Increasing uptake of mental health services through the activities of Self-Help Groups

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Gede Foundation started its Community Mental Health and Development Programme in 2016 in the Federal Capital Territory and Nasarawa State. The programme focused on raising awareness about mental health and providing treatment and care at the community level to those with mental illnesses and epilepsy. It has reached 949 people with common mental illnesses such as (depression, anxiety, post-traumatic stress disorders, and substance dependence) and epilepsy, through the mental health camps with specialists at the rural communities of Mpape amd Mararaba. Psychiatrists and clinical psychologists visit communities through the Primary Healthcare Centres, screen, diagnose and offer treatment as appropriate.

Over the period, self-help groups (including users, careers and community volunteers) have been established in these communities, with the aim to engage with available community networks to address the various barriers for uptake of mental health services including prevention activities. More than 200 members are actively involved in prevention and referral activities within the self-help groups in both communities.

The Foundation has provided series of trainings to the primary healthcare staff and members of the self-help groups to support their activities. This uptake has been made possible with a generous donation from BasicNeeds US. 

These trainings were to set a trend for the self-help groups to be self sufficient and true to the term - “self-help” and to facilitate smooth referral pathways for delivering of mental health services.

The trainings, which fell during the ‘mental health awareness week’, were two-fold and hinged on leadership and advocacy, as well as, referral pathways for those affected by mental illnesses and epilepsy.

The self-help groups meet every last Saturday of the month in their respective communities. They have been doing so since inception, in November 2016. During their meetings, which the Foundation has observed, they discuss various issues such as bringing more awareness about mental health issues to their communities as well as advocating for more care and support towards their cause. They also counsel each other where necessary; refer cases first to the Primary Healthcare Centres for proper care and to the secondary health facilities as needed. They also encourage themselves to be present at meetings, to adhere to medication as prescribed by specialist and support others to do same.

During the meeting, the chief of Mararaba Gurku, Allahyayi Gambo expressed gratitude to the Foundation for not ‘deserting’ the community and continuing to champion the cause despite the obvious stigma attached to it.

Going forward, the Foundation hopes to lend a helping hand to the community with hopes of scaling up the community programme and encourage referrals/adherence to medication. It is hoped that the self-help groups would be empowered to respond to issues that affect their mental wellbeing and also get rooted in interventions that will make them self-sustaining.

 

 

WHO tags video game addiction ‘mental disorder’

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The World Health Organisation (WHO) has, for the first time, tagged compulsive video gaming as a mental health condition in its updated classification manual released on Monday.

The UN health agency said video game addiction should now officially read ‘gaming disorder’.

“For gaming disorder to be diagnosed, the behaviour pattern must be of sufficient severity to result in significant impairment in personal, family, social, educational, occupational or other important areas of functioning,’’ WHO said.

It added that such behavioural pattern would normally have been evident for at least 12 months.

The formal designation of “gaming disorder” within WHO’s International Statistical Classification of Diseases and Related Health Problems (ICD) was welcomed by some groups as helpful to sufferers.

Others, however, saw the official designation as causing needless concern among parents.

“There are few truer snapshots of a country’s well-being than its health statistics,’’ the UN agency also said.

WHO said while broad economic indicators such as Gross Domestic Product may skew impressions of individual prosperity, data on disease and death reveal how a population is truly faring.

According to WHO, ICD is the “bedrock for health statistics,” codifying the human condition from birth to death, including all factors that influence health.

These statistics form the basis for healthcare provision everywhere and are at the core of mapping disease trends and epidemics; helping governments decide how money is spent on health services.

 

WHO said crucially, in a world of 7.4 billion people speaking nearly 7,000 languages, ICD provides a common vocabulary for recording, reporting and monitoring health problems.

“Fifty years ago, it would be unlikely that a disease, such as schizophrenia, would be diagnosed similarly in Japan, Kenya and Brazil.

“Now, however, if a doctor in another country cannot read a person’s medical records, they will know what the ICD code means,’’ WHO explained.

Without the ICD’s ability to provide standardised, consistent data, each country or region would have its own classifications that would most likely only be relevant locally.

