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The Royal College of Psychiatrists Improving the lives of people with mental illness

Maribu (traditional healer)

 
 The scouts band on the beach

As a British doctor working in The Gambia the local beliefs about mental illness become a part of understanding the patients and their lives.

Of course the local beliefs reflect in patients’ and families interpretations of mental illness. Many people diagnosed with schizophrenia will complain that a Maribu (a traditional healer) has put a spell on them.

To clear things in my own mind, I find I have to look closely at the symptoms of schizophrenia as ICD 10 describes them, but the individual’s interpretation and understanding of what is wrong with them is quite distinct. It’s expressed as a recognition there is something wrong and out of their control, and it’s a problem in their mind that they want to resolve. I’ve found that people can work with psychiatry on this, and collaborate in their treatment. Indeed it doesn’t always hinder their relationship with medical treatment, although it does delay them in seeking it, having invariably already sought help from a Maribu first.


The message to patients is that the two approaches can work together to avoid losing their engagement in a medical approach which after all, they have not grown up with.

A young woman was brought to Tanka Tanka by the police last month having been charged with infanticide of her 4 day old baby. Rather tragically, she had defaulted treatment for schizophrenia some 3 years ago. Her family have been supporting her at home in the way they believed was best for her, intending to help her care for her baby at home but with no intervention from services. During her illness, she offended a neighbour by interfering with their good luck charms by cutting them off her body. The family may have believed a spell was cast upon her as revenge for doing this, explaining her state of ill health and their reason for not seeking medical treatment.

After arrest the police were convinced of her unstable mental state at the station and brought her to hospital. We negotiated an agreement with them that she should stay in hospital rather than on remand. They advised me that her mental illness would be taken into account if provided with a medical report, as no one was in doubt of her condition.

She has somewhat improved with treatment from a fluctuating catatonic state and is now able to communicate and speak about all that has happened, which she finds unbearable but seems to be coping. There is no relevant forensic mental health law to help here, and plans for the patient's future care will be a challenge considering a lack of outreach community services. The staff will of course do their best but in constrained circumstances.

 

"He told me about the beliefs of the causes of mental illness, which are based in the work of djinns and spells invoked against people by other Maribus."

The need for a secure unit has complex implications to the community, not least in that some families despair of bringing their relatives for care after they abscond, and turn back to traditional medicine, taking their relatives to a local Maribu (traditional healer).

I went with the CMHT to visit a traditional healer, specialising in mental health, who is about an hour and a half’s drive outside Banjul, near the South Gambia-Senegal border. He has a large compound in a rural village with rooms for inpatients and consulting rooms for outpatients. The treatment is by way of the Quran, using recitations of certain verses, and herbal remedies.
 Fishing boats on the sea

He told me about the beliefs of the causes of mental illness, which are based in the work of djinns and spells invoked against people by other Maribus.He said he believed there are psychoses which do not respond to his treatment and took me to meet such patients.One young man had been there for 7 months, his mother staying with him in the healer’s compound.

He was floridly psychotic and threatening, and being kept there with no improvement in mental state despite the healer’s best efforts.He had absconded from the hospital twice before his mother took him there in desperation.The healer is allowing us to work with him, including supply him with appropriate medication, in fact he asked the CMHT to help.Of course the first instinct is to wade in with medical interventions, but the services here are well aware that without providing a safe alternative, that would be a naive and potentially dangerous interference.
Tanka Tanka Psychiatric Hospital

I have been made aware of lessons learned with these issues in other countries in Africa, and that a thoughtful approach is needed. Work is being done in The Gambia to find funding to develop Tanka Tanka into a more secure inpatient environment, to prevent absconsion and provide a seclusion facility, and in all to work towards a more comprehensive service. I have found I have needed to put so much of my assumptions aside, and look at things in a pragmatic way, locate my thinking in this environment and culture rather than superimposing my experience of psychiatry in a developed country onto the complex needs of this one.

 

Janneh Kunda village

"Of course the first instinct is to wade in with medical interventions..."

 

 

 

 

 

 

 

 

 

 

 

 

 

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About this blog

Dr Imogen Kretzschmar

 

Dr Imogen Kretzschmar is a CT2 in psychiatry at South West London and St Georges Mental Health Trust, and is spending 6 months in The Gambia in West Africa on Out of Programme Experience.