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Archive for July 21st, 2013

Unchained Minds: Somalis Mental Health State.

Posted by African Press International on July 21, 2013

  • By Farhia Ali Abdi

Mental health needs a great deal of attention. It’s the final taboo and it needs to be faced and dealt with” Adam Ant.

The past and present capacity:

Given the Somalia political and economic turmoil suffered during the civil war, the country’s mental health system collapsed, and mental health disorder became rampant across the country.  To date, government in Somalia does not have an official mental health plan of action to combat mental illness, rebuild facilities, and grant funding to support programs. The apparent lack of medicine, and adequately trained staff and professionals have forced families, and mental health centers to chain their patients to beds or rocks as it shows in the picture above, leaving them with permanent trauma and physical injuries.

World Health Organization (WHO) indicated in their recent study of Somalia’s mental health care that people with mental illness in Somalia face degrading and dangerous cultural practices such as being restrained with chains, which are not only widespread, but also socially and culturally accepted.  WHO further expressed that Somalia has one of the world highest rates of mental-health disorder. Approximately, one-third of its eight million Somalis are affected by some kind of mental disorder, yet there are only three trained psychiatrists in the entire country who specialize in mental illness. Psychiatry as a profession is heavily stigmatized in Somalia by both the general public and the medical community. Healing for mental problems is provided by religious leaders or by traditional healers, and it has become an ineffective method in the current Somalia society.

Historical Context:

The country established a health care system after its independence in the 1960s; however, in the 1970s, there were few noticeable achievements with the military regime run health care system such as the creation of medical schools in Mogadishu and in Hargeisa (Nursing). Nonetheless, problems within the country’s meager national health care system were exacerbated by the state’s collapse in 1991. At this time, the healthcare system suffered a major setback and forced many Somalis to go without proper health care.

In a conceptual framework, Somali culture considers mental health as one is either “crazy or not crazy.” There is no assortment of health and disease, mental health and mental illness.   People’s beliefs and understanding of mental illness are predominately spiritual and metaphysical: mental illness comes from evil spirits; it can be brought on by another person or oneself through curses or bad behavior. These beliefs, coupled with the lack of a strong plan on mental health in the government at the federal, regional, and local levels, deepen the country’s mental health crisis.  According to, a 2010 World Health Organization report: “A Situation Analysis of Mental Health in Somalia,” medical education and training of health professionals is a key issue for the health sector as a whole. There are no medical institutes, universities and schools that have an internationally recognized and standardized curriculum. The only exception is the Nursing School in Hargeisa, recognized by WHO. They further noted that, there is one private medical school in Gaalkacyo, the Gaalkacyo University, which started in 2006, the first basic training program for Assistant Physicians (three-year course). In the South, the Benadir School covers the whole South-Central Zone. Aside from Somaliland, there has been no effort to introduce curriculum focused on mental health curriculum into the basic teaching package. The lack of resources, including, medical equipment, and administer medications and treat emerging high rates of trauma-related disorders throughout the country, requires an urgent attention.

Contemporary Somali Society:

Since the aftermath of the civil war, there is an apparent change in the perceptions and stigma regarding mental health. The causes of mental illness are now understood as chemical imbalance rather than a bad spirit. Specialized mental health professionals in the diaspora and locals in Somalia brought a new approach of looking at mental illness diagnosis and treatments, and in so doing, reduce the barrier to seeking care. Their efforts are already making a huge difference in how people view mental health disorders and to seek information to improve their conditions. For example, in Mogadishu, there are few mental health facilities run by Abdirsaq Ali Habeeb. Mr. Habeeb is a Psychiatry Nurse by training and operates mental health centers to care for in patients and outpatients with the support of NGOs such as the World Health Organization and other donors. Mr. Habeeb who is living in Mogadishu goes out to the streets of Mogadishu to find chained, mentally ill persons; he unchains them and brings them to his facilities for care, thus restoring their dignity. In Somaliland, there are similar public and private mental health centers with the same patient treatments and outcomes. These facilities are sustained by the support of few donors and NGOs such as the World Health Organizations (WHO).

