The Plight of Zimbabweans with Common Mental Disorders
The Global healthcare space has seen drastic changes in the last few decades as technology and human innovation continue to push the boundaries of discovery as the medical community strives to serve the seven billion vital earth constituents. However, the African continent has for a long while been the last to receive these advances. Till today, the majority of African nations fails to cover the basic medical needs that have been dealt with elsewhere on the continent. Take, for example, how Chad and Sudan are still battling the poliovirus (Beaumont, 2020), while the last European case of indigenous wild poliovirus was in 2002 (WHO, 2002). This brings to light the many gaps in African Healthcare systems and more-so when it comes to mental health. A recent study carried out by Lancet Global Health showed that “the scarcity of research reflects the weakness of mental health systems on the continent and the blind eye turned to the problem by many Africans and their governments” (Sankoh, Sevalie and Weston, 2018). Therefore the continental lack of urgency and infrastructural inadequacies require a further unveiling to understand the plight of mental health patients in Africa truly.
One African nation that sticks out when mental health is in purview is Zimbabwe. With a population of nearly 14.5 million (World Bank, 2020), a torrid economic history and a collapsing health system, it is a prime breeding ground for inadequacies in addressing the mental health crises. Zimbabwe has had a rollercoaster of a decade as it drove from economic pandemonium to a momentary breath of fresh air and then a slow descent into the abyss of dilapidation. As wages provided the in local currency became useless and corruption depleted resources in medical facilities, a massive and persistent brain drain has depleted the nation of many highly-skilled individuals, especially in the medical sector (Chikanda, 2006). This has led to the whole country only having 11 registered psychiatrists to serve the population (Sternfels, 2019). These clear markers will be further elaborated to break down the mental health crisis in Zimbabwe and Africa.
Shame is a deterrent as multiple hurdles prevent individuals from seeking help. At first, their own idea that if they press on, they will overcome the dark spell that they will not fully understand. Depressed individuals continue to wallow in their problems as multiple jokes are chided off by peers if they open up about a stressing issue (Dindoyal, 2017). In many African homes, the mere possibility of revealing a problem is seen as exposing one’s dirty laundry to the community (Gatera, 2020) and as internal dilemmas are covered-up, so are external ones. Teenage pregnancy, mental breakdown and sexual assault are all significant issues that are hidden in family structures, and victims of these crimes are silenced and often continue living with their tormentors. Due to loopholes in the justice system, victims prefer to hide their trauma as only a few cases of sexual assault are prosecuted, and many cases go on uninvestigated (IRIN Africa, 2003). A compromised justice system is an environment that allows for depressive bouts to take hold and further torture the victims who never find solace in society.
Under cover of night, families seek out traditional or archaic methods of dealing with their family member’s mental calamities (Kajawu, 2017). Families visit the local conventional healer or fight tooth and nail to have a one-on-one session with a renowned self-styled prophet. This is not to discredit the effectiveness of traditional medicine, but rather to bring to light how Zimbabwean are still firmly attached to their ancient spiritual practices. Though the mostly Christian society (Evason, 2017) may put a facade of righteousness, these incognito sessions show the extent to which Zimbabweans will go to hide mental health problems and resort to alternative means of resolving mental disorders.
Financial constraints are also a significant obstacle to the ability to reach medical professionals. The scarcity of these qualified practitioners raises their demand and in turn, increases their consultation fees (Sternfels, 2019). Recent economic fluctuations that eroded pensions and life-long savings means parents, guardians and caregivers are unable to cover the cost of basic necessities (World Bank, 2020), let alone a specialist in mental health. With a projected tripling of the African population, without intervention, the economic woes will only persist. As more and more youths fail to find meaningful occupations, the stress of providing for the family keeps mounting (World Bank, 2020). Research suggests that three out of ten youths are gainfully employed (World Bank, 2020), which is a worrying figure as it begs the thought of what these other youth spend their time doing to survive. These are a few of the pressures that weigh upon the common Zimbabwean, as navigating life begins to strains one mental facility.
Chasing the rabbit.
