Concealing an Illness – Stigma, Shame or Privacy Right?

Written by Ekaette Udoekong

The disclosure of one’s health status comes with a lot of sensitivity. There are various factors to consider, such as confidentiality and the right to privacy. It is not enough to dwell on good intentions and invade another’s right to privacy. Although informed consent is sought prior to the treatment of some illnesses, situations arise in which some of these ethics are ignored.

In February 2017, a close friend passed away. He was young but ill, very ill. Nobody, not even family members or friends, knew what he was suffering from. At first, he was aggressive when he was asked to seek medical attention and adamantly refused to talk of any sickness even when it was obvious his health was deteriorating. What is the phobia of hospital called? Nosocomephobia! This might not have been Michael’s reason for refusing to seek medical attention. May be it was shame or stigma but Michael was not even diagnosed of any condition because he did not accept that he was sick. Or maybe he had the right not to go to the hospital because it was his life and could deal with it his way!  

There are a number of reasons why people do not disclose their health status. The most popular among them is stigma, pity, anxiety and concerns of family and close friends. Strangely, Michael might have had the right not to disclose his status to anyone but what if he had a communicable disease (depending on form of transmission) that needed him to be isolated and treated, do we, his family and friends not have a right to be disease free? 

I remember telling Michael that he needed the help of a Psychiatrist or a Counsellor. He responded calmly that he was not sick and he definitely did not have a mental health disorder. Months past, family and friends watched Michael go out and come in, gradually losing weight. Later on, he could not even leave his bed and perhaps the time came that he thought was appropriate to seek medical attention - only then did he agree to be taken to a hospital. The Doctor said he was physically sick and was also very depressed because of what he suffered from.  In situations such as these, how could family member manage his refusal to seek medical help? Should rights be considered first when handling health status disclosures or offering care to the sick? For us at Gede, we work to lessen the suffering of individuals/communities that are underserved and stigmatized because of their health conditions, and this calls for action within the civil society organization especially those providing health services,  to integrate elements of mental health to their overall service delivery. This may not have saved Michael but it may help someone else who is in a similar situation.

 

Gede Presents Results of Prevalence Study Project

Yesterday, 19th April 2017, Gede was invited by NACA’s Treatment Care and Support Technical Working Group to share its findings on the recent Prevalence Study Project with People living with HIV-AIDS. Dr Cynthia Ticao presented the study design and key findings from the 3 conditions under the study—depression, alcohol abuse and suicidality.

These results had remained one of the catalysts driving the integration of mental health services into treatment, care and support for PLHIV in Nigeria for more than a year.

The meeting that was attended by representatives from WHO, PEPFAR, CDC, IHVN, NACA, MSH, CRS and others from the Federal Ministry of Health, reorganized the significance of this integration and considered as key in enhancing adherence to HIV treatment. It will be worth mentioning that the 2 important aspects of this advocacy had been achieved, namely: i) mental health in the National Strategic Framework (2017-2022), and, ii) inclusion into the recent Country’s Global Fund Grant application for 2018. 

Maiden Yoga At Gede Foundation

Do you want to destress, relax and rejuvenate? Join us at Gede Foundation, 13 Danube Street, every Friday between 4 and 5pm for only N2000. The instructor, Basant Ram is very experienced and has a desire to impart the benefits of yoga to others. He has pursued a career in Yoga and finished a course as Yoga Master. 

The Foundation held its maiden session on Thursday last week, April 13th. Please see pictures below and join us this week!! Call us on 080-5840-4610 for reservations as places are limited. 

See you April 21st at 4pm!

 

Rising Cases of Suicide and Suicidal Attempt Among Nigerians

By Ekaette Udoekong

In my local community, Ndon Ebom in Akwa Ibom State, young men and women were warned about families with a history of suicide. They were warned that it was passed down from one generation to the next. More often that not, suicides were seen as an oyibo thing, but recently suicides and suicidal tendencies are a common occurrence in Nigeria.