The new understanding of mental health illness in Somalia is partially due to the contribution from Somali diaspora professionals who are returning home.  Good example is the recent opening of Somalia Mental Health Foundation Centre in Puntland region by Dr. Abas M. Jama and his colleague Mr. Hassan M. Esse. Dr. Jama and his colleague Mr. Esse are Somali diaspora professionals and the founders of The Somalia Mental Health Foundation. Their foundation is a non-profit organization that provides services and guidance for people with mental health conditions. One of the program’s mandates is to develop adequate facilities with highly qualified mental health professionals for the diagnosis and treatment of mental, neurological and psycho-social disorder. Furthermore, the mandate states that the foundation is to set up mental health camps where psychiatric consultation and medicines are provided free-of-charge. What is unique about this particular organization is that, it is initiated and run by Somali diaspora professionals who decided to dedicate their time and effort to support other Somalis inside the country, and one that I hope others follow suit.

Dr. Jama is a well-respected Psychiatrist by training in the United States. He has a private practice in Sandusky, Ohio and specializes in adult psychiatry. He is a member of the Medical Staff of Firelands Regional Medical Center and Firelands Physician Group, Mercy Hospital in Lorain, Ohio and a member of the American Medical Association and American Psychiatric Association.

Dr. Jama recognizes the need to treat individuals who are suffering from mental illness in Somalia as a result of the prolonged civil war, and the absence of proper mental health centers to treat these individuals. Hence, Dr. Jama and his colleagues opened their first office in Qardha, Puntland, and are working their way throughout the country to treat mental illness. The facility is run by Abdiqani Abdullahi Askar who has a Bachelor of Nursing Degree and Medical Psychiatry Training Certificate. Since opening the clinic in 2011, Dr. Jama and Abdiqani have treated over 4000 patients and returned to the region twice to train nurses, educate patients and their family members, and dispense medication.

Dr. Jama’s vision in Somalia is to establish collaborative working relationships with the medical community and hospitals in Somalia in order to facilitate needed medical training to care for mentally ill patients.  The top priority for this year he said is to provide and develop educational training programs. To this end, Dr. Jama (The Somali Mental Health Foundation) in partnership with the existing Mental Health Centers in Somali such as Mr. Habeeb’s run facilities in Mogadishu will conduct a two-four week of educational course on mental illness to nurses, nurse practitioners, and aides who live in Mogadishu and the surrounding region. The training program will be offered in three different cities in Somalia. Moreover, as part of this course, Dr. Jama will train approximately 60-100 nurses and aids in Somalia in the effort to give the participants the necessary tools and knowledge desperately required to treat mental illness.

More than providing education, Dr. Jama and his colleagues are changing societal views on mental illness by helping to lessen the stigma surrounding mental illness in Somalia. By this, they are providing the platform for sufferers to seek needed medical care for their illness. In Puntland regions, the municipal officials are putting requests to Dr. Jama to train the hospital staff in order to care for patients. As seen from video clips on their website: http://somalimentalhealthfoundation.com/ people are lining up for treatments.  A recent interview on Somali TV, the Dr. and his colleague Mr. Esse expressed an overwhelming experience by the new patients who for the first time since their illnesses were released from their chains.Line up in front of The Somali Mental Health Foundation, Qardha center, November, 2011

Though there are no monitoring oversight bodies except for the mental health institutions that regularly monitor patients at health facilities, this is a tremendous achievement on the onset of fighting mental illness in the country.

Advocacy and Public Education and Awareness

In an interview with Al-Jazeera TV, 2011, Mr. Habeeb who runs the Mental Health Centre in Mogadishu said, “I believe there is no one with good mental health in Mogadishu or in the entire South and Central Somalia because of what is going on. Normal people will not kill and maim their own, and for such a long time.” This is true for the entire country and there are dire needs for trained and educated professionals within the field of Mental Health and on the health field in general. The 2001 UN Development Programme’s Human Development Report, ranked Somalia lowest in all health indicators except life expectancy. In its latest report, the country is not even ranked due to the lack of reliable data. Somalia needs human resources for medical health development who can deliver integrated primary health care services. The backbone of any health care system is the mental health and in order to maintain and encourage a culture in which respect and healing for the mentally ill are a priority, there needs to be an education.  The new concept of training medical practitioners as exemplified by Dr. Jama and his colleagues has been successful, and it should be considered as a viable strategy for treating mental illness in Somalia and enhancing community awareness of mental illness.

