Gede Foundation Meets With The Leprosy Mission Nigeria

Yesterday, October 20th, Gede Foundation had a sit down with The Leprosy Mission Nigeria (TLMN). The meeting included Dr. Moses Onoh - Country Director of TLMN, Mr. Terver Anyor - Funds Development Manager, Mr.Gareth Shrubsole - Programme Officer, TLM (England and Wales), Aminu Ahmed, a survivor of leprosy, Mr. Godwin Etim - Performance Director: Resource Mobilisation and Partnership Management(Gede Foundation) and Mrs. Zunzika Thole - Okpo, Media Officer for Gede Foundation.

From L to R Zunzika Thole, Gareth Shrubsole, Terver Anyor, Godwin Etim, Moses Onoh and Aminu Ahmed

From L to R Zunzika Thole, Gareth Shrubsole, Terver Anyor, Godwin Etim, Moses Onoh and Aminu Ahmed

The team from TLMN talked about the stigma still surrounding leprosy and how they can increase awareness about the disease. They went further to discuss socioeconomic issues surrounding leprosy and their holistic approach towards treating it. In line with this, they sought some expertise from Gede Foundation on Mental Health. Dr. Moses, and rightly so, noted that empirically, the two organisations are doing the same job. He went on to say that the health burdens that the Foundation has undertaken are rife with stigma and so is leprosy. 

Sufferers of leprosy often face stigma and discrimination. Sometimes, they may even stigmatise themselves (keep themselves in seclusion so as not to be seen or pointed at). Mr. Shrubsole suggested that perhaps there could be a self care group where users can talk to each other about what they go through with their illness. Mr. Etim informed the meeting that some users that have been enrolled in the BasicNeeds project do have Self Help Groups. 

Going forward, perhaps Gede and Leprosy Mission can have a partnership that can try to bring leprosy ‘out of the shadows’. An integration of mental health into leprosy treatment will be closer to the holistic approach the Leprosy Mission uses in treatment and care of its patients. It will not only encompass the physical, but the mental as well.

Breaking Free: My Battle With Alcohol

‘My name is Don and I have been drinking since I was 15. I grew up around drinkers, I spent many hours of my childhood around brewers within my local community. I first tried a bottle of beer, then two and I craved to get drunk. I was curious about how it felt to be drunk. My first bad state was when I passed out in the detached bathroom outside the main house.

After my secondary school I got very mixed up with young men in my local community and we always ended every evening at a local bar. I started working as a menial mason and got very skilled but I spent most of my earnings on alcohol. Bit by bit I graduated from crates of beer to mixing beer and spirits/dry gin. I had a young woman, a good woman I wanted to spend my life with but I could not make enough money to keep her. At this time I needed to take up a job that paid more to be able to care for my woman and myself. Not being able to do this stressed me so much that I delved more into drinking and eventually the young woman left me. 

I felt my ego had been dented and I became violent and very aggressive. One day, I got physical with a fellow drinker at the local bar and was arrested and detained by the Police for three days. For the period I was detained, nobody came to see me, not family not friends. While in detention, I craved for a drink (I was thirsty for beer), it was as if I would not wake up the following day. This was the first time I had stayed off a bottle since I became addicted. When I was released my first stop was at the local bar and I had one bottle of beer on the house as a ‘welcome-back’. I got to my workplace next day, I was told by my Supervisor that my services were no longer needed for the obvious reasons – alcoholism and aggressive behaviour.

At that time I knew I needed help but did not know where to go to for help. I thought of going to the primary healthcare centre at the community council or seeing a Pastor or an exorcist. This was a very difficult moment of my life, I had no money, no job, and family wanted nothing to do with me and no friends. I calmed down a little, tried getting back with a brewer friend I had known from my childhood. He allowed me few shots for free and I would work with him to make just enough for a day’s meal. Over the few months I spent hanging around the local dry gin brewer I managed to cut intake. I was not eating well and I needed a stable mind to find a job, and energy to work. 

Today, I don’t drink every day. I can go for two days and just take few shots occasionally. I have a new job and another woman who is currently carrying my baby. Now, I want a normal life and want more control of myself. I want a good life for my child and my woman. I hope to find help to completely stop alcohol, I have stayed away from my old friends and my woman is very helpful. It’s very difficult but I am determined to stop. I hope I find what I need to help me long-term’.

