The university of Maiduguri Medical students association took time out to launch their Medical Journal which they called Deedok yesterday.It is noteworthy that they have decided to do that given the challenges of Medical education with the attendant financial and academic stress.However this is not the main reason why I am writing about them today.Quite a number of Medical schools already have journals that have been in publication for years.Say for example DOKITA IN UCH Ibadan,OAU also have a journal of many years standing.
The major reason that we are celebrating the Unimaid Medical Students Association is the lecture that was held alongside the launching!Dr Isa Bukar Rabbebe,a Consultant Psychiatrist was the guest lecturer,and he took time to educate about the burden of Mental illnesses in Nigeria.In his lecture,he gave some thought provoking statistics.For example the WHO has declared that Mental illnesses are the 5th leading cause of disability in the world!Over 50 million people suffer from major mental illlnesses.The import of this statement should be noted.We are not talking of all mental illnesses,but the major ones.Definitely the number that suffer from all/any form of mental illness like somatization disorders,mild depression,mild anxiety,maternal blues etc will be way more than that!He further declared that the ratio of Psychiatrist to the population in Nigeria is 1:1,000,000!That means that in Nigeria with a population of 150million people there are only 150 qualified Psychiatrist!
Kudos must be given to the Unimaid Medical Students Asssociation for taking steps in the right direction.Many such a lecturre would have been on the more popular topic of HIV/AIDS what with the myriad of notable organisation who will be willing to sponsor their programme.That they chose to talk about Mental health instead shows that they are reading the signs of the times and now understand the disease burden that is posed by mental illnesses both in the world over and Nigeria in particular.
Like the activists on Campus will say;THREE GBOSAS TO THE ENTIRE UNIVERSITY OF MAIDUGURI MEDICAL STUDENTS ASSOCIATION AND THE EXCOS IN PARTICULAR!
Tuesday, October 30, 2007
Friday, October 26, 2007
A CALL TO ACTION.
The ward round was quite lengthy.For some reasons we had so many patients to review.
However,there was more to it than that.We saw a couple of patients that gave insight to the debilitating nature of mental illness and Schizophrenia in particular.
There was a good representation of both patients from low socioeconomy background and those from good socioeconomic background.Of course the theme of their delusions are different based on their respective backgrounds,but the striking thing is how it turns people from the sharp and intelligent people with good judgement to people with poor judgement and ridiculous delusions.
It is really split mind as it was described.
The impact of schizophrenia on the significant others is better imagined than experienced.A situation where someone will reject all good things of life from the relatives and choose to suffer because he/she simply believe that they are against him/her.You can now imgine the impact of that on the relatives.A wife sees her once loving husband become withdrawn and suspicious,and a husband has all his gift to his wife rejected because she believes that he wants to kill her.
There is also the effect on the social funtioning of the patient.Imagine what happens when somebody is suspicious of everybody at work.In a country like mine when persecutory ideas are really common and people always find an enemy responsible for all their failures or predicaments,it may go on unnoticed for sometime before it is detected.
Another issue that was highlighted is the issue of the high cost of the antipsychotic drugs.We are still largely restricted to the typical antipsychotics!The high cost of the atypicals is simply prohibitive.Not many of the patients who would have done well on these drugs can afford them and as such we have to simply make do with the typicals and as such sometimes we don't get the desired results most especially with the negative symptoms schizophrenia.
This brings us to the issue of the parameters used to assess the importance of illnesses.To see that the treatment of tuberculosis and HIV/AIDS have become free simply because of the mortality involved with them while psychotrophic drugs are exorbitantly high despite the morbidity involved is something we should ponder about.Maybe we are not doing enough advocacy about mental illness and the shattering effect they can have on the lives of people in all ramifications in terms of global assessment of functioning and the effect on the social networks.
At least we should also note that these mentally ill people may commit suicide when it is severe.This may be more common with depression,but also holds for schizophrenia expecially when they gain insight into the chronicity of the condition.Moreover,some of them may respond to hallucinatory voices telling them to kill themselves! All these should make us cry for the liberalisation of these drugs to force down the prices even if they are not free.
