Where there is no psychiatrist

Mental illness happens everywhere in the world. I have seen Zambian patients with depression, anxiety, obsessive compulsive disorder, psychosomatic conditions and hysteria. Being aware of the cultural context is important, and good communication is essential. To get a history from patients, you need a good translator who can help you interpret patients’ symptoms. It may be a false impression, but I think that neurosis occurs more frequently in people who are middle class, have had some education and can speak English. When I don’t have a translator, these are the patients who consult me.

Psychosis is less common. Over the past two months I have seen half a dozen people suffering from severe mental illness. One teenager may have had a brief psychotic episode, which made her dreams seem like reality. She had dreamed someone was cutting her legs with a knife, which caused her to experience leg pains for several weeks. She also suffered visual and auditory hallucinations, seeing things which no one else could see and hearing voices threatening to cut her legs. This have been the first presentation of psychosis, but her symptoms improved when she changed schools. We will just have to watch and wait.

Other patients with psychosis manage their symptoms differently. An older lady who hears voices deals with them as though they were tinnitus. A younger man just smokes more cannabis in an attempt to mask his symptoms.

I have tried to requisition some basic drugs for mental health problems. Ironically, diazepam (which is despised by most GPs in UK) is the only medication I have available. Perhaps this will change if my attempt to have Kakumbi recognised as a higher level health centre.

M is a 22 year old man with a three year history of severe mental illness. His hypomania can be a bit wearing if he insists on making his presence felt. Perhaps he is just asking for attention in a dramatic way. But last week, when he started assaulting people, wrecking his home and destroying his family’s goods, his mother took drastic action. She chained him to the door he had pulled off its hinges. I did a home visit, examined him and tried to arrange for an ambulance to take him into hospital. The ambulance driver was sympathetic but my request was denied because it was not an emergency. No mental health problems are seen as emergencies. M was certainly not well enough to travel by public transport. I sedated him with diazepam while we considered our options.

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As luck would have it, the following day we needed to transport a newborn baby urgently to Kamoto Hospital so we persuaded the driver to take M and his mother as well. The District Commissioner agreed to help out with a vehicle if M needed to see a psychiatrist in Chipata. I hope he will make a swift recovery and be discharged to my care with a guaranteed supply of medication.

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One Reply to “Where there is no psychiatrist”

  1. From MICHAEL CLARKE Ian as a certificated manic-depressive once in your care here in Leicester I find your account of this man’s crisis poignant and totally believable. You were and clearly still are the mental health champion ; I was unhinged, but only figuratively. LOVE M

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