Health
Why Nigeria-American Institute for Mental Health must be supported – Ngwadom
An America-based professor of psychotherapy and mental health clinician, Eze (Prof) Ekele Alphonsus Ngwadom was a member of the panelists that recently discussed the challenges of mental healthcare in the country at the Barrister Peter Mbah Law Auditorium, Godfrey Okoye University, Enugu. In this interview, he stated quite eloquently why adequate mental health must be supported.
Excerpts:
Let us kick off this conversation by asking you, what do you mean by primary mental health and what it portends for Nigeria?
I am a mental health licensed clinician. I am also a licensed clinical substance abuse counselor. The reason I went to the United States is to acquire knowledge and use it all over the world, especially to serve my people. A few years ago, one governor from one state in Nigeria came to the United States with an agenda to do a project on mental health. While on his USA journey, he encountered me but that attempt failed because the government did not follow up very well. He then went to another colleague of mine in another state, Dr Adiche who also had a similar experience that I had with that state governor in Nigeria. After that experience, both of us (Adiche and I) decided to form a non-governmental organization (NGO) that would focus on mental healthcare. It was our dream to extend it to our country, Nigeria.
So, we formed an organization called the Nigeria-American Mental Health Practitioners in 2000 and launched it in 2021. After the launch, we began thinking about how we could expand to Nigeria. So, two years ago, in 2022, we registered another organization here called Nigeria – American Institute for Mental Health. We have an office in Abuja. We registered with the Corporate Affairs Commission (CAC), Abuja. We hired an executive director, Charles Aneke. We have board members and I am a member of the board. The chairman of the board is Mr. Tunde Ipinmisho, from Kogi State. Since last year we have been operating outside of Abuja. Our focus is to bring this idea to the Igbo nation. It is Nigeria as a concept. However, we want to start from the South East and we could not find a better place to launch it than Enugu. Graciously, the Godfrey Okoye University generously decided to host us in collaboration with Umuada Igbo Nigeria and Diaspora.
So far, how have you been succeeding both in scope and concept in creating awareness for this gigantic program?
One of the goals why we are here is to create that awareness and education. More importantly, since the planning, we have extended an invitation to different people across the country; government agencies; governors, commissioners of health, minister of health, the Nigerian masses as well as well-meaning individuals. At least, Umuada Igbo has been quite helpful in this regard. Again, we have been doing radio commercials, newspaper advertisements, and publications. I hope that the people we can reach through the media can hear us, and hopefully, they can help us achieve our ultimate goal.
And given that we are doing this within the university environment or campus, we are expecting students also to participate. But this initiative is geared towards the people, the community, and the individuals that are affected by all kinds of mental disabilities and that is the focus. I can say we have been making tremendous success in this area.
People do not understand your particular idea of mental health. What is it all about, coming from your definition?
When we talk about mental health and primary health, what we mean is, that people with physical health challenges, headaches, stomachaches, and all kinds of ailments, usually go to hospitals, clinics, maternities, and health centers for treatments. However, people who suffer from anxiety, people who have depression, those with bipolar and others with one type of mental health challenge or the other have no place to go. There is no provision for them in the system or industry.
When it is primary mental healthcare, we mean where people can run to and get care.W hen we talk about primary healthcare, we mean having access to diagnosis; access to treatment, and access to care.
The essence is to have professionals who can take good care of individuals who have this type of ailment. Maybe I have to define what this means. When we talk about mental health and disabilities, it means anything any individual is doing that obstructs, or disturbs, his daily activities, normal daily activities in a way that is going to achieve a fruitful gain to advance his living. Anything that obstructs that normality is a mental challenge. It is called disability. Those disabilities can come in different ways. It could be intellectual, physical, substance abuse, stress of life, and so on. For instance, waking up one morning and not knowing where the next food would come from could induce somebody into stealing, which we call kleptomania. It is a mental health diagnosis. It doesn’t mean that such a person is a thief or what people in Nigeria call being mad or that such a person is a lunatic. It doesn’t mean that. Of course, that is to the extreme. Even the politicians and public officers or the wealthy that have so much money to effect changes in their communities but use the money for private gains. That is a mental problem. You go to somebody’s house, he has a mansion but nobody is living in it., and there are six, 10, 15 or 20 cars there parked in the garage. That is hoarding and hoarding is a mental health issue. It comes from insatiable wants and needs. You know you can only sleep in one room at a time but you litter the whole community with houses you don’t need. But, if you have this wealth and it is used to serve the masses, it is hilarious. That is the money that is appropriated that the government gives for the development of the community, and you give them good roads, hospitals, schools, water and electricity projects, and other amenities that could make life better. But, when someone is sitting on it or holding on to it, that is a mental issue. Now, I can go to the lowest of the lowest. When you talk of people naked, those running around on the streets, using “mkpuru mmiri” or using all kinds of drugs to mitigate their pain, because sometimes people engage in alcoholism or drugs to suppress pain. That is a mental issue. If these people had somebody who could have told or advised them what they were doing was not the solution to their problems, because they were suffering from repression. In the psychological world, when somebody takes something to reduce pain, to make it go away but comes back in a few days later, that is repression. There are many mental challenges. So, many stresses because of the way the country has done everyone and we need to bring some help. There must be answers to these and other questions to be mentally healthy.