These brings us to the issue of the Doha declaration as was highlighted a couple of months ago by my friend in his blog.The declaration states that developing countries must use public health safeguards written into the World Trade Organization’s intellectual properties rules to access less expensive, generic versions of patented medicines.For more about the Doha declaration check the link below;
AdvocateHealth!: In the Spirit of the Doha Declaration
However,there was more to it than that.We saw a couple of patients that gave insight to the debilitating nature of mental illness and Schizophrenia in particular.
There was a good representation of both patients from low socioeconomy background and those from good socioeconomic background.Of course the theme of their delusions are different based on their respective backgrounds,but the striking thing is how it turns people from the sharp and intelligent people with good judgement to people with poor judgement and ridiculous delusions.
It is really split mind as it was described.
The impact of schizophrenia on the significant others is better imagined than experienced.A situation where someone will reject all good things of life from the relatives and choose to suffer because he/she simply believe that they are against him/her.You can now imgine the impact of that on the relatives.A wife sees her once loving husband become withdrawn and suspicious,and a husband has all his gift to his wife rejected because she believes that he wants to kill her.
There is also the effect on the social funtioning of the patient.Imagine what happens when somebody is suspicious of everybody at work.In a country like mine when persecutory ideas are really common and people always find an enemy responsible for all their failures or predicaments,it may go on unnoticed for sometime before it is detected.
Another issue that was highlighted is the issue of the high cost of the antipsychotic drugs.We are still largely restricted to the typical antipsychotics!The high cost of the atypicals is simply prohibitive.Not many of the patients who would have done well on these drugs can afford them and as such we have to simply make do with the typicals and as such sometimes we don't get the desired results most especially with the negative symptoms schizophrenia.
This brings us to the issue of the parameters used to assess the importance of illnesses.To see that the treatment of tuberculosis and HIV/AIDS have become free simply because of the mortality involved with them while psychotrophic drugs are exorbitantly high despite the morbidity involved is something we should ponder about.Maybe we are not doing enough advocacy about mental illness and the shattering effect they can have on the lives of people in all ramifications in terms of global assessment of functioning and the effect on the social networks.
At least we should also note that these mentally ill people may commit suicide when it is severe.This may be more common with depression,but also holds for schizophrenia expecially when they gain insight into the chronicity of the condition.Moreover,some of them may respond to hallucinatory voices telling them to kill themselves! All these should make us cry for the liberalisation of these drugs to force down the prices even if they are not free.
These brings us to the issue of the Doha declaration as was highlighted a couple of months ago by my friend in his blog.The declaration states that developing countries must use public health safeguards written into the World Trade Organization’s intellectual properties rules to access less expensive, generic versions of patented medicines.For more about the Doha declaration check the link below;
AdvocateHealth!: In the Spirit of the Doha Declaration
Wednesday, October 24, 2007
`MAKE WE MONEY WORK FOR WE'
I Had been away for some days now.I traveled out of town. I was on the road for almost every day for about 5days,and at the end of it I could not achieve everything I was set out to do. The story of that journey is for another post.
Now lets get back to my post. I am not writing in grammatical error. On the contrary I am quoting the title of a jingle that I heard on the radio a few days ago. It is in pidgin English, otherwise called broken English. It is widely spoken everywhere in Nigeria. Some are of the opinion that it could be called the real lingual franca of the Country.Ebuka of the Big Brother Nigeria fame actually wrote an article in his column in This Day on Sunday newspaper calling for it to be made the official lingual franca!
Back to my topic. It means, let our money work for us.It is the name of an NGO which seek to awake the government to her responsibility to her citizens.The theme of their celebration this year according to the jingle is SPEAK UP.They dedicated Oct 16th&17th to the celebration and called on all Nigerians to SPEAK UP and demand the dividends if democracy from the elected leaders.
Now,how does this fit into the theme of this blog?The jingle started by talking about a baby that just lost the mother during child birth from hemorrhage because there was no facilities for blood transfusion!It then went ahead to give t he poor health indices of the country as well as some social indices like the level of unemployment among qualified youths.It painted a very gloomy picture indeed.The picture portents a lifetime of stress and social deprivation as well as frustration for any child born in Nigeria today.
