IRIN World Health Day Web Special: Taking Africa's Pulse

Although Africa has among the fewest resources to help it cope with mental health problems, Africans experience some of the greatest strains on their psyches and emotions than any other group in the world. The challenges seem insurmountable. There is poverty, unemployment, civil strife, political turmoil, armed conflict, HIV/AIDS, drought and other obstacles to overcome.

"As we observe World Health Day, more than 20 of the 46 countries in our region are experiencing one form of civil disturbance or other," said Dr E.M. Samba, regional director of the World Health Organisation (WHO). "This has created at least 10 million refugees and more than 30 million internally displaced persons. All these people, especially women, children and the elderly among them, are invariably severely stressed physically, psychologically and emotionally."

Samba was speaking during the commemoration of World Health Day at Mathari Hospital in Nairobi, the country's largest mental health institution. This is the second time in WHO's history that mental health has been the theme for World Health Day. The first time was in 1959.

Obstacles still need to be overcome worldwide to provide adequate mental healthcare, but there have been positive changes over the past 42 years, WHO officials said. Health experts have found that psychosocial rehabilitation carried out in communities works, that treating diseases in their earlier stages helps to avoid causing total disability, that more effective drugs with fewer and milder side effects are available, and that teaching parents and primary health workers how to detect early signs of mental illness arrests problems at an early stage.

"Not long ago it was hard to speak about AIDS, and before that cancer," said Dr Gro Harlem Brundtland, WHO director-general. "It still is, in some places, but gradually these taboos are being broken down. Yet many of us shy away from talking about mental illness. We don't want to know and we don't want to see. We don't dare to understand and to care."

Gladys Okoth is well acquainted with the stigma associated with mental illness. Her son has schizophrenia.

"Many times people who are mentally ill are associated with violence," Okoth said during a recent meeting of the Schizophrenia Foundation of Kenya. "You come to realise that this is just a stigma and something that society at large has decided."

The meeting, which was held on 1 April, marked the first time that schizophrenia sufferers linked with the foundation spoke in public. Martin Nganga Kamau, a 50-year-old father of eight, said he has struggled to recover from the illness for 30 years. "I didn't know that it was going to take a lifetime," he said.

Okoth said the foundation, which is led by Lilian Kanaiya, who has two children with schizophrenia, could fight the stigma associated with mental illness through the group's family support component.

One person in four will be affected by mental illness at some stage in life. More than 400 million people worldwide are estimated to be suffering from some kind of mental and neurological disorder, including alcohol and substance abuse. Of the 10-20 million people who attempt suicide each year one million die - a rate as high as the death toll from malaria, according to WHO.

"Stigma can be reduced by openly talking about mental disorders in the community, like we do here today," Brundtland said. "But we also need to constantly counter the negative stereotypes and misconceptions surrounding mental disorders. Governments must review their laws to ensure that legislation to reduce discrimination in the workplace and in access to health and social community services is put in place."

Depression in AIDS-hit Uganda

High rates of depression in areas of Uganda that have been hit hard by HIV/AIDS could lead to further spread of the disease, according to a study by the international NGO World Vision. Depressed people generally feel a sense of hopelessness and are more likely to engage in risky behavior, such as unprotected sex, which increases chances of spreading the virus, researchers said. Almost a quarter of the people in Uganda's southern districts of Rakai and Masaka, which have a high prevalence of HIV infections, have been found to be clinically depressed, according to the World Vision study. It also also showed an exceptional 3.7 percent to be suicidal, although depression has rarely been shown to affect more than one person in 20 in previous African studies.

"The big surprise was that the rates were much higher than in Rwanda," where World Vision counsels genocide survivors, said Lincoln Ndogoni, a counselling psychologist involved in the World Vision projects. He said that 19 percent of Rwandans surveyed were found to be severely depressed, compared to 24 percent of Ugandans in areas with HIV/AIDS prevalence rates. More men than women in the Uganda survey were found to be depressed, Ndgoni told IRIN, whereas women generally have higher rates of depression around the world. This raised important questions about the assumptions underlying HIV prevention and AIDS mitigation strategies.

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Fighting the stigma in Kenya

NAIROBI, Kenya (IRIN) - Lilian and Zachariah Kanaiya were proud of their first-born son, Bacia. They liked that others admired the tall young man, too. He was an outgoing and popular 18 year old and it wasn't unusual to find a crowd around him. He had a talent for mathematics and physics and dreamed of a career in science.

Lilian, a nurse, and Zachariah, a librarian, highly valued academic achievement, knowing that it would help open doors for Bacia as it had for them. Lilian had studied nursing in Australia and Zachariah had a degree in library sciences from the United States. Both had good jobs in Nairobi.

Schizophrenia in the family

But then Bacia's schoolwork began to slip. Sometimes he refused to go to school. He became stubborn and argumentative. He grew withdrawn. Other times he was hyperactive. He cared less and less about his appearance. The classmates who once gravitated to him began to keep their distance. Those who used to look for him on the schoolyard now turned away.

Because Bacia was a teenager, Lilian and Zachariah initially attributed his behavior to the normal ups and downs of adolescence. When disciplinary measures continued to fail they decided to take him to a doctor.The diagnosis was crushing. Bacia was sick, and he wasn't going to get better. He had schizophrenia, a lifelong mental illness characterized by erratic behavior and delusions.

"It's not easy, especially when it is your first child, a son, and you have wonderful dreams for him... all of that comes to an end," said Lilian.Lilian and Zachariah struggled to cope with their son's illness - first by denying that he was mentally ill and seeking a second opinion from other doctors. But eventually they accepted it, and took heart that they had three healthy daughters in whom they could instill their hopes.

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