A few weeks ago in Lagos, Nigeria, a young man jumped into the lagoon on 3rd Mainland Bridge. Reports stated that he was a doctor and that this was not the first time someone jumped into the lagoon. There have also being reports from other states in Nigeria about attempted suicide and completed suicides. The big question then is, why are the services of the psychologists and psychiatrists not being utilised? Do the victims or their carers not know where or how to get help? Are they ashamed or afraid of being shunned?

There are a lot of stressors these days, ranging from financial failures, unemployment, inability to pay debts, family pressure, loss of a loved one, insecurities and broken relationships, and allof these could be depressive. In my local community, togetherness used to be a major factor in the prevention of these tendencies. Individuals could speak freely about their frustrations and losses and were consoled and counselled. Gossip was not paid any mind. Today however, individualism, culture mix, the high-homed ‘fences’ have gradually replaced communality and this has arguably increased depressive tendencies and substance/alcohol use.

Mental health has to be taken more seriously and it does not have to start with the government but with the mindset of the individual. Awareness needs to be created in our religious meetings, schools, local/town hall meetings. Mental health awareness has to be integrated into welfare regimes at workplaces, employers of labour should take cognisance of the mental health of their employees and come up with activities that aid relaxation.

Civil society organisations have a major role to play in this regard. At Gede SS (South South), managing stress in the work place programme will be one way to raise awareness. This programme will start soon at the zone. Look out for more information.

 

 

 

World Health Day 2017 - Depression, Lets Talk

On April 6th 2017, Gede Foundation, with the Global Association of Mental Health Awareness, (a Coalition of Civil Society Organisations, Non Governmental Organisations, Community Based Organisations, Clinical Psychologists, Psychiatrists, Faith Based Organisations on Mental Health in Nigeria), held a press conference at Gede Foundation Headquarters. The press conference was organised to raise awareness about mental health conditions with the media with a focus on depression which is the theme for World Health Day 2017.

Mr. Godwin Etim, the Performance Director: Partnership Management and Resource Mobilisation for Gede Foundation, welcomed participants and stressed the role of media in raising awareness about stigmatised and underserved health burdens which include mental health. Mrs. Udoh Margaret, representing the coalition, gave a speech in which she highlighted the rising number of suicide cases in Nigeria and linked it to the extreme case of depression.

Media representation at the press conference included NTA, AIT, CORE TV, NAN, Radio Nigeria, Kiss FM, Love FM, Galaxy TV, Vision FM, Powersteering Online, Aljazeera News Online, Voice of Nigeria, Cool Wazobia Info FM and many more.

During the question and answer session, the media sought clarification on where to get help for those depressed, and how to get help if they, or someone they knew was depressed and if there is a directory for mental health specialists in country.Mr. Godwin Etim informed them that there is, indeed a directory of psychiatrists and there are centres such as Karu Behavioural Unit in the FCT where they can access mental health services. 

Mrs. Udoh made reference to the National Institute of Mental Health and listed some common symptoms of depression some of which were persistent sadness, anxiety, or empty mood, feelings of hopelessness, pessimism, loss of interest or pleasure in hobbies, difficulty concentrating, remembering, and making decisions as well as having difficulty sleeping, amongst others. She insisted that any affected person seek help from a mental health professional immediately and if they are not able to do so on their own, a close friend or relative should seek help for them.

Participants at the press conference were interested in the details shared by Mrs. Zunzika Okpo (Media Officer - Gede Foundation) on the current community based mental health programmes by Gede Foundation. In her presentation she highlighted the dangers that are associated with substance abuse especially among youths in Mararaba and Mpape communities. Upon this revelation, the media were interested in attending some of the activities, including mental health camps that the Foundation conducts. It was agreed that depression plays a major role and can be termed as a silent killer and therefore, the media should play their role in disseminating appropriate information. 

Below are some pictures from the event as well as a video!

PHD

Recently, I have been plagued with a question. Will my exposure to mentally challenged individuals affect me? If so, how? Will it be damaging? Should I be scared or should I be proud of the work that I am doing?

