It’s morning and a group of volunteers is gathering in a building on Freetown’s Siaka Steven Street. The volunteers, over a dozen of them, mostly social workers are about to embark on a routine exercise. They will spend between three and four hours walking in separate groups across the central business district of the capital, distributing food to the mentally ill who are for the most part homeless.
By Kemo Cham
Mental health is among the least prioritized sectors in Sierra Leone, and lack of awareness at both the level of the public and within the healthcare system itself has led to widespread stigmatization and discrimination, which campaigners say add to the trauma and worsen the condition of victims.
Consequently, it is common to see people considered as “mad” roaming the streets in shabby conditions. Some of them eat from waste disposal bins and sleep in their feces.
The Sunday Walk to Feed, as the organizers call it, is the brainchild of second year Social Work student at the University of Sierra Leone’s Fourah Bay College, Hassan Koroma. Through his organization – Social Workers Sierra Leone (SWSL) – he mobilizes fellow volunteer social workers to, as he put it: “help restore the dignity of fellow human beings.”
Koroma said the idea came about from a firsthand experience.
There was this lady selling food and suddenly a ‘mad’ man appeared to buy food from her.
She refused selling to him.
“I felt bad as a social worker,” Koroma said, explaining further how he later intervened and asked why the lady refused to sell to the man.
According to him, she said she feared it could be a cause for bad luck for her to sell to a mentally ill person.
“From that point, as a social worker, people who cater for the marginalized in society, it kept boiling in my mind that I needed to do something about that,” Koroma told the African Press Agency.
SWSL prepares on average 100 plates of meals every Sunday.
But a programme catering for a plate of food for anybody just once a week is hardly the best way to address their problem.
Koroma said that the goal is to raise awareness and get the government to act.
And the goal, it seems, is being achieved, even if at a very slow and sometimes frustrating pace.
The programme, which started as a low key affair, has gradually grew in momentum, so that over the last one year since it started it has attracted the attention of a lot of people with humanitarian inclinations, from individual government officials to celebrities.
Least prioritized sector
With a huge competition for a share of the national budget, Mental Health occupies the bottom level on the priority list of the Sierra Leone government. Even within the Ministry of Health itself, the department is one of the least prioritized.
It was only about three years ago when mental health was upgraded from a programme to a directorate – the Directorate of Non-Communicable Diseases and Mental Health.
But even at this, there is very little to show for the commitment of the government to an issue so widespread in society.
To start with, there is no reliable statistics about the number of people suffering from mental illness in Sierra Leone.
This is because until when the Directorate was created, there was no recording system in place for it.
But that’s also because there was virtually no available mental health services in the country.
The streets of Freetown and other major towns across the country are full of mentally ill people who have been abandoned by their families who see their condition as irredeemable. Many are abandoned partly due to the way they are maltreated due to superstitious beliefs, like the one exhibited by the food seller at the top of the story.
Dr. Donald Bash Taqi, Deputy Chief Medical Officer in charge of Clinical, admitted that the sector had been neglected for a long time.
But he said there have been some development in the sector, citing the creation of the directorate and the training of about two dozen healthcare workers on dealing with mental health.
The Ministry, he said, has installed at least one mental health nurse in every district hospital across the country.
Freetown is home to Africa’s oldest mental health hospital, which is the only facility treating mental illness in the entire country of over seven million people.
The Kissi Psychiatric Hospital, established in 1820, was designed as an asylum.
For decades the state of the 150-bed capacity facility served as a perfect illustration of the effect of lack of prioritization of the sector.
It was characterized by overcrowding and constant shortage of drugs.
The patients were kept in shackles, which discouraged many people from taking their loved ones there for treatment.
Last year, through a US funding, the facility has been renovated and upgraded.
“It is not something to write home about, but it is progress,” said Dr Taqi, referring to the improvement in the sector in the last three years.
“And we hope to make more progress by attracting young doctors,” he added during a press conference marking World Mental Health Day on October 10.
Under funding
In spite of Dr Taqi’s optimistic view, the reality on the ground suggest that the country has a very long way to go to fixing its mental healthcare system.
For instance, despite the impressive facelift at the Kissy Psychiatric Hospital, it is still dealing with drug shortages, thanks to serious under funding of the facility by the government.
Expertise is also a major part of the seriousness of the situation around mental health. Four over three decades, the country relied on only one trained psychiatric doctor, Edward Nahim.
He worked as head of the Kissy Mental hospital for years even after his official retirement because of a lack of a qualified doctor to replace him.
But he was eventually replaced by a young surgeon, Dr Abdul Jalloh, who was one of two young medical doctors trained in South Africa recently.
The second is posted at the 34 Military Hospital. Sadly none of these is actually a psychiatrist.
Jalloh is assisted by only three trained mental health nurses at the hospital.
“There is no social worker, no psychologist, no occupational therapist, and no addiction expert. These are crucial professionals,” he told me in an interview earlier in the year.
Sierra Leone has been struggling to deal with the impact of recurrent traumatic events in the last three decades, which experts say have left many of its citizens susceptible to mental health problems.
First it was the [1991-2002] civil war.
Besides the trauma caused by the human rights abuse acts of the rival warring sides, the rebels were particularly notorious for drugging young people to have total control over their actions.
Many of those youths ended up in the streets dealing with visible mental health complications as a result.
Very recently there was also the Ebola epidemic, and the mudslide tragedy in Freetown, both of which caused additional trauma to many.
But experts say the largest fueling factor of mental illnesses in Sierra Leone is drug abuse, which is also fueled by a high youth unemployment.
There is also a lot of alcohol consumption in the country.
Consequently, the majority of inmates at the Kissi Mental Hospital for instance, are psychotic cases.
The hospital said 40% of the inmates are mostly victims of drug induced psychosis. There are also schizophrenia and bipolar disorder patients, as well as neurotic cases like depression and anxiety.
The Mental Health Coalition of Sierra Leone has been advocating for reforms in the sector.
Among its requests are for increased government funding.
It also wants the “outdated” colonial era lunacy Act reviewed.
KC/as/APA