“Standardisation is the key that unlocks global health data analysis,’’ WHO said.

The 11th edition of ICD was released to allow Member States time to plan implementation before it is presented for adoption at the 2019 World Health Assembly.

Noting that it has been updated for the 21st century, WHO said “over a decade in the making, this version is a vast improvement on ICD-10.’’

It added that ICD now reflects critical advances in science and medicine.

Moreover, the guidelines can also be integrated with modern electronic health applications and information systems – making implementation significantly easier, vulnerable to fewer mistakes and allowing more detail to be recorded.

80 Nigerians commit suicide in 13 months

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Culled from Daily Trust

There is a surging trend of Nigerians committing suicide with about 80 killed in the last 13 months, according to reported incidents collated by Daily Trust.

Seventy-nine people had committed suicide between April 8, 2017, and May 12 this year, according to the data obtained by Daily Trust from content analysis of Nigerian newspapers.

Majority of the reasons given for the reported suicides range from financial difficulty, marital problems, academic challenges, among others. Lagos State leads the pack with 14 reported cases within the period under review.

Close to 800 000 people die globally due to suicide every year, which is one person every 40 seconds, the World Health Organisation (WHO) said. According to WHO Suicide Ranking, with 15.1 suicides per 100,000 population in a year, Nigeria is now the 30th most suicide-prone (out of 183 nations) in the world.

Nigeria is also ranked 10th African country with higher rates of suicide, leading countries like Togo (ranked 26th), Sierra Leone (11th), Angola (19th), Equatorial Guinea (7th), Burkina Faso (22nd) and Cote d’Ivoire (5th).

The International Association for Suicide Prevention (IASP) said suicide occurs throughout the lifespan and is the second leading cause of death among 15-29-year olds globally.

Suicide is a global phenomenon; in fact, 78 percent of suicides occurred in low- and middle-income countries in 2015. Suicide accounted for 1.4 percent of all deaths worldwide, making it the 17th leading cause of death in 2015.

There are indications that for each adult who died of suicide there may have been more than 20 others who have attempted suicide.

Reasons and signs of suicide – Experts

Medical experts said some of the signs that someone may be thinking or planning to commit suicide include change in behaviour or the presence of entirely new behaviours, when a person is always talking or thinking about death or killing self, when a person loses interest in things he or she used to care about before and making comments about being worthless, helpless or hopeless.

Others include when the person has depression, takes risks that could lead to death, sudden switch from being very sad to being happy, visiting or calling people to say goodbye, looking for a way to kill themselves, such as searching online for materials or means, acting recklessly and withdrawing from activities to mention a few.

They said people around anyone exhibiting these signs or who have attempted suicide before should be concerned and seek help from experts and appropriate authorities.

Dr Mustapha Gudaji, a consultant psychiatrist with the Aminu Kano Teaching Hospital and a senior lecturer with Bayero University Kano, said there are many factors responsible for the rising cases of suicide.

He said there are biological causes such as people committing suicide because of personality defects, and some diseases that make them feel incomplete and want to take their lives, adding that other causes are the mental illnesses like depression, drugs abuse, and adjustment disorders.

Dr Gudaji said the high rate of drug abuse is also increasing the prevalence of suicide in the country saying that some people engage in drug abuse to escape from the high realities of life, and to take care of mental illnesses like depression, known as mal-adjustive ways of coping.

The psychiatrist said sociological causes of suicide include unemployment and socioeconomic hardships among others.

Dr Maymunah Yusuf Kadiri, a consultant neuropsychiatrist and psychotherapist, said depression, reactions to failure and disappointments, in response to accumulated domestic violence, unemployment, alcohol dependence, are some reasons for committing suicide.

“Against the general belief that suicide results from mental illness, not all people who commit suicide are mentally ill,” Dr Kadiri who is also the Medical Director of Pinnacle Medical Services, Lagos, said.

She said suicide prevention needs proper coordination and collaboration to ensure effective outcomes.

According to her, suicide is not the best way of dealing with personal loss or the way to manage any situation. “Suicide has to stop and this involves joint campaign by everyone,” she added.

