- The Washington Times - Sunday, March 15, 2009

KISII, KENYA (AP) - Every day before she leaves home to fetch food and water, Esther Nyaboke forces her two daughters into a baking, windowless shed and slams the door.

For Nyaboke, whose children display the symptoms of serious autism, the only way to keep the girls safe while she is away is to lock them up.

“If no one will help me, then what can I do except lock them up?” Nyaboke told The Associated Press from her traditional thorn-fenced compound near the town of Kisii. “I have to leave sometimes even if it’s just to fetch water.”

In Kenya and many other African countries, poverty, lack of access and the stigma of mental disease prevent many patients from getting the help they desperately need. Despite some recent progress, just 0.01 percent of Kenya’s health budget is spent on mental health, compared to around 6 percent in the U.S., for example.

Yet about a quarter of Kenyans seeking medical help have problems with mental health, says Dr. David Kiima, director of mental health. He estimates that about 10 percent of Kenya’s people have mental health issues, and about 1 percent have disorders serious enough to warrant inpatient treatment.

The problem is worse in some other African countries such as Liberia, which suffered 15 years of brutal civil war and had numerous child soldiers. The World Health Organization says up to 85 percent of mentally ill or disabled people in the developing world never get treatment.

“The community does not see these people as human beings. They do not see their suffering,” says Edah Maina, who heads the Kenya Society for the Mentally Handicapped.

Over the last seven years, the organization has forcefully taken more than 3,000 children and adults with mental illnesses or disabilities from homes where they were abused. The organization tries to educate families to accept their mentally ill relatives back and treat them well. But some refuse, and the mentally ill or disabled person may then end up in a government hospital for the rest of their lives.

The bland beige binders lining the walls in Maina’s busy Nairobi office hide a litany of nightmares. In one photo, a 16-year-old autistic girl is led from a dark shed into the sun but can no longer see the light that warms her. After being locked up by her mother for 12 years, she has gone blind.

A grainy video shows a man with mental disabilities chained in a dog’s kennel by his parents for a decade. In another incident, rescue workers open a corrugated iron door to reveal a chained, emaciated man with schizophrenia. His legs dangle uselessly after 15 years of malnutrition and confinement.

Countless other files show insects feeding on tied-up, swollen limbs and open sores festering under plastic bags used as diapers.

“Sometimes we can’t sleep for days after an intervention,” Maina admits.

Some of the worst abuse is sexual. People with mental illnesses or disabilities are often unable to protect themselves. In some African countries, like Kenya, Zambia and Egypt, their evidence is not admissible in court.

Some steps are being taken. Kenya’s 2003 Disability Act made it an offense to “conceal” or imprison the mentally ill or disabled. Some self-help groups have been set up to offer them and their caregivers support, and primary care workers are being trained in mental health.

But Kiima acknowledges there is little public knowledge about mental illness and not enough funding for a campaign. There is not even enough money to track how many people with mental health issues are treated each year. Kenya has only one psychiatrist for every 500,000 people, compared to one for every 8,000 at most in the United States. With so few doctors, many mentally ill or disabled Kenyans have no chance of a proper diagnosis and the conditions, which require very different care, are often confused.

Subsidized drugs are offered by the government but are often out of stock and can only be accessed by the few that can afford bus fares to local hospitals. Often the mentally ill or disabled are unable to get HIV/AIDS drugs through normal channels, since patient consent is required for testing. These patients _ described in Kenya’s own penal code and constitution as “idiots,” “imbeciles” and “persons of unsound mind” _ are legally deemed unable to give their consent and so can normally get neither tested nor treated.

Only a handful of trained specialists offer diagnosis or counseling outside the capital of Nairobi. Without access to doctors, many still believe the conditions are caused by witchcraft.

Families take affected relatives to traditional healers. Sometimes their personal knowledge of the patient’s culture allows successful treatment _ Kiima hopes to alleviate staff shortages by offering some healers formal training as community outreach workers.

But practitioners can also be destructive.

A few minute’s drive from Nyaboke’s house, a 28-year-old woman diagnosed with schizophrenia displayed slashes on her stomach from a witch doctor’s razor blade. Her relatives took her for treatment, hoping to exorcise the voices in her head. Instead her attacks worsened as she spent three months tied up naked, sliced and beaten, and forced to drink mysterious potions. The woman, who asked not to be named to protect her from attacks by fellow villagers, eventually received a correct diagnosis and subsidized medication from a government hospital.

Others do not survive. In the cool darkness of Hema Hospital morgue lies the corpse of a man in his 60s. Hezron Manduku, the hospital director, says the patient exhibited signs of mental illness when he was brought in by relatives. They said he had been treated with “traditional remedies.” Before the man could be diagnosed, his body swelled with fluid and the skin peeled off. Days later, he died.

“These traditional healers often administer medication which is the wrong dose, or expired, or otherwise inappropriate,” Manduku said. “We have no way of knowing what they have been giving patients because they prefer to keep treatments secret.”

With so few options available, some Kenyan families remain torn between their loved ones’ freedom and their safety.

“I feel so bad to lock them up because they’re human like me and my kids, so I love them, but what can I do?” Nyaboke asks as her daughter barrels into her lap for a hug. She strokes Veronica’s hair gently as the girl chuckles and coos.

“Sometimes I feel like a prisoner myself,” she adds softly. “But how could I give up on my kids?”


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