Sunday, June 30, 2013

More people with mental illness need to speak out

By Lukoye Atwoli
Sunday Nation, 30 June 2013

Today, please allow me to write a note of personal appreciation to a special Kenyan living with mental illness.
I know her because she actually told the world her name, and her story, obviating any fear I may have had of breaching her privacy. The purpose of writing to her is to thank her most profoundly for playing a major role in clearing up a lot of the myths around mental illness.

Last Thursday, Ms Nancy Thuo wrote a beautiful piece in the Nation’s Living magazine. She gave such a vivid description of her experience with schizophrenia that I would recommend everyone who wants to understand this devastating condition to read.

In simple language that often escapes those of us learned in these things, she explained how it feels to hear voices nobody else could hear, to hold abnormal beliefs and to have difficulties interacting normally with people around you.

Above all, the hope she exuded in that article would serve as balm for anyone newly diagnosed with this or any other mental disorder -- that you can have this “severe” mental illness and still go on to achieve great things with your life. That you can be on long-term treatment and follow-up for schizophrenia and still enjoy a fulfilling life, perhaps even more fulfilling than if you had never experienced this illness.

This is the message those of us in the mental health field have been trying to pass on for ages, with only qualified success. Stigma continues apace, and people keep asking whether “madness” can be treated. People keep making derogatory statements about those living with mental illness. Mental illness tags are used as insults against people we do not like.

For a long time I have wondered what it would take to shock our nation into the realisation that most people with mental illness are not dangerous or “finished”, and are able to lead perfectly normal lives with treatment and follow-up. Ms Thuo’s article thrilled me, and gave me the opportunity to discuss these ideas with anyone who cares to listen.

Psychiatrists, psychologists and other mental health workers are taking care of a large number of people in our population. Among these people, I am more than certain that there are successful businesspeople, politicians, magistrates and judges, lawyers, teachers, doctors and lecturers at our universities.

It is my humble request to these successful individuals to follow Ms Thuo’s lead, and begin speaking publicly about their own journey with mental illness. Kenyans need to see that at least some of the people they idolise, who are very successful at what they do, are also living with mental illness.

The message we need to get out there is that mental illness is not a death sentence, and it does not have to curtail one’s life and ambitions. Mental illnesses, as we are discovering in the scientific world, may actually give one deep insights on life, and help people to appreciate many things they take for granted in their lives.

One hopes that Living magazine, and other daily and weekly publications, will begin featuring such stories more regularly, and allow readers to give their feedback on the same. Thank you Nancy Thuo for opening this gate, and I hope we shall have a flood of articles coming through courtesy of your initiative. 

Dr Lukoye Atwoli is a consultant psychiatrist and senior lecturer, Moi University School of Medicine.; Twitter @LukoyeAtwoli

Tuesday, June 25, 2013

State must fulfill mental health pledges

By Lukoye Atwoli
Sunday Nation 23 June 2013

Just over one week ago, the Kenya Psychiatric Association held its most successful annual conference yet.
With an impressive attendance representative of the mental health field in this country, the ground was set for presentation of ground-breaking issues in research and practice. Psychiatrists, psychologists, social workers, nurses and students in mental health were among the participants, and the discussions, centering largely on the area of psychological trauma, were very stimulating.

For the first time in the recent history of KPA, the policy leadership at the ministry of Health participated actively, and made specific pledges that will go a long way in improving the mental health of our people. The Cabinet Secretary, who was held up in Cabinet and budget meetings, delivered his speech through the director of mental health at the ministry.

The highlight of his speech was his commitment to deliver results in four main areas.

First, the Cabinet Secretary pledged to strengthen leadership and governance in mental health in this country. He promised to establish a Directorate of Mental Health and Substance Abuse to coordinate mental health with other important sectors such as education, labour and the legal justice system, among others. He also indicated that the draft Mental Health Policy and the Mental Health Bill will be expedited in order to provide a policy and legislative framework for mental health activities.

The current Mental Health Act of 1989 provides for a Kenya Board of Mental Health to oversee mental health activities in the country. For over 20 years, this board is yet to be properly constituted, and there is no vote for it in the ministry of Health budget. The Cabinet Secretary indicated that this anomaly will soon be corrected, and the board will be constituted and facilitated to begin work expeditiously.

Secondly, the Secretary has indicated that mental health services will soon be available in all 47 counties through an initiative in which mental health will be integrated into comprehensive health services at all levels of care. One hopes that this will include ensuring that all county referral hospitals have a mental health department to carry out promotive, preventive, curative and rehabilitative mental health activities.

Thirdly, we were informed that national Mental Health Promotion and Disease Prevention Programmes are on the way. These will incorporate promotion of healthy lifestyles, as well as prevention of suicide and child maltreatment in order to improve the population’s mental health. Programmes such as these must be evidence-based if they are to show effectiveness.

