Life in Chains: The Plight of Somalia's Mentally Ill

[OdaySomali]

this is what I said in another thread

 

OdaySomali;932653 wrote:

The villages

 

Travelling between the major cities you will drive through a number of small villages, usually one every few KM's or so. There are a lot of very small villages between Hargeisa and Berbera, very few villages (less than you can count on one hand) between Berbera and Burao and a greater number (larger too in size) between Burao-Las Anod-Garowe. The rampant poverty and underdevelopment are evident as you drive through these villages which consist of nothing more than houses that are buulal, dergado or the typical African slum-house made of metal sheeting. There are brick and mortar houses to be found in these villages, but this type of housing is almost exclusive to the larger villages and are even then few in number. As one drives through these villages, it becomes clear that an overwhelming majority of the villages are severely malnurished. Their bodies are lean, their faces look gaunt, their clothes are in many cases tattered.

 

Of course these villages do not have any modern infrastructure and though I did not explore, probably very few public amenities such as healthcare, education. Because these villages have extremely limited purchasing power, there are very few business or private enterprises offering products or services in these villages. Most of the villagers are in someway engaged in the livestock trade. The little trade that is conducted in these villages is supplementary to their livestock rearing and this trade consists entirely of selling milk, and in some cases meat, by the road-side. Some villages will have a small shack that serves as an eatery for traffic that passes through. The recurring pattern is once-again of, god bless them, Somali women almost exclusively forming the petty traders and being the small business owners.

 

The Pothole Kids & Crazy Men

 

Driving between the cities and through the villages you will find come across many surprises. Some of these surprises will be the surprise of seeing a camel or sheep laying in the middle of or suddely running across the road. Certainly not something that you will be accustomed to if you've come from abroad.

 

Other surprises will be the mentally ill men you will see along the highway, especially as you travel between the cities. These men (I did not see a woman in such a state in all my time there, makes you wonder why) who just wonder along the road or the side of it; their appearance is schocking: their clothes are ripped, they are malnurished, they have unkempt and overgrown hair. These men are known as the crazy men. They are clearly disoriented, dazed, seemingly unaware of their state and location and not even remotely lucid. Some are entirely naked, walking or sitting by the road.

 

Having experiences just how underdeveloped and impoverished the homeland is, having seen the extent of lack of opportunities, education, health, jobs - all hings that we take for granted - I had indeed learnt a big lesson even though I might not have known it then. I was simply shocked at the number of mentally ill people - in every street there were at least several houses with mentally ill people either chained in front of them or screaming from the inside them. It seemed everywhere I looked there was a huge challenge waiting to be resolved.

 

Lastly you will find what I've termed "the pot-hole kids". I call them "kids", but really I ought to say boys. These are boys who stand in the middle of or the side of the road near their village with a shovel adn fill the potholes with sand to smoothen the drive for those who are driving through. At the first sight of them I wondered what they were doing on the road or at the side of the road when they could see a car approaching. Then, when I saw them filling the potholes on the paved road, I naively thought and said out loud: "how good and charitable of them". I was immediately told: "they are doing it in hope to get some money!". The boy

finished filling the potholes with the small shovel

and they stood at the side of the road. Slowly the car drove further along and the the boy

stood at the side of the road, arms stretched before them and their hand extended towards the window of the car. These boys are to be found on the outskirts of most villages and in many instances we threw them some money from the window, as is the norm for those who choose to reward their effort. At least those boys do not ask something for nothing, unlike the next group of people I am about to discuss.