A little background, in my work as a media officer, I have met a lot of people with mental illnesses; some illnesses that are strange to even imagine (dissociative identity disorder). It is a well known fact that talk of mental health is generally a taboo, especially in Africa. The fear of being affected has made me question myself when I see similarities between myself and for instance, someone that battles with depression. It is when thinking about this when I came across an interesting term. PHD. No, not PhD (Doctor of Philosophy) but, People with Hidden Depression.

I listened to a podcast which talked about this phenomenon. In it, I heard of a clinical psychologist who, in her career, had probably seen over a hundred patients with various mental health conditions. Interestingly, the psychologist also needed to see a psychologist after a while because of what she had heard over the years. To the outside world, she was a vibrant, warm, fun loving mother with an amazing job and husband. She was the type to volunteer to coach a volleyball team or the first
parent at a bake sale. She was hands on. She was always there for other people and not allowing others to be there for her. Over the years she had taken to self harm; either cutting herself or burning herself and expertly covering it up. She did everything that a seemingly depressed person is not supposed to do. So when she took a gun and shot herself, nobody understood the reasons behind it.

I’m not a clinical psychologist or a psychiatrist and I cannot be impartial. I cannot remove emotion from it all. Yes, it affects me. Sometimes I cry as I listen to some stories but the resilience of people who, for instance, could have ended it all but decided not to, is quite humbling. Others who face so many “demons” end their lives and I shudder to think what they go through. 

Sometimes I am scared. What if this was my life? Would I be like this? Why her and not me? The truth is I cannot tell your story if you are facing some kind of mental illness. You are the only one that knows exactly what your story is and the only one that can stand boldly and say this is how I feel or think. For instance, in the above example, the clinical psychologist wore a mask. She may had faced some depression and anxiety but hid it well; so well that not even her husband realised it. 

I suppose this is the problem with being highly functional; YOU ARE STILL FUNCTIONING and therefore may not fall under that umbrella that only caters to those who are NOT functioning due to their mental illnesses. It is difficult enough that mental health is one of the underserved and
stigmatised burdens without having to question functionality as well. However, with the work that Gede is doing in conjunction with the government, these issues will be brought to light eventually.

Written by Zunzika Thole-Okpo

Ageing Population in Sub Saharan Africa ; A Call to Action

The following article was featured in Health Reporters; Africa's Online Health Newspaper

By John Minto, Managing Director

It was Albert Einstein who famously said that, “I have reached an age when, if someone tells me to wear socks, I don’t have to”. We all seek to live to a ripe old age when we are respected for our life experiences, wisdom and calmness. And who does not hope for a time when we are also perhaps a little self-indulgent? In old age, if we don’t want to wear socks, surely we shouldn’t have to?

But what is the old age reality for many of those living in sub-Saharan Africa? Recent research[1] has provided some much needed insight into a range of key issues and has also underlined the need for action if an old age ‘demographic time bomb’ is to be stopped from exploding.

Pivotally, research is starting to show that the world’s population is ageing rapidly, even in low and middle income countries where the overwhelming focus of ‘development’ has been on young people of mainly reproductive age. This has tended to defocus attention away from the needs of older people (ie those aged 60 and over) which needs to be reconsidered when one reflects on the fact that the number of older people is predicted to rise in sub-Saharan Africa – from 46 million in 2015 to 157 million by 2050. Within this overall picture, consideration also needs to be given to the fact that life expectancy is also rising in sub-Saharan Africa. Currently, if a woman reaches the age of 60, she can expect to live 16 more years (14 for a man), which suggests that, for those who have reached 60, old age is indeed already a reality.

In focusing much of ‘development’ on the needs of the relatively young, attention is being diverted from recognising the role older people play in helping the young to achieve their potential. Research is starting to show the important role which older people play as carers and guardians of the young, as well as how they shape access to health, education and livelihoods. Caregiver roles performed by older people are even more important within the context of health burdens such as HIV-AIDS, TB and malaria. Beyond the family, research is only now starting to highlight the vital role which older people play in the economy of all countries across sub-Saharan Africa, largely in the context of remaining in the labour force as smallholder farmers, without which it is difficult to see how ‘food security’ can be realised throughout the region.

