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AfricaLive Sunday, 24 November, 2002, 18:11 GMT
Zanzibar: Mental health case study
Basket-weavers in Zanzibar
Basket-weaving is one form of occupational therapy used

In a small roughly constructed house in Zanzibar's Stone Town, thirty-nine year old Raya Ahmed Mohammed sits absent-mindedly on her bed in the half-light of dusk.

She stares into the distance. Her television and radio remain switched off.

Twenty years ago Raya began experiencing psychiatric problems and was diagnosed with schizophrenia.

She has been on medication for most of that time, but it often makes her drowsy and emotional and can markedly slow her speech.

But unlike many of the people who suffer psychological problems in Zanzibar, Raya was willing to speak to me about living with schizophrenia.

"I can't do anything, I have a disease," she said.

"I'm feeling bad today. I'm not happy. I don't feel angry, I just feel as though I have problems all the time.

"I take my drugs - they just make me want to sleep most of the time."

Causes

Raya was once a promising student with excellent grades at school. Her family has given different accounts of her illness.

One version suggests that she studied hard at school and was disappointed with her results and that somehow that disappointment triggered the schizophrenia.

Another version of her story indicates that, on completion of her education, she went on to work as a civil servant and had a later relapse.

Mahmound Mussa
Mussa says there are not enough drugs
Either way, Raya's hopes of leading a fulfilling life have been disappointed.

'I'm afraid," she says.

"I'm afraid things won't work out well for me. I'm afraid about how I will live in the future."

The medication has never completely blotted out the voices Raya hears or the feeling that she is being constantly watched.

Her family spends about $20 a month on medication, a considerable amount of money on an island where the average wage for people in work is around $60-70 a month.

Some drugs are obtainable free from the Kidongo Chenkundu Mental Hospital where Raya is an out-patient.

The building itself was built just after World War II and is beginning to show its age, with leaking roofs and crumbling walls.

There is no money to repair those problems; the priority is first to repair the one broken telephone line the hospital owns.

Constraints

Mahmound Mussa, Zanzibar's mental health co-ordinator, told me the hospital was hampered by an acute shortage of funds.

"The main constraint is the lack of drugs," Mussa said.

"If we had enough money we could buy more drugs and treat more people at home. Our aim to provide a proper care in the community service."

Once in hospital, patients are offered occupational therapy. It can include instruction in life skills such as cooking or washing clothes and trades like carpentry or basket weaving.

Occupational therapy is playing an increasingly important role, partly due to the fact that the hospital has plenty of nurses who can facilitate the programme.

But what Kidongo Chenkundu Mental Hospital does not have a lot of is psychiatrists.

Traditional approach

Dr Abdul Wakil Idrissa is the hospital's only psychiatrist and he is part-time - one of around twelve psychiatrists in the whole of Tanzania.

Dr Abdul Wakil Idrissa
Dr Idrissa is one of only 12 psychiatrists in Tanzania
"We can only move ahead with more psychiatrists," he said.

"At the moment it is not seen as an attractive branch of medicine so we need the government to offer incentives to students to encourage them to become psychiatrists."

The hospital dispenses its medicines free of charge. When it runs out of drugs or does not stock them the patient or their family has to buy them.

The cost of medication is one reason why many sufferers of psychological disorders are first taken to see a traditional healer.

The healers offer some interesting approaches which are based on the Koran and which appeal to Zanzibar's largely Muslim population.

They include writing passages of the text with a special ink and then drinking the ink.

In the early days of her illness, Raya Ahmed Mohammed's family consulted a traditional healer, with mixed results.

"Sometimes, I felt better," said Raya, "but only for short periods of time."


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