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 

Drug Use: What You Don’t See

Submitted By Ete-Obong - Calabar South

It is hard to understand or appreciate what an addict goes through if you have never been addicted to anything, be it drugs, sex, food or alcohol. 

Most people do not understand or see reasons why or how drug users become addicted. They may wrongly think that those who use drugs are delinquents or lack moral principles or willpower and that they could stop their drug use simply by choosing to or if they are pressured by loved ones. Drug use changes a person mentally, physically and socially in such a ways that make quitting hard, even for those who want to. People who use drugs or alcohol do so for various reasons. Some are influenced by peer groups or social affiliation, others like, me just started off with drugs out of curiosity and to experiment. Therefore, you would only understand or handle a drug user if you understand the reasons for use, the environment and user social mix. I don’t smoke I do ‘crack’, and never in public just in my closet so no one suspects I am a drug user. I keep track of what I take, when I take it and how much I take. For over 10 years I have maintained this habit. I am reserved so it’s very difficult to imagine me with drugs. I drink sparingly and not in public because I represent an outstanding business firm. 

Who can honestly say that they don’t use drugs? I’m not necessarily talking about illegal drugs, like marijuana but alcohol, nicotine, caffeine, codeine and aspirin are all drugs. However, the way drugs are spoken of in our society is hugely problematic. Not all drug users are problematic, like me for instance. Legal drugs like tobacco and alcohol are responsible for deaths as much as illegal drugs each year, one might argue even more so. People like me need help and want to come out and not to be stigmatised or seen as criminals. Being a drug user is a psychological problem and being seen as problematic is just as psychologically demeaning as the problems associated with usage. And what people don’t see is how much users want to stop, how much we want to be able to speak out and get help, how much we wish we never had that first drag or sniff.

These substances damage the brain and cause a lot of mental and physical health problems. There should be continuous awareness on the effects and impact especially in schools. Drug education should enjoy a face-off just as much as HIV and ebola do. I am able to manage my situation now because I can afford the “good stuff” and I am able to hide my identity but I cannot speak for the future. However, there are others who cannot and need help. I want to stop the use of this substance and get clean but this comes with a lot of fears that I do not know if I am ready to face. 

 

Mental Health Camp Round 1 for 2017 — Mpape

Gede Foundation held its first round of 2017 Mental Health Camps (MHCs) in Mpape on Saturday, 28th of January 2017 at the Primary Healthcare Center. As always, there was an array of cases both old and new.

The tone of the MHC was quite different from the previous ones held in 2016. There were more cases of depression and anxiety (including other mood disorders) and less of the more common seizure disorders and mental retardation. Two cases in particular spring to mind. The first is a lady who lost her husband 5 years ago. When she heard about his death, she completely went into shock and it appeared as though she could not comprehend what had transpired. She began talking to herself, her blood pressure shot up and she was hospitalised. This, coupled with other symptoms she described led the Psychiatrist to conclude that she had had a psychotic break. She was hospitalised, treated and released. However, she had a relapse and was taken to a traditional healer. For some time now, she has been taking herbs to suppress her symptoms but they are still present. Her mood is always low, she talks to herself or completely out of turn. Furthermore, she has had suicidal ideation but has made no attempt yet. She was one of the first people to be enrolled in early April 2016, but had refused to attend any MHC. There was a similar case, with an elderly lady whose low mood and hopelessness was obvious even to the untrained eye. She sat down by herself and only spoke when spoken to. She’d been hospitalised several times but her symptoms are still present. She barely sleeps, is always tired and can hardly get out of bed. The Psychiatrist spoke to her at length and encouraged her to take her medication and to return for follow up. 

Our regular readers will recall the schizophrenic lady that was chained to a pole in a church due to her wandering tendencies and erratic behaviour. After over a year of being chained and starting medication last year, she is now much better and back home with her family. Unfortunately, another woman has taken her place in the church and has been tied to a pole - with a similar condition. Efforts to reach the carer by our Community Based Volunteers (CBVs) proved futile. Another user that is doing a lot better is the young boy that used to have about 5 seizures daily. After starting medication, he is doing a lot better and as long as he remains compliant, he will remain seizure free. There were other old cases where users relapsed due to non-compliance. They were encouraged to continue with their medication but they pleaded for help from the Foundation as they could not afford the medication. It is important to mention here that the Foundation which is a BasicNeeds franchisee, gave livelihood training to some of the users and carers with the hope that they will be able to sustain themselves and be reintegrated into the communities. 

The CBVs brought to the Foundation’s attention news of users who abuse drugs. There are 3 boys whose mother has reached out to the Foundation through the CBVs to enrol them. However, upon hearing this news, the children beat up their mother. The smallest of the boys is 9. One of them wanders the streets and is very violent and aggressive when approached or when he senses provocation - warranted or unwarranted. The CBVs will keep trying to enrol them into the BasicNeeds Project so they can have access to help.

The next MHC will be held in Mararaba. Please come back to the blog to read more!