“There is need to develop resilience (the ability to cope with adverse life events and adjust to them), a sense of personal self-worth and self-confidence, effective coping and problem-solving skills, and adaptive help-seeking behaviour because they are often considered to be protective factors against the development of suicidal behaviours,” she advised.

What religious leaders say

The Founder of the Al-Mustofiyyah Society of Nigeria, Ustaz Maisuna M. Yahya, said while it is haram (forbidden) to commit suicide, some of the reasons for the rising cases of suicide in the last one year include economic hardship with some who graduated having no job and those who learnt apprenticeship have no money to buy instruments, as well as the low-income salary, sacked or retrenchment.

“Suicide is a great punishable sin in the sight of Allah. And whoever hopes in God, will be repatriated by Him. So also, are divorced cases loss of hope in the nearest future lack of strong faith in Allah as the Sole Provider (Sustainer).

“Also, are orphanages and widows’ predicaments, frustration from indebtedness, peers’ influence, effects of drug addiction, the harshness of parenthood, loneliness without socialising with other responsible people,” Yahya said.

On his part, the Chief Imam of the Al-Habibiyyah Islamic Society, Sheik Fuad Adeyemi, said, non-reliance on Allah and over ambition among others also contribute to the high cases of suicide in the country.

Also, President of the Christian Association of Nigeria (CAN), Dr. Samson Ayokunle told Daily Trust that the economic situation in the country is largely responsible.

“From all indications, the political class has failed us. They over-promised but under-deliver and instead of joint hands in solving social and economic problems, they are indulging in blame game. The jobless, the hungry, the homeless, the hopeless, the rejected, the poor, the sick who has no one to take care of him or her at all, do not care which party is ruling or the opposition.

“All they want is a solution to their problems. If the religion is telling them hereafter, the government is not put in place to send them to the early grave but helps them to justify their existence. Our government at all levels should wake up from their unholy slumber before the situation snowballs into revolution. A hungry man is an angry man. 

“Nigeria has what it takes to make life comfortable to all and sundry. The political class should stop cornering our commonwealth,” Ayokunle who spoke through his spokesman, Pastor Adebayo Oladeji said. 

Americans are depressed and suicidal because something is wrong with our culture

Don't pathologize the despair that is a rational response to a culture that values people based on ever escalating financial and personal achievements.

In September of 2004, I received the call that every person dreads: My father had dropped dead of a heart attack at the age of 61. It came at a time when I was already grappling with other issues, including watching my mother fight breast cancer for the preceding six months, a breakup with a boyfriend and a lack of structure in my life as I was freelancing as a consultant while I tried to determine what I wanted to do next with my career.

I was in an emotional free fall, so I visited a psychiatrist. He said the antidepressant my general practitioner prescribed to help with my life-long struggle with anxiety wasn't what I needed, so he prescribed a new one. This seemed to only make things worse. Within a few days, I found myself thinking the unthinkable: I want to die. 

I couldn’t imagine a life without my father and our hours-long conversations about, well, everything. The pain was debilitating, getting out of bed was an Olympian event, and life was utterly devoid of meaning. I stopped eating and shed 15 pounds in a month. I couldn’t see any reason to be alive.

I’ve thought a lot about this period following the suicides of Kate Spade and Anthony Bourdain, two people who by public appearances seemed to be living their best lives. We also learned this week that suicide rates have risen nearly 30% since 1999, making it a national crisis. 

I decided to share my story after interviewing John Draper, director of the National Suicide Prevention Lifeline, who happens to be my future brother-in-law. “What people don’t really know is that there is research that shows the media can reduce suicide,” Draper told me. “What creates a contagion effect is when the media focus mostly on the suicide and the way the person killed themselves. If people are more open about talking about coping through suicidal experiences, and the media highlight those stories, the evidence is very clear that this has a very positive effect on getting people through a suicidal crisis.” 

More: From Anthony Bourdain to Kate Spade: How news media only covered one death correctly

Anthony Bourdain's death highlights rising suicide rate among middle-aged adults

So it might help a person contemplating suicide to read that I am thankful I didn’t succumb to my suicidal impulses. Or to learn that people like Halle BarryElton John and Drew Barrymore attempted and survived suicide. Or that OprahOlympian Michael Phelps and singer Demi Lovato considered suicide but didn’t go through with it.

