The country with three psychiatrists

October 10, 2013

Zambia is drinking itself into a coma

By Charles Mafa

It is estimated that one in every five people in Zambia is living with some form of mental illness.

This astonishing figure was first revealed back in 2005 when the World Health Organisation (WHO) estimated the prevalence of mental disorders to be at 20% of the population.

They went further and said that 6% to 10% of Zambians have severe mental disorders that need hospital care.

There has been no statistical analysis of the prevalence of mental health problems since then. However, it is a fact that mental healthcare has suffered probably more than any other branch of medicine in terms of funding, and the country is grappling to contain the problem. The Minister of Health, Dr Joseph Kasonde, has described mental health care as being “in a state requiring urgent attention”.

That being the case, the lack of recent data on the burden of mental disorders in Zambia raises questions about how successive governments, including the present one, have been planning for the sector. 

Mental disorders come in a variety of shapes, sizes and seriousness. At the “top” they range from schizophrenia,or mania, that is marked by delusions, hallucinations and distorted perceptions of reality, down to less severe problems that usually do not need hospitalisation but nonetheless impair efficient functioning of an individual. These problemscan be triggered by difficult life events that might include illness, divorce, death of a loved one, losing a job, alcohol and other substance abuse, social expectations or a dysfunctional family life.

At the very top is alcohol abuse. William Phiri, principal clinical officer at ChainamaHills Hospital in Lusaka, says: “Out of the top 10 (mental disorders), the most ranking is alcohol induced psychiatric disorder…and this is countrywide. Alcohol is being consumed in all angles of this country and people are dying as a result of that.”

Chainama is the country’s only tertiary referral psychiatric hospital. It isoverburdened by patients seeking help. Health workers at the hospital say they admit more than 10 patients with severe mental health problems every day. This figure excludes those who come in to seek medical services on a daily basis but are not admitted. It is believed that sometimes the number goes beyond 120 patients a day. The total number of beds at Chainama is 210, excluding 167 floor beds which are not officially recognised by the Ministry of Health.

With a staff of only 15, the institution currently operates below 40% of the required establishment. Observers warn of a crisis, that Chainama is struggling to cope with increased numbers of patients.

“It is a huge crisis that we have in this country,” says Mr Phiri. “You’re going to see that we combine alcoholics with those who are schizophrenic – acute ones. We are supposed to have independent wards but we do this [combine patients]because of a lack of infrastructure.” 

Dr Kasonde says: “For me I agree entirely that mental healthcare is in urgent need of reorganisation. Whether that is equal to crisis or not is maybe an issue of language which you [the writer] and others may wish to deal with.”

He did say, however, that the current mental health system is inadequate and does not promote the dignity and respect of people with mental and intellectual disabilities. The structures were built like prisons,” he said, adding: “The entire system was acquired of course from our colonial masters. It was based on a system where you control a person who is violent or is behaving in what society would say is not normal.”

Treating mental illness has been a huge challenge in Zambia. Currently there are only three Zambian psychiatrists for the population of around 13 million. The reason for this is because until recently there was no local psychiatry training in Zambia. The majority of the patients have therefore been treated by clinical officers and nurses who are assisted by general staff.

In the absence of services to meet the mental health needs of Zambians, traditional healers and spiritual leaders play a crucial role in diagnosing and treating them, says Dr Venevivi Lekani, one of the first batch of seven doctors undergoingpsychiatric training locally. He explained that treatment for mental health at the primary healthcare level is either lacking or provided in a fragmented manner. His views are supported by Dr Nita Besa, another doctor undergoing local training in psychiatry, who will be graduating next year. She said it is a cause for concern that mental health at the primary level has been largely overlooked.

Dr Besa added that mental illness is treatable and many people can live quality lives after treatment. It is also widely agreed that treatment for mental illness is most effective when started early, but Dr Kasonde says “until we lay our foundation in the care of individuals’ mental [illness] from childhood to adulthood, we shall not catch people at the right time and prevent a lot of those admissions which are now showing up in hospitals”.

Budget cuts to the mental healthcare sector have driven down access to treatment for hundreds of people with mental illness. It is a fact that mental illness is not anywhere near being a priority sector for the Ministry of Health. In 2008, it was estimated that a paltry 0.38% of healthcare funding was directed towards mental illness.

To understand why the situation remains bleak, the minister offered some history. “It has consistently been underfunded… and in terms of priorities in the health sector, about two, three years ago, it was number 12 on the list.” The “yellow book” points out that in the 2013 national budget for instance, there is an allocation of something over K203,000, and this represents a budget cut of more than K48,000 from the 2012 approved expenditure of about K252,000. (The yellow book is a national activity-based budget for a specified year. It outlines the estimates of revenue and expenditure of government's line ministries, provinces and spending agencies.)