What does this potent for the mental health of our people.Let us go back to the hypothetical case of the baby born in the jingle.He is already subjected to maternal deprivation with all its negative effect on a young mind.If he happen to grow up in the midst of relatives,he may be subjected to child labour,sexual abuse and molestation,prostitution,gangsterism,as well as drug abuse with all their sequelae.
If by some stroke of luck and fortune smiles on him and he survives early life and all the above mentioned,he may discover that means of livelihood is almost non- existent because of unemployment!
How then does one avoid widespread alcohol and drug use leading to dependence, withdrawal state with or without delirium,harmful use and psychotic disorders associated with alcohol and drug use?How do we reduce the prevalence of depression,anxiety and even schizophrenia which develop because of stressful life events?How do we ensure good and sound mental health for our people?
We must SPEAK UP and demand the system to work.We must make our money i.e revenue from oil and gas and the tax payers money,to work for us instead of against us.We must channel the abundant resources and wealth generated from oil to other sectors of the economy so as to develop them and make life better for all Nigerians!
SPEAK UP!
Now lets get back to my post. I am not writing in grammatical error. On the contrary I am quoting the title of a jingle that I heard on the radio a few days ago. It is in pidgin English, otherwise called broken English. It is widely spoken everywhere in Nigeria. Some are of the opinion that it could be called the real lingual franca of the Country.Ebuka of the Big Brother Nigeria fame actually wrote an article in his column in This Day on Sunday newspaper calling for it to be made the official lingual franca!
Back to my topic. It means, let our money work for us.It is the name of an NGO which seek to awake the government to her responsibility to her citizens.The theme of their celebration this year according to the jingle is SPEAK UP.They dedicated Oct 16th&17th to the celebration and called on all Nigerians to SPEAK UP and demand the dividends if democracy from the elected leaders.
Now,how does this fit into the theme of this blog?The jingle started by talking about a baby that just lost the mother during child birth from hemorrhage because there was no facilities for blood transfusion!It then went ahead to give t he poor health indices of the country as well as some social indices like the level of unemployment among qualified youths.It painted a very gloomy picture indeed.The picture portents a lifetime of stress and social deprivation as well as frustration for any child born in Nigeria today.
What does this potent for the mental health of our people.Let us go back to the hypothetical case of the baby born in the jingle.He is already subjected to maternal deprivation with all its negative effect on a young mind.If he happen to grow up in the midst of relatives,he may be subjected to child labour,sexual abuse and molestation,prostitution,gangsterism,as well as drug abuse with all their sequelae.
If by some stroke of luck and fortune smiles on him and he survives early life and all the above mentioned,he may discover that means of livelihood is almost non- existent because of unemployment!
How then does one avoid widespread alcohol and drug use leading to dependence, withdrawal state with or without delirium,harmful use and psychotic disorders associated with alcohol and drug use?How do we reduce the prevalence of depression,anxiety and even schizophrenia which develop because of stressful life events?How do we ensure good and sound mental health for our people?
We must SPEAK UP and demand the system to work.We must make our money i.e revenue from oil and gas and the tax payers money,to work for us instead of against us.We must channel the abundant resources and wealth generated from oil to other sectors of the economy so as to develop them and make life better for all Nigerians!
SPEAK UP!
Monday, October 15, 2007
AN OPPORTUNITY MISSED.
October 10th was the World Mental Health Day.That was five days ago!
Unfortunately,the day went bye without much notice in my environment.I really don't know the percentage of psychiatrists and psychiatrist in training who really know about the day.I don't want to be seen as commiting a fallacy of hasty generalisation by making a sweeping statement,but I have reason to believe that the greater majority of us are not aware of it.What then do we say about other members of our managing team including the clinical psychologists,the social welfare officers/workers and the occupational health therapists.
