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The challenges of defeating depression
According to the WHO, Mental health illness affects 15 percent of the Ethiopian Population

The challenges of defeating depression

Driving off the main road and taking a turn on a narrow road while going to Eke Kotebe Hospital feels like the car will tilt over and fall any second. People and cars are practically shoving one other. Yet, one would be astonished since they will reach their destination without being in an accident.

The area is far from being considered as subdued; there are lots of activities going on. It could be considered as a busy neighborhood. And down the gravel road is a special kind of medical facility. One that caters to the needs of people who seek mental treatment

Eka Kotebe General Hospital is a hospital that has integrated mental health center. A facility that is being closely monitored by the Minister of Health. There are 350 beds in the hospital and 180 beds are allocated to the psychiatric ward.

It is located on a hill and has a huge compound. There is a secluded section, where patients who are mentally ill can relax and play sports. It has four floors all separated in different wards painted white.  People who are mental ill are left to wonder around the hospital, though some sections are closed off.

It could be a shocking sight, seeing people who suffer from mental illness walking around the hospital in scrubs talking to themselves or abruptly coming up and talking to you; however, they are harmless and can only walk around in some sections.

Until recent years, mental illness has long been a taboo in Ethiopia. It was seen as the work of evil spirits. Now, many are aware of mental illnesses; however, the overall understanding has a long way to go.

A university student, who has requested to stay anonymous, told The Reporter that she was diagnosed with depression when she was a 16-year-old high school student and during her Freshman year. Her situation got worse, so she was forced to take a year’s gap until her condition improved. Thankfully, her family was educated and accepted her situation, where they took her to get treated by a doctor, but other people around her could not understand her situation. Some accused her of being too lazy for not continuing her studies and some accused her of hypocrisy. She mentioned to The Reporter that people would bully her or treat her badly because they do not understand her situation, making her feel stranger and isolated.

She shares her journey with The Reporter. When she was diagnosed with depression, the community urged her to go to a Church and dip/wash in holy water and was advised by priests to stop her medication, which led her to have a relapse and have a hard time dealing with depression and bipolarism. She describes how both depression and bipolarism has affected her in her day to day life. Her social life was hugely hindered due to her mood swings and she became more isolated and enclosed.

 “My depressive episodes are filled with guilt, loneliness, sadness suicidal thoughts, seeing things in a negative way and wanting to escape from this life,” she told The Reporter.

Her mother said that at first it was hard to accept her situation as it was shocking and was not aware about the situation. “Once you accept it, you can work towards curing it,” she said.

“I didn’t know about depression and bipolar disorder or mental illness, I just thought it sometimes happens to teenagers like a teenager crisis,” her mother told The Reporter the whole experience was something that she was not able to comprehend. She says that the labeling is quite problematic as there is no clear demarcation between bipolarism and depression and that some symptoms overlap.

She told The Reporter that there is lack of facilities in Ethiopia. “To begin there are only two government run and a handful private health centers that work on mental illnesses. Private sectors are expensive and government facilities have very poor services. It is a pity; the problem is widespread but there are less than five health centers that work with mental illnesses,” she said.

When asked about the hardest thing about her daughter’s mental illness, she said that it was hard to accept. “But once you accept it, you move on, I support my daughter with everything that I have. The emotional support is very important. As a mother, I am always worried especially in the beginning but through time, you get accustomed to it,” she said.

She advices other parents to listen to their children and to understand them and give them the right advice and take them to the hospital. “It is something that can be treated, so parents should take the children to hospitals and not dwell on it, because many are doubtful to take their children to hospitals possibly because of lack of awareness,” she told The Reporter.

Mental disorder is also known as mental illness or psychiatric disorder. It is a behavioral or mental pattern that causes significant distress or impairment of personal functioning. Such features may be persistent, relapsing and remitting, or occur as a single episode. Depression, anxiety, bipolar disorder, dementia, ADHD, Schizophrenia, obsessive compulsive disorder, autism and post-traumatic stress disorder are all considered as mental illnesses.

Living in a very communal society, where life is less individualistic as compared to the western world, it is sometimes surprising to see people affected by depression. It is hard to believe that one in every five persons have some sort of mental illness in Ethiopia, according to a recent report by the Ministry of Health. This is due to many causes which include, abuse, human rights violations, violence and cultural and environmental factors. It is not uncommon to see people walking around the streets of Addis Ababa, half naked, talking to themselves or screaming. This can show the extremes of mental illness. People like this are neglected by their families, society and health officials. Many people in Ethiopia believe that most types of mental illness do not exist. For instance, depression is seen as an imaginary problem. Some believe that mental illnesses are works of the devil and that one needs to go to a religious space to get rid of it. 

Dawit Kebede (MD), a psychiatrist at Eka Kotebe Hospital, describes mental illness as a change in normal behavior or line of thoughts and feelings that disturbs one’s daily function. There are around 300 mental health illnesses but the most common ones are depression, anxiety, bipolarism, schizophrenia and substance use disorder. The youth is more vulnerable to be affected by mental health issues, and especially women in rural areas are more likely to develop severe depression, usually due to the rural lifestyle, domestic abuse and huge workloads.

Another doctor, Tefera Beyelew (MD), case team leader at the Psychiatric Ward in Eka Kotebe Hospital, told The Reporter that many young talented people are affected by substance abuse disorder, especially university students. “Youth, especially 40-60 percent of those attending university are diagnosed with substance abuse disorder,” he told The Reporter. Dr. Tefera continues to explain that this can have a huge toll in the country’s economy because it loses talented young people that can contribute to the country’s development. According to the World Health Organization (WHO) mental health illnesses affect 15 percent of the Ethiopian population. Mental health also affects the economy of the country because majority of the patients are young productive people.

People addicted to khat, a mild narcotic that is widely consumed in Ethiopia, and cannabis are vulnerable to mental disorders. Dr. Tefera says that something must be done about the consumption of khat in Ethiopia the consequences could turn out to be dire.

According to a study conducted by Amanuel Hospital, up to 70 percent of patients have tried other forms of treatments before going to professional mental health centers. For every three out of four patients with mental health illness, mental health hospitals are not of the first choice. This is usually associated with religion and cultural annotations.

Dr. Tefera and Dr. Dawit agree that while generally they do not discourage people to go to religious institutions, they condemn the abrupt quitting of medications as it can be very dangerous and lead to relapse; and that makes the treatment harder. But still, Dr. Tefera thinks it could actually be good to go to religious places.

Beyond lack of access to mental healthcare, there is the stigma issue. Clinical evidence indicates that stigma takes two forms. People who seek mental healthcare may face public stigma in the form of discrimination and exclusion, owing to endemic misconceptions about mental illness. When those beliefs are internalized, sufferers may also struggle with self-stigma: low self-esteem, low self-efficacy, and unwillingness to pursue productive opportunities.

According to Dr. Dawit, people are usually doubtful when it comes to getting professional help because it is stigmatized by society. He asserts that this is one of the main issues as stigma and discrimination can lead to poor outcomes. “Even though, stigma is a global issue, Ethiopia has a positive advantage because of family correlations. Family members are positive attribution for people with mental health issues to have a good recovery. Here people tolerate violent mentally ill people,” he told The Reporter.

Dr. Dawit and Dr. Tefera warn that if mental illnesses are not treated properly and in a timely manner, mental illnesses can escalate and become harder to treat.

Contributed by Sesina Hailou