A story of a young man form the hinterland who is fighting alcoholism. There is need for awareness raising on alcohol abuse and other non-communicable diseases such as mental health.

By Ekaette Udoekong.

GEDE AT THE ROYAL SOCIETY FOR THE ENCOURAGEMENT OF ARTS, MANUFACTURES AND COMMERCE (RSA)

Gede’s Managing Director, John Minto, attended an important “Mental Health Matters” meeting at the RSA in London on Thursday, 13th October, 2016. Key speakers included Lord Victor Adebowale (CEO of Turning Point (a major UK charity which offers services for those suffering from mental illness and learning difficulties), Sarah Brennan (CEO of Young Minds) and Jonny Brennan (mental health campaigner), who focused on the rising tide of mental illness within young people, largely within the context of high income countries where social media, bullying and a culture of high achievement in schools is producing a generation of youngsters bedevilled by issues such as stress, depression, substance abuse and, in extreme cases, suicide.

One of the key areas of interest for Gede was the discussion on why so many mental health agencies focus almost exclusively on treatment rather than on a balanced approach which would include prevention and stigma reduction. Speakers and members of the audience noted with some concern that Schools all around the world tend to focus on high academic attainment and physical health – without any recognition of mental stress which ‘School’ and teenage years in particular can bring. Calls for mental health to be incorporated into Schools (and this need not be expensive – simple early years lessons in ‘mindfulness’ have been shown to be highly effective) from the earliest ages were also supported with calls for ICT to also be engaged – any mental health initiative without a digital component is likely to fail for the vast majority of children and young people living in richer countries and as the internet makes its way across low and middle income countries, this tenet will almost certainly hold true.

Discussions also centred around the stigmatising nature of seeking mental health support, with a consideration of the Australian model which has ‘made fashionable’ mental health care and support for teenagers through their ‘Headspace’ programme. One key issue cannot be denied – without a consideration of positive mental health in young people, all societies are simply storing up expensive problems for the future.

The Case of the Destitute

He is about 50. He has no known family. He claims he is divorced. Efforts to locate his family have proved futile. For over 15 years there has been no known contact with a member of his family.

In 1999, a pastor found Mr. Edwin. He was in his 30s and was transporting people using his motorbike (okada). The pastor took keen interest in Mr.Edwin as not only was he one of the most regular church goers, he was also gifted in speaking in tongues. However, the speaking in tongues took a turn for the worst when Mr. Edwin could be seen and heard violently screaming in tongues and hitting the walls. Edwin’s then landlord decided to evict him as the disturbances were getting too much. The pastor narrated that Edwin’s prayers went beyond the norm. He noticed that Edwin would drive his motorcycle into the church and leave the keys in the ignition with the engine running. 

After Mr. Edwin was evicted, a church member took him in and employed him to start selling pure water. His condition further deteriorated as Edwin could be heard talking to himself, wandering aimlessly even though he was supposed to have been selling pure water. It got to a situation where he could hardly even take care of himself. The pastor and other church members looked once more for any family member, even as far as his village but none was found. 

In line with this year’s theme, ’Psychological and mental first aid for all’, the church community gathered together to help Edwin so as to ensure that he gets his life back on track, even though their means were not medical. It cannot be easy to assist someone you are not related to for over 15 years. During the Mental Health Camp held on 8th October in Mpape, Edwin was diagnosed with Schizophrenia. Through the partnership with BasicNeeds, of which Gede is a franchisee, Edwin will be able to have access to medication for the first time in fifteen years. It may take a while, as the case has gone untreated for some time but there is still a glimmer of hope for Edwin.

Mental Illness and the Human Face of Marginalisation, Stigma and Discrimination

The following was submitted by Gede Foundation to United Nations Social Development Network and can also be read on their website. Special thanks to UNSDN for featuring the Foundation!

“Why must I be in bondage – doesn’t everybody deserve to be free?” she asked with tears in her eyes. Laura (name changed) has been living in physical bondage “for years” but was allowed by her caregivers to attend a mental health camp run by the Gede Foundation in Abuja, Nigeria in late March 2016. The camp was the first in a series of programmes run under a social franchise agreement with BasicNeeds UK, with support from BasicNeeds Ghana and funding from Grand Challenges Canada.