Finally, the Cabinet Secretary promised to strengthen and improve mental health information systems and create a research infrastructure for mental health. An easy win in this regard will be to incorporate mental health indicators in the health management information systems that are already in existence.

As far as research is concerned, it is noteworthy that the Kenya Medical and Research Institute (Kemri) has already established a mental health research programme. Those of us working outside Nairobi will also be happy to host a Mental Health Research Institute to provide a strong evidence base for mental health interventions.

The government needs to look beyond the usual approaches to generate truly innovative solutions to mental health problems. 

Dr Lukoye Atwoli is a senior lecturer at the Moi University’s school of medicine; Twitter @LukoyeAtwoli

Tuesday, June 18, 2013

No, Mr Murugu, you can’t cure cancer in 6 weeks

By Lukoye Atwoli
Sunday Nation 16 June 2013

Lately there has been a focus in a section of the media on medical malpractice, with some even referring to “killer doctors” and “killer hospitals”. Some of the claims have been factual, but many have been exaggerated. The Medical Practitioners and Dentists Board has eventually been jolted into action, revisiting cases filed several years ago and handing out harsh penalties.

All this is probably symptomatic of the direction the practice of medicine is headed in these litigious times. Medical practitioners will just have to learn to evolve with the times, and engage in what in other jurisdictions is referred to as “defensive medicine”.

It would be even better had the media and the Board also directed their attention at some practitioners of so-called “traditional and alternative medicine”. One such person who should be in their cross-hairs got a big splash in the newspapers, in which he made several claims, some outright dangerous.

Going by the name “Dkt Murugu”, he claimed that he is able to make several conditions “disappear” within a set time-frame. He suggested that he can cure cancer in six weeks, cerebral palsy in two months, hypertension in 25 days and diabetes in five weeks. He even claimed to do “HIV management” in four months.

This same person and several others are given prime airtime every weekend on several television channels to advertise their wares and their prowess. They explain illness using obscure terms that mean nothing to the expert, but are calculated to wow their audience with their supposed brilliance.

It is time someone took up the responsibility of protecting Kenyans from such shameless charlatans, and the law ought to punish these people who are preying on the ignorance of the masses. The Medical Practitioners and Dentists Board is, by dint of its own title, expected to regulate all those who present themselves as medical practitioners.

In my view, a medical practitioner is anyone who claims to possess the knowledge and ability to treat or cure an illness. The Board is, therefore, failing in its mandate when it ignores these charlatans who advertise and ply their trade in broad daylight.

Ludicrous “healing” claims by religious and traditional practitioners have been brought to the Board’s attention in the past, but they are brushed aside with the assertion that these practitioners do not fall within the regulatory ambit of the Board. In actual fact, there is no other regulatory authority for “religious healers” and “traditional” or “alternative” practitioners.

Shall we then let Kenyans to continue suffering unknowingly at the hands of these unregulated practitioners? If the Medical Practitioners and Dentists Board cannot stop these people from exposing Kenyans to death-threatening “treatment”, who will?

If anyone had discovered a cure for cancer, diabetes, hypertension and other chronic diseases, we would not be investing so much money on these conditions in this country or elsewhere. Further, the discoverer of these elixirs would become an instant billionaire, even if they protested about their philanthropic intentions. In health care, any claim of cure must be backed by a large body of research on safety and effectiveness before it can be tried on humans.

And there is nothing like “alternative medicine”, since any medicine that works against an illness cannot be considered “alternative”. It would become the standard of care.

Dr Lukoye Atwoli is a senior lecturer at Moi University’s school of medicine; twitter @LukoyeAtwoli

Monday, June 10, 2013

We are a traumatised nation in need of healing

By Lukoye Atwoli
Sunday Nation 09 June 2013

The Kenya Psychiatric Association (KPA) holds its fifth Annual Scientific Conference from Thursday. This year the theme focuses on trauma and post-traumatic stress disorder, and several experts are lined up to make presentations in this specialised area. Although this theme was agreed on several months ago, it seems appropriate that we tackle it at this point in time for several reasons.

Firstly, the British Government is finally owning up to its colonial excesses and is discussing compensation with Kenyan liberation veterans. Previous work with these veterans uncovered a stunning magnitude of psychological scarring that far outweighs the visible wounds they may have sustained during the Mau Mau struggle. That this remains unaddressed to this day is a testament to our skewed national priorities, and leaves us exposed to the consequences said to follow those that forget their past.