The World Mental Health Day was first celebrated in the year 1992.It was started as an annual activity of the World Federation for Mental Health by the then Deputy Secretary General Richard Hunter. Since then,it has grown to be celebrated annually in many parts of the world.Every year since 1994,the day had been celebrated with a particular theme.The theme of this year's celebration was 'Mental health in a changing world: the impact of culture and diversity'.The purpose of the day is to promote mental health advocacy and educate the public on relevant issues.
It is therefore a great opportunity missed for us care givers in psychiatry to educate the populace about mental illnesses and mental health with a view to promoting better understanding and dispelling myths associated with mental and therby reducing stigma.
My father use to say that one should blow his own trumpet otherwise it will rust from lack of use as nobody will blow it for another.Who best is better qualified to educate about mental health but the psychiatrist.With the magnitude of morbidy suffered by the mentally ill in an oppressive and unsympathetic environment,there is need to get involved in aggressive advocacy and education.
It should be noted that mental problems can affect anyone, rich or poor, young or old, shattering the lives of those affected and the lives of the people close to them. A former minister of the Federal Republic of Nigeria from a family that have made name for themselves over the years granted an interview once describing an experience that clearly fulfil the diagnosis of Depression.He was able to pull through because of strong social support.With better understanding,many more people could pull through similar experiences and get their lives back on track!
Kudos must however be given to the Psychiatrist Hospital,Yaba for organizing a seminar and a walk on the streets of Lagos in the bid to educate and inform.I don't know how many other Psychiatric Hospitals or Psychiatry departments did anything in that direction,but we must never allow such an opportunity to pass us again!
Below are the themes of the past World Mental Health Days;
1994 Improving the Quality of Mental Health Services Throughout the World.
1996 Women and Mental Health
1997 Children and Mental Health
1998 Mental Health and Human Rights
1999 Mental Health and Ageing
2000-2001 Mental Health and Work
2002 The Effects of Trauma and Violence on Children & Adolescents
2003 Emotional and Behavioural Disorders of Children & Adolescents
2004 The Relationship Between Physical & Mental Health: co-occurring disorders
2005 Mental and Physical Health Across the Life Span
2006 Building Awareness - Reducing Risk: Mental Illness & Suicide
2007 Mental Health in a Changing World: The Impact of Culture and Diversity
Unfortunately,the day went bye without much notice in my environment.I really don't know the percentage of psychiatrists and psychiatrist in training who really know about the day.I don't want to be seen as commiting a fallacy of hasty generalisation by making a sweeping statement,but I have reason to believe that the greater majority of us are not aware of it.What then do we say about other members of our managing team including the clinical psychologists,the social welfare officers/workers and the occupational health therapists.
The World Mental Health Day was first celebrated in the year 1992.It was started as an annual activity of the World Federation for Mental Health by the then Deputy Secretary General Richard Hunter. Since then,it has grown to be celebrated annually in many parts of the world.Every year since 1994,the day had been celebrated with a particular theme.The theme of this year's celebration was 'Mental health in a changing world: the impact of culture and diversity'.The purpose of the day is to promote mental health advocacy and educate the public on relevant issues.
It is therefore a great opportunity missed for us care givers in psychiatry to educate the populace about mental illnesses and mental health with a view to promoting better understanding and dispelling myths associated with mental and therby reducing stigma.
My father use to say that one should blow his own trumpet otherwise it will rust from lack of use as nobody will blow it for another.Who best is better qualified to educate about mental health but the psychiatrist.With the magnitude of morbidy suffered by the mentally ill in an oppressive and unsympathetic environment,there is need to get involved in aggressive advocacy and education.
It should be noted that mental problems can affect anyone, rich or poor, young or old, shattering the lives of those affected and the lives of the people close to them. A former minister of the Federal Republic of Nigeria from a family that have made name for themselves over the years granted an interview once describing an experience that clearly fulfil the diagnosis of Depression.He was able to pull through because of strong social support.With better understanding,many more people could pull through similar experiences and get their lives back on track!
Kudos must however be given to the Psychiatrist Hospital,Yaba for organizing a seminar and a walk on the streets of Lagos in the bid to educate and inform.I don't know how many other Psychiatric Hospitals or Psychiatry departments did anything in that direction,but we must never allow such an opportunity to pass us again!
