By Conan Businge
A wail pierces through the mental department ward of Gulu Referral Hospital, sending everyone into shock. Oketch, a 10-year-old boy with a mental disorder, is caged in one of the rooms.
Five months ago, Oketch was taken to the hospital after suffering major traumatisation.
He is a victim of brutality, following the Lordâ€™s Resistance Army insurgency in northern Uganda.
Northern Uganda has one of the worldâ€™s highest rates of a mental illness. A survey conducted by a team of British and Ugandan psychiatrists established that the prevalence of post-traumatic stress disorder in northern Uganda is higher than that ever recorded anywhere in the world.
They blamed it on the war that has lasted two decades. The team said people suffering from the resultant stress and depression do not have access to the required mental healthcare.
According to a research paper that the team published in the journal BMC Psychiatry, out of over 1,200 adults in Gulu and Amuru districts who were assessed by the psychiatrists in 2006, more than half (54%) were suffering from post-traumatic stress disorder.
Organisations which are trying to restore peace in the region have not paid much attention to mental rehabilitation.
The mentally ill feel scared and have scary dreams of their past experiences.
The illness is characterised by worry, lack of sleep and anger outbursts. In extreme cases, the victims claim they see ghosts.
What is mental health?
Mental health is how we think, feel and act as we cope with life. It also helps determine how we handle stress, relate to others and make choices. Like physical health, mental health is important at every stage of life, says Dr. Okello of Gulu Hospital.
Everyone gets worried, anxious, sad or stressed sometimes. But with mental illness, these feelings do not go away and are severe enough to interfere with oneâ€™s daily life. The illness can make it hard for one to make and keep friends, hold a job or enjoy life.
Psychiatrists say mental illnesses are common but many times, the patients do no get treatment. Disorders which include depression and irrational fear should not be ignored. Fortunately, they are often treatable. Prescriptions and therapy can improve the life of most people with mental illnesses.
Post Traumatic Stress Disorder (PTSD), the most common mental ailment in northern Uganda, is a result of events that cause horror. These include war, accidents, loss of loved ones and sexual abuse like rape.
The rate of PTSD recorded among refugees is 11.8% in Guatemala; 38% in Mexico; 4.6% on the Thai-Burma border; 5.6% in Croatia and 20-42% in Afghanistan.
The researchers say more than a third of the individuals surveyed (67%) had signs of depression. A person who is depressed feels irritable, persistently sad, unnecessarily tired, anxious, guilty, worthless and lacks sleep.
One also loses interest in pleasurable activities like sex or may fail to concentrate on tasks and usually has problems remembering details. Oneâ€™s appetite may also rise or decline.
Dr. Seggane Musisi, a lecturer of psychiatry at the Faculty of Medicine, Makerere University, says the high rate of mental disorder in Uganda could be due to the fact that the research was started in 2006 when the war in northern Uganda was still severe.
Link between mental health and poverty
In Uganda there is a close association between mental illness and chronic poverty. Although statistics on mental health are scanty, there is an increase in cases of mental disorder.
The acting director of Butabika Hospital, Dr. James Walugembe, says the number of mental health cases treated at the hospital rose from 4,274 in 2005/2006 to 5,604 in the last financial year.
According to a survey carried out in Gulu and Amuru districts, many people were traumatised by hunger, homelessness, unnatural death and murder of their family members, narrow escape of death, lack of medical care and torture.
Other causes were family breakups, abduction, coercion, serious injuries and sexual abuse.
In another research done by psychiatrists Dr. James Okello, Dr. T.S Onen and Dr. S. Musisi from Gulu and Makerere medical schools and Butabika National Referral Hospital, respectively, among adolescents in Gulu, 71% of children suffered from psychiatric disorders.
According to Okello, living in war-torn areas puts children at a higher risk of developing psychiatric disorders, particularly PTSD. Among these children, adolescents are the most affected and are at risk of getting psychological trauma because they are targets for recruitment; sexual exploitation and abuse.
According to the research, more abducted adolescents suffered from PTSD (26.8%-12.7%) , major depression (19.5%-4.2%) and generalised anxiety disorder (13.4-4.2%) than non-abducted adolescents. More suicide cases were recorded among adolescents who were not abducted.
Adolescents in war-affected areas, whether abducted or not, have varied and clinically significant emotional responses to different kinds of traumatic exposure. Mental health experts say the majority of patients with psychiatric complications seek treatment from traditional healers.
This is partly because there are a few mental health clinics in the country. Gulu district medical officer Dr. Paul Onek says there are plans to do more research on post-war rehabilitation programmes.
The Uganda National Health Policy and Draft Mental Health Policy (2000â€“2005) committed to prioritise mental disorder because it is the major contributor to the countryâ€™s disease burden.
Warning signs of Mental Illness
A person with one or more of the following symptoms should be evaluated by a psychiatrist or other physician immediately:
Marked personality change
Inability to cope with problems and daily activities
Strange ideas and excessive anxiety
Change in eating or sleeping patterns.
Extreme highs and lows
Abuse of alcohol or drugs
Excessive anger, hostility, or violent behaviour
Having only one or two of the
problems below is not necessarily cause for alarm. They may simply indicate that a practical solution is called for, such as more discipline and counselling.
A combination of these symptoms, however, is a signal for professional intervention.
Child seems overwhelmed and troubled by their feelings Crying a lot
Frequently asks for help
Being constantly preoccupied, worried, anxious, and tense. Some children develop a fear of certain things or unreasonable phobias
Failure to concentrate in classroom. Decline in performance and not picking up again
Difficulty mastering school work
If teachers suggest a child may have a learning disability
Loss of interest in playing
When a child stimulates one self in various ways like excessive thumb-sucking, hair pulling, rocking of the body, head banging to the point of hurting oneself and masturbating often or in public
Having no friends and getting into fights with other.
Self-isolation or talking about death regularly
Acting in a provocatively sexual manner, commonly in girls as they approach puberty or much younger girls flirting with men in sexually suggestive ways.
Settings up fires