One of the problems facing people with mental illness is that they are feared and stigmatised by society. To make matters worse, the majority do not receive treatment because they are embarrassed or afraid of being ostracised. This is partly because of the community and its prejudices about mental illness, where such an affliction is not viewed as a sickness. 

Take the case of Ms Maria Tembo as an example. When the full horror of mental illness struck her, she was divorced and abandoned. She is now, at the ageof 32 and a mother of three, tucked away in Matero Aftercare Centre in Lusaka, six months after being discharged from Chainama Hills Hospital where she was receiving treatment.

She was happily married. Upon having a mental breakdown, the husband divorced her,” explained Ms Chisala Mateyo, social welfare officer at the Matero Centre. “Now she is better. In her mind she believes she is still married to him. So she has since withdrawn, she is not working, she is not doing any basic effort to survive.”

Maria is lucky to have a place of recovery because many people, perhaps most, with mental illness receive no treatment and end up on the streets. A few rehabilitation centres not funded by the Ministry of Health are usually inadequate, and are located far away from patients. Matero Aftercare was built to offer rehabilitation services to people like Maria but the place is small and doubles as a home for the old and homeless people. The centre is managed by the Social Welfare Department of the Ministry of Community Development, Mother and Child Health. At the time of writing, there were more than 40 people residing there, some of them for the past 15 years.

“Our role for the mentally challenged is to provide psychosocial counselling. There is just my colleague and myself, and we have to deal with about 20 mentally challenged clients,” says Ms Mateyo. “We don’t have a specific number we look after because some people are left even by the gate… just dumped. So we admit at whichever hour or minute.”

Many people with mental illness, even those who have received treatment at Chainama, do not fully recover from their illness because places where they can continue to receive rehabilitation like Matero Aftercare are few in Zambia. In the absence of such services, the burden of care for people with mental illness falls on families, which can be a problem too far. It is also the case that treatment at various health institutions around the country is of poor quality.

If we treat them…they feel better. We send them back to the community. But are we sorting out the problem?” asks Mr Phiri of Chainama Hospital. “No.”

Dr Kasonde’s proposal to deal with mental illness includes changing the law and overhauling the existing infrastructure. Legislation related to mental health care in Zambia dates back to 1951. The policy at that time discusses how the general population needs to be protected from the mentally ill but fails to mention basic human rights related to those living with mental illness.“We’re currently reviewing the Mental Health Act which dates back to 1951 and we should be submitting to Parliament a revision of the Act which will show some of these areas where controls were emphasised as opposed to care. So I think the legal framework is number one and we’re dealing with it.”  

Dr Kasonde further explained that plans are under way to change the method of training psychiatric clinical officers who under the current system cannot progress to obtain degrees in their field. This has led to a brain drain among staff who are dissatisfied with their qualification.

Revamping the mental healthcare system will require adequate funding, but as the Minister pointed out, funding goes with priorities and mental health is way below the list of priorities in the health sector.

It may be of little comfort, but WHO says this is a global problem.“For instance, annual spending on mental health is less than US$0.25 (K1.3) per person in low-income countries, with 67% of thesefinancial resources allocated to stand-alone mental hospitals, despite their association with poor health outcomes and human rights violations,” reports WHO.

The agency recommends redirecting this funding towards community-based services such as the ones provided by Matero Aftercare Centre and the integration of mental health into general health care settings through maternal, sexual,reproductive and child health, HIV/AIDS and chronic non-communicable disease programmes. This, they say,wouldallow access to better and more cost-effective interventions for many more people.

Back at Matero Aftercare, there seems to be a lot of work ahead but Ms Mateyo and her team have a sense of duty in a country where “many services are failing the poor”. The task facing them in attending to everyone’s needs is enormous, especially since the facilities need a drastic overhaul.

It would be an advantage for the institution to employ a nurse or doctor to cater for the medical needs that the clients have because anything can happen at any time,” says MsMateyo. “There is also need for someone to be providing spiritual support to the people here on a daily basis.”

As for Ms Maria Tembo, all she can remember is that her husband was upset with her because she was admitted to Chainama Hospital. “My husband is not happy with me because I was admitted at Chainama,” she said in her local dialect. She will soon be leaving the centre to be reunited with her relatives in Eastern Province, and she will be empowered with some funds from Matero Aftercare Centre to pursue the skill of her choice.