Below are the themes of the past World Mental Health Days;
1994 Improving the Quality of Mental Health Services Throughout the World.
1996 Women and Mental Health
1997 Children and Mental Health
1998 Mental Health and Human Rights
1999 Mental Health and Ageing
2000-2001 Mental Health and Work
2002 The Effects of Trauma and Violence on Children & Adolescents
2003 Emotional and Behavioural Disorders of Children & Adolescents
2004 The Relationship Between Physical & Mental Health: co-occurring disorders
2005 Mental and Physical Health Across the Life Span
2006 Building Awareness - Reducing Risk: Mental Illness & Suicide
2007 Mental Health in a Changing World: The Impact of Culture and Diversity
Sunday, October 14, 2007
MUCH ADO ABOUT SPACE.
It was an hectic call!
There is a lot of difference between taking a call in a Psychiatric hospital and a teaching hospital for me.At least everybody in a Psychiatric hospital is there for the patients and they are the most important people in the place as far as I am concerned.Same cannot be said of the usually crowded Casualty room of my hospital.It is usually difficult to make the patients comfortable because both the staffs and the other patients see them as different,neglect them sometimes and the place may not be very conducive for the usual detailed and personal history taken from the patients.Sometimes one cannot just understand the level of stigma and ignorance displayed by people who are even in the health profession.The mere mention of the word psychiatric patient arouses bias and stigmatization.
Well, out of the five patients I saw,two were severelly depressed,two were manic,while the last came with dystonic reaction.This goes to show how common mood disorders are,especially depression.The overall burden of mental illness is obviously increasing as typified by scenerio in JUTH.
The facilities are simply inadequate!
For a unit that serves states that include Plateau state and the neighbouring Nassarawa state,Bauchi state,Kogi state,some part of Kaduna state;it is becoming obvious that the 20 bed female ward and the 26-bed male ward allocated to the unit are not adequate.More especially as most Psychiatry patients stay at least one month in the hospital.
I had earlier treated the first patient who obviously needed admission on out patient basis.However,I just had to admit this other patient who came in from a neighbouring state,severelly depressed and almost going into stupor.There was no space both in the female Psychiatric ward and the female medical ward,so I had to relocate a stable patient from our ward to the female surgical ward and admit the patient as I had met resistant in trying to admit her in the surgical ward.It seems they just don't want to hear the word psychiatric patient.One has to turn into a lobbyist more or less.The energy expended in trying to get this done seems to be more than one expends on really attending to the patients.
The two manic patients were something else.Most especially the last patient that I saw in the night.Very garroulous and intelligent really.Says he wanted to ease himself and outran the people that brought him and absconded after almost two hours of clerking in the middle of the night.
I was simply drained by the time I left the hospital,more from trying to get right treatments and space for my patients than from the consultations given them!
There is a lot of difference between taking a call in a Psychiatric hospital and a teaching hospital for me.At least everybody in a Psychiatric hospital is there for the patients and they are the most important people in the place as far as I am concerned.Same cannot be said of the usually crowded Casualty room of my hospital.It is usually difficult to make the patients comfortable because both the staffs and the other patients see them as different,neglect them sometimes and the place may not be very conducive for the usual detailed and personal history taken from the patients.Sometimes one cannot just understand the level of stigma and ignorance displayed by people who are even in the health profession.The mere mention of the word psychiatric patient arouses bias and stigmatization.
Well, out of the five patients I saw,two were severelly depressed,two were manic,while the last came with dystonic reaction.This goes to show how common mood disorders are,especially depression.The overall burden of mental illness is obviously increasing as typified by scenerio in JUTH.
The facilities are simply inadequate!
For a unit that serves states that include Plateau state and the neighbouring Nassarawa state,Bauchi state,Kogi state,some part of Kaduna state;it is becoming obvious that the 20 bed female ward and the 26-bed male ward allocated to the unit are not adequate.More especially as most Psychiatry patients stay at least one month in the hospital.