Dissemination of Findings of the Gede and IHVN Prevalence Study on Depression, Alcohol Use Disorder and Suicidality Among People Living With HIV-AIDS in Nigeria

On January 20, 2017, the Institute of Human Virology in Nigeria (IHVN) and Gede Foundation hosted participants in Nassarawa State to discuss findings and results from the Study that was championed by both organizations in 2015.

The Study was conducted in the Federal Capital Territory (FCT) with 1187 respondents in 3 HIV treatment sites — Asokoro District Hospital, Garki District Hospital and University of Abuja Teaching Hospital Gwagwalada. Using the DSM-IV diagnostic criteria, the lifetime prevalence of major depressive episode was 28.2%; 7.8% engaged in harmful alcohol use; and 14% thought of committing suicide in their lifetime.

 Heads of HIV treatment sites in the FCT, treatment site managers, researchers, interviewers, and members of the press attended the dissemination meeting in Nassarawa. This meeting was the first time the results were made public in order to generate discussion on the integration of mental health services into the HIV/AIDS treatment platform using evidence-based information.

Dr. Ernest Ekong (IHVN Director of Clinical Services and Co-Investigator for the project) introduced the study, its objectives, and major results. Mr. Chidozie Bright Edokwe (Project Field Coordinator) presented the section on research methods, while Mr. Godwin Etim (Performance Director, Resource Mobilization and Partnership Management, and Project Field Supervisor) presented the conclusions and recommendations.

Participants viewed the study results as essential, representing significant evidence that supports the need to integrate mental health services into the HIV treatment and care pathway in Nigeria. IHVN acknowledged and recognized the work of those who were directly involved in field activities. The complete report will be widely published and disseminated in due course.

ADVANCED RESEARCH FOR HEALTH AND DEVELOPMENT: METHODS AND SKILLS FOR ACHIEVING IMPACT TRAINING

Gede Foundation, in collaboration with King’s College London (KCL) and the Nigerian Psychological Association (NPA), held a two day training (24th and 25th January2017) at the Foundation’s headquarters in Abuja on Advanced Research for Health and Development. There were participants from leading organisations such as the National Agency for the Control of AIDS (NACA), Society for Family Health (SFH), Institute of Human Virology in Nigeria (IHVN), Nigeria Centre for Disease Control (NCDC), Excellence Friends Management and Care Centre (EFMC), Society for Community Development (SCD), the Centre for the Right to Health (CRH), Centre for Family Health Initiative (CFHi) and individuals who attended independent of their organisations. 

Dr. Rosie Mayston, a senior researcher from the Centre for Global Mental Health, King’s College London, had this to say about the training, "We had two great days research training- it was very inspiring to be a part of this, alongside Prof. Andrew Zamani and colleagues from Gede Foundation. It was really exciting to see so many people from governmental and non-governmental agencies with enthusiasm for research. I am very much looking forward to taking part in future similar events!” Dr. Mayston included theory as well as practice in her lectures. She began with a seemingly simple question - what is research? and then moved to different types of research methods. 

Professor Andrew Zamani, the President of the Nigerian Psychological Association and also the Dean, Faculty of Social Sciences, Nasarawa State University, was one of the facilitators and covered ethics in research, research in health development in Nigeria and other topics.

The training was fashioned in such a way that it appealed to audiences who had little or no experience in research as well as expert researchers. At the end of the second day of training, there was a panel discussion that included Professor Zamani, Dr. Mayston and Gede’s Managing Director, Mr. John Minto. Among the topics discussed were were challenges and opportunities related to research dissemination, partner engagement and sourcing key information

Participants also asked questions relating to research as well as contributions on how research can be made more effective. One of the participants noted that there is need to generate culturally relevant research. She said that usually, research methods are not adjusted to fit Nigerian standards but instead, carried out as they would in other parts of the world and this may affect the results. Professor Zamani agreed with her and noted that there were gaps in research which are being addressed to ensure better collaboration between organisations.

The training ended with calls from participants for more in depth training. Some organisations wanted personalised training for their staff members. This is definitely an avenue that the Foundation, King’s College London and the Nigerian Psychological Association will explore. The training offered opportunities for participants to recognise the significance ofquality research in adding value to their work and this is reflected in their feedback from the training. If you would like to be offered similar opportunity, please email training@gedefoundation.org

Please come back to the blog for more on further trainings with KCL and NPA.

John S. Adakolo: Recipient of Award from IHVN

John Simon Adakolo, received an award from the Institute of Human Virology in Nigeria (IHVN) for his significant contributions to the Study of Mental Health (Depression, Alcohol Use and Suicidality) among HIV Positive Patients in Nigeria in 2015. 

John Jr, as he is called by fellow colleagues at Gede is an energetic and inquisitive young man who is always eager to learn new things. It is his enthusiasm that has seen him through his journey in Gede Foundation where he started as a cleaner in February 2003 to a Programme Officer in 2014.

The Foundation, through this blog would like to recognise and applaud John Jr on this achievement - which is just one of several awards and certificates that he has been given due to his hard work and dedication. 

In his own words, “I am one of the happiest people right now. I was not expecting such an award from such a reputable organisation like IHVN. It is not only a dream come true but also a reminder that hard work pays.”

Congratulations John!