Due to the long neglect of mental health issues in Somalia, and the long-held beliefs on mental illness, the country needs Somali community organizations, and community health centers such as the one developed by Dr. Jama, Mr. Esse, and Mr. Habeeb. Somali led mental health treatment, and training is the best hope for Somalia. Dr. Jama’s actions will hopefully encourage other diaspora professionals to invest back to the country. The efforts of these professionals have led to many successes, and Somalia continues to benefit from their tireless efforts and much-needed expertise in establishing a comprehensive strategy for battling mental illness in Somalia. Creating community awareness and empowerment in the area of mental health is a key to treating the disease and with the training and support from the international NGO also, will position Somalis to further improve mental illness. The current Somali government also needs to encourage, support, and partner with Somali professionals with mental health expertise to create mutual support, conduct advocacy and influence the policy-making process in line with international human rights standards.

The way forward for mental health policy implementation is to.

  • Establish a centralized public health institution mandated in managing the Mental Health program and services in the country.
  • Integrate mental health into the primary health care services, so mental health care can be seen as an essential aspect of health care.
  • Create a clear, well communicated future vision for the healthcare system, and to consider mental health research findings that can be used most effectively in influencing the delivery of services.
  • Assist in capacity building on the community-level models of care that effectively involved in mental health treatment and delivery of services.
  • Support service providers and users alike to understand and promote human rights, recovery and rehabilitation of mental illness, and to recognize mental health as a crucial component of personal health.
  • Lastly, build and maintain a health care related database in the country.

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North Kivu sees fresh clashes: What’s happening with the Kampala talks?

Posted by African Press International on July 21, 2013

Talks have stalled as fighting continues (file photo)

KAMPALA/GOMA,  – Fresh fighting between the rebel M23 and the army of the Democratic Republic of Congo (DRC) in the eastern province of North Kivu could spell the end of efforts to reach a negotiated settlement to the conflict, analysts say.

In what have been described as some of the deadliest clashes since the rebellion began in April 2012, FARDC (the DRC army) and M23 have been fighting since 14 July in areas around Mutaho, Kanyarucinya, Kibati and in the mountains near Ndosho, a few kilometres from Goma, the provincial capital.

An estimated 900,000 people are displaced in North Kivu, more than half of them by the M23 rebellion; tens of thousands more have fled across the DRC’s borders with Rwanda and Uganda. Humanitarians continue to flag the issue of civilian protection in and around Goma, where fighting over the past year has displaced more than 100,000.

IRIN has put together a briefing on recent developments in the talks and the conflict.

What’s happening with the Kampala talks?

A new round of peace talks between the two sides in the Ugandan capital, Kampala, has stalled, with Raymond Tshibanda, the DRC foreign minister and head of the government delegation, and Apollinaire Malu Malu, his deputy, absent from the venue.

The talks, which kicked off in December 2012 under the auspices of the International Conference on the Great Lakes Region (ICGLR), first broke down in April: M23 representatives walked out following a decision by the UN to deploy an intervention brigade to neutralize armed groups in eastern DRC.

“The two sides are still extremely far apart in their negotiating positions and a compromise is difficult to envision without hefty intervention by diplomats. So fighting is almost inevitable, even if only to improve negotiating positions,” Jason Stearns, director of the Rift Valley Institute‘s (RVI),Usalama Project, which conducts research on armed groups in eastern DRC.

“The Kampala talks are moribund. I can’t envision a deal acceptable to the M23 that foreign diplomats and the Congolese government could sign off on; the M23 would have to disband and reintegrate into the national army, which its leaders will find difficult to stomach, as they don’t trust the government.”

Each side accuses the other of not being sufficiently committed to reaching a diplomatic settlement to the conflict.

“It depends on whether M23 is ready to accept on what has been decided in Addis Ababa and [with] UN for them to disarm. If they accept, we are ready to finalize the Kampala process,” DRC government spokesperson Lambert Mende Omalanga told IRIN by phone.

On 24 February, 11 African countries signed a Peace, Security and Cooperation Framework for the DRC and the Region, aimed at, among other things, improving security and consolidating the state’s authority in eastern DRC.

What are the accusations being traded?