 

Isbaaroyinka Duceysan - The Blessed Checkpoints

 

Driving between the cities, you will find yourself stopped at roadblocks/checkpoints at every few KM (maybe every 20KM or so), from Hargeisa to Garowe (probably from Boorama to beyond Garowe). These roadblocks are "official government checkpoints" and consist of a square small mortar and brick structure that perhaps is 1.5m wide and the same in hight to indicate that this is a roadblock/checkpoint. At those checkpoints the road is blocked, often they use a rope extended across the width of the road and in other cases they use a hand operated traffic barrier. These barriers were apparently introduced after the 2008 Alshabab bombings and are used to check the contect of vehicles travelling between the cities and the road-humps at these check-points are used to slow traffic "in-case al-shabab operatives try to 'escape' or drive off after doing some malicious act. The police officers at these checkpoints will note down the registration number of the car, the name of the driver, ask that the windows be lowered and check the content and passengers on the car (I am told they keep a look out for big-beard types, foreigners and excessive baggage). The checks are as strict when you are driving "out" of Somaliland as when you are driving into it.

 

To the nuxur of mentioning these checkpoints and where the pun in the subtitle ("isbaaroyinka

duceysan

") is. After these police officers complete their checks and questions, they turn to personal profiteering. They will harangue you incessantly to give them "duco" and in quite an aggressive manner, ak47 slung on their shoulder on in their hand: "ducada keen", "ducada keena". I was perplexed and wondered what on earth they were talking about. Again I was told, they want money, "duco" is a euphemism for money. The peculiar choice of words is inspired by the job-roles and their official capacity as public-servants. The "duco" then, is a supposed show of grattitude from you the [returnee/qurbojoog] civilliant, to thank them for their public service. In many cases we gave them money to save us the hearache and any possible negative consequences of not doing so. In other cases we did not and they let us pass. It all determines on how determined those particular police officers are to get money out of you. You will experience the same with traffice police within the cities who will forcibly stop you, look at who is in the car and demand money: "waryaa, jooji gaadhiga. Haye, gaadhigani ma cashuuran yahay? Yaa leh gaadhiga? Gaadhigani ma casuurna (waa ka marmarsiinyo). Waa qurbojooga, war lacag keen waryaahee hadii kale gaadhiga ma sii daynayno. We had to drive off because the situation was becoming quite hostile.

[Wadani]

ElPunto;981178 wrote:

Usually Somalis keep their mentally ill with them in their houses. They may not know how to care for them properly and lack community support to tackle this issue.

Not sure about this 'in chains' business

. And the one in three - BS.

Unfortunately this is quite common. But it's not done out of a cold hearted disregard for the mentally ill, but out of sheer desperation on the part of the families who have no other means of ensuring the safety of the family member and the saftey of others in the community.

[Alpha Blondy]

OdaySomali;981181 wrote:

this is what I said in another thread

.....what a pathetic thread it was too.

 

abti,

 

you will incur the inkaar of the same people you continually denigrate ee wax isku faal.

[Alpha Blondy]

Wadani;981182 wrote:

Unfortunately

this is quite common

. But it's not done out of a cold hearted disregard for the mentally ill, but out of sheer desperation on the part of the families who have no other means of ensuring the safety of the family member and the saftey of others in the community.

xigasho please.

[Haatu]

Psychology, what a load of rubbish.

[Mad_Mullah]

Yet they're happy they got rid of the General.

[Saxansaxo]

Wadani;981156 wrote:

And here lies the predicament for those of us who are passionate about the field, and would consider taking it to a graduate level of study. It would be a terrible feeling to return home with the hope of doing your part and having ur knowledge scoffed at by the very people u came to help.

It¨ll be challenging as somalis are proud people and are cuturally expected to be strong and endure hardships. This "nin ama naag adag iska dhig"or jiljileeca dadka ha tusin" is unfortunately taken to the extremes. Though it might make it difficult to reach out to them, especially as stigma is prevalent, there is definitely a great need for it. You can work with psychiatrists back home and with patients that are recieveing treatment and help them in their transition to the harsh life outside the clinics, among other things. There are several psychiatrist who left or partly left qurbaha inorder to treat and educate the public, maandheeye clinic/hospital in burco being an example. Ha ka niyad jabin inshaAllah.

[Khadafi]

Just as Saferzz said mental illness is a real problem in Somalia, come on, let us not fool ourselves. What do you expect from a nation has gone through a vicious civil war, and on top of that over 20 % of the population are internally displaced refugees. The signs of of mental illness does not always have to be "waalida dharka siibka eh'

 

Many people probably suffer from depression and other stress traumas, that's why we often see people who self-medicate on Khat and other ddrugs. Other problems are exactly what other posters said: Mental health issues are a real stigma in Somali society. We need to change this and talk a lot more about how we can help these people.