Many factors in suicide

We often assume that people who commit suicide are mentally ill, but this isn’t always the case. There are many factors that can contribute to suicide that have nothing to do with mental illness, including loss of a relationship, loneliness, chronic illness, financial loss, history of trauma or abuse and the stigma associated with asking for help.

Even for those who do ask for help, friends and family can be flummoxed by “successful people” planning their own deaths. My family and friends told me I was “living the dream” and that I was “too strong” to succumb to suicide. Even my psychiatrist didn’t take my complaints seriously, saying I didn’t present as a suicidal person who was more likely to show up disheveled and unbathed than with a blowout and a fresh manicure.

Never mind that the day before, I had stood pressed against the 20th floor bathroom window of a building where I was consulting for a campaign, sobbing and wishing I could open it and jump to my death. Or that a few days before that, I had turned on the oven and put my head in, pulling it out only when an image of my younger brothers, also grieving my father’s sudden death, flashed in my mind.

Despite my doctor’s claim that nothing was wrong, I insisted that he change my anti-depressant, and within a few weeks my suicidal thoughts diminished. I’ll never know whether the anti-depressant was the cause of my suicidal thoughts or not. What I do know is that every day I didn’t kill myself felt like a victory.

Though my suicidal thoughts passed, an oppressive depression ground me down that year. Life was an agonizing and daily struggle. So, when I hear that Kate Spade was reportedly fighting depression and anxiety for five years, all I can think is that it was nothing short of heroic for her to stay alive as long as she did.

Why we suffer emotional despair

“What a lot of people don’t understand is that a person contemplating suicide is in overwhelming emotional pain and they think very differently than people who are rational,” Draper told me. “It’s cognitive constriction. Your pre-frontal cortex goes off line and you have a flight, fight or freeze impulse. In that case suicide seems like the best way out or the best way to fight for your survival. They think, maybe my afterlife will be better.”

But why are so many more Americans getting to this level of emotional despair than in the past? As journalist Johann Hari wrote in his best-selling book Lost Connections: Uncovering the Real Causes of Depression — and the Unexpected Solutions, the epidemic of depression and despair in the Western world isn’t always caused by our brains. It’s largely caused by key problems in the way we live.

We exist largely disconnected from our extended families, friends and communities — except in the shallow interactions of social media — because we are too busy trying to “make it” without realizing that once we reach that goal, it won’t be enough. 

In an interview this year, the comedian and actor Jim Carrey talked about “getting to the place where you have everything everybody has ever desired and realizing you are still unhappy. And that you can still be unhappy is a shock when you have accomplished everything you ever dreamed of and more.”

If only we get that big raise, or a new house or have children we will finally be happy. But we won’t. In fact, as Carrey points out, in many ways achieving all your goals provides the opposite of fulfillment: It lays bare the truth that there is nothing you can purchase, possess or achieve that will make you feel fulfilled over the long term.

Rather than pathologizing the despair and emotional suffering that is a rational response to a culture that values people based on ever escalating financial and personal achievements, we should acknowledge that something is very wrong. We should stop telling people who yearn for a deeper meaning in life that they have an illness or need therapy. Instead, we need to help people craft lives that are more meaningful and built on a firmer foundation than personal success.

Yes, there are people who have chemical imbalances who should be supported and treated with medicine. But most Americans are depressed, anxious or suicidal because something is wrong with our culture, not because something is wrong with them.

Changing our culture is critical. Being honest with others about our own personal struggles and dark nights of the soul is the first step. People on the edge need to hear stories that assure them there is a way through the all-consuming pain to a meaningful life.  

I’ve told mine, now go tell yours. 

Kirsten Powers, author of The Silencing: How the Left is Killing Free Speechwrites often for USA TODAY. Previously, she worked for Fox News and is now an analyst for CNN. Follow her on Twitter @KirstenPowers.

