Lilly Achola sat on a tree trunk at the Gulu regional referral hospital with her chin cupped in her palms and a despondent look on her face.
For two weeks, the hospital became Achola’s home as she nursed her son, John Bosco Obodo, who was battling a mental illness. Obodo’s condition had taken a turn for the worse when, following a drinking and substance abuse spree on Christmas day, he set the family house on fire and attempted to kill his mother and his five siblings.
Although Achola and her children survived the arson, albeit with severe injuries to two of Obodo’s siblings, the family lost property, including savings worth Shs 500,000, 10 goats and 30 chickens.
In an interview with The Observer last week, Achola said that at first she thought her son had been bewitched. However, she later found out that indulging in drinking and smoking marijuana made her son have unstable mood swings.
“I took him to a witch doctor because I thought someone had cast a spell on him. But when I discovered he was smoking marijuana, I decided to go to a health centre,” she narrated
At Unyama health centre III, Achola was simply referred to Gulu hospital, where she found out that the facility was facing a drug shortage.
“I was shocked when I was told to buy drugs from a pharmacy because there were no drugs at the mental unit,” a teary-eyed Achola reveals.
The regular need for drugs has drained Achola’s little income from farming. Every two weeks, she spends Shs 40,000 on her son’s drugs alone. She is now worried that his condition could exacerbate again since she can no longer afford his medication.
“Buying drugs has become costly for me. Sometimes I get a little help from kind people [in form of] money, clothes and food to survive on since our home is even far away from town,” Achola adds.
Just like Obodo, Mary Lakot, a mother of eight from Koch Lee in Nwoya district, is also a patient at the mental health unit suffering from depression. Lakot’s condition started when her husband squandered all the money she had solely earned from selling farm proceeds in the last harvest.
“I almost committed suicide when he beat me up just because I asked for the money that he had already used for drinking alcohol”, she recalls.
Lakot’s mother, Annet Anena, took her for treatment. Anena says, her “hands are now tied” because paying for her daughter’s medication is costly.
“I am worried that if I can’t afford my daughter’s drugs any longer, she will commit suicide,” she narrates, pain written on her face.
DRUG SHORTAGE
Dr Canaan Katerega, a senior psychiatrist, says that for a long time, there has been an “inconsistent” supply of drugs at the Gulu mental health unit.
“Mental health is a virgin area that needs urgent help because it has been neglected for long,” Katerega said. “More funds are needed from the government to rescue our patients who are suffering here.”
Katerega said the drugs hitherto supplied by the government usually run out earlier than the stipulated time they are supposed to last. He said this is due to the high influx of patients who come from outside Acholi sub-region.
“Treating mental illness is just like treating HIV. Patients have to be on drugs for a long time.
But drugs don’t last here because many patients come from Lango, West Nile and South Sudan, yet Acholi [sub-region] is the catchment area for this unit,” he said.
Drugs that have not been available for the last three months are anti- psychotics (Aldondiconate, Fluphenazine and Chlorpromazine) and anti-depressants (Imipramine, Sodium Valproate, Artane and Flueoxetine). In addition, mood stabilizers (Carbamazepine), anti-convulsants (Phenobarbital, Phenytoin) have not been supplied for the last one year.
Some of the drugs available at the moment are malarial tablets and antidepressants like Amitriptyline and anti-chronagic like Benzhexol artane for controlling anti-psychotic drugs side effects.
Annah Naula, a psychiatric nurse, says that at times the drugs run out of stock before the end of the week, adding that patients are told to wait until the following week to get drugs.
“Our patients get frustrated because their treatment has been interrupted whenever they are told to wait but we have no choice,” she adds.
The director of Gulu regional referral hospital, Nathan Onyachi, faults the National Medical Stores (NMS) for supplying a limited quantity of drugs to their medical facility, contrary to what they requisitioned for.
NMS, a department that distributes drugs to government hospitals, dispatches drugs to Gulu regional referral hospital on a quarterly basis (every three months). Every financial year, Shs 750 million is earmarked for drugs for Gulu regional referral hospital but, according to Onyachi, that money is inadequate.
“The hospital needs at least Shs 2 billion for drugs but the government has continued remitting the same amount of money yet it’s [money] value has reduced over the years due to inflation,” he says.
EFFECTS OF WAR
According to Onyachi, because of the Acholi sub-region’s post- conflict setting, mental illnesses continue to affect people even after the war ended. In addition, the region faces many social problems such as extreme poverty, alcohol abuse, and high incidence of domestic violence, which continue to increase mental issues.
During the war between the government and Lord’s Resistance Army (LRA) rebels in the north, lasting at least two decades until 2006, tens of thousands of people were killed, 1.9 people were internally-displaced and others abducted as sex slaves and child soldiers from the Acholi sub-region and its neighbours.
