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The Painful Reality Behind Mental Health in The Gambia

The number of people affected by mental disorders in the Gambia is very significant though not empirically quantified by a national study. The prevalence rate in our country is estimated to be between 27,300 (severe disorders) and 91,000 (all mental disorders) according to the WHO. Health officials say almost 90% of people with severe mental disorders in the Gambia are left without access to treatment while others are left homeless with no care by their families and the State.

Mental Health is yet to be considered accordingly a priority by public decision makers in The Gambia in the light of the number of mentally ill people seen roaming the streets accross the country, those kept in the houses and at the Tanka Tanka psychiatric centre in Banjul. The Program manager, mental health and substance abuse, at the ministry of health, Bakary Sonko, said the Edward Francis Small Teaching Hospital (EFSTH) is given an annual budget from the ministry health for the management of the whole hospital to provide needs to all the various units attached to it in terms of medications and other basic needs. “But you don’t have a specific amount from the National budget to say D10 or D10,000 is allocated for Tanka Tanka for psychiatric medications. There is nothing like that.”

He said the Tanka Tanka psychiatric is not an independent hospital but rather it is under the care of EFSTH so the hospital provides for all its needs, in terms of medication, sanitation, electricity, food and other needs. “There is a budget for EFSTH but I don’t know how much, but that budget is for all the units the hospital is overseeing be it the Children’s ward, Polyclinic, sanatorium and Tanka Tanka so the budget does not come specifically for one unit but for all the units.”

Sonko notes that EFSTH disburses funds to all the units depending on the needs of that particular unit within the hospital and units the hospital is overseeing across the country.

A Matron of TankaTanka Psychiatric Hospital, Saffiatou Kinteh says her care is under budgeted and is under the care of EFSTH. However, she has no exact idea as to how much the ministry of health gives. “We have a store keeper who goes to Banjul two to three times a week to bring food supply and other basic needs to the unit.”

Mrs Kinteh said that all the staff at the psychiatric unit are employees of EFSTH and they are all paid by the hospital be it the cooks, plumbers and all those who work at the psychiatric unit. “We get all our medications from EFSTH once or twice in a week depending on the number of patients we have and pretty much everything we need is provided by EFSTH.”

Matron Kinteh added that the psychiatric unit is an entity where patients are not charged anything and all their basic needs are provided be it maintenance, clothing, laundry machines and dryers by EFSTH but sometimes donors support them with certain things.

We request things from EFSTH based on the needs from the hospital management and it goes through procurement and then finance will issue the check and procurement will go and buy the things we requested and collect it from them at the end of the day.”

Mrs kinteh said sometimes a patient will get violent and break two or three plates and they will have to request from EFSTH for it to be replaced, “This is how things work here for accountability purposes.”

She said they often have minor challenges when it comes to managing the unit but EFSTH normally give them petty cash of D10, 000 to take care of such issues, like repairing a broken padlock or when a patient needs a sanitary pad and the unit will produce receipts when the D10, 000 is exhausted.

Tanka Tanka sinks in the Budget allocation for EFSTH

In 2020, EFSTH received a budget of D100 million from the Ministry of Health for the management of the various units under the hospital, like the Children’s ward, Polyclinic, Sanatorium and Tanka Tanka respectively.

The breakdown of the amount of money that goes to mental health programs for 2018, 2019 and 2020 is as follows: In 2018 D269, 796 was allocated for printing expenses, specialized and technical materials and training respectively.

In 2019 D1, 200,000 was allocated for miscellaneous office expenses, printing expenses, specialized and technical training, supervision, analysis and strategy preparations and training.

Lastly in 2020 D920, 000 was allocated for the same purpose bringing the total expenditure from 2018-2020 to D2, 389,796.

Life after Tanka Tanka

Aji Bintou Ceesay (Not her Real Name) was a patient at the Tanka Tanka psychiatric unit for a few months, she was suffering from depression but now she is fully reintegrated into society. “The few months I was at the psychiatric unit was the worst time for my family and loved ones because of what they went through, the  daily stigma until the day I was released from there, they suffered more than me because I was not conscious and unaware  of what was going on and it had less impact on me.

Aji suffered from depression because her husband married a second wife without her consent and she learned about the new wife when everything was done and she felt betrayed and went into a serious depression.

Even though I have already moved on but you can clearly see that I am still not completely over it because healing takes time, when it happens, I feel worthless, betrayed, angered and at some point, I wanted to take my own life if it was for my mother and uncle by my side.”

She said it came to her as a shock and the depression started getting into her and her mother took her to Banjul polyclinic for check-up but her condition was getting worse as days passed so she was referred to Tanka Tanka for proper medical attention.

You see at the Tanka Tanka you have a lot of patients that are suffering from depression, some of the women are betrayed by their husbands and some are still grieving over the loss of a beloved one”.

She added that Tanka Tanka changed her life and she can’t thank them enough and urge the government, individuals and NGOs to continue supporting the only psychiatric unit because they are doing tremendous work when it comes to mental health.

Look at me now, I am doing just fine and grateful to all the people that had helped me through this horrible journey.”

Lamin Saine, was a patient at the TankaTanka psychiatric unit, he is fully recovered and back with his family, he was suffering from drug induced psychosis. Lamin now sells vegetables which he grows at home and business is going well with him. “I got support from MOBEE Gambia, an NGO that rehabilitates and supports patients from the psychiatric unit to reintegrate into the society, they help you to venture into gardening or restaurants and the profit you make at the end of the month or year is yours.

I will hold onto this business and take it very seriously because I don’t want to go back to doing drugs again because it almost ruined my life and that of my family.”

70 to 100 mental health patients received daily at the polyclinic

Dr. Pedro Hernandez, Head of Psychiatric Department, Banjul Polyclinic said the polyclinic receives in a day 70 to 100 patients from the ages of 18 and above with mental health conditions, ranging from, acute psychosis, drugs induce psychosis, and schizophrenia.  “We refer at least 4 patients daily to Tanka Tanka for proper treatment because their conditions are very serious and they can be very violent so we cannot send them back to their homes.”

Dr. Pedro said Tanka Tanka receives 70 to 100 patients a day and a psychiatrist doctor from the polyclinic visits the psychiatric unit twice per week to check on patients whether they are taking their medication because sometimes the psychiatric patients will refuse to take them.

He said sometime there is a shortage of medication at the Polyclinic and at Tanka Tanka while it’s impossible to have the medications at the pharmacies either. “We have problems sometimes with the medications because we used frequently modern injections to inject into the brain of the patients to keep them calm for four weeks but the moment the medication finished the patients became very violent”.

He urges the public authorities to help the polyclinic and Tanka Tanka with the necessary medications like, stabilize RT that help avoid the reaction of the injection of the medication when the patient takes it.

In The Gambia there is a large gap between the numbers of people affected by a mental disorder and those receiving treatment. While the prevalence rate is estimated to be between 27,300 (severe disorders) and 91,000 (all mental disorders) the maximum number of people receiving treatment is estimated to be 3,278. According to WHO.

The total number of patients with psychiatric conditions at Tanka Tanka from 2019 to 2020 is 1,717 their conditions range from schizophrenia, Bipolar, Mania Depression, organic psychosis among other psychiatric conditions.

 

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