Throwing off the chains of mental illness in Ethiopia

Modernizing mental health care in a land where priests are often on the front lines

Stefano De Luigi/VII Network/Corbis

On a recent visit to Debre Libanos, a 13th-century monastery outside Addis Ababa, one of Ethiopia’s few psychiatrists found 17 people in chains. Suffering from serious mental health issues ranging from schizophrenia to bipolar disorder, they’d somehow ended up at the monastery with other sick Ethiopians, seeking blessings from the Christian priests.

But the chains were not meant as a deliberately cruel measure, explains psychiatrist Dawit Wondimagegn; the monks were attempting to ensure the mentally ill didn’t “end up on the street,” where they would be in danger, a harm to themselves and others. The chains are a desperate, stop-gap effort to keep patients safe, says Yonas Baheretibeb, a professor at Addis Ababa University. In a way, they are emblematic of the state of psychiatry in Ethiopia today—there are only 44 psychiatrists in the mostly rural Horn of Africa country, where the population tops 85 million. Due to the shortage of health workers, and a centuries-old belief that possession by evil spirits or supernatural forces are to blame for afflictions of the mind, priests often end up on the front lines of mental health, treating the sick with prayers and holy water.

Yonas and Dawit know there is another model of mental health-care delivery. They’d both studied psychiatry with a team of Canadian physicians thanks to the Toronto Addis Ababa Academic Collaboration (TACC), a nine-year-old partnership between the University of Toronto and Addis Ababa University. They recognized that the patients simply needed antipsychotic medication.

After months of back-and-forth meetings with the priests, where the doctors gently suggested that psychiatry could supplement—but not replace—religious healing, Dawit and Yonas talked the priests into a pilot project; priests still provide spiritual guidance, but medical staff are now allowed to visit the monastery every two weeks, where they administer medications and practise psychotherapy.

“Now no patient is chained,” says Dawit. Indeed, they now help with the day-to-day running of the monastery—“fetching water, doing gardening.”

The Addis Ababa-based doctors are working to extend this model throughout the Ethiopian capital, where a network of thousands of religious healers now treat the mentally ill. Eventually, the program could be expanded elsewhere in Africa, where mental health care is rudimentary or non-existent. Last week Grand Challenges Canada, a government-funded non-profit, provided a $1-million grant to assist TACC, part of a $20-million investment in 15 mental health projects in the developing world. The reason for the push? According to the World Health Organization, more than 75 per cent of the world’s mentally ill live in developing countries—and fewer than one-fifth of the sickest patients receive any care at all. “It’s better to go where patients are and try to help them,” says Dawit. Even if that’s in the church.

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