Laura’s history of mental illness is connected with the birth of her first child, after which she began to “act erratically” and exhibited symptoms of mental illness. The initial treatment pathway involved visits to local pastors who suggested physical confinement and isolation due to a perceived “flight risk.” Laura was then shackled to a pole in the middle of a church where a pastor prayed for her, fed her, and released her from chains only when she needed to use the bathroom.  Laura’s frustration increased as she began to realize that her “treatment” was leading to little more than further stigmatization from her community as her mental illness continued. Meanwhile, she was unable to engage in any income generating opportunities and was increasingly becoming a “burden” on her family. Laura’s family was aware that mental health expertise existed that could help treat her, but they could not send her to the large and expensive (and often stigmatizing) urban hospitals where she could receive such treatment. However, Laura was able to attend Gede’s Mental Health Camp with the recognition that the programme would offer community based access to a trained psychiatrist.

Working Towards a Solution

As with all under-served and stigmatised health burdens, there are no easy solutions. The inclusion of mental health in the Sustainable Development Goals (3.4 – By 2030, reduce by one third premature mortality from non-communicable diseases through prevention and treatment and promote mental health and well-being) is an important recognition of the human and economic cost of mental illness and pushes communities to find sufficient expertise to be able to deliver quality care.

The approach of the Gede Foundation (working with BasicNeeds) is focused not only on addressing stigma and discrimination, but also on enhancing the understanding of mental illness through the formation of self-help groups and engaging community leaders. In addition, the BasicNeeds model combines the mapping of livelihood opportunities for those suffering from mental illness (and their caregivers) so that income opportunities can be engaged at the earliest appropriate stage of recovery. This has the added benefit of allowing people to afford psychotropic medication when needed, as well as making them feel, yet again, worthwhile members of their community.

Lessons Learned and the Future

Gede began implementing the BasicNeeds model in March 2016 and aims to reach 1000 people living with mental illness or epilepsy and 800 primary caregivers and family members over the next two years. Initial lessons learned have focused largely on the need to, (i) see mental health in a holistic manner and to clearly recognize the cross-cutting impact of mental illness related to education, health and livelihoods, (ii) generate appropriate and high quality research, often into prevalence and impact, as related to mental illness. It is difficult to gain traction with community leaders and decision makers without well thought through and credible evidence, (iii) develop long term approaches to address the “treatment gap” (the number of people needing treatment related to the number of trained health workers available to provide it) which, initially, needs to focus on enhancing key screening/treatment and referral skills within lay health workers at the community level, (iv) engage with existing structures within communities to encourage the formation of mental health self-help groups which are pivotal in helping to address issues of stigma and discrimination (as well as giving an amplified voice to those who are suffering from mental illness), and, (v) ensure that all tools (most of which have been designed for use in high income settings) used in screening/diagnosing mental illness are culturally adapted and are, consequently, appropriate for the specific circumstance in which they are to be used.

Advocating only for “more treatment pathways” is commendable, but one-dimensional within the context of mental illness in low- and middle-income countries. Culturally adapted and validated approaches to research and stigma reduction also play an essential part in bringing this key issue “out of the shadows.”

Learn more about our work on disabilities at un.org/disabilities

Out Of The Shadows: World Mental Health Day

“This is an area that has been highly neglected”. So said Dr. Chris Elumelu from National Primary Health Care Development Agency (NPHCDN) and his words could not be truer. In line with this year’s World Mental Health Day (WMHD) theme, “Psychological and Mental First Aid for All”, Gede Foundation, in collaboration with NPHCDN, National Orientation Agency (NOA) and the Chief in Mpape commemorated the day. Despite the heat, the event brought over a hundred people from the community and beyond. 

NOA presented a sketch which depicted how society reacts to people with mental illnesses. They are labeled “mad”, “crazy”, among other demeaning words. The sketch, in its entirety can be viewed below. The sketch told the story of a man who appeared to have had a psychotic break and how people in the community reacted. First, they were terrified and refused to get close to him. After sometime, it was suggested that he visit a church or a mosque for healing. However, one of the actors mentioned - and correctly so, that delaying medical intervention is detrimental and could worsen the condition. She suggested that instead, the ill person could be taken to a hospital and he will need family as well as community support. These words rang true with the theme, “Psychological and Mental First Aid for All”. 