Taking a cursory look at all what you have been explaining, you will discover it sounds highly intellectual and elitist. You don’t seem to factor in the grassroots or the low class?
Since I came back, everybody I have spoken to says we need it even now. They say Nigerians are suffering. That is why we are here. How do we get this done? We are partnering with the Nigerian Nurses Associations, we are partnering with Nigerian Midwifery Associations, of course, Umuada Igbo (Home & Diaspora) has always been there for us. We are still open to partnership with community agencies that are willing to work with us. This is so because, in some communities, there are health centres, communities hospitals, and clinics. We want to start from those areas, and begin to train already professionals in the fields. Here, we are talking about nurses or nursing assistants. We train them to understand what mental health is all about and give them the resources they need to understanding the concept and how it works. It is our goal to take that to the other professionals, not just nurses but social workers , psychologists, and students in the universities that are offering some of the social sciences to integrate mental health in their curriculum. The next concern is, how do we send this to the communities? Naturally, if you want to send message quicker to the people, you certainly use the women. If the women are interested, definitely the rest of the men will listen and that is the secret. We are glad that Umuada Igbo is partnering with us to drive this through. Through them we shall reach out to other professionals like nurses and social workers, those who can take the materials and educate the community, and make it primary. It is not something people will say they cannot afford. In the community health centres, there are nurses that are paid by the government and people can go there for attention. They may not have all the money, but then when they get treatment they can get prescription from a psychiatric assistant or a nurse practitioner. They will then take that treatment to the chemist and get the prescribed medicine. As we move on, we will incorporate other professionals in the field like teachers, police officers, correctional officers, and some government workers because this will trickle down to the communities and families. If your family gives up on you, your second level of socialization and care is the community. We want to teach the families to be responsible, to care for one another. We begin to give to the families what the unit is supposed to mean. And that is what brought about the saying: “primarily back to the people”.
Using a cliche, this project or task appears to be humongous. What is your source of funding?
This is a very good question. But before I go into that, let me introduce another layer of engagement or investment we need in the universities. We want to be a part of the team that will be designing the curriculum. We have a shortage of psychiatrists. There are about seven mental health hospitals in the entire country of over 200 million people. And then we don’t have up to 20,000 psychiatrists as others are based overseas. Thus, we gave the ratio of two million people to one psychiatrist. That is not good enough. What we want to do is to bridge the gap, to make sure that the universities, and probably, the National Universities Commission, NUC, can engrain the training of mental professionals, especially nurse practitioners to be a degree in itself in the universities where it can train people as degree awarding institution.
This is exactly what I do because as a supervisor at the master’s degree level in America, I supervise nurse practitioners who are helping to mitigate the shortage of psychiatrists in America. You see, before somebody goes to medical college, gets a degree, becomes a medical doctor, and then proceeds to be a licensed psychiatrist, that is a long term. But there is a short term that can assist that gap. When you train nurses to be nurse practitioners in the field, they can prescribe medicine. And when they go to a center where a psychiatrist is a licensed clinician who can diagnose, access, and give prescriptions to somebody with mental illness, such nurse practitioner can prescribe medicine and the people can go to the chemist to access what was prescribed. Yet, our partnership did not end here. We need pharmacists as well as multiple disciplines to join us.
And now to funding.
The Federal Government just passed a bill called Senate Bill 2022 which repealed the Lunacy Act 1964. In that bill, there is a provision that the government will appoint a minister, and in the ministry, there is a role for the governor, and the local councils in this issue. It means that everyone has a role. My point is, that there is a provision for money to be accessed in that bill.
So, with this bill, one of the things we will be asking from the Federal Government is to make the states and LGAs map out a budget for this care and training. We are not limiting to that, we are also asking individuals and corporate organizations for donations in this area. This is because any money they put into the fund can go a long way. Possibly, about two, three, or four persons that may benefit in a particular community, will be great. Again, we have a program that helps us to ensure that people buy into it.
What are the challenges you envisage as you take this project to its deserved position?
Graciously, Godfrey Okoye University Enugu in collaboration with Umuada Igbo has given us a piece of land to erect our permanent site here in Enugu. I was fortunate to sign the MoU with them. So, we want to kick off with a fundraising and a permanent site plaza, not just having a clinic but also having other offices where other professionals can come and exercise their professionalism.