Whether in the family or in the wider economy, there is little doubt that older people can only execute these essential functions if they have the physical and mental capacities to do so. However, a vicious cycle can often be created within families if these functions fail and other family members (often women) have to dedicate time and other scarce resources to care for them. This is a very real issue for relatives and carers whose older relatives and friends face a range of health challenges including cardiovascular and circulatory disease, nutritional deficiencies, cirrhosis of the liver, diabetes, as well as hypertension, musculoskeletal disease, visual impairment, functional limitations, depression and dementia (all of which require additional research into the complex set of needs they create over time).

However, a key problem lies in the age based inequality to health care across most countries in sub-Saharan Africa. Put simply, older people tend not to access health care as often as younger people do. Many reasons have been put forward for this, but most insights reflect a range of factors including the absence of an escort to travel with, the relatively high cost of transport, along with the fees charged for treatment and medication – even when health care is supposed to be free at the point of delivery. More often than not, older people are also aware that many health facilities are tailored towards the needs of the young, with an emphasis on reproductive and family health services.

Given the social and economic role which older people play throughout sub-Saharan Africa, voices are being raised to call for a greater emphasis on their physical and mental health. Such voices have also called for greater attention to be given to policy frameworks which deliver extended health care in the community which balance the prevention of early mortality with the provision of chronic care for key non-fatal conditions which impact on older people. In the final analysis, research is starting to suggest that families might be increasingly less able to cope with the challenges associated with ‘ageing’ as ‘modernity’ takes hold. Governments (through policy frameworks and funding channels) must, therefore, be able to keep up appropriately with sociodemographic and social change.

These calls have come hand in hand with calls for more research into the better definition of health needs for older people, care gaps, as well as the development of practical ways in which to adapt sub-Saharan health systems. Such evidence will form an integral part in persuading decision makers to make older people a ‘development priority’ and will build on the longitudinal studies from, for example, the WHO and the 10/66 Dementia Research Group which have started to deepen the understanding we have of priority interventions.

One such intervention is being developed by WHO and is called integrated care for older people (ICOPE). Unusually, but positively, the ICOPE guidelines do not target a single disease, which tends to be the modus operandi of many development initiatives. Instead, ICOPE has developed a set of guidelines for dealing with the many problems associated with older age – many of which occur at the same time. ICOPE is being designed for use by non specialist health professionals in primary health care settings – something akin to the mental health guidelines currently being used in low and middle income countries. As many of the challenges facing those in old age are cognitive in nature, it will be interesting to see where the connection points are between these two important initiatives. A pilot programme in India has shown the efficacy of ICOPE and it is to be hoped that a wide range of stakeholders will work together to make this a reality for older people across sub-Saharan Africa. With an increasing number of older people living with multiple, coexistent chronic diseases, calls to move health systems away from a single disease approach to one which is more holistic will only grow over time. With time definitely not on our side, isn’t it time to discuss these issues openly and regularly?

Pot of Gold?

He is 25. He owns a business and is married. He earns N30,000 a month from his job as a butcher. He is also an avid drug user. This is hard enough given the present economic condition in Nigeria but coupled with ‘other expenses’ how does this young man make ends meet?

A typical day for this young man involves 40 wraps of cannabis, 4 bottles of Codeine, 4 tablets of Benzodiazepine and 10 cigarettes. He takes all of this in one day. This costs him N5,000 everyday. Then repeats it the next day, everyday of the week. Needless to say, he is restless, he has visual and audio hallucinations, which in lay man’s terms means he can see and hear things that are not there. To him however, they are as real as the chair I am sitting on. He usually hears these things when not on drugs. It is possible that he takes all these drugs to stop the voices and to stop seeing things. Only he and a psychiatrist can know for sure. 