Culled from USA Today

 

THEORY OF CHANGE SEMINAR AT GEDE

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On Tuesday, May 9th 2018, Gede Foundation hosted Dr Mayston from King’s College, London to deliver a Theory of Change seminar focusing on ways to integrate mental health into HIV care and support, using the Theory of Change (ToC) model to identify key issues. There were 20 participants ranging from mental health experts as well as HIV/AIDS organisations. Participants represented the following organisations: Society for Community Development (SCD), Organisation for Positive Productivity (OPP), Heartland Alliance International Nigeria, Karu Behavioural Medicine Unit, Federal Medical Centre (FMC), AIDS Healthcare Foundation (AHF), National Primary Healthcare Development Agency (NPHCDA), Brain Specialist Hospital, Presidential Committee for the North East Initiative (PCNI) and the Institute for Human Virology, Nigeria (IHVN). 

It was an opportunity for participants to review the results from the earlier ToC seminar that was held at Gede Foundation in January 2017. Our regular readers will recall that the ToC in 2017 sought to, i) review the evidence base related to integrated mental healthcare for people with HIV, ii) better understand the barriers and facilitators to designing and implementing effective integrated care in the Nigerian setting, and, iii) share these ideas among people with interest in this area, with a view towards carrying out future collaborative work/service development. Theory of Change is defined as “a way to understand how, why and to what extent change happens.”

During the course of the seminar, Dr. Mayston asked participants to think of an overall impact so as to map out the Theory of Change process. Participants agreed on greater involvement of mental health professionals in the care of PLWHA, care that is patient-centred, improved quality of care, improved HIV and mental health outcomes. The map is accessible here.

At the end of the seminar, it was agreed that if integration of mental healthcare into HIV is to be practical, there are changes that need to be made to the existing structure. Healthcare workers who were present noted that they may not be fully equipped to care for someone whose mental and physical health is challenged as as they had yet to be trained to screen and treat such conditions and the medical training given to facility doctors at the community level had very little in the way of psychiatry/psychology. The challenge is integrating mental health screening, treatment and referral expertise into the very busy lives of frontline health care workers. Participants also agreed on how to go about treatment depending on the severity of the mental health disorder when an individual is first diagnosed. 

Participants agreed on the road map as articulated and that this will form the basis of Gede’s forthcoming engagement with Government agencies and grant applications.

My Journey with Gede Foundation

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Hello!

My name is Luka Henry Akumuko. I am from Anchuna in Kaduna State. Somewhere you don't want to visit right now. LOLS. I graduated from Ahmadu Bello University, Zaria where I studied Geography - about how the earth rotates and all that. Currently I stay with my entire family in Mararaba. We are such a happy family. I love my siblings in as much as you love yours or even more than you love yours. Winks!

Three things are fundamental in my life; getting wisdom, sharing revelations and maintaining an intimate relationship with God and man. There's a whole lot to write about me but for now, let’s save it for the moment and draw the introduction to a close.

Me, Gede Foundation and I

I am a beneficiary of what Gede Foundation is doing and here is my story. 

I was introduced to Gede Foundation in 2003 by my elder sister. At first when I lost my dad at the age of 15. Hmm, it never occurred to me that I will have an education. I was too young to understand and my thoughts were limited to envision that God is the author of my destiny. Gede Foundation came onboard and that was the dawn of a new era for me.

All I could gather from what my sister told me back in 2003 was "you will be going back to school very soon, because someone will pay your school fees and everything will be alright." But guess what? She was right because Gede Foundation paid all my tuition fees from Primary school up to my graduation from University. I am deeply honoured for what they did to me and hundreds of others I knew about. And I will never forget. If my brain will serve me right this morning, then I will say that we were 25 when Gede Foundation picked us in 2003 and  I can only imagine what the number might be as at today. I met with some of them few years back and I believe they are all doing fine.

I remember serving in the Foundation after my secondary school in 2009 when I couldn’t gain admission into the higher institution. The one year of volunteering at Gede Foundation was worthwhile. I was able to learn Computer Basics under the tutorship on Uncle Godwin Etim, Mr Okafor and Aunty Helen. I don't have any certificate for computer training but what I was able to obtain in front of that desktop in the program office was enough to propel  me into ICT to the point of teaching Computer Science during my NYSC program in Kebbi State. And I will be launching a new website very soon, God willing.