Secondly, we are just emerging from the first General Election after the 2007 debacle that resulted in massive loss of lives and destruction of property ostensibly due to political differences. Similarly, studies carried out among those affected by post-election violence have shown high rates of mental disorders such as post-traumatic stress disorder, depression and substance use. Tragically, we do not have an organised mechanism for helping people affected in this manner.

Thirdly, there is overwhelming evidence that our population has over the years been so brutalised physically and psychologically that we are collectively suffering from the group equivalent of post-traumatic mental disorders.

For instance, traumatised people tend to re-experience the traumatic event in distressing ways, and also do everything they can to avoid memories, events or even people related to the traumatic event. They also tend to be easily startled and overreact to trivial stimuli.

If this description does not fit our collective national behaviour, then I don’t know what does. We are the nation of “forgive and forget”, or as the song goes, tusahau yaliyopita tujenge taifa (let’s forget the past and build the nation). We are the nation led by people who exhort us to “avoid opening up past wounds” due to the fear that they could cause upheaval.

We are a people plagued by so many unspoken “historical injustices” that even the Truth, Justice and Reconciliation Commission only managed to scratch the surface. And more recently, we have become the oversensitive nation that must be constantly reminded to “accept (any event we consider unpleasant) and move on”.

The KPA conference, therefore, provides an ideal opportunity for us to start a national conversation on what ails us as a nation, and how we can begin to conclusively address our traumatic past and embark on a journey of healing. The association is ready to provide the expertise necessary to point us in the right direction.

In this connection, it is gratifying that the Cabinet Secretary for Health has graciously agreed to open the conference and interact constructively with mental health experts during this meeting. One hopes that this sort of positive engagement will continue in the coming years if we are interested in guaranteeing the mental health of our people.

We have already presented the Health ministry with information on problems that need fixing in order to improve mental health services. A mentally healthy population will also be happier, healthier and more productive. 

Dr Lukoye Atwoli is the secretary, Kenya Psychiatric Association and a senior lecturer at Moi University’s School of Medicine; Twitter @LukoyeAtwoli

Monday, June 3, 2013

We must become our brothers’ keepers again

By Lukoye Atwoli
Sunday Nation 02 June 2013

Almost three weeks ago, I received the following message from a medical doctor who is also a good friend:

“Hello Lukoye, hope you are well. I text with great sadness. Depression took my friend on Saturday. She hanged herself. It was chronic and she was in treatment for so many years. Still no one understands and there will be many more like her.”

As if to drive the point further home, a teacher suffering from mental illness emailed me last week to thank me for writing about the plight of people living with mental illness and, specifically, for trying to reduce the stigma society attaches to such illnesses. Here is an excerpt from that email:

“Am a graduate teacher living with a mental illness ... Am not even very sure of what I suffer from. It all started in 2007 while outside the country as an expatriate teacher ... It is the worst thing that can happen to a person and one needs love and care.

“Luckily for me I have a very loving wife and I generally live a near normal life. She monitors me in love and cautions me in case of an abnormal behaviour and I follow her advice religiously. However, I pass through humiliation everyday and so are my sickmates (sic).

“Before 2007 the term mad was like any other word in the dictionary. After my traumatic experience that had me repatriated, I became very sensitive to the term. 

Switch off

“Any time I am in a conversation and someone says ‘don’t be crazy’, which is ordinarily normal in a Kenyan conversation, I switch off. One day the principal of the school (where) I teach, while addressing the heads of departments, said: ‘leave that teacher alone, he is crazy, he was brought here to just grow old, retire and die.

“If you give him any class he will just butcher the learners.’ I felt so humiliated (even) though he was referring to another teacher.”

These stories illustrate just how pathetically we treat our compatriots suffering from mental illnesses.
We need to be aware that people with mental illnesses do not have signs on their foreheads proclaiming their diagnoses. The assumption we tend to make that everyone around us is just fine, and that mentally ill people are those “crazy” fellows safely “locked up” in Mathari Hospital is completely wrong.

Based on research estimates, one would not be mistaken to argue that anything between 25 and 40 per cent of Kenyans will have significant symptoms of a mental illness at some point in their life. This suggests that almost all of us have interacted with a person suffering from mental illness, and chances are that this person is closely related to us.

We must, therefore, be sensitive about our language, given the potential pain we cause daily as illustrated in the cited teacher’s case. 

Early signs

We must also be on the lookout for early signs and symptoms of mental illnesses both in ourselves and in our loved ones in order to get early interventions that often improve the prognosis. For instance, what happened to my colleague’s friend may have been prevented if we all understood the pain she was going through and provided a supportive environment in which to recover whenever she had an episode of illness.

We must become our brothers’ keepers again. 

Dr Lukoye Atwoli is the secretary, Kenya Psychiatric Association, and a senior lecturer at the Moi University’s school of medicine; Twitter @LukoyeAtwoli