But Omalanga accused Rwanda of continued influence over M23, a charge both the Rwandan government and M23 strenuously deny.

“Kinshasa is not interested in the talks, but a military option. We have been here seeking for a bilateral ceasefire. But government has since refused and prepared for the ongoing war,” Rene Abandi, the head of M23’s delegation, told IRIN. “It’s playing double standards… trying both methods – peace talks and military solution.”

“It may sound like a paradox but, for peace negotiations to start, the balance of power on the ground must be changed. The two parties [M23 and the DRC army] will only negotiate if they lose on the battlefield.”

Abandi added that until the head of the government delegation or his deputy arrived, M23 would not negotiate, and called on the ICGLR, the African Union and the UN to put pressure on Kinshasa to actively participate in the talks.

“Long before the resumption of fighting, the Kampala peace talks have had a bleak future. Over the course of the last seven months, the warring parties have employed deliberate delaying tactics, militaristic bluster and traded fierce accusations of foul play as a means of furthering narrow political agendas,” Timo Mueller, Goma-based field researcher for the Enough Project, which fights genocide and crimes against humanity, told IRIN.

“As the fighting rekindled on Sunday [14 July], some analysts see a direct relationship between the deadlock in Kampala and the renewed fighting. But while the fighting is a near-death experience for the talks, both parties have an interest in keeping the talks alive so as to be seen as willing to seek political peace, albeit crippled they may be.”

He added: “The rhetoric and actions of the Congolese army reflect a consistent strategy to pursue only military confrontation with M23 on the battlefield and forego any existing political efforts. But while military actions undermine and contradict the talks, Congo has no interest in unilaterally withdrawing from an initiative strongly favoured by the international community.

“M23, will desperately hold onto the talks to present itself as a grievance-driven group eager to discuss political reforms with Kinshasa and because it is too weak militarily to advance its interests outside political avenues. The talks offer the only existing avenue for M23 to deliver agreement on amnesty for senior leadership and military reintegration into FARDC, something that the UN PSCF [the Peace, Security, and Cooperation Framework] or any other international process would be unlikely to yield. Both parties will remain at loggerheads for the foreseeable future, leaving scant hope for a genuine peace agreement.”

Could fighting spur talks?

According to Thierry Vircoulon, an analyst with the think tank International Crisis Group, “It may sound like a paradox but, for peace negotiations to start, the balance of power on the ground must be changed. The two parties will only negotiate if they lose on the battlefield. Kinshasa accepted to come to the Kampala talks only because it lost Goma last year and was dominated on the ground.”

But Usalama’s Stearns says neither side is keen to escalate the ongoing conflict. “The M23 is limited by its troop numbers, which are probably still under 2,000, with a large area to cover. For the Congolese army, they would probably want to wait until the UN Intervention Brigade is fully operational, which could take another month.”

3,000-strong intervention brigade mandated to “neutralize… and disarm” armed groups in eastern DRC is due to be fully operational at the end of July. The UN Stabilization Mission in DRC, MONUSCO, also intends to have unarmed surveillance drones in eastern DRC to monitor developments.

How much support is there for talks?

The problem in eastern DRC is primarily political, and “no amount of military power can solve it,” Lt-Col Paddy Ankunda, Uganda army spokesman and spokesman for the talks, told IRIN.

“The causes of the M23 rebellion and the wider conflict are a mesh of political, socioeconomic and security factors. A political, non-military solution is needed, including, amongst others, security sector reform, democratization, decentralization, human development, reform of the minerals sector and regional economic integration,” said the Enough Project’s Mueller. “The Kampala peace talks should best be subsumed by the UN PSCF. It will also be critical to get Congo, Rwanda, and Uganda together to start negotiations to deal with economic and security issues that have been driving the war.”

Fighting between FARDC and M23 has already displaced half a million people (file photo)

“[UN Secretary-General’s Special Envoy to the Great Lakes] Mary Robinson must also ensure that the Congolese reform process and national Congolese dialogue are mediated by an impartial facilitator and have civil society directly at the table. If the process is not neutral and inclusive, the reforms will fail,” he added. “Another behind-the-door deal among elites will be just another recipe for failure, likely brewing new dissent and stoking a wholesale resurgence of violence.”

