You might think people locked away in inhumane institutions from birth until death will be a relic of the past, but as I discovered it’s too real in the world which we live in where heavy medication is common, therapy is rare.
Mathari hospital, one of Kenya’s national referral hospital is the biggest psychiatric hospital in the country. It is an overcrowded government institution where for most, this is a life sentence, People with psycho social disability know little of the world beyond the walls and bars of the institution where days and nights pass unnoticed.
In 2011, rights groups called for an investigation into alleged human rights abuses at the hospital following a CNN documentary “Locked up and forgotten”.
CNN reported that during a visit to the hospital, they found a dead body locked up in a seclusion cell with a patient.
Mental health treatment continues to lag — where locking patients up and over-drugging them appears to be the norm. Because so little is understood about mental illness by most of the people, family members are often outcast and given over to well-meaning — but severely understaffed and under-resourced — professionals. This is of little surprise when poverty is so high in Kenya
The African society believed that psycho social disability was caused by moral or spiritual failing thus considered it a bad omen and looked at those people with mental illness as though they had leprosy or some other inexplicable, communicable disease.
In the past, if a child was born with a mental disorder he/she would be killed, thrown in the forest for the wild animals to fest on them and if one is lucky to survive that ordeal, the wrath of stigmatization awaited them for the rest of their lives.
According to David M Ndetei, a Professor at University of Nairobi, “Mental disorders can be caused by physical diseases, such as infection of the brain by parasites (e.g., malaria), viruses (such as that which causes AIDS), and bacteria. It can also be caused by physical accidents or through assault, which involves the head. Cancer of the brain and a stroke (i.e., a rupture or a clot in the brain) can lead to destruction of brain cells. There are also certain generalized diseases of the body that can have adverse effects on the brain, such as uncontrolled diabetes and diseases of the kidney, the liver, and other bodily organs”.
It’s the prayer of every mother to give birth to a healthier and normal baby; Mary Wangui was not among the fortunate ones, her son, Munene Kariuki who is now twelve years was born with deformities.
“Despite his disability Munene has been a source of happiness in my family, I had stayed in my marriage for 5 years without I child. I cried myself to bed every night and praying to God.”
“I knew the challenges that awaited me but I had the support of my family and though it was very painful I accepted my child just the way he was”, said Mary Wangui.
Mary is among the few who can afford to pay for a private teacher.”Munene has a teacher here at home and apart from learning the curriculum he also undergo therapy 3time per week and its helping a lot in terms of the he communicated to people” adds Wangui.
I thinks compared to other countries we still have a long way to go with our mental health facilities in terms of infrastructures, medics and just the whole understanding by the community at large, “said Wangui.
Mary lives with her son and she is not considering taking him to a mental institution any time soon. ”I take care of him with the help of my house help and I feel at peace when his here with me, at least I can feed him, clean him and just spend quality time with him,” said Mary.
Mathari hospital which has 675 patients in its general wards cannot accommodate everyone, so those who cannot access the right rehabilitation services are locked up and subjected to very inhumane treatments by their families ,” according to Edah Maina, the chief executive officer of the Kenya Society For the Mentally Handicapped.
“Mathari psychiatric hospital is violating its patients’ rights under Kenya’s constitution. Patients at Mathari are recognized as people with psychosocial disabilities under the new constitution, which means they should be in a rehabilitation program that does not isolate them from their families.” said Edah Maina
“They should be in a program … one that they consent to and is not forced on to them; and among other things, a program that ensures their continued productivity as members of society, not one that immobilizes them through use of outdated/outlawed drugs that turns them into mere zombies,” University of Nairobi Professor David Ndetei.
Michael Njenga, Head of Programs, Users and Survivors of Psychiatry in Kenya (USPKenya) could not agree better with Prof. David Ndetei.
Users and Survivors of Psychiatry in Kenya (USPKenya) is a non-governmental organization that was established and registered in Kenya in the year 2007, whose major objective is to promote and advocate for the rights of people with psychosocial disabilities.
“If they could introduce community mental healthcare it will help a lot in making the society understand and know how to treat the sick. It will also help the psycho social people to live in a community environment than to9 be locked up in the mental institutions.”