I am so confident about myself right now. Thanks to Gede Foundation because I am a living proof of what they stand for. I was transformed from hopelessness to hopefulness with the support I received from Gede Foundation and that hope is a living one. My history is incomplete without mentioning Gede Foundation.

 Written by

Luka Henry Akumuko

Five steps to building resilience at work

Culled from Mental Health Today

Stress is the theme of the UK's mental health awareness week this year. We asked Laurel Alexander, author of The Resilience Coaching Toolkit, how to confront workplace triggers of stress. 

Step One: Take Ownership

It’s very tempting to lean towards an easy life at work and let others do most of the running. While there is something to be said for being laid-back, it’s possible that your relaxed attitude could metamorphosis into inertia and passivity, allowing work colleagues to walk over you.

Taking ownership means that you are in the driving seat of your working life.  You might not always know where you’re going (or be happy with the tasks you do), but ultimately you’re in charge of the vehicle (you) that is going somewhere.  Ownership is about being the adult in your life.  You can say yes, no or I don’t know.  If you say yes or no, you deal with the consequences, warts and all.  If you don’t know, you move onto Step Two – and become informed.

Pay-off tip:  By taking ownership of your working life, not only will you feel more in control, but others will respect you more. 

Step Two:  Increase Pro-Activity

When we’re pro-active, we take action sooner rather than later.  We don’t wait for life to swipe us around the face like a wet kipper.  We anticipate.  We become informed.  We make decisions.  The decisions might be right or wrong.  If they’re right – yippidedoda.  If they’re wrong, then we know what not to do, and we continue being pro-active to find a better solution.

Pay-off tip:  By being proactive in the workplace, you are likely to find something better than the situation you’re currently in.

Step Three:  Improving Self-Care

All this taking ownership and pro-activity can be wearing, so we need to implement and maintain a sustainable self-care programme for ourselves.  By self-care I mean look after our physical, emotional and mental wellbeing.  While it’s great to have someone in our lives who will give us this TLC, we can’t always rely on that especially in the workplace, so we need to look after ourselves.  Ways we can do this is physical, e.g. taking breaks and ensuring good nutrition, through relationship, e.g. assertive communication and psychologically, e.g. through self-compassion (e.g. not beating yourself up when you aren’t perfect).

Pay-off tip:  Looking after yourself, at home or work, is a nourishing mindset and behavior which will make you feel better about yourself.

Step Four: Manage Strong Emotions

We are emotional animals, and while we want to feel as good as we can about our work, there are times when our emotions feel uncomfortable.   While we need to honor our emotions, if we let them get out of control, we tend to lose cognitive function and may be more inclined to make impulsive decisions based on trying to avoid feeling bad.  The balance is in allowing ourselves to recognize and accept our emotions while understanding why we feel as we do and how we can use our thought processes to reframe the faulty thinking that often comes with emotional poop.

Pay-off tip:  Knowing you can manage those difficult emotions across the board of your life including the workplace, will improve your self-esteem and confidence.

Step Five: View Change as Opportunity

Change is a constant fact of life and our working day is no exception. Every day in the workplace we need to adapt to something different. Positive change management skills such as becoming more adaptable and changing perspective can often open us up to fresh opportunities that we might not otherwise have had.

Pay-off tip: The most simple way to change at work (or anywhere else) is to say ‘yes’ or ‘no’ to something for the first time and mean it.

The Resilience Coaching Toolkit is available to buy online from the Pavilion Publishing bookstore

Tackling Nigeria’s Codeine Crisis Is A Marathon, Not A Sprint

By Nigeria Health Watch

“…drug abuse is with us. It’s happening closer to us than we can imagine. It’s wrecking our youths, our future, our pride. All hands must be on deck towards solving this problem.” – Pharm. Chijioke Onyia

One of the most talked about issues in the Nigerian health sector currently, is the codeine crisis in Nigeria, and the government’s reaction to the issue. The story, an investigative documentary was aired by BBC Africa two weeks ago after correspondent Ruona Meyer went undercover to learn how the cough syrup turned street drug was getting into the black market. The documentary revealed how Meyer and her team unravelled the underground trade and highlighted how cough syrup was being sold by representatives of three major pharmaceutical companies in Nigeria. One of the representatives with Emzor Pharmaceutical boasted in the documentary that he could sell 1 million cartons of codeine containing cough syrup a week. This damning revelation quickly had the company distancing itself from the sales executive, who has since been fired. Meyer’s reason for investigating this issue was hinged partly on her brother’s experience as a codeine addict.