In eastern DRC, however, not everyone is keen on a peaceful solution to the crisis. Kabila has repeatedly done deals with rebels as a way of ending national and local conflicts, and has been criticized for this by oppositionists, civil society and national media. “Give war a chance” has been a popular refrain with many fierce critics of the regime.

Is there any unanimity on the ground?

“We think the government should crush the M23 rebellion,” Thomas d’Aquin Muiti, president of The Civil Society of North Kivu (an association of NGOs working for better governance in the province), told IRIN, although privately, some of his colleagues deplored his statements.

Kabila’s recent pursuit of the military option against the M23 certainly appears to have the support of many ordinary people in Goma. There were jubilant scenes on 15 July when it was learned that FARDC had retaken a hill overlooking Goma from which the rebels had threatened to target the airport. Crowds of men waving leafy branches did victory runs on the outskirts of the town, and rumours that MONUSCO was trying to block a further advance by the army prompted angry demonstrations outside a UN base.

A group of women who had been displaced by the fighting voiced strong support for FARDC when asked by IRIN what they thought of its offensive. “We will be very happy to see our village liberated and we hope the army will do it,” said 44-year-old Fouraha Kanamu to a loud chorus of approval from the other women.

But condemnation of M23 is not unanimous in Goma. Thousands gathered and cheered the rebels after they briefly occupied the city in November 2012 and organized a rally in a stadium. Many of these people were government employees who were hoping the M23 would pay them, but even before the rebel takeover some citizens were quietly expressing support for the movement.

“They can’t be any worse than those in power now,” was the kind of comment heard from some people, who would claim that the Rally for Congolese Democracy (RCD) rebels – a Rwandan-backed movement that occupied eastern Congo during DRC’s second civil war (1998-2003) – had at least provided better policing and road maintenance in Goma.

The M23 makes much of the DRC government’s notorious corruption and incompetence, but has never held any elections, and judging by the electoral record of its predecessor movement, the CNDP (National Congress for the Defence of the People, which won just one seat in the 2011 national elections) would be unlikely to win many votes.

However, M23’s behaviour during the 10 days that it controlled Goma alienated many erstwhile sympathizers. “They plundered government offices, officials’ houses and even a hospital, so we saw they weren’t really interested in better governance,” said one civilian.

so/nl/kr/cb source http://www.irinnews.org

 

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Millicent Wanyama – Breadcrumb seller, Kenya

Posted by African Press International on July 21, 2013

Name: Millicent Wanyama

Age: 35Location: Baba Dogo, Nairobi

Does your spouse/partner live with you? No, he is dead.

What is your primary job? Selling bread crumbs and doughnuts.

What is your monthly salary? 8,500 shillings ($99)  from 5,000 shillings ($58)

What is your household’s total income – including your partner’s salary, and any additional same sources? 8,500 shillings ($99) from 5,000 shillings ($58)

How many people are living in your household – what is their relationship to you? Eight people, which includes me and my seven children.

How many are dependent on you/your partner’s income – what is their relationship to you? My children, and at times I send a small amount of money back home to my mother.

How much do you spend each month on food? 5,000 shillings ($58). from 4,000 shillings ($47)

What is your main staple – how much does it cost each month? Maize flour, which costs 150 shillings ($1.74) per kilogram-packet $15.

How much do you spend on rent? 1,000 shillings ($12). from 800 shillings ($9)

How much on transport? I walk to work every day.

How much do you spend on educating your children each month?About 1,500 shillings ($17) because they go to a government school, which is highly subsidized.

After you have paid all your bills each month, how much is left? I always keep aside 50 shillings ($0.58), which I take to my ‘chama’ (pooled-saving group), and I save 300 shillings ($3.49) in readiness for my daughter joining form one next year.

Have you or any member of the household been forced to skip meals or reduce portion sizes in the last three months? Yes, we forgo lunch, but now I make sure my children can take tea with milk in the morning.

Have you been forced to borrow money (or food) in the last three months to cover basic household needs? Yes, but many times when I don’t have money, I buy foodstuff on credit from the local sellers and pay later or provide services to them as a way of paying them.

“I hope the government will keep its promise to reduce the cost of food”
NAIROBI, June 2013  – When she first told IRIN her story, Millicent Wanyama, a 35-year-old widowed mother of seven, was living in the sprawling Ngomongo slums in the Kenyan capital Nairobi.Five months later, she is living in Baba Dogo, another informal settlement not far from her previous home.

