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Last Updated: Wednesday, 18 June, 2003, 07:58 GMT 08:58 UK
Kenya's mix and match mental health policy
The compound of traditional healer Joas Agengo
Treatments at Joas Agengo's compound are not as different as they appear
A radical approach to mental health policy is beginning to see real positive benefits for patients in Kenya.

Today Kenya has 60 psychiatrists, or one for every 500,000 people - 10 times fewer per head than Britain, but remarkably good for Africa.

But they work alongside a combination of herbalists, spiritualists and traditional healers - and, unlike in the West, no group competes in the belief they offer the only solution.

"There are very many strengths in countries where there are few resources," British psychiatrist Professor Rachel Jenkins, who has been trying to improve the quality of mental health provision in sub-Saharan Africa though a British-funded project, told BBC World Service's Health Matters programme.

"The strengths are the people that they have, the calibre, their commitment, their dedication - often at astonishingly low salaries and low levels of support."

Controversial methods

Professor Jenkins added that early on in an illness victims get full support from their family, but after a number of relapses the quality of care was likely to deteriorate.

"Families get exhausted, frankly," she said.

Witch doctor
Traditional beliefs are made to work with Western approaches
"They reach a point where they've just had enough, and then rejection sets in."

To ease the burden on families, a number of different approaches are being used to help make patients better.

At Mathari hospital in Nairobi - which admits patients from all over the country, often those who failed to improve elsewhere - psychiatrists use mainly advanced Western methods.

This includes Electro Convulsive Therapy (ECT), where an electric shock is applied to the brain.

"I know it's controversial, and people have got different views on ECT, but all said and done it's a very effective way of giving treatment," explained Dr Onyango, the hospital's medical director.


However, there remains much stigma in Kenyan society towards psychiatry, even from other doctors.

"First of all if you introduce yourself as a psychiatrist they look at you as if to say, 'are you alright upstairs?'," Dr Onyango said.

"People don't want to accept that mental illness is an illness like any other. They think that when you become mentally ill, either you did something wrong to your community, or the demons and spirits are now following you,"

British psychiatrist Dr Raj Persaud with Joas Agengo
Healer Joas Agengo says patients can recover in a week
Consequently, traditional healers have been used more than psychiatrists.

But instead of competing, the two treatment methods compliment each other.

At the Chulaimbo Provincial Rural Health Training Centre near the western town of Kisumu, doctors collaborate with traditional healers rather than compete with them, even offering them training.

Particularly important is how to recognise those with severe mental illness who might need the care of a hospital.

"Traditional healers will - just like a medical doctor - take the history of a patient, to know the details and the extent of the illness," explained Moses Kigani, head of the Chulaimbo centre.

"They also do examinations of the patient, which we also do, so there are some similarities."

He added that traditional healers actually tended to listen more to the clients than his centre did, although he also admitted that there was little medically proven benefit to their work.

"The type of medicine that we offer is based on scientific evidence - the benefits we can prove," he said.

"What the traditional healers are giving we may not prove."

Similar methods

Certainly, their treatment methods at first appear very different.

Joas Agengo, one witch doctor based near Kisumu, treats some of his patients with concoctions taken in a number of different ways.

But other treatments seem familiar - patients whose illness includes the compulsion to run around manically are restrained with ropes, in a similar way to the use of straitjackets.

Dr Frank Njenga
Top Kenyan psychiatrist Dr Frank Njenga says stigma towards mental illness dates from colonialism
"He has to remain tied for some time. Treatment will be administered and he will be untied later," explained Agengo.

"When we remove the rope [the patient] is calm."

The treatment usually lasts one week - about the same time as in the West.

Further on from Kisumu, another traditional healer uses a combination of herbs and minerals to treat patients.

One medicine involves treatment with minerals obtained from a lizard - which on investigation includes lithium, which is in common usage as a mental illness treatment in the West.

The Kenyan government are hopeful that expanding this approach will pay dividends - they have embarked on an extensive research programme in the hope of licensing new medicines from indigenous herbs and plants.

Exporting their approach along with the remedies could be a useful advancement in improving the continent's mental health.

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