This piece of exceptional investigative journalism has stirred up vigorous debate in the country about the codeine crisis, which, although evident for years in some parts of Northern Nigeria, has not received the priority it deserves. The discussion has been particularly virulent on social media, and people did not hold back their feelings about the crisis.

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In reaction to the release of the BBC video, the Minister of Health Professor Isaac Adewole, on May 1, 2018 announced that the Nigerian government had banned the issuance of permits for the importation of codeine. In addition to the ban, the National Agency for Food and Drug Administration and Control (NAFDAC) shortly afterwards announced the shut down of the three pharmaceutical companies indicted in the BBC video for their alleged involvement in codeine syrup black market sales; Emzor Pharmaceuticals Industry Limited, Peace Standard Pharmaceuticals Limited, and Bioraj Pharmaceuticals Limited. Emzor has since come out on social media to say that NAFDAC has only temporarily sealed one of its production sites, the liquid line.

Since the news of the ban was announced, there have been several online and offline arguments across Nigeria. The discussions have been centred on the ban imposed on pharmaceutical companies and whether the ban this was the right solution to end the codeine crisis in Nigeria.

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While these are compelling and critical discussions, it is not enough for us to spend too much time debating the narrow issue of whether the government should or should not have placed a ban. There are deeper issues involved, that we must resolve if we are to find a solution to this growing crisis.

Following the several conversations and our review of the situation, we have highlighted three key areas that may contribute to a final solution to the Codeine crisis in Nigeria.

Defining the size and dimensions of Nigeria’s codeine problem

Our first priority is to ascertain the size and distribution of the problem. The data flying around, including by officials on the Nigerian Senate has stated that 3 million bottles of codeine syrup are consumed daily in Kano and Jigawa states alone. However, it is unclear exactly where this data is from or how accurate it is. What are the national figures? Who is collecting the data? How is the data collected? Are there different patterns in different states? Are there particular age, gender or socioeconomic groups affected? What other data can we use to define the problem – school absenteeism? Hospital consultations? While anecdotal and other suggestive evidence indicate that the problem is entrenched and growing, working towards a solution requires accurate data to reveal the real magnitude of the problem. With credible data, we will be in a position to examine and make projections about the long-term impact of this problem. Some of these questions can be answered through relatively rapid to deploy well designed quantitative and qualitative studies, but it is critical that there are evidence-base underpinning proposed solutions. We cannot manage what we do not measure.

Defining a coherent and broad prevention strategy

The government’s ban, while understandable, should only be a first step in addressing the problem and should reflect the evidence base around the effectiveness of the prohibition of illicit substances and should, if deployed only be part of a wider strategy to address the problem. With better understanding of the magnitude of the crisis, backed by better data, we must then put in place a framework of primary, secondary and tertiary prevention strategies. Primary prevention will focus on stopping new cases of codeine abuse. We must begin a thoughtful, well-designed risk communication campaign communicating clearly to the public the dangers of codeine abuse, and saturating the airwaves and public spaces with anti-codeine abuse messaging, much as we have done with anti-tobacco messaging. Can we enlist some of our celebrities and public figures who are widely admired in the fight as Egypt has done with the footballer Mohammed Salah? Secondary prevention needs to focus on early detection and treatment of people who are affected and can be achieved by educating the public and clinicians about the early signs of codeine abuse or addiction. We should ensure that doctors and other health workers understand the problem, are able to educate their patients about the harm of codeine abuse and possess the right information to support or refer them for specialist help if needed. The education system should also play a role- we should think critically about how to train and support our teachers and educational institutions to respond to this crisis.