“I moved from Ngomongo just before the election because I feared there would be violence there.

“This is also still a slum, but my life is now a little better. The last time you visited me, I was living in a tin-walled house. Now, this is a single room, but the walls are concrete and it more spacious.

“I still sell my bread crumbs, and because the times are hard for many people, people buy my breadcrumbs more because they can’t afford the normal loaf of bread [a loaf of bread still costs 45 shillings, US$0.50, and Millicent sells her breadcrumbs for 21, or shillings $0.24]. It is good business for me. Now I also sell doughnuts, and I earn more than before.

“Now with the doughnuts, my profit is higher. In one month, I can make about 8,500 shillings [$99], which is higher than the 3,000 shillings [$35] I used to make before.

“But when it comes to food, things are still very hard because prices are not coming down. So even when your income improves, it is eaten up by the expenditure on food.

“I still save part of my income to help me pay for school fees later for my children. This year, my first born will sit for her primary school examinations, and when she passes her exams, she will join form one. I want to prepare for that.

“We have a new government, and they are promising free education and healthcare, but you can’t believe that. You have to be ready to pay for it when the government fails to do it.

“I hope the government will keep its promise to reduce the cost of food.”

ko/rz source http://www.irinnews.org

*Exchange rate as of 26 June 2013 (86 Kenyan shillings to US$1)

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Samir Uddin – Street hawker, Bangladesh

Posted by African Press International on July 21, 2013

Name: Samir Uddin

Age: 50

Location: Charpara village in Mymensing District

Does your spouse/partner live with you? Yes.

What is your primary job? Street hawker.

What is your monthly salary? My income was US$60 just two or three months ago. Now it’s around $55.  from $60

What is your household’s total income – including your partner’s salary, and any additional same sources ? I don’t have any other income. My wife doesn’t work.

How many people are living in your household – what is their relationship to you? Four – wife and two children.

How many are dependent on you/your partner’s income – what is their relationship to you? Four.

How much do you spend each month on food? It was about $50, but it has increased recently. Now I spend around $55.  from $50

What is your main staple – how much does it cost each month?Rice. It was $12 four months ago. Now it costs around $15.  from $12

How much do you spend on rent? Nothing. I own my own home.

How much on transport? It was $5, but it’s increased to $7.  from $5

How much do you spend on educating your children each month? My children don’t go to school. I can’t afford it.

After you have paid all your bills each month, how much is left?Nothing.

Have you or any member of the household been forced to skip meals or reduce portion sizes in the last three months? We aren’t skipping meals yet, but we have reduced portion sizes.

Have you been forced to borrow money (or food) in the last three months to cover basic household needs? In August, I borrowed $400. I can’t repay that loan and will likely need to borrow again.  

“Food prices continue rise every day. I’m afraid it’s only going to get worse if the political situation continues”
MYMENSING, June 2013  – Recent political instability in Bangladesh has worsened the plight of Samir Uddin, a 50-year-old street hawker, who was already struggling to get by. He lives with his wife and two children in the village of Charpara in Mymensing District, 120km north of the capital, Dhaka. His children do not go to school.“Because of the strikes, I can’t earn half the money I used to. When they occur, people simply don’t leave their homes unless there is an emergency. And if people don’t go out in the street, how can I sell them anything?” he asked.

He said that his income is decreasing, but expenses are increasing.

“Food prices continue rise every day. I’m afraid it’s only going to get worse if the political situation continues,” he said.

Efforts to secure another job over the last few months have also failed.

“It’s difficult to manage three meals a day on the money I earn. We have reduced the portions of food we normally eat, but may need to start skipping meals if it continues like this. Everything is more expensive. The transport cost has increased in just two or three months.”

Adding to his worries, he cannot repay a US$400 loan he took out earlier to pay for the family’s living expenses.

“Each day, the money lender is calling for his money, but how can I pay him when I can’t even manage my day-to-day expenses? There is nothing left after I pay them so I will likely need to borrow again.

“Either the government should control food prices or introduce a rationing system for the poor. Otherwise, we cannot survive,” he said.

mw/ds/rz source http://www.irinnews.org

end

 

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