Sketch by NOA in commemoration of World Mental Health Day in collaboration with Gede Foundation

After the sketch, questions were posed to the audience as to what they had learned and there were various answers given. A Psychologist, Mr. Sam Jinadu, was present to clarify some of the issues raised in the sketch. A considerable number of people simply asked what the signs of mental illnesses were. Mr. Jinadu informed them that there are quite a number of mental illnesses and symptoms differ depending on the type of illness. He gave examples of depression, bipolar disorder, anxiety disorder and schizophrenia. He urged the carers and community members to seek medical attention. When some people complained about funds for treatment, he informed them that government prices are highly subsidised and with Gede’s work - a BasicNeeds franchisee, livelihoods for some people is something to look forward to. 

The event brought scores of people together and was indeed a platform for strong partnerships to be formed. Dr. Chris encouraged the Foundation to continue to work hard in the community and that their initiatives should be supported. The Media, who were highly involved during the course of the day also asked a number of questions concerning mental health were also encouraged to shine a brighter light on mental illnesses. It is through them that such initiatives will come out and it is up to them to present mental health as they would malaria. It may not be a physical disease, but it is a disease worthy of dignified mention.

Stakeholder’s Meeting for Tertiary Students

Gede’s partnership with the United Cement Company Ltd (UNICEM), a subsidiary of Lafarge Africa PLC in Cross River State, has supported over 25 tertiary students in 10 rural communities since the 2013 academic session.

The stakeholder’s meeting, which was held at Lafarge premises had 70 people in attendance, including the Commissioner of Education in Cross River State represented by Mr. I. A. Oyeyem, the Plant Manager of Lafarge Plc represented by Mr. Inyang Bassey, Community Relation Manager Lafarge Plc, Gede Foundation, tertiary beneficiaries, Community Trust Committee CTC, other community leaders and parents/guardians of beneficiaries. The aim of the meeting was to find out which issues have arisen since the educational support programme for tertiary students started. Among the issuesdiscussed were achievements, performance challenges and new ideas for effectiveness.

A detailed report on the achievements of the the programme, general performance of beneficiaries, challenges faced over the period outlined and limitations in the programme were all part of presentation delivered by Gede Foundation. As part of the event, graduates of this programme shared experiences and expressed their gratitude to Lafarge and Gede Foundation. The representative of the Honourable Commissioner of Education, lauded the effort of Lafarge Africa Plc and Gede Foundation for the educational support offered to indigent students and noted that Cross River State is one of the educationally disadvantaged states in Nigeria and this kind of support is worthy of commendation and emulation by other companies and agencies working within Cross River State.

Beneficiaries and parents

Beneficiaries and parents

The meeting ended with a plan of action for 2016/2017 which included mentoring and community health initiatives to be carried out by the tertiary student with supervision from Gede Foundation; continuous support from parents and community stakeholders and more engagement with InstitutionalAuthorities for sustainability.

By Ekaette Udoekong

I Need A Ladder To Help Me Out Of This Ditch I Am In

These were the chilling words of a 26 year old man. He was obviously very smart, very eloquent and it was clear he wanted his life back on track.

Jackson* was barely in senior secondary school when he started to dabble in alcohol and marijuana smoking. He insisted it was not peer pressure, it was not because everyone else was doing it. He insisted that he was a very strong willed person but once he started smoking marijuana, he could not stop. This continued for many years. It has now been well over 5 years. He has not been able to kick the ‘habit’. “To be honest with you,” he said, his voice quaking and his hands trembling a little, “today is the only day I have not smoked and it’s because I knew you guys were coming here”. He was referring to Gede Foundation and this was the very first Mental Health Camp the Foundation had held. 

Asked on why he still smokes, he said it was part of him now, it was like food. He cannot do without it. If he feels tense or is lacking confidence, he simply smokes marijuana and he is better. While he knows it is not good for him and wants to stop, he does not have the will power to desist from it even though he earlier stated he has a strong will power. He is surrounded by friends that do the same activities and so even when he tries to stop, he finds himself back in the ‘ditch’. At this point, his friend chipped in and said that Jackson had even been to a rehabilitation centre but once he came out, he relapsed. Relationships with his family are strained. The community has labeled him a bad influence and no one really gives him a chance anymore. Sometimes, the friend said, he talks to himself and is very irritable when others interrupt his conversations.

He did something that was inspiring though. He asked for help. He said, “I need a ladder to help me out of this ditch I am in”. According to our Psychiatrist, Jackson not only needs support from his family, he also needs psychotherapy. It will not be a short journey, it will be long, sometimes hard but it is one he is willing to undergo. 