Now this begs the question, with N30, 000 a month and an expenditure of N5,000 every day, how does he eat or take care of his family? By spending N5,000 a day out of his N30,000 income a month, all his money is gone in less than a week. To put this into perspective, he spends N1, 825,000 on drugs a year. He makes N360, 000 a year from his business. Where does the extra N1,465,000 come from? Does he borrow it? Does he steal it? Does he have other businesses? Why does he need this much psychotropic substances? Are these drugs the only thing he lives for? What about his wife? Does she give him money? What does this mean for her? Is she the breadwinner? Are they in this together? Is help available for him? Does he even want the help?

This young man was recently diagnosed with poly-substance induced psychotic disorder - schizophrenia like. What this means that because of his drug use, he hears and sees things and may continue to do so for some time after he stops taking the substance. He generally has a low mood and is very restless. This means that his drug use has gone so far that to his mind, the drugs are an essential part of his daily consumption, much like food is to others. Without the drugs, his brain senses that something is not quite right.

He was recently enrolled into the Community Mental Health Development Programme of Gede Foundation and BasicNeeds UK and attended a Mental Health Camp. He is one of the occupants of what our more regular readers would remember as the ‘jungle.’ Being enrolled into the programme means he has access to a psychiatrist and healing, however long it may be, is in sight for him and his family. It means he has a chance to leave the jungle and be part of society again. Hopefully. 

Written By Zunzika T. Okpo 

Media Officer 

Gede Foundation Participates in Advocacy Training Workshop in Uyo

In early January 2017, the Zonal Representative participated in an advocacy training workshop at Uyo Akwa Ibom State. The training was organised by Community Intervention Network on Drugs (CIND) and coordinated by Dr. Ebiti William. The workshop was to sensitise Civil Society Organisations (CSOs) working within its network on the legal regulation of drugs and how to advocate for drug control policy/policies. Participants at the workshop cut across CSOs working in the area of drug prevention, demand control, treatment and rehabilitation. 

The key message at the training was the need for stricter legal regulation or control policy on the production, supply and use of illicit drugs. A few of the CSOs present at the workshop shared their field experiences working within drug users’ communities. They noted that several interventions with this high risk group do not usually get the desired impact due to the following reasons; (i). Misinformation on the source, quality and type of drugs people consume. Most users have no idea of the source, quality of drug or drugs mixture they consume. An ex-user shared with the group that sometimes users are sold paint (powdered paint) for ‘crack cocaine’. He told the group that there is a dramatic change in the trend of drug use from the 1980s and 1990s. These days, creativity has been introduced into the use with complex “cocktails” of unimaginable substances ranging from pharmaceutical products (like Tramadol, Codeine) to dung, paint and other conventional drugs. He also noted that legal control would give cover over packaging, vendors and outlets, users will be more open to treatment and freely access health facility for help, (ii) Drug abuse or use is treated as a crime rather than a public health issue. A case of alcohol use was compared to a wrap of cannabis. A person who is a drunk is not seen as a criminal but one caught with a wrap of cannabis would most likely be considered a criminal and can be detained, in other cases imprisoned or fined. A critical consideration of both cases would present issues for public health as both alcohol and cannabis abuse present similar negative outcomes, health impact and social affectation. All drug users are not drug dependent or addict and drug use is not synonymous to crime but problematic drug use would present criminal outcomes. Therefore, regulation and better health education would be more effective and humane ways of encouraging people to make healthier lifestyle choices, (iii) prohibited drugs are unfortunately affordable and this makes it difficult to control supply, (iv) drug users are mostly labelled and stigmatised resulting to affected persons developing fear of ‘coming out’, delay in seeking necessary care, fear of discrimination and self stigmatisation. 

This calls for CSOs and other stakeholders in the health sector to support government efforts in curbing and bringing to the barest minimal the impact of drug abuse on individual health, society through awareness programmes, lectures and for CSOs to advocate for stricter policy control and regulations on drug production, supply and demand. 

This training came at the time when Gede Foundation is reaching out to communities and stakeholders to deepen its partnership in intervening for mental health as an essential aspect of health development programmes.

Written by Ekaette Udoekong

The Zonal Representative