AllGambian.net | COMMENTARY - Mental Health in Gambia

Mental Health in Gambia

The state of our forgotten Citizens at Campama

By Abdoukarim Sanneh, Greater Manchester, UK

01/02/2007

“Efforts to establish a mental health care unit at Campama Banjul, was a timely intervention by the previous regime in tackling the world’s most common social plague. At the time, only few cases of mental health were reported. Families preferred to treat affected members by domestic therapy. Increased stress and other social cases of exclusion impose severe impact on vulnerable members of society. When the APRC came to power through force of arms, one of their boastful propaganda methods has since been about provision of health services to the population. Abdoukarim Sanneh was privy to have had firsthand knowledge of Campama mental unit in Banjul some time ago. From then he follows developments and concluded that conditions have gone worse ever. He challenges the APRC government to pay more serious attention on this most neglected sub-sector of Gambia’s health system.”

A renowned Pan Africanist, writer social commentator and psychiatrist, Frantz Fanon carried social research in Algeria during French colonial rule in that country. His hypothesis links up the state of mental health in that country with the dehumanisation of French colonialism. Fanon did not limit to his medical practice and scholarly writing. As a non native of Algeria; he joined the liberation struggle with zeal and determination to fight for Algerian war of independence. Relating Frantz Fanon’s research of the 1950s and 1960s, comparing conditions in Algeria then and present day Gambian situation, there is a fitting match. One can significantly accept his hypothesis on the state of mental illness in Gambia of the 21^st century. The prevailing condition of mental ill health in our society is linked to social depression, hopelessness, despair, drug culture, isolation; break down of families, anxiety etc. All these lead to conditions of trauma- a gateway to mental ill health.

Any person who is aware of the situation in Campama will know that the mental ill health patients of that unit are the forgotten citizens of The Gambia. Having visited the unit few years ago motivated me to make a write-up about the state of care and the prevailing conditions which became a topical discussion on Gambia-L (internet discussion forum on Gambia and related matters and also fund-raising activities both in Gambia, United Kingdom and United States). After more than six years now, the conditions in Campama are still not improving. Recent recommendations from the World Health Organisation is for the unit to be closed and replaced by services in the general hospitals, primary health centres and by the support of the community in general. These recommendations are not a surprise to me. What our country needs is the field of mental health services, for the people who are experiencing severe and enduring mental ill health.

I was totally shock on a visit to the Campama mental health hospital. I was with a colleague, Medical Doctor in National Health Service in United Kingdom specialising on mental health in Black communities. In my mind, I knew that the hospital will not be set or being managed in the ways and conditions like in the developed countries but no way was I prepared for what I encountered. On approach to the hospital with my colleague, we requested to meet with the Medical Director for the purpose of sharing ideas and development for the care of mental ill. Shortly after a man in white gown approached us and escorted us to his office. It consisted of an old battered table, one broken down chair, battered filing cabinet and cupboard, which I believe was for storing medication. During our discussion, we were informed by the nurse that the hospital had the capacity to cater for 50 patients but as the only mental hospital in the Gambia, there were a total number of 209. This meant an excess intake of over 200 percent of its maximum intake. I could not imagine how this was possible with sleeping arrangements and other therapeutic activities. My colleague was lost for words when we were told by the nurse that there was no consultant psychiatrist, no doctors/general practitioner attached to work with the team at the hospital. The overall management was done by three nurses and handful of nursing aids. I felt that I did not want to hear anymore either and we want to see what the wards looked like by curiosity.

As we walked along the corridors, I knew, we should not go further but we continued. It’s really difficult to explain to the media what we actually encountered with our own eyes. The picture of degradation, dehumanisation, unhealthy and overcrowding stays imprinted on my mind, something that I will never forget. These are dormitories supposed to have capacity of 8 individuals. This is triple to 24 individuals. The bedding and linens were dirty and scanty. Dressing and bandages were filthy. People in general were just contained behind the walls away from the society/communities on the whole. The fact that there is no structure, no policy framework and no mental health Act for the present day care is not surprising. Mental illness is a taboo amongst Black people irrespective of where they are living. The Gambia is certainly an example of how much fear and stigma there is around the area of mental illness.

The fact that someone is experiencing major disturbance, confusion, distress, anxiety, frustration and depression is further compounded by unhealthy over crowding environment. By this, I mean if I was experiencing any of the above illness I would want to be in a nurturing, caring, healthy, therapeutic environment/community. I am not for one minute saying that nurses are not caring and nurturing individuals but the lack of resources inhibits their skills and ability to effectively care for the people. I wholeheartedly commend their continuous efforts to manage in such disheartening conditions. Mental illness is worldwide. We should not be afraid to recognize that this can happen to anyone of us at any given time. The stresses of life are such that without care and support this area of nursing will continue to rise. The statistics in medical science shows that one in four individuals within any given population will experience some form of mental illness in their live: therefore there is nothing to be swept away. The reality is that this is not going away. It is already prevalent, its numbers will rise, and here to stay.

Having a first hand information about deteriorating health care system and unrealistic political slogan it is easy to draw a logical conclusion that the APRC political propaganda is masked with nothing other than mystification of infrastructural development. The regime is not taking health care delivery system into serious matter. With World wide atrocities such as flooding, famines, civil wars and social inequalities our extended family system is being displaced which gives rise to instability. These, undoubted will give rise to mental ill health. Education on mental health is paramount and should begin from the very top to the grassroots. We have to move beyond the mindset of fear and powerlessness to address important health issues confronting our population.