 

Apo: It's very strange that some one like you, who sees him cultured and well read on issues to see psychology as as pseudo-science or bullshit.. Your probably the first Marxist to make that critique. I hope that you understand that psychology has developed a lot since Freud. Behavioral psychology is today widely accepted within the scientific community.

[Wadani]

Saxansaxo;981364 wrote:

It¨ll be challenging as somalis are proud people and are cuturally expected to be strong and endure hardships. This "nin ama naag adag iska dhig"or jiljileeca dadka ha tusin" is unfortunately taken to the extremes. Though it might make it difficult to reach out to them, especially as stigma is prevalent, there is definitely a great need for it. You can work with psychiatrists back home and with patients that are recieveing treatment and help them in their transition to the harsh life outside the clinics, among other things. There are several psychiatrist who left or partly left qurbaha inorder to treat and educate the public, maandheeye clinic/hospital in burco being an example. Ha ka niyad jabin inshaAllah.

Waad ku mahadsantahay dhiirigalinta walaalo.

[Hawdian]

the report made by osman is not in Somaliya but in the republic of Somaliland a different country . i cnt see what he is doing there if he cnt utter the words republic of somaliland he should have gone to Moqdisho . the reason why the ill man is in chains is because his family is afraid he will do harm to others and to him self . also the reason for him

not being given medecine is that the family is poor . i hope the somaliland gov focuses on helping mental ill. patients . 10 min clip is not enough

for such a big health issue.

[Tallaabo]

Abbaas;981170 wrote:

Alpha,inaar, you've one bad spirit that needs to be forced out.

;) So true

[Tallaabo]

This a very sad situation, one which is not unfamiliar to me at all as my own abti(AUN) was one of those unfortunate.

[SomaliPhilosopher]

This article may interest you, Wadani. It is on the current state of physiatric care in Somalia and one practitioner's plight in particular

 

Quote by the nurse turned physiatrist

 

"I have cried on TV, I have cried in public places, I have cried in front of presidents," he says. "Even now I feel like crying."

 

http://www.bbc.co.uk/news/magazine-24539989

[Safferz]

Where hyenas are used to treat mental illness

 

By Richard Hooper

BBC World Service

 

 

Somalia has one of the highest rates of mental illness in the world and with a healthcare system devastated by years of war, most sufferers receive no medical help. Many are chained up - to trees or at home. Some are even locked in cages with hyenas. But one man is trying to change all that.

 

Dr Hab's advert runs up to three times a day on Mogadishu's radio stations.

 

"He's gone crazy! He's running away!" screams the actor. "Chain him down!"

 

The scenario is familiar in Somalia. A man has become possessed by spirits and the only option for his family is to restrain him and call the sheikh. But as the young man protests, a voice that challenges Somali tradition booms out.

 

"Stop with the chains!" the voiceover orders. "Take him to Dr Hab's hospital! If he's having mental problems, take him to Dr Hab. He won't chain him, he'll help him."

 

Dr Hab is not actually a real psychiatrist. Rather it's the persona of Abdirahman Ali Awale, a nurse who after three months of specialist training from the World Health Organization (WHO), has made it his mission to rescue Somalia's mentally ill. He claims he is able to treat everything from post-natal depression to schizophrenia.

 

But the alternative to a trip to Hab could be a visit to one of Somalia's popular herbalists or sheikhs who still advocate traditional - and sometimes barbaric - cures.

 

 

"There is a belief in my country that hyenas can see everything including the evil spirits people think cause mental illness," says Hab. "So in Mogadishu, you will find hyenas that have been brought from the bush and families will pay £350 ($560) to have their loved one locked in the room overnight with the animal."

 

The expensive treatment - more than the average annual wage - is as brutal as it sounds. By clawing and biting at the patient, the hyena is thought to force the evil spirit out. Patients, including young children, have been known to die during the process.