“I interact in the day to day life with people with psycho social disability and these people should be treated just like you and me. They help in the community work a lot and this make them feel important in the society,” said Michael.
Under the Kenyan Constitution there are a number of provisions that protect the rights of persons with special needs. Under part three of the Bill of Rights (Articles 52- 57), the Constitution provides for the special application of rights with the aim of ensuring equality in the enjoyment of rights and fundamental freedoms by all.
The Constitution does this by requiring that affirmative action programs be set up to ensure that these groups enjoy their rights and fundamental freedoms without discrimination. As already noted, vulnerable groups are more likely to suffer from mental health conditions. This mental health dimension of their
Vulnerability must be addressed in affirmative action measures.
In 2016, Kenya adopted the Kenyan Health Mental Policy 2015-2030 in a bid to shift national attention to mental illnesses, a long-neglected issue. It is aimed that it will provide appropriate mental health services to her people. However, much more has to be done.
Dr. Frank Njenga, a top psychiatrist in Kenya has changed how many Kenyans think about mental health issues. He has been championing to bring quality mental health care in a country where mentally disabled people receive little help from the state and face massive stigma from society.
“Reality is that very little has been done systematically and deliberately by government or by us to bring up the level of mental health in this part of the world,” says Njenga.
“There is no health without mental health and there is no economy. We are losing far too many men and women to mental illness and therefore to un-productivity by not treating them for mental illness,” he added.
Kenya has little provision for mental health; the government only spends 0.01percent of its health budget on mental health. Community mental health care programme lack adequate funding to reach a wider portion of the population affected. The general hospital runs a mental health programme with funding from the ministry of health but lacks a comprehensive community based rehabilitative scheme to reintegrate the mentally ill persons back to the community.
Mathari hospital’s conditions were described as “prison-like” in a recent report by the Kenya National Commission on Human Rights but I took it upon myself to prove it and my quest for the truth landed me at Mathari hospital.
After enjoying the spectaculars scenario of The Thika Super Highway for nearly 20 minutes and letting my mind wonder around the world of the unknown for a while, the bus conductor announced my destination, notifying me of my arrival.
At the entrance of the hospital, people walked in and out chatting and laughing while I was scared not knowing what to expect. In my mind I had this picture” I will find very hostile patients, some probably tired up, others shouting and throwing anything there could get their hands on.”
I am one person who believes in facing my worst fears and I would not let this be any different, so I walked past the hospital building which later on I came to know are the hospital wards.
The hospital superintendent Dr.Kisivuli was already waiting for me when I got there. We walked around the hospital premises as he explained to me the challenges they face at the hospital.
“At the moment the rate of staff to patient is a bit challenging because we all have 10 psychiatrists .and the ratio of nurses to patients is 1:40 which is very challenging but we are doing our best to take care of our patients. They are human being and we do not treat them any less”
“My patient’s aslo have a day to day activities such as therapy, sports, indoor games, rehabilitation but all this is done when the patient have underwent through medication. so they do not spent their time locked in as such but they do not leave the compound”,
“We have 14 wards in the hospital and with the number of patients rising tremendously, we are forced to make them share the bed because it cannot accommodate all the 675 patients we have here.”
Like any other department in the health sector Dr. Kisivuli explains to me the challenges they face as doctors in the institution:
“The building in this facility are very old, it’s not what we would want but we do not have a second option, the government allocation is below what is required by Abuja declaration which is 15% of all the health allocation, we also have shortage of health personnel who are trained to deal with people with pyscho social disabilities and last but not least, both the medics and patients have to deal with the issue of stigmatization from the community and us from the medics in other fields,” added Dr. Kisivuli.
Through the fenced premises I could see some patients seated and others walking around. The environment here is just the same as any hospital I have been to.
With all said and done I think we all have a part to play in understanding the psycho social people, the government should hold seminaries in the community level and the doctors should tell us the symptoms and how to handle such cases.
We should not allow the different diagnosis in the sector of psychosocial disabilities to define the people with disabilities. They have a lot more that defines them other than their disabilities.
Article by Amina Mbuthia.