17.33% of the study population. Only one subject was identified with schizophrenia.
Conclusions: A pattern of differential prevalence for bipolar disorders and schizophrenia appears to exist in this isolated population, which also seems shared by other isolated population groups. The high prevalence of bipolar disorders with clustering of cases on one island may represent an environmental or genetic factor of etiologic relevance that deserves further exploration.

According to a 2003 WHO report, close to 90 per cent of those in developing countries who need treatment for mental health problems receive no assistance. [2] Across Africa, there is only one psychiatrist for every million people. [3] As a result, doctors throughout the continent are realising that if they want to widen access to mental health, they can’t wait until there are more psychiatrists. source

St George's Mall, Cape Town