I had earlier treated the first patient who obviously needed admission on out patient basis.However,I just had to admit this other patient who came in from a neighbouring state,severelly depressed and almost going into stupor.There was no space both in the female Psychiatric ward and the female medical ward,so I had to relocate a stable patient from our ward to the female surgical ward and admit the patient as I had met resistant in trying to admit her in the surgical ward.It seems they just don't want to hear the word psychiatric patient.One has to turn into a lobbyist more or less.The energy expended in trying to get this done seems to be more than one expends on really attending to the patients.
The two manic patients were something else.Most especially the last patient that I saw in the night.Very garroulous and intelligent really.Says he wanted to ease himself and outran the people that brought him and absconded after almost two hours of clerking in the middle of the night.
I was simply drained by the time I left the hospital,more from trying to get right treatments and space for my patients than from the consultations given them!
Friday, October 12, 2007
WELCOME!
Hi,
I finally got to writing this welcome piece!This blog is about mental health/Psychiatry.
Mental health or Psychiatry in a branch of medicine that is poorly understood by both the average medical doctor and worse,the average man on the street.
The reason is not far fetched.What people dont understand,they tend to scorn.It takes a bit of an extra effort to talk to mentally ill people and to make diagnosis.After all, what you are doing is to use the mind to explore and understand the mind which is really not an easy thing to do.Moreover a couple of people in my country still largely think of psychiatry in terms of the vagrant psychotic roaming about the street naked,constituting a nuisance to the society.
In my country of so many tribes and ethnic groups ,myths surrounding mental illness is as diverse as the number of ethnic groups!There is a need to educate the people of the nature of mental illness and the management modalities available.
It is a known fact that Mental health is one of the component of the Primary health care of Nigeria.But be that as it may,little or no impact is being made at this level of our health care.Most of the psychiatric services are limited to only the tertiary centres and the number of Psychiatrists are few.
However the burden of mental disorders on the patient,relatives and the society is immense.Prof Gureje noted in the Bulletin of the W.H.O vol 78 no 4 that mental disorders are among the ten top causes of disability in Africa and that their contribution to the overall burden of diseases in Africa is going to rise.It therefore behooves us to preempt this and to make sure that mental health education and advocacy is at the disposal of our people.
This blog may at the same time serve at the diary of my first hand experience in mental health as I pursue my fellowship programme in Psychiatry.
Here is the link to the bulletin ot the W.H.O written by Prof Gureje.
www.scielosp.org/scielo.php?pid=S0042-96862000000400009&script=sci_arttext&tlng=
I finally got to writing this welcome piece!This blog is about mental health/Psychiatry.
Mental health or Psychiatry in a branch of medicine that is poorly understood by both the average medical doctor and worse,the average man on the street.
The reason is not far fetched.What people dont understand,they tend to scorn.It takes a bit of an extra effort to talk to mentally ill people and to make diagnosis.After all, what you are doing is to use the mind to explore and understand the mind which is really not an easy thing to do.Moreover a couple of people in my country still largely think of psychiatry in terms of the vagrant psychotic roaming about the street naked,constituting a nuisance to the society.
In my country of so many tribes and ethnic groups ,myths surrounding mental illness is as diverse as the number of ethnic groups!There is a need to educate the people of the nature of mental illness and the management modalities available.
It is a known fact that Mental health is one of the component of the Primary health care of Nigeria.But be that as it may,little or no impact is being made at this level of our health care.Most of the psychiatric services are limited to only the tertiary centres and the number of Psychiatrists are few.
However the burden of mental disorders on the patient,relatives and the society is immense.Prof Gureje noted in the Bulletin of the W.H.O vol 78 no 4 that mental disorders are among the ten top causes of disability in Africa and that their contribution to the overall burden of diseases in Africa is going to rise.It therefore behooves us to preempt this and to make sure that mental health education and advocacy is at the disposal of our people.
This blog may at the same time serve at the diary of my first hand experience in mental health as I pursue my fellowship programme in Psychiatry.
Here is the link to the bulletin ot the W.H.O written by Prof Gureje.
www.scielosp.org/scielo.php?pid=S0042-96862000000400009&script=sci_arttext&tlng=
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