Mental Health Group Reflection

Since returning to Kampala last week, the Mental Health group, comprised of Molly, Raphael, and Alex, has been collecting information and observations to present to the Makerere and JHU faculty on Wednesday.  On Friday, January 18, we visited the Makerere University – Johns Hopkins University Research Collaboration Center (MU-JHU). We learned about the services provided by MU-JHU to help HIV+ pregnant mothers prevent HIV transmission to their unborn children. The doctor who spoke to us at MU-JHU is greatly involved with the antenatal ward at Mulago Hospital and was willing to give us an extensive tour of this unit. Through this tour, we learned how the HIV testing is performed on site for rapid results, that there is counseling available for mothers and adolescents who are trying to understand their infection status, and the various types of medications administered to HIV+ women who want to prevent mother-to-child transmission.

Mental Health Group (from left: Alex, Raphael, and Molly)

After this very eventful morning, the Mental Health group had the opportunity to visit the Psychiatric Ward at Mulago Hospital to compare their past experience of rural psychiatric services to an extensive psychiatric unit in an urban setting. We were able to talk to a psychiatric clinical officer who provided us with a different perspective of mental health issues regarding volume of patients, services offered, and treatment plans.

The following day, Saturday, January 19, all JHU and Makerere students travelled to a water and sanitation treatment facility in Kampala. There we learned the steps and processes required to convert toxic water in Lake Victoria to safe, useable water in homes in the surrounding districts in Uganda. Most of the JHU students were able to compare what they learned in their previous public health courses regarding the successive steps of water sanitation and treatment in the US to that of Kampala, Uganda. Shortly after returning from the water treatment plant, a Ugandan Member of Parliament (MP) discussed his successful attempt at election and current term issues and plans. One major problem face is governmental corruption, which he believes will stall long term development in Uganda if not addressed.

That evening, the Mental Health group engaged the group in a reflection session to discuss the events of both the current and previous day. We first gathered opinions on the groups feeling toward the MP. Many thought he was inspiring, courageous, genuine and brave because of the obstacles he had to face in attaining his position. Another topic of discussion was that demonstrations are often effective in enacting change, but should not be used exclusively as solutions in all situations. Then we discussed our experience at the water treatment plant the previous day. Many flaws were obvious, including the contamination of the potable water after traveling through the pipes to the homes and the suggestion to boil the tap water to ensure purity even after chlorination. These issues are not foreign to some locations in the US. For example, in Baltimore there are still lead pipes carrying water to homes, which also makes the water treatment process inefficient.

The mental health group then shared their findings with everyone, including the comparisons between Kalisizo in rural Rakai and urban Mulago in urban Kampala and witchcraft and traditional medicine as compared to western medicine. At Kalisizo Hospital we discovered that there is only one psychiatrist who mainly deals with HIV related mental illness. He is the first psychiatrist at the hospital and has been working there for the past three years. He mentioned that the incidence of autism in children is only one per year. This is much different from what we found at Mulago Hospital in Kampala where the practicing psychiatrist in the established psychiatric ward diagnoses upwards of 60 children a year with autism. Based on our comparisons between the two facilities, we questioned the group about other similarities and differences they may have noticed. Students believed there was overcrowding, long waiting times, and lack of clean supplies, sterilization, and privacy at both Kalisizo and Mulago. However, students were aware of the greater availability of technology and resources at Mulago as compared to Kalisizo.

Psychiatric Ward at Mulago Hospital in Kampala

Another topic of discussion that arose was the stigma associated with mental health treatment. The Luganda word “mulalu” translates in English to “crazy,” “mad,” or “mentally ill.” This may be a contributing factor to mental health stigma in Ugandan society. Although the association of crazy behavior with mental health is apparent in Uganda, many American students also admitted to stigmatizing those with a mental disorder as crazed.

A major mental health issue we have discovered thus far is the high prevalence of witchcraft and traditional medicine in Uganda to treat ill patients. During the past two weeks, we have had the opportunity to compare not only urban and rural mental health facilities, but also the comparison among witch doctors, traditional healers, and psychiatrists. We found that many mentally ill patients prefer to first seek out witchcraft or traditional medicine techniques to treat their affliction and only visit a hospital as a last resort after spending all their money and giving away all their cattle as payment for treatment.

To gather more information on the practice of witchcraft, we explored the village around Mulago Hospital. Although we did not have the opportunity to meet with a witch doctor, we spoke with a couple of people who provided us with insightful information. One man explained how his aunt took her convulsing son to a witch doctor for treatment. After many unsuccessful debt producing visits, she decided to bring her child to the hospital for treatment where he was diagnosed with epilepsy and effectively treated. Another woman explained that she was a Christian believer and felt uncomfortable speaking about the witch doctor because of stigma.

     Our group is having an information-packed experience learning about the different types of techniques and settings used to treat mental health in Uganda. We are looking forward to presenting our findings and observations to the Makerere and JHU faculties on Wednesday.