science, health & technology

Also in this section:
The lone psychiatrist in a Third World setting
Two instruments used in the CR-AVE project
STRI social sciences lecture: social inequality needs no market
The La Niña effect

From the World Health Organization's Health Worker Diaries:

The lone psychiatrist
by Alain Maxime Mouanga

"A man came to see me. He could not sleep at night. He had disabling headaches. He was weary. I asked him about his past. Eight years ago, during the civil war, his house was burned down, just as he was getting ready to retire. It had taken him 30 years of hard labor to build that house, as is true for most people in the Congo. Now he is renting a small apartment under wretched conditions.

"I asked him if he could see any relationship with what happened in 1997 and his current problems. He made light of it. "That happened to everyone. Why should I complain?" he asked. "Yes, that happened to many people, but what happened was terrible for you," I told him. Like most of the patients who seek psychiatric care in the Congo, he is suffering from depression.

"Here in the Congo, even after experiencing the most terrible indignities, people struggle on as they live with major depression. It is extraordinary. They look for a solution. They go from church to church and from doctor to doctor, to understand why they don’t feel well. Finally if they get to me or someone like me they start to understand the link, and it helps. I wish I could help them more.

"I have a recurring dream. I walk into the psychiatric unit at the University Hospital in Brazzaville, and it has changed. The paint on the walls is no longer peeling. The décor is cheerful. A phone is ringing. One group of patients is in a group therapy session; another group is painting pictures with an art therapist. I believe my dream can come true, when I look at the progress we have made. When I first took up my post in 2000, the unit had no indoor sanitation. The odor of the place was overwhelming, nauseating. That changed two years ago when WHO installed a water tank for us and Dutch donors repaired our plumbing and built new latrines.

"But the building remains badly damaged from the war. Instead of its original 50 beds the unit has only 20, which is not enough. We still do not have a single telephone. Or a computer. When it rains outside, it rains in my office. We lack the means for a full program of occupational therapy and psychotherapy. And the only medicines we can offer are classic psychiatric drugs that industrialized nations abandoned years ago in favor of new, costlier drugs because of their debilitating side effects.

"Because of the side effects, and because they are obliged to buy medicines themselves and can't generally afford to pay for them for more than a short period, most patients --- even those with a serious psychiatric illness --- generally stop treatment. At the moment we have a woman on our service in exactly that situation. She had a first episode of psychosis, was put on treatment, and stopped after a while. She had a relapse and came to the conclusion that her 13-year-old daughter was possessed and killed her.

"People were surprised when I entered psychiatry. I could have focused on neurology and worked in more pleasant surrounding and earned a better salary. Now I want to help my compatriots understand that psychiatric illness can be treated successfully, that people can recover, find satisfying lives and be useful to society.

"And I want to inspire others to enter this field. There are two young residents working for me. They say they plan to enter psychiatry. I hope they will turn out to be serious enough to go abroad for specialty training; and then turn out to be crazy enough to come back here to work at this hospital. I believe they will, because I know I am not alone in my dream. They share it."

Alain Maxime Mouanga is the sole hospital-based psychiatrist in the Republic of the Congo, a country of 2.5 million inhabitants.

Also in this section:
The lone psychiatrist in a Third World setting
Two instruments used in the CR-AVE project
STRI social sciences lecture: social inequality needs no market
The La Niña effect