By
Rowan Moore Gerety
IBADAN, Nigeria—Al-Hajji Mojeed thinks
of himself as a reformer. After he welcomed me to the offices of his Olaiya
Naturalist Hospital in Ibadan, Nigeria, he led me to a small, windowless room
where a patient was shackled to a rusty engine block, recovering, as Mojeed put
it, from “head surgery.” Three days earlier, Mojeed had used a razor blade to
make a long incision in the patient's scalp, then filled the gash with herbs in
order to allow malevolent spirits to escape through the wound.
The room was the last in a row of
cubbyhole-like shops that sit in front of Mojeed’s house, concrete painted
sea-green, with double doors cut from the walls of shipping containers.
Mojeed’s wife operates a hair salon in one of the rooms, small general stores
rent two rooms in the middle, and at the other end of the row, Mojeed keeps a small
office lined with shelves of herbal concoctions in recycled plastic water
bottles.
Back in his room, Mojeed’s patient was
sprawled out on a mat across the entrance, using his arms to shield his head as
he slept. A chain around both ankles left him enough slack to sit up and face
the street or to turn and lean against the wall. Beside him, his mother sat
silently, smiling. She planned to stay with her son at Mojeed’s hospital for
the next two months.
According to Mojeed, spirits had
haunted the man periodically for 12 years. Before the surgery, he was hostile
and violent. When his family delivered him into Mojeed’s care, they brought him
with his hands and feet bound with rope. The patient had been cursed by debtors
in a business deal gone bad, Mojeed said, and his family had taken him to a
series of spiritual healers with no change for the better.
Standing in the
doorway, Mojeed was ready to declare the surgery a success. “That is why he is
sleeping,” Mojeed said. “The medicine is taking effect.”
Professional psychiatric care is
basically inaccessible for most Nigerians with psychosis, a term used to
describe a broad range of conditions that involve some disconnect from reality,
including schizophrenia and bipolar disorder. Fewer than 200 psychiatrists work
in a country of 168 million, and since Nigerians usually consider psychosis a
supernatural affliction, psychiatrists are rarely seen first, if at all.
Increase Adeosun, a psychiatrist who
manages intake at Nigeria’s largest psychiatric hospital, says patients usually
only turn up there when the symptoms have reached a “melting point, when every
other [option] has failed.” Most have already put in long stints at churches
and mosques—where they are often subjected to fasting and periods of
isolation—or in centers run by traditional healers. Flogging and shackling
patients is sometimes practiced at all three.
The clinical rule of thumb for
psychotic disorders, meanwhile, is “the shorter the onset, the better the prognosis,”
Adeosun says. As a result, psychiatrists typically find themselves treating the
“treatment” as well as the illness, with many patients suffering from symptoms
that have been exacerbated by the work of other healers.
But spiritualists like Mojeed represent
the only consistent frontline psychiatric care in Nigeria.
Whether they’re
Christians, Muslims, or animist complementary providers (medical jargon for
traditional and faith healers), they are present in nearly every community in
the country. In Ibadan, Nigeria’s second-largest city, a single Muslim healer
operates a facility that houses twice as many patients as the only psychiatric
ward in town.
For Nigeria’s medical professionals, the trick is to convince
spiritual healers to modify their treatments and even refer some cases to
clinical doctors. If that type of collaboration happened on a large scale, it
could transform the prognosis for thousands of people suffering from acute
mental illnesses.
That’s exactly the cooperation that
Ibadan psychiatrist Oye Gureje is hoping to encourage. He’s the principal
investigator of a six-country research project called the Partnership for
Mental Health Development in Sub-Saharan Africa. Gureje says that the goal of
the program, which is funded by the U.S.-based National Institutes of Health,
is to design a collaborative “shared care” program between professional
psychiatrists and traditional healers.
The hope is to spare patients from the
most harmful practices, and ideally have some referred to specialists for
treatment sooner rather than later. African medical literature is rich with
studies on how both patients and practitioners view mental illness and its
causes, but this is the first research project devoted to evaluating the
feasibility and benefits of psychiatrists and traditional healers practicing in
tandem. “We don’t really know how it will work,” says Gureje. “We just have to
wait and see.”