This story brings to mind the theme for this year’s World Mental Health Day; Dignity in Mental Health - Psychology & Mental Health First Aid for All. According to the World Health Organisation (WHO), “psychological first aid covers both psychological and social support. Just like general health care never consists of physical first aid alone, similarly no mental health care system should consist of psychological first aid alone. Indeed, the investment in psychological first aid is part of a longer-term effort to ensure that anyone in acute distress due to a crisis is able to receive basic support, and that those who need more than psychological first aid will receive additional advanced support from health, mental health and social services.” 

The work that Gede has started with BasicNeeds in Nigeria will surely empower users as well as those in a position to help (carers) to recognise, acknowledge and appreciate mental health. Will you be doing your part October 10th this year?

Jackson* - Name has been changed to protect the user’s identity.

By Zunzika Thole-Okpo

Schizophrenia: A Glance Into The Mind

Written by Zunzika Thole-Okpo

We walked in and she was just sitting there, covered in her wrapper from head to toe. Only a few stray braids graced her face. Clearly we had woken her. She was withdrawn but returned our greetings. I wondered why she did not leave as we sat down to conduct our interview with the pastor. 

Since this was my first field trip with Gede, I tried to pay attention to what the pastor was saying and not to the young lady on the floor. This was one of the first Key Informant Interviews (KII). It was not until the pastor started talking about mentally ill people that he was praying for that I realised what was happening. The young lady, Faith*, had been in church for a long time. I turned to have a better look and discovered she was chained to a pole. Apparently, she had been chained to that pole for over a year. 

It all started in 2011. Faith was a fashion designer and she was doing well for herself and her family. Her husband also had a good job. One afternoon, he came back from work to find his wife frantic. She claimed someone had come into her room through a window. She was inconsolable. They looked everywhere and did not find anything but she was adamant. Someone had come into her room through a window. Even after searching the whole house, she was not convinced. The husband decided to humour her and told her the person had been sent out and she calmed down. After this first episode, she had another where she said there were things all over her body. She kept scratching, screaming and writhing in pain. She said the things were going into her body. She attempted to cut them out but there was nothing to cut out. 

This episode prompted Faith’s husband to take her to her parents for help. When they got to the village, Faith had another episode. Since her husband had just dropped her off and left, they called him back to take her to the hospital. When they got there, they were told that Faith had malaria, possibly cerebral malaria and typhoid. Wishing for it all to go away, they started treating malaria and typhoid. However, Faith was not getting any better. She was wandering around, talking to people that were not there, hearing things that weren't there. Furthermore, she was terrified. Sometimes she refused to go to bed because there was ‘something’ on the bed. As was their natural proclivity, the family decided to go to a pastor for healing. 

After many months of prayers and no change, Faith’s husband decided to take her to see a psychiatrist. She was on treatment for six months and in those months, everything was OK. She was back to her normal self, doing the things she used to do before. As Faith was now better, the couple decided to discontinue with the medication, Faith got pregnant and the family was happy once more. Right after her baby was born, the episodes started again. This time, she was wandering off and would not be seen for days on end. The husband, naturally, was very worried and once more, decided to take her back to the church, where she has been for one year now.

For the year that Faith has been chained to the pole she is only let loose to go to the bathroom. She eats and she sleeps there. The pastor described that sometimes, she speaks in an unearthly language known only to her. To the pastor and other congregants, that is the demon talking, not Faith. The only medical intervention Faith has received in the one year she has been chained, came from the Mental Health Camp organised by Gede Foundation, a BasicNeeds Franchisee. The MHC, held on the 30th of July 2016 at Mpape Primary Healthcare Centre, was the second one that Gede has held. 

Faith is now on medication and according to her husband, she is becoming more and more herself. Having gone through what she has, it comes as no surprise that she is withdrawn and reserved. Imagine living in so much fear that it appears everyone is out to get you. That is what she has been living with for the past 5 years. However, she is now on the road to recovery. She has to follow her medication strictly. 

Faith’s story is only one of many which reflect the significant progress Gede has made in delivering community based mental health services. Many users and carers have have stepped forward, especially after the formation of Self Help Groups. The possibility of a support system and a voice is something that gives the users and carers hope for the future. 

*Name has been changed to protect the identity of the identity of the person.