 

"We are trying to show people that this is nonsense," says Hab. "People listen to our radio advert and they learn that mental illness is just like any other and needs to be treated with scientific methods."

 

Hab's campaign was prompted by an incident in 2005 when he witnessed a group of female patients being chased through the streets by youths. "There was no-one to help them," he says. "I decided after that I would have to open Somalia's first mental hospital."

 

The Habeb Public Mental Health Hospital in Mogadishu became the first of Hab's six centres across Somalia. Together, they have now treated over 15,000 patients.

 

There were only three practising psychiatrists in the whole of Somalia at the last count, and Hab - despite his lack of advanced qualifications - is head of what has become the country's leading provider of mental health services. He even carries a letter from the minister of health that says so.

 

 

Chaining mentally ill patients to trees has been a widespread practice in Somalia

Hab faces a near insurmountable task. WHO estimates that one in three Somalis either is or has been affected by mental illness, compared to a global average of one in 10. In parts of the country, where the population has been the most psychologically scarred from decades of conflict, the rate is even higher. Cases of post-traumatic stress disorder are common and the situation is further complicated by widespread substance abuse.

 

"Khat is a big, big problem," says Hab of the herbal stimulant which has been chewed for centuries in East Africa. Side effects are thought to include anxiety and even psychosis. "We treat them in the hospital and they leave, but then they start eating khat again. Sometimes I see the same patients seven or eight times."

 

Western aid agencies in Somalia have often promoted projects targeting communicable diseases, not least because results are quicker and cheaper to obtain. Hab, meanwhile, says he is left to run his organisation with minimal resources and an erratic supply of psychotropic medicines that he sources from NGOs and private pharmacies.

 

Even getting sufferers to recognise that their condition constitutes an illness is difficult. Psychological problems are more likely to be reported by Somalis as physical pain - headaches, sweating, and chest pain. Some concepts of mental illness do not even exist in Somali culture - depression, for example, translates as "the feelings a camel has when its friend dies".

 

 

Dr Hab uses his minibus to rescue patients who have been left in chains

But nothing is more indicative of the population's poor understanding of mental health than the widespread practice of chaining-up sufferers to trees and in rooms. GRT, an Italian NGO, has documented sufferers who have been chained up their entire life.

 

"I myself have saved many patients who have been left to die," says Hab who drives a minibus into rural areas, unchaining people and taking them to one of his centres. "Parents, siblings, relatives - they've just been chained up to a tree and the family has gone."

 

The WHO has funded a "Chain Free Initiative", with the aim of eradicating the practice altogether, starting with the use of chains in hospitals. But even Hab admits to having chained up some of his most aggressive patients.

 

He tells the story of how, in 2007, one unintended consequence of his acquisition of a batch of the anti-psychotic drug, fluphenazine hydrochloride, was an increased appetite in his patients. They took to scaling the walls of his hospital in Mogadishu to scavenge for food. But still desperately unwell, some of the escapees had been shot when they ignored orders at a military checkpoint. Chaining them to their beds, concluded Hab, was the only option.

 

 

Dr Hab regularly speaks in public to raise awareness of mental health issues

"Many patients take a long time to treat," he says. "There has been no outside help focussed on treating mental health problems and the main reason NGOs are not getting involved is because of the expense."

 

Hab is motivated by the thousands of patients he believes remain chained up in private homes. He sends through a spreadsheet showing what he needs - new mattresses, food for patients, and diesel for his minibus. There is also a shortage of qualified psychiatrists and nurses. The daily struggle to provide for his patients and the suffering he witnesses is clearly taking its toll.

 

"Physiologically and mentally it's a very hard job" he says. "I was healthy when I started, now I suffer from diabetes. I am dealing with big, big problems all by myself.

 

"I have cried on TV, I have cried in public places, I have cried in front of presidents," he says. "Even now I feel like crying."

[SomaliPhilosopher]

You fool Safferz, stealing my thunder dee! i beat you to that article!