It’s clear that Gureje would like to
see the traditional healers phased out immediately. But he has to be more pragmatic.
“It will be decades before we have enough psychiatrists in Nigeria to meet the
need. Until we're able to convince people that their worldview is wrong, that
there is no supernatural causation of mental illness, these people are going to
be patronized,” says Gureje. “If that is the case, what can we do to make their
practice less harmful, to make it beneficial to patients?”
For his part, Mojeed seems like an
unlikely candidate for compromise. Although the head surgeries he performs are
technically illegal, he believes in the procedure and views Western medicine as
ineffective against psychosis. There may be physical causes for anxiety and
depression, but psychosis, Mojeed explained using a Quranic term for spirits,
is caused by “djinns taking over a person’s mind.”
Where psychiatrists see cycles of
remission and relapse, traditional healers see the failure of Western medicine.
“The treatment at UCH doesn’t reach the brain,” Mojeed said, referring to the
University College Hospital of Ibadan. “It only manages, never heals.” His
consultation room is decorated with local news clippings heralding outright cures
against the odds: “Madwoman completely healed after 21 years,” one reads.
Since
1997, Mojeed has run an association called Atorise—in Yoruba, the name means
“repairer of heads”—organizing the ranks of Ibadan’s traditional mental health
practitioners with an eye toward proving their legitimacy to the Nigerian
medical establishment. Last year, Mojeed suggested that the university hospital
should refer patients to him they are unable to cure, a proposition he says
they rejected out of hand.
As horrifying as Mojeed’s methods may
sound, he is considered more progressive than most. Wole Adejayan, a researcher
at UCH, says Mojeed stands out among dozens of traditional healers for his
efforts to temper the methods used by his colleagues. Through Atorise, Adejayan
says Mojeed has argued against beating or withholding food from patients. His
facility is one of only a handful that requires the presence of a caretaker
alongside the patient for the duration of the treatment.
Indeed, a few decades ago, techniques
performed in U.S. asylums were every bit as cruel. A 1946 article in Life
describes life-threatening beatings routinely visited on inmates of
psychiatric hospitals by their attendants, as well as long periods of
confinement in dank cells where patients slept on the ground and wore thick
leather handcuffs.
Three years later, in 1949, a Portuguese
neurologist won the Nobel Prize for developing the lobotomy—a procedure no
doctor today would recommend. Insulin shock therapy, designed to induce a
comalike state in schizophrenic patients, was common in the United States through
the 1950s.
Mojeed remains leery of participating
in collaborative treatment for psychosis. His concern is actually based on
medicine; he’s worried about the possibility of negative interactions between
pharmaceutical drugs and the sedative, plant-based concoctions he gives his
patients. Unless, that is, it could be done sequentially by making referrals
when one form of treatment proves ineffective. In that case, he said, “If the
government will provide shelter and food for patients, members of Atorise will
provide our services for free.”
Other faith healers are similarly
open-minded. In Ibadan, I spoke to a pharmacist who says he periodically sells
Largactil—the anti-psychotic chlorpromazine—to robe-wearing pastors who
administer the drugs dissolved as a cocktail in a glass of holy water.
One problem, as with so much in
Nigeria, is money. Psychiatric treatment is expensive, and even the government
can’t always pay its hospital bills. In July, when Ogun State’s funds were
tight, officials stopped sending homeless patients with severe mental illness
to a more expensive government-run psychiatric hospital, instead opting for
Ademola Mental Hospital.
Ademola is a traditional healing center that practices
diagnosis by incantation, reciting verses to invoke the presence of gods
responsible for mental illness. When I visited in the middle of October, two
patients were chained to pillars on the front porch.
It’s hard not to see psychiatric
hospitals and traditional healers remaining in direct competition. For now,
though, it’s the psychiatrists whose livelihood seems most uncertain. Last
month, residents in Nigeria’s public hospitals went on strike for more than
three weeks; some doctors hadn’t been paid in more than four months. Most patients
were left to look elsewhere for treatment.
This story was made possible by a grant
from the International Reporting Project (IRP).
Rowan Moore Gerety is a
writer and radio producer based in California.
Source: http://www.slate.com
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