Statistics from the mental health unit indicate that since October last year, 74 new cases have been recorded. At the moment there are 691 out-patients (OPD) and 29 in-patients also receiving treatment at the facility.
The commonest mental illness in Acholi are psychosis disorders (bipolar, schizophrenia, depression), mood disorders (mania and depression), as well as anxiety disorders (post-traumatic stress disorder and panic attacks). In Acholi, youths have been found to be vulnerable and easily susceptible to social problems that often result into mental cases.
One of the efforts put in place to fight metal illness and at the same time increase productivity among the youths in Gulu is a by-law banning the sale of sachet waragi. The alcohol ordinance was enacted by district officials in December last year.
Many activists and local leaders in Gulu look at the banasa big step towards the struggle against mental illness since indiscriminate consumption of alcohol is among its leading causes.
INADEQUATE STAFF
Inadequate staffing has been another major challenge at the mental health unit, with the few staff stretched thin.
“The number of patients will now rise again since many of them we believe stopped taking their medication because of the festive period that ended. This will overload our staff with work,” he narrates.
Currently there are only 19 employees at the facility. They include five psychiatric clinical officers, three psychiatric nurses, eight clinical psychiatrists, and two nursing officer psychiatry III. However, according to Onyachi, the unit needs 30 personnel.
The unit also has a 40- bed capacity for in-patients. Whenever it gets full, patients who have improved a bit are discharged so as to create space for new patients.
According to a 2014 study that involved the Refugee Law Project (RLP), Northern Uganda, especially Acholi sub-region – was found to be undergoing a “mental insurgency.”
At least five out of 10 people were found to be mentally-ill in Acholiand 60 per cent in the entire formerly war-ravaged northern Uganda. Suicide cases were also found to be many, with the majority, especially in Gulu, linked to cases of especially those were suffering from PTSDs and psychosis.
Gulu Central police station (CPS) records show that at least 68 cases of suicide were recorded since 2014. Mr Stephen Oola, a Transitional Justice and Governance Program manager, said their findings also revealed that many people have failed to participate in many government programmes that are meant to improve their well-being.
“We have so many people who are still suffering silently and this whole thing is happening like a time bomb because it continues to get worse every day. That’s why many have failed to take part in many government programmes like PRDP,” says Oola.
Since the LRA war ended, several government programs like Peace, Recovery and Development Plan (PRDP) have been put in place with an aim of uplifting formerly-war-torn northern Uganda.
NEED FOR DRUG BANK
The northern regional coordinator at Mental Health Uganda, Dorine Atto, says district leaders and other partners need to support the idea of starting a drug bank where patients can easily access treatment in their localities without reaching the hospital.
“Last year we submitted a concept paper to all leaders in Gulu informing them about the initiative of starting up a drug bank for the mentally -ill and we are still waiting for their response on the matter,” she says.
Atto adds that the drug bank initiative will at first start as a pilot project, with patients expected to start by accessing their drugs through community-based organizations (CBOs) located in villages. Already, Shs 7 million has been put in place for the drug bank.
“We also expect leaders in the district and other interested partners to provide assistance to start this new plan [drug bank]. It can be in form of donations,” she says.
However, Gulu Woman MP Betty Aol Ochan says there is need to ‘publicise’ the initiative of starting a drug bank, adding that more well-wishers could be part of it.
MP Aol, a member of parliament’s health committee, points out that having more members would also reduce on drug problems that Acholi faces since the sub-region is also battling the nodding syndrome, whose patients also take drugs for the mentally-ill.
Besides advocating for a drug bank, sensitization programmes are also being carried out by Mental Health Uganda, where leaders are tasked to get involved in the fight against mental illness in a bid to have a healthy free environment. So far, Mental Health Uganda has 40 mentors who help educate locals about mental health on the grassroots level, Atto says.
Paska Ayoo, a senior social worker at Peter C Alderman foundation, however, says although they are unable to provide drugs to the unit, ‘psychological education’ is often given to patients so that they can realise the value of taking medication on time.
“We basically teach our patients and their caretakers on the importance of taking drugs daily to maintain sanity. We also give them psychotherapy that helps to develop life skills like saving money habits that can help keep them going,” she adds.
Since 2013, at least 5,000 patients received psychological and life skills training from Peter C Alderman foundation. Last October, Rene Industries, an Indian pharmaceutical company, donated drugs worth Shs 1 million to Gulu mental health unit following media reports that the unit was facing a drug crisis.
And so, for people like Obod and Lakot, treating mental illness will remain a big challenge if the government does not address the persistent drug shortages.
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