The government’s ban will not do away with the need by those who have already developed a problem from needing to use codeine. We must seek to understand the underlying reasons for people being drawn to abuse codeine- there are suggestions that undiagnosed mental illness, genetic predisposition and chronic pain may all be factors.

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Regulation, of course, is an important part of any prevention strategy. Beyond banning the importation, perhaps this may be an opportunity for the government to improve the regulation and enforcement of existing regulations on sales of medicines, especially in open markets in Nigeria. Clinicians need to carefully assess patients’ legitimate clinical needs for sedatives, opioids and stimulants, to ensure that these medicines do not get into the wrong hands.

A cohesive prevention strategy will allow the country to tackle this problem from various angles. This will yield both short and long-term results.

Defining an approach to manage the existing problem – it will not disappear on its own

In the meantime, there is an existing crisis. For thousands of those suffering from codeine addiction, the ban only means that codeine syrup is bound to become scarce and even more expensive. We must, therefore, look at access to rehabilitation and treatment support services- are they enough? Are they well distributed across the country, matching the areas of need? Do they have the resources they need? Are they providing evidence-based care? The sight of patients chained up in the BBC documentary suggests there are clear areas for improvement. Are they effectively using substitution, treatment and societal reintegration to rehabilitate addicts? Civil society organisations such as Federation of Muslim Women Association of Nigeria (FOMWAN) and Youth Awareness Forum Against Drug Addiction (YAFODA)  in Kano, are already intervening with community-based approaches, and seeing some success. Can the lessons learned and models used be evaluated and spread more widely?

MEMBERS OF JAJIRCEWA GROUP OF KWANAR DALA WITH OFFICIALS OF FOMWAN DALA LGA AND KANO STATE AMIRAH OF FOMWAN. PHOTO CREDIT: NIGERIA HEALTH WATCH

Ultimately as a country, we must understand that this race to rid our nation of codeine abuse is a marathon, not a sprint, and not expect one-stop answers for such an entrenched problem.

Meyer says in the BBC Africa documentary; “Some journalists pursue stories for fun or for money; I am pursuing cough syrup, in anger, in rage, in love.” As a country, we must join Meyer to pursue this codeine addiction crisis out of Nigeria… in anger and rage against what it is doing to the next generation… out of love for our country’s young people and our nation’s future.

TAGS: codeinecodeine and tramadol abusecodeine ban in Nigeriacodeine cough syrupfsp

 

 

Review of Mental Health Screening Tools for use among OVC in Nigeria

On Monday, February 12 2018, Gede Foundation and the Catholic Relief Services (CRS) hosted a stakeholders meeting in Abuja to review the report from a research towards ‘Developing Culturally Appropriate Mental Health Screening Tools for use among Vulnerable Children in Nigeria.’ The research was conducted by Gede in 2017 in the Federal Capital Territory, with Dr. Bonnie Kaiser from Duke Global Health Institute, USA, as the Principal Investigator.

Participants at the meeting included experts within mental health sector from the federal ministry of health, federal ministry of women affairs and youth development, universities, development partners, hospitals, civil society organisations and health practitioners.

Dr Emeka Anoje, Chief of Party for CRS- SMILE project welcomed participants in his opening remarks, stated the rationale behind funding the research and potential impact that could be achieved when appropriate screeners for mental health conditions are used within the orphans and vulnerable children programmes.

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 Dr. Kaiser gave an overview of the report and explained different sections of the research such as the procedures, results, challenges and conclusions. She mentioned that four screeners were validated in two languages-Hausa and Pidgin, and these are easy-to-use tools that can be implemented at the community level. 

At group sessions, participants made useful inputs into the report and recommended ways in which similar research can yield more positive impacts in future. Although the research suffered some limitations and challenges, the tools are said to be i) semantically and conceptually understood, ii) appropriate for use by lay community members, iii) symptoms sensitive that best distinguish between cases and non-caseness in the Nigerian context and are similar patterned across ethnic/language groups, and, iv) effectively administered as rapidly as possible in emergency situations.

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The meeting concluded with questions of ‘what next?’ All the suggestions and questions were taken into consideration and may be included in the final report. Please check back regularly to find out the next step.