Discrimination, staff shortages mean mental health short changed

Taking her 15 year old daughter to see a psychiatrist was the last resort for Dianaba Dia. For months beforehand she had used a local doctor who prescribed valium to control the girl’s violent seizures. “At first, it was not easy to pass through the gates of the neurological centre – just the word psychiatrist made me afraid!”

But after traveling to the Mauritanian capital Nouakchott and consulting doctors at the country’s only mental health centre, she was pleasantly surprised. “He was a doctor just like any other. What counts for me though is that since we saw him my daughter has got better.”

Awareness that mental health is a medical concern and many of its symptoms can be treated by medical doctors is gradually spreading in Mauritania.

Experts say the turning point was a study published in 2004 by the health ministry and the World Health Organization (WHO) that showed 34 percent of the three million people in Mauritania suffer or have suffered from some form of mental problem during their lives, including everyone who has experienced severe stress, depression and schizophrenia, for instance.

According to the study, 2 percent of Mauritanians suffer from psychosis.

Mental health problems are often caused in Mauritania by the struggle people have to accept the dramatic changes in their lives caused by poverty and rapid urbanisation over the past 40 years.

“Drought in the 1970s followed by rapid urbanisation has provoked the destruction of the traditional way of life,” said Ahmed Hamady, director of the Neuro-Psychiatry Centre (CNP) in Nouakchott, the capital, which opened in 1994 and is the only major mental health centre in the country.

“People live today with enormous pressure,” agreed Mamadou Dongo, an assistant at the CNP. In towns and cities, people struggle to cope with small salaries while still being part of a system that demands communal living and mutual assistance, he said.

Poorly prepared

The country’s impoverished health system is poorly prepared to cope with the influx of cases.

Photo: Manon Riviere/IRIN

A sign showing Mauritania's only mental health clinic. There are just two full time mental health specialists in the country

Thirty years after psychiatry and modern medicine were introduced to this sparsely populated poor West African country, there are just two full-time psychiatrists and two others who split their time between Mauritania and France.

“It is necessary to recognise that mental health has never constituted a priority in this country,” said Mohamed Ould Ely Telmoudi, secretary-general of the Ministry of Health.

Today, the CNP, which is the main psychiatry centre in the country, employs 133 people, among them two permanent psychiatrists, three neurologists, three GPs, 30 nurses and nine experts in mental health.

As well as struggling with human resource problems, mental health experts say they face discrimination from both within and outside the medical establishment.

“It is very badly viewed to work at the CNP, but it is even worse to come for a consultation,” explained Dongo, who has worked at the CNP for almost a decade. “People say that if you work with the insane you must be a bit mad yourself.”

“The big problem is that the problems which psychiatrists diagnose are not yet seen by the population at large as something relevant to the medical field,” said one of the nurses at the hospital. “People think it is something to do with the devil.”

As a consequence, patients often resort to traditional medicines. “We are in competition with the marabouts [religious leaders],” said Sall Ousmane, one of two psychiatrists at the CNP. “However, the treatments based on religion and mysticism usually end up just wasting the time and money of the patients.”

Human resources

Experts say the fear of psychiatry has slowly changed since the 1970s. Today, people are a little more willing to speak directly to the doctor, especially if they cannot afford the therapy for long. “Before, people did not like that we asked them so many questions,” said Ousmane. “They always asked for the depressants and medicines instead.”

...Young people don't want to practise psychiatry. They don't find it a noble discipline...

However, the lack of qualified staff needs to be addressed before more work can be done on changing stereotypes, the officials said.

“We lack the human resources,” complained Professor Dia al Houssein, who founded the CNP and is now retired. “Young people don’t want to practise psychiatry. They do not find it a noble discipline like cardiology or surgery.”

“Our fundamental problem is the absence of the intermediaries who can work between families and hospitals,” said Hamady at the CNP. “It is necessary to develop a system for the treatment of psycho-social problems that can take charge of psychological suffering of individuals.”

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