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Prime: recuperating souls in agony

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Famished I and crew members were when we arrived at Sodo Gurage at nine in the morning for we kicked off travel from Addis Ababa before sunup in a blood curdling cold. Even after alighting from the vehicle we had no time to order Kocho (Gurage’s’ traditional food) in the hotel because we had to join the Program for Improving Mental Health Care (PRIME) meeting very soon.

In the meeting room, it took me not long to forget my hunger as I started to listen to touching and sometimes shocking stories flooding from participants in the meeting room.

Dr Abebaw Fekadu is the Principal Investigator of PRIME-Ethiopia, Part of an international study launched by Addis Ababa University in Collaboration with the Federal Ministry of Health. He had to cut short his presentation of six months’ performance report majorly focusing on the treatment of psychosis, depression and epilepsy. To back his LCD presentation with instances borrowed from practical experience, he resorted to the story tellers who had taken seats at every corner.

Wagaye Diro, a woman in her 40’s, knew a violent woman living in a shanty plastic shelter by the street behind her home in Bui town. She said she was always scared to pass by this woman. “I never pass by her shelter unless I had money or food at hand to throw at her. She had a strange clothing; she often wore layers of T-shirts, coats, and dresses one on top of the other,” Wagaye said.

The woman lived there for 8 years with no sign of improvement. But some day when Wagaye walked to church by the woman with mental sickness, the woman did not show up. She checked her for the next fifteen days; the woman did not come out of the plastic shelter.

“I wondered what had happened to her. I dreaded getting close to her shelter. She was asleep. I read from her face that she was ill. A bit courageous drawing close, I asked her whether she had become ill. ‘Yes’, she said. When I asked her, shall we go to a clinic? She said, ‘Ok’. I was caught by surprise when I saw the violent woman turned weak and peaceful all of a sudden. While she walked behind me, people thought that the woman was intent to capture and hit me,” said Wagaye.

At the health center, Wagaye learnt that treatment was being given for people with mental disorders at the health center supported by the PRIME project. Wagaye was assigned a supporter for the woman while she followed her treatment at the project.

“I bathed her. She came out to be a very slim woman when I changed her clothes. People took her for somebody else because they knew her enveloped by lots of clothes and that made her look very fat,” Wagaye said.

She had a twelve-year-old child who at the age of ten was taken to a protestant benefactor. The day Wagaye changed the woman’s cloth, the boy arrived at his mother’s shelter with a portion of his meal to give to his mother. But he could not recognize his mother in the new dressing.

“Where is Mimi! he shouted on the top of his voice assuming that she had run away from the plastic shelter”, Wagaye said with tears breaking loose from her eyes.

In not longer than three months, the woman gained her consciousness back as she took treatment in the health project. Excluding those treated for less severe illnesses such as depression and alcoholism, PRIME has supported treatment for more than five hundred people with psychosis and nearly 700 with epilepsy over the last five years. The project also supports patients who do not recover fully with medication alone. The CBR workers travel through remote rural villages crossing hills and rivers to treat psychotic patients tied down hand to foot with chains as well as those suffering from epilepsy and depression.

Zenabua Deres is a door-to-door community rehabilitation worker. She says heading to remote areas is very demanding especially in the absence of transport. However, once a person needing their help is identified, she and her colleagues continue travelling to those places to create awareness, provide treatment and monitor the recurrence of mental disorder.

The noticeable achievement of the PRIME project would not have been possible without the support of compassionate people in the community who willingly invite people with psychosis to their homes, provide them food and bring them to mental health care centers.

Masresha Adenew is gifted in approaching people with mental disorder and taking them to mental health care. He says, a psychotic person who is violent to others peacefully comes and talks to him.

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“Two weeks back, friends showed me a girl with mental illness who went out to the street. She was a very attractive girl. It was eight days since she ate food. She had declined to eat Injera,” Masresha said with his pointing finger pressed to his mouth.

“Come to me, I said, and she came close. Do you want to eat food, I inquired. When I asked again, she said, “I will”. I gave her Shuro (Enjira with a stew of pea). She asked me to sit by her until she was done. She ate well, Thank God,” he said.

He paid the cafe owner enough money to cover her meal for eight days and told the girl to come and eat there any time she needed.

At dusk on the morrow, a shocking thing occurred. Four thugs carried the girl to a nearby bush to rape her. Residents and the community police who heard her shout for help arrived in time and rescued her.

Masresha understood that she was in trouble when he saw her face beaten and her arms scratched. This is a showcase for the Sodo district and the whole country that people with mental disorder living on the streets need their protection.

Masresha had helped another psychotic patient whose name is Shanko. Shanko had for several years run naked on the streets of Sodo. He now takes his treatment regularly. “He walks to the care center and receives medication alone,” Mesresha said. But the next worry to mentally recovered patients like Shanko is a house to call home.

Deputy Administrator of the Woreda and head of the district Health Office Feleke Asfaw confirmed the full commitment of the Woreda and the health office in addressing both the health and housing issues. Feleke also pledged to ensure that people who need treatment for serious mental illnesses will be prioritized in receiving certificates that grant care for free and in receiving housing.

According to Dr Abebaw, the PRIME project will conclude its implementation in Sodo district six months from now. The project has made mental health care accessible for 180,000 people of the district and is attempting to scale up its care to cover 1.2 million people of the Gurage Zone. The Commitment of the local government and the community has ensured the exceptional success of the PRIME project.

For the past year, the district health facilities were purchasing medication and care coordinated through the health office. The big question, however, remains to be whether the service will be sustained. Although PRIME project will be ending in six months, the team that is working in prime will continue supporting the district and other zones through ongoing projects.

Many of the health care providers, patients and families of patients who took part in the projects’ performance report meeting attest that the key to change was the awareness the project created in them regarding the nature and treatability of mental illness.

“I spent many nights with my leg tied to my mentally ill sister who then fled home at midnight. When things got worse on my sister, I decided to stay away from home not to see my sister die before my eyes. But the awareness I got through this project has enabled me do the right thing. This is why I can see my sister alive today.”

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This young man’s sister was seriously ill and tied up against a tree on the main street of the village after the family exhausted all available sources of care including a visit to Butajira hospital and Amanuel hospital in Addis Ababa. She was naked, agitated, hostile and was covered in dust when one of the community advisory board members, a commander in chief of the police, saw her and advised the family to take her to the nearby health center. She recovered completely after treatment and was back to school – then grade 3. Now she is in grade 6.

One more additional job to the general health care provider

Dr Abebaw, Principal investigator of the project, said that efforts to bring a significant change in mental health care provision should integrate the service with other health care provisions in the country. In other words, a general health care provider should provide mental health care, which is currently not the case in almost all parts of the country.

“We have demonstrated the possibility of doing so. We have skilled practitioners; we have demonstrated that the community participates in supporting patients and seeking the services. We have also done it in a way that could be replicated in other Gurage Zones and all other districts of the zones,” Dr Abebaw said.

He pointed out that a system has been laid down to train all newcomers in mental health care provision. Medication is also being provided to centers more regularly than was the case a year before.

The government of Ethiopia is paying increased attention for the care of people with mental disorder. It has a mental health strategy for the first time and various pilot programs have been carried out.

There are numerous causes to mental illness. However, whether the illness is caused by the stress of life, loses, use of substances, head injury, birth trauma or due to broader factors we know little about at present, more attention has to be given by the government and the public.

Feature story

December 2016