South African Psychiatry Review - Volume 10, Issue 1, 2007
Volume 10, Issue 1, 2007
Author O. GurejeSource: South African Psychiatry Review 10, pp 11 –14 (2007)More Less
Information regarding the occurrence and nature of mental disorders in Africa is still grossly limited. For many years, anecdotal reports and personal views, many of them based on very limited data, prevailed. Subsequently, many early studies were based on clinical samples and thus limited in generalizability. These factors led to a number of myths about mental disorders among Africans. In this short review, some of these myths are examined in the light of current information. It is observed that sufficient information probably exists to discard some old myths while some other current views, even though suspect in regard to their validity, await further exploration. It is concluded that while some racial differences may have been mistaken, there nevertheless remains the possibility that some unique features of psychiatric and behavioural disorders in Africans offer the prospect of advancing our knowledge in regard to etiology and possible interventions.
Author F. KigoziSource: South African Psychiatry Review 10, pp 17 –19 (2007)More Less
Most developing countries and indeed many African countries have been undertaking reforms of the mental health policies and strategies to improve access and equity for the community to mental health and psychiatric services. This has been in conformity with a health policy philosophy which emphasize decentralization of services to the lower administrative units such as districts, community care as well as integrated delivery of health services within the lower health units. Uganda, one of the developing countries in sub- Saharan Africa, has been implementing its Health Sector Strategic Plan in which mental health has been identified as a major priority. The guidelines from World Health Organisation (WHO), the Alma Ata Declaration and the subsequent WHO recommendations have provided the guiding philosophy for the implementation of this process. However despite embracing the philosophy and having developed sound policies and implementation programs, practical realities are being experienced on the ground. The need for research and evidence-based approach is urgent to evaluate the success of the programmes, which have been developed by many member countries but whose implementation is still a very slow process.
The paper reviews some of the international recommendations towards availing mental health to the majority of the population and the steps undertaken in implementing the integration approach with a case study for Uganda, points out the challenges and also proposes a way forward.
Author T.A. OkashaSource: South African Psychiatry Review 10, pp 22 –24 (2007)More Less
The world celebrated 68 years of electroconvulsive therapy (ECT) recently. Whilst ECT has stood the test of time for nearly six decades. stigma remains one of the main issues that needs to be addressed. ECT is a technically advanced and effective treatment that is often misunderstood and maligned not only by the lay public but by psychiatrists as well. One of the main causes of stigma is the nomenclature which needs to be changed since shock and convulsion are absent when giving modified ECT. Based on the evidence derived from randomized controlled trials and extensive clinical experience for nearly 70 years, ECT is presently the most effective treatment for certain psychiatric disorders. The most transient memory disturbance is a moderate price for what can be achieved, as the benefit to risk ratio of ECT is usually favorable. The economic aspects of ECT use in Egypt, as well as the problem of ECT training, are discussed in this paper. The ethical aspects of ECT are reviewed as well as the discrepancies between developed and developing countries in its application, which needs to be addressed from a transcultural perspective.
Trauma in African women and children : a study of the Kenyan experience as illustration of the phenomenon : original articleAuthor F.G. NjengaSource: South African Psychiatry Review 10, pp 27 –30 (2007)More Less
In traditional African societies, roles and responsibilities of its members were carefully regulated, giving the community a sense of cohesion, continuity and integrity. Following the periods of colonization, wars of liberation, independence and post colonial self governments, many countries in Africa have disintegrated into volatile autocratic dictatorships that have led to many wars, genocide, internal and external displacements of the people, recently complicated by natural and man made disasters. AIDS is a recent entrant to the equation. In the midst of these changes (and traumas) the family unit has been denuded of its security, continuity and order. African traditional education systems have been replaced by ill tested western models of education, while time tested rites of passage have been declared health hazards (e.g. circumcision) in many parts of Africa. Marriage systems that traditionally conferred stability derived from the nature of the marital bonds have been replaced by fragile western monogamous unions. These changes have affected relationships "Behind Closed Doors". This paper describes the effects of this type of globalization on Africans taking Kenya as a case example, exploring domestic violence and the abuse of children.
The content of this paper was presented at a symposium "Behind closed doors in Africa. The case of women and children", American Psychiatric Association annual conference Atlanta, Georgia, 23rd May 2005.
Source: South African Psychiatry Review 10, pp 33 –36 (2007)More Less
Objective : Africa faces a skills shortage, in spite of training suitably qualified professionals. This is particularly evident in the discipline of Psychiatry. An analysis of the distribution and availability of psychiatrists in Kenya was thus conducted and findings compared with specific other African countries (Uganda and Zimbabwe).
Method : Questionnaire, emailed to Heads of Academic Departments within the specified countries
Results : In 2004, there were a total of 53 psychiatrists practicing in Kenya, for a population of 31.5 million. The country has about 4,000 medical practitioners, with psychiatrists constituting 0.013% of the total number of medical practitioners. This is equivalent to a psychiatrist: population ratio of 1:594,339; doctor: population ratio of 1:7,875; a psychiatrist: overall doctors' ratio of 1:75.5, that is only 1.325% of Kenyan doctors are psychiatrists. When the psychiatrist: population ratios are considered on the basis of the provinces, then the ratios vary from 1:63,007 in the capital city of Nairobi to 1:4,393,19 in other provinces, with one without a psychiatrist for a population of 962,143. The ratios decline further when psychiatrists available for clinical work in public facilities are considered. Up to 34% (n=18) of all Kenyan psychiatrists were in private practice. The remaining 66% (n=35) were in the public sector, of whom more than 20 were in full time administrative or academic positions and therefore not available for full time clinical work in the public sector. Locally trained psychiatrists, compared with foreign trained psychiatrists, fared better on: non-migration to other countries, working in rural rather the urban areas, working in public rather than private sector and in overall academic achievements.
Conclusion : In the fore-seeable future in Kenya it will not be possible to achieve a psychiatrist: population ratio equivalent to that in Western countries, both in terms of overall ratio for the country, and more importantly, for the average distribution within the country. For the needs of Kenya, and other developing countries, local training of psychiatrists is superior to foreign training in several parameters. If Kenya and other similar developing countries in Africa are to achieve realistic mental health service delivery in the foreseeable future, alternative non-specialist training in mental health is required.
Conflict of Interest : None. This study was conceptualized by DMN. It formed the basis of the Key Note speech at the WHO Regional Conference of Psychiatrists, Arusha, Tanzania 2004. It was funded by the Africa Mental Health Foundation (AMHF).
Author Franco P. VisserSource: South African Psychiatry Review 10 (2007)More Less
The race between education and catastrophe - curbing teen suicide in South Africa : patients as partnersSource: South African Psychiatry Review 10, pp 49 –52 (2007)More Less