Mental health is an often under-reported and under-recognized health issue in our world today. Much of the problem is our society’s failure to acknowledge mental health problems in loved ones and seek proper treatment for them. However, in places of the world such as Kenya, health care innovators are pursuing the unique blend of traditional and Western medicine to better serve people with mental health issues in a healthier and more culturally appropriate way than approaches of the past.
Kenya’s Mental Health Issue
The World Health Organization (WHO) estimates that the leading cause of ill health and disability on a global scale are mental and neurological disorders. However, because of cultural taboos and stigma, many mental health cases go untreated. WHO asserts that mental health issues should in fact be part of a larger development plan since they have a big effect on a country’s economy by adversely affecting people’s abilities to care for themselves and their families.
Part of the issue surrounding mental health is the lack of medical professionals trained to help, especially in poor and under-served areas of the world. In East Africa specifically, the problem is dire. There are only 79 working psychiatrists in the East African nation – one for every 500,000 people! In 2013, there were only 25 licensed psychiatrists in Kenya.
In developing countries, seventy to eighty percent of people with a mental health problem in developing countries receive either no treatment at all, or ineffective treatment, such as treatment given by waganga, or traditional African healers.
It has been recognized in Kenya that while some waganga approach healing with well intentions and have been trained to perform customs passed down for decades in the traditional medicine community, many are in the healing business for the ulterior motive of taking advantage of Kenyan’s who will pay large amounts to have their ailments cured the traditional way.
Private psychiatrist offices that many people in the Western world are used to are just not feasible in the urban areas and informal settlements in Kenya, where most of the country’s population is concentrated, the same types of communities that our programs and clinics at Access Afya serve. Trying to imitate Western psychiatric systems is problematic, as specialists and hospitals are in such short supply. So how do we get mental health services to people who need them, especially in a country where the stigma and taboo surrounding mental health issues are resounding?
A Creative Solution
One outstanding organization has begun to tackle this question by incorporating traditional medical beliefs into long-standing Western practices. They are attempting to utilize waganga to reach populations that may not wish to try Western approaches to mental health at first. Basic Needs, an international development charity focused on mental health issues, has been working with a group of Kenyan traditional medicine and faith healers for the past five years to educate them in patient protection and human rights.
Basic Needs recognizes that their approach needs to be a two-way street. They are training traditional healers how to identify mental health problems and refer patients to licensed psychiatrists, and psychiatrists in Kenya have recently begun to recognize the need for some of their patients to seek traditional help. Each party must accept that the other has a presence and necessary position in the mental health treatment of many Kenyans.
Dr. Monique Mutheru is one of Kenya’s few psychiatrists. She believes that traditional medicine is an appropriate route for some types of mental distress. Cultural beliefs surrounding mental illnesses, such as possession by spirits, can often cause psychological distress that traditional healing may best alleviate.
However, Dr. Mutheru emphasizes cooperation between Western medical practitioners and waganga. She says, “The idea is to work together, to work as a team.”
Dr. Daphne Ngunjiri, Access Afya’s Medical Director, recalls a case at one of Access Afya’s micro-clinics during which the patient, a young girl, had been suffering from a septic (severely infected) leg wound, and Access Afya’s clinicians found out about her case when her brother visited the Access Afya pharmacy looking for pain medication. The family was having her leg wound treated using herbal medications for months with no signs of improvement. At Access Afya, clinicians recognized the problem was serious and referred her to a government hospital where she was diagnosed with cancer.
This unfortunate incident, Dr. Ngunjiri says, highlights that “patients need to feel comfortable to share all additional measures they are taking…[to] help doctors assess the benefits and risks and ensure patients are making informed decisions.” If doctors and health care workers do not acknowledge that traditional healers are still very active in our communities today, patients may not feel comfortable reporting any traditional healing techniques they may be simultaneously using.
International psychiatrists and experts on cultural psychiatry are agreeing that the most effective approach to health issues, especially mental health issues, may be to incorporate cultural beliefs and traditional medicine. Dr. Miscol Ascoli, cultural psychiatrist at the Newham Centre for Mental Health in East London, says, “I think we have to consider that in a globalized world explanatory models are sometimes multiple. It’s not like you either believe in spirits or you believe in mental illness. Sometimes you believe in both.”
This past Monday, August 31st, was African Traditional Medicine Day, and what better way to celebrate long-standing medical traditions in Africa than acknowledging that proper training of traditional healer may be able to bridge the needs gap for mental health in Kenya?