Many youths from all social levels have decided to take matters in their own hands and decided to alter their minds and momentarily forget their burdens through the use of drugs. In a recent VICE documentary, young residents from the high-density area of Mbare in the capital of Harare swear by the wonders of a cough syrup that they take to reach an altered mental state for the day and forget the stresses (Jellestad, 2020). Drug abuse has become a significant issue among Zimbabwean youth as they try to evade the realities of unemployment, police brutality and societal decay. The problem has reached a level where Dr Chido Rwafa, Zimbabwe’s deputy director of Mental Health Services stated the government could not afford to single handedly deal with the of the substance abuse problem (Mavhunga, 2019). Ultimately, as the societal pressures, mount and professional help outlets are scarce, the common Zimbabwean resorts to internalising their hurt or hurting their bodies with substances.
When your thoughts burden you, your family fails to support you, your community strives to put you down, and the country is in the retrogressive state, the only option for some is suicide. Zimbabwe has one of the highest suicide rates in Africa of 1.3% of all recorded deaths in 2018 (The Herald, 2020). With 1641 recorded suicide deaths, coming in close to the 1838 road accident deaths (The Herald, 2020), the nation would not be amiss in labelling it as a looming crisis. Families are often caught unaware, as their seemingly happy relatives turn to strangulation or a myriad of self-inflicted harming methods. Survivors of attempted suicide are in far worse condition as they will not have the necessary medical support to assist in their recovery and relapse prevention.
A step in the right direction
Despite mental health patients facing multiple barriers to assistance in the mental health space, there is a glimmer of hope. Small but steady strides are being made by Zimbabwean citizens decided to take matters into their own hands for a change. Take, for example, The Friendship Bench. Dr Dixon Chibanda took the initiative of filling the psychiatrist gap through the intervention of training lay health workers (LHW) who are stationed in local health centres across the country (Sternfels, 2019). Results collected to date, show that among individuals with common mental disorders in Zimbabwe, LHW-administered, primary care–based problem-solving therapy with education and support using the Friendship Bench improved symptoms at six months of therapy. Proving that though the task may be overwhelming, subtle strides like this are in the best interest of Zimbabweans.
In the last two decades, a few non-profit organisations were launched or grew exponentially to address societal and mental health concerns of overlooked minority groups in the Zimbabwean community. On the frontline of assisting the LGBTQIA+ population, The Gays and Lesbians of Zimbabwe (GALZ) has availed its services to help displaced individuals who in most cases, had been disowned by their families. GALZ’s advocacy has mostly been incognito as Zimbabwe is a heavily conservative society that has homophobia entrenched in multiple facets of its fibre. The work of GALZ was hampered mainly by homophobic rhetoric spread by the late former president of Zimbabwe, Robert Gabriel Mugabe. He is famously quoted for saying that members of this community were “worse than pigs and dogs”(Moyo, 2017). Such a harsh societal tone results in members of the LGBTQIA+ community avoiding health facilities as they will be stigmatised, intrusively interrogated or even handed over to the authorities and having their sexuality exposed to the public (GALZ, 2017).
Another organisation that tackles mental health issues is the newly formed OCD Trust seeks to support citizens of Zimbabwe to end the mental health disorder stigmas (Zimbabwe OCD Trust, 2020).
Bringing mental health to the forefront and addressing it is crucial now more than ever due to the significant health gaps that have been exposed by the COVID-19 Pandemic. Global lockdowns and policy inconsistencies, many people have lost their jobs, lost relatives due to the virus, and some unfortunate souls are trapped with their abusers in quarantine arrangements (UN, 2020). When all is said and done, we realise that the Zimbabwean mental health dilemma is not an isolated instance. Multiple African nations face identical or far worse instances of inadequacies with this issue. In Zimbabwe, the social effects pile up on the average citizen until they are diagnosed with one mental condition or another. However, initiatives are springing up that will help address mental health from a grassroots level. Even as one deals with their struggles in school, work-space trials or life in general, there is always a shoulder to cry on or a willing listening ear.
The following resources may assist Zimbabweans struggling with a common mental disorder (CMD), such as depression or anxiety:
Suicide Hotlines: Harare – 080 12 333 333/ Bulawayo – (9) 650 00/ Mutare – (20) 635 59
The Friendship Bench: https://www.friendshipbenchzimbabwe.org/
LGBTQIA+ Support: https://galz.org/health-1/mental-health-resources/
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