As government continues to lurch from one crisis to another over the Covid-19 virus, another malady burbling below the radar, threatens to outlast the pandemic and leave an entire generation under the clutches of emotional turmoil.
Uganda only has 50 psychiatrists for a population of nearly 45 million people. This means that there is only one psychiatrist to attend to 900,000 persons.
In 2014, the World Health Organization (WHO) estimated that 90 per cent of people with mental illnesses receive no treatment in Uganda.
In an archetypal conduct of shirking its responsibility to its most vulnerable communities, government in 2008 parcelled about 176 plots of the Butabika National Referral Mental hospital to private individuals.
Amongst the key beneficiaries of the land bonanza included members of the First Family, State House, Lands Ministry officials, Cabinet ministers and prominent members of the opposition.
Speaking to Vox Populi, one of Uganda’s foremost psychiatrists, Prof Musisi Ssegane, who is the the former Chairperson of the Department of Psychiatry at Makerere University College of Health Sciences, says the government should hastily appoint a mental health taskforce to address this crisis.
“There are people who had mental illness and became sick with Covid-19 and whose condition worsened, there is a category of those who have never had mental illness and got Covid-19 and got mental illness,” Prof Ssegane, who is also the proprietor of Entebbe Lakeside Hospital, revealed.
He listed four other categories, including people who have never had mental illness as well as those who never had Covid-19 but broke down due to stress. The other subset involved people who did not get Covid-19 and never had a history of mental illness, but broke down after their relatives and friends died. Then there are those who never had Covid-19; never had mental illness; but were stressed as a result of lack of jobs and the lockdown and started taking drugs and alcohol and developed mental problems.
As the Covid pandemic barrelled across the country, it laid bare the country’s ailing and dysfunctional health system with its venomous sting.
Mental health units that usually isolate and treat mental health patients across referral hospitals in the country were converted into Covid-19 treatment centres posing a great risk to those grappling with mental health illness and exposing them to Covid-19.
“It is very unfortunate that they closed mental health units. When you close them, you are not respecting their rights for mental health, they have no where to go because if you are mentally ill, you breakdown and you end up on the streets,” Ssegane proffers.
There are fears that mental health patients who couldn’t find treatment centres suffered bouts of severe illness.
Edward Nkurunungi, who is a mental health patient and peer support worker, says he has been affected as a result of the Covid-pandemic.
“For the last 24 years, I get monthly treatment from Butabika [national referral] hospital. With regard to the lockdown, I was affected in a number of ways. First of all, I failed to access the hospital services because during the first lockdown you couldn’t drive but [people] were allowed people to walk,” revealed Nkurunungiwho often walked to hospital to receive treatment.
He says the situation worsened for mental health patients in the rural backwaters who had no access to treatment after hospital units were converted turned into Covid-19 treatment centres. “They didn’t have anywhere to go. It was worse. But it also reached a point when the admitted patients couldn’t be discharged because there was no transport to take them back home,” he revealed.
In April 2020, Uganda imposed one of the most stringent lockdowns in Africa peppered with a dusk-to-dawn curfew. One of its poorly trained and ruthless quasi-military outfits, the Local DefenceUnit (LDU) behaved like Hitlers’s Gestapo. It meted out some of the most egregious human rights abuses at those deemed to be violating the curfew that as a result of a public outcry, the force was briefly withdrawn.
“You have severe illness, you have homeless people who will breach curfew times and become victims of security brutality,” argued Ssegane.
Nkurunungi reveals further, “The second lockdown was more challenging because we couldn’t be allowed to walk. At one time I tried to walk from Makindye to City Square where we would find the hospital vehicle to take us to the hospital. But when I reached the Clock Tower, I found police stopping everybody to access town. They were actually caning people to go back home.”
Nkurunungi had to sneak through Kafumbe Mukasa Road and OwinoMarket to finally walk to the City Square. “I was able to dodge the security ring mounted by the police after a pedestrian advised me to take the route I took.”
But before the second lockdown was sanctioned, Nkurunungi contracted Covid-19 after interacting with colleagues at Makerere University Business School (MUBS) where he is pursuing studies.
“The signs started coming after feeling feverish and I thought I had malaria. I went and tested for malaria but I was negative. They told me to take fluids but I insisted and went to Butabika Hospital and took a Covid-test, which turned out to be positive. My spouse also tested positive. We had to take our little baby to his grandmother’s home to avoid infecting him. After two weeks, we tested and we were negative,” he revealed.
Nkurunungi suffers bouts of bipolar and schizophrenia, which he has battled since 1997.
“It’s now 24 years [of treatment] and I’m turning 50 years next year. The treatment helps me to calm me down. When I’m unwell, I have racing thoughts and fail to sleep. But when I get treatment, I can sleep comfortably, I’m calm and predictable,” he told Vox Populi.
As part of treatment, he receives an injection in his back.
Nkurunungi turns poignant when asked how he developed this mental illness during the interview.
“I was at National College of Business Studies Nakawa, the current MUBS and I involved myself in guild elections which was very stressful. I became very suspicious of my opponents and I developed paranoia. I started feeling insecure. I was living with my girlfriend. I left where I was staying and came to Makindye to stay with my parents and barricaded myself in the house. They brought the police and broke the room and took me to hospital. They brought a psychiatrist who gave me a jab. From then I started my journey at Butabika.”
Nkurunungi offers counselling services to recovering mental health patients by sharing anecdotes of inspirational stories of “how they have coped with illness to inspire and instil hope in them.”
He says government ought to give mental health patients a special pass during the lockdown to access medical treatment and put in place services that can simplify the delivery of medicines to patients at their homes. “They can use motorcycles to deliver medicine to the patients during the lockdown to ease the pressure.”
Jimmy Odoki Accelam, who is a mental health advocate, says patients were affected by public transport restrictions during the lockdown that also extended to medical personnel.
“The most difficult problem was transport to go to hospitals, healthcare facilities in order to see a doctor, psychiatrist, psychologist, psychiatric clinical officer, or psychiatric nurse. In cases where permits were to be granted by local leaders to allow the use of private transport means, the process was not easy and some cases bribes were asked before the permits were granted. Many patients were not able to be reviewed within the recommended time as some reviews are done weekly,” revealed Odoki.
During lockdowns, patients couldn’t access medicines prescribed by doctors, which are only found in specific pharmacies in Kampala.
Odoki says the few mental health specialists operating then were not facilitated to deal with a surge in episodes such as depression, anxiety and mania.
“Because few patients were coming to their facilities, [specialists] reduced or stopped coming to attend to the few patients who trickled in. Where there were new episodes that required urgent attention, it was not easy to access help thereby putting new patients at great risks. Also where review needed to be done as a result of some side effects of drugs, it was not possible to do so immediately. The lockdown put many service users [of psychiatric facilities] at risk. Something ought to be done in future to help them better.”
He suggests that mental health treatment embraces ICT methods and applications like zoom during counselling and treatment.
Odoki told Vox Populi “face-to-face interaction is still the best for patients to get full attention as well as expressing what they are going through. In the past most doctors didn’t allow diagnosis and prescription on phone but because of the lockdown, some of them adjusted to the new realities. This means both doctors and patients should be flexible and able to adjust where possible.”
Prof Ssegane says the country needs to hastily establish a mental health national taskforce to amongst others implement a psychosocial support programme to deal with the crisis.
“We have a spike in domestic violence, homicides, suicides, child abuse, alcohol abuse, there is no psychosocial support, there is no number for those in distress to call, there is no funding for private mental health centres,” he argued.