See this and other stories in the October edition of the Bulletin and Record Magazine

 Maria Tembo’s real name has been withheld

 

The flood of second car imports: Good news & bad

October 4, 2013

By Charles Mafa

Last year, 66,000 secondhand vehicles were imported into Zambia, mostly from Japan. That averages out at 180 used vehicles coming into the country each and every day. These cars and trucks then add to the estimated total of more than 427,000 vehicles already here – and that figure does not include the thousands of vehicles registered as belonging to government.

In Japan, thousands of used vehicles constantly become available for re-sale because of a strict and very hi...


Continue reading...
 

Medardo Cardinal Mazombwe dies at 81

August 30, 2013

We all know that some day we are destined to die. Yet when the cold hand of death visits us, the shock in us all is palpable. I can’t help but provide some reflections on the death of Zambia’s first indigenous Cardinal, Medardo Joseph Mazombwe. The country has been robbed of a much loved son of the land, the man who preached the word of God to all of us and stood for justice.

I want to take you back to 2010 when in the company of other Zambians, I travelled to Vatican in Rome, Italy to ...


Continue reading...
 

Chief Mukuni, Zambia and Zimbabwe must work in tandem for tourism

August 20, 2013
Snr Chief Mukuni
As Livingstone city gears up to host the United Nations World Tourism Organisation (UNWTO) General Assembly this August, one man who has been keeping a keen eye on the preparations is Chief Mukuni of the Leya people in Kazungula District. This event is important to the traditional leader because it is being hosted in his chiefdom.

Speaking to the B & R at his Mukuni Palace, 7 kilometres east of the Victoria Falls, the chief said: “In terms of preparations, we are on course...


Continue reading...
 

Sex workers cruise to UN Indaba in Livingstone

August 19, 2013

Along the highway that winds to Livingstone, sex workers are cruising. They are converging on the town from all points within Zambia and from across the borders, heading for the hoped-for rich pickings to come from the delegates, staff and others in town for the UN indaba on tourism later in the month.

Already, as night falls in Livingstone, the girls teetering on high heels totter down the street in their mini-skirts with their jackets slipping provocatively off their shoulders. Perhaps ...


Continue reading...
 

‘Dilapidated, insufficient, worn out’ The state of our trades training schools'

July 24, 2013

There is an argument that under-utilisation of human capital – which could be described as a lack of job skills -- is perhaps the biggest single factor contributing to Zambia’s lack of development. Without it, all other resources such as capital, land and nature are of little use. People have to be trained in the techniques and skills to do their jobs, but in the area of technical and vocational training it all comes unstuck. Charles Mafa reports.

The importance of technical and vocati...


Continue reading...
 

The Lion from Mbole Village - A profile of Daniel Munkombwe

June 17, 2013

By Charles Mafa

Daniel Munkombwe defies categorization.  He has been called a radical, lion or even someone “from the archives”. Whatever name you may choose to call him, he is a man of all seasons. He has worked with both the UNIP and MMD governments, and now at 81, people may have thought there might be no role for him in modern politics.  They were wrong. His nomination as Member of Parliament and subsequent appointed as Southern Province Minister by President Michael Sata, proved h...


Continue reading...
 

Scruffy Livingstone scrubs up for UN Indaba

May 9, 2013

By Charles Mafa

Livingstone is scrambling to have all promised facilities in place in time for the much – heralded general assembly of the United Nations World Tourism Organisation (UNWTO), scheduled for August.

The conference which is being co-hosted by Zambia and Zimbabwe in both Livingstone and the town of Victoria Falls across the border is the principle gathering of the UNWTO, which meets every two years to consider its budget and programme.

Zambia and Zimbabwe won the right to ...


Continue reading...
 

UNZA fails the grade

December 31, 2012

Mired in debt estimated to be at least K1 trillion, Zambia’s bastion of higher education, UNZA, appears to be crumbling under the burden of poor funding, low staff numbers, inadequate facilities and an out-of-date curriculum. Charles Mafa investigates

Picture the scene. A poor boy from the rural area works hard at his local school, passes his exams with flying colours, then comes to Lusaka for the first time to get a degree, only to find a crumbling university education system and nowher...


Continue reading...
 

School in the community

October 4, 2012

From the centre of Lusaka, it takes 20 minutes by car to reach Linda Compound on the southern side of Zambia’s capital city. Heavy traffic and giant potholes make it hard-going and the closer to the compound the worse the road becomes, eventually deteriorating into little more than a bumpy pass.

A township-cum-settlement is home to more than 18,000 people, most of whom are unemployed.

It is here where you will find Linda Open Community School, which provides education to more than 1,600...


Continue reading...
 

Recent Posts