How to tackle mental illness, brain-drain in Nigeria —Psychiatry expert

Ernst Josef Franzek, German professor of psychiatry and neurology and vice-president of the International Society of Differentiated Psychiatry, is a frequent visitor to Nigeria. The renowned psychiatrist, who once delivered a lecture at the Federal Psychiatric Hospital, Uselu, Benin City, recently inaugurated his non-governmental organisation, the Legionnaire for Mankind’s Health in The Netherlands. In this online interview, he speaks with EBENEZER ADUROKIYA about his plans to tackle mental illness in Nigeria with a special interest in Delta State. Excerpts:

 

Why did you decide to establish the NGO, Legionnaire for Mankind’s Health?

The population of Nigeria, now about 200 million people, is mostly younger than 40 years. The mean life expectancy is far below 60 years. This is caused by many early deaths before age five. The reason for this is prenatal and early postnatal malnutrition, lack of adequate midwifery and early baby care. Another reason for the high prevalence of deaths before 59 years is disease which could have been easily treated by a normal functioning health care system. However, proper healthcare is only available for the privileged and upper class people. It is obvious that only the few privileged people in the country have a life expectancy compared to the civilized western countries. An overwhelming number of people in Nigeria, however, live in poverty or even in extreme poverty with less than one dollar income per day. This means that the great majority of Nigeria’s populace do not suffer from diseases caused by abundance, but in contrast by diseases caused by scarcity like lack of healthy food, lack of clean drinking water, lack of proper sanitation. It screams to the sky that more than 40 million people do not even have functioning toilets and adequate sanitation.

The consequences of this dreadful and inhuman situation are high levels of violence, criminality, insurgencies, child soldiers, mental diseases, including addictive behaviours.

The problem of Africa is poverty, mismanagement of resources, neglect of the youth, exploitation of natural resources through the highly civilized world.  Since more than 500 years, Africa is exploited for its resources. The common population is enslaved with starvation wages and child labour. The last century’s modern work-slavery took over the place of the ancient slave trading.

Charity is often used to cover up crimes on humanity and environment. The NGO “Legionnaire for Mankind’s Health” is not a charity organisation. Nigeria and Africa does not need charity. Nigeria and Africa can preserve themselves. What Africa needs is empowerment of its own population. Magic elements of this approach must be respect for the sanctity of every human life, free midwifery and primary baby care, available healthy food and clean water, quality education for everybody, free university education for skilled young people, keeping well educated people in the country (no brain drain), making natural resources benefit the whole populace and not only being of benefit for a few privileged and often greedy business organisations. Not the status of parents should determine the life and development of Nigeria’s and African’s children and youths, but talents, skills, ambition and personal efforts.  These issues should belong to the major tasks of elected governments.

 

What informed your choice of location, in other words, why did you specifically target Nigeria among other African countries?

The primary starting point of the “Legionnaire for Mankind’s Health” is Africa with a special focus on Nigeria. When I first met Comrade Sunny Ofehe, living in The Netherlands, born in Delta State, I started to immerse myself into the problems of Nigeria. Sunny informed me about his own story and the exploitation of natural resources through a well-known oil company of Europe. My heart cramped and I got constantly thinking about solutions for this great nation of now about 200 million people. I visited the country together with Sunny first in December 2017 and then alone in December 2018. I saw the unbelievable contrast of extreme richness and extreme poverty, I saw a country that could be a paradise for its people, but is kept in custody  by few selfish and greedy people who are only looking for power and money without respect for basic human rights and needs of common people. I fell in love with this sleeping beauty and her common people, who are fighting every day for their daily living. I got inspired by Sunny Ofehe,  his deep love and passion for his people in Delta State and his restless activities to bring Delta State and its problems into the  attention of the public. I correlated the situation of Nigeria with the results and conclusions of our studies on the consequences of prenatal malnutrition on somatic and mental health later in life. I found it conceivable that the consequences of chronic hunger and malnutrition, lack of future for the youths are at least partly a reason for the high prevalence of violence, criminal and addictive behaviors in Nigeria. We deduced the overall conclusion that criminals, addicted and other (mentally) ill people must not be the only focus of interventions of governments. However, the underlying problems like lack of enough and healthy food, lack of clean water and adequate housing, lack of midwifery and adequate baby care, lack of adequate sanitation, lack of primary and secondary education, have to be tackled intensively.

 

Specifically, what are the aims and objective?

The Legionnaire of Mankind’s Health is not a charity organisation. The organisation stands for encouraging and putting people in a state where they can peacefully gain access to basic human rights for everyone; respect of sanctity of life; cooperation when it comes to resolving common (global) issues of mankind, infrastructure for agriculture, industrial and economic development without being hampered by individual greedy behaviors.Reconciliation with and integration of people fighting for basic human rights, better life circumstances and a proper future for their children, their youth and their own people and communities in general.

 

As a renowned expert on mental healthcare, will your organisation be focused on this area alone or you intend to look at the general healthcare sector in Nigeria?

Mental healthcare is a part of the general healthcare sector. Prenatal and postnatal malnutrition affects the health of a population in general. Our organisation has to look at the general healthcare sector in Nigeria and thus intend working together with primary, secondary and tertiary health organisations. There is also the need for intensive discussions with the church and other religious institutions: (Mental) Health is not a matter of only praying to God in order to better the situation. God gives mankind the prerequisites for a healthy lifestyle, but people have to actively use their skills. Life is a matter of action, personal effort and personal initiative.

 

Nigeria is Africa’s largest population with the highest rate of people with mental illnesses. How do you think your organisation can make an impact in this area and what is the organisation’s long term vision?

This question is already partly answered. The problems with respect to mental health care challenges are in particular acute psychiatric issues like depressive disorders, acute psychotic disorders and acute drugs related disorders. Mental health care should be integrated in the primary health care within the communities. Trained health care workers should be able to go with mobile units to the patients’ houses or communities. Regular consultation hours should be held by trained health care workers in the communities. It would be desirable that at least one psychiatrist would be available for 10.000 people (now 0.1 for 1 million people). Treatment wards should not only be concentrated in big cities. Mental health care in the primary health care situation should be fully funded by the government. The revenue of natural resources of the country must be used for the health and wealth of local people and not only for the privileged ones and foreign investors coming from US, Europe and China. Health is wealth, which is our current driving principle as stated in our motto.

 

You have  published articles in several world journals, which of your published articles do you think carries the burden of health care challenges in Africa and how did this article deal with this problem generally?

The exposure to prenatal nutritional depletion of still unborn babies was found to be associated to a variety of somatic and mental diseases later in life, including addictive behaviours, antisocial personality disorders and, interestingly, we found a not earlier reported enormous excess of male births in our recent study, published in 2019 in the Open Journal of Nutrition and Food Sciences 1 (1): 1004.

Based on known and accepted facts in the scientific literature, we discussed the consequences of pre-conceptual, prenatal and early postnatal malnutrition on Mental Health in adulthood. We came to the following conclusions and hypotheses: first, prenatal exposure of the unborn baby to severe malnutrition significantly increases the risk of addictive behaviours later in life for both men and women. Men are most vulnerable after famine exposure in the first trimester of gestation, however, women after famine exposure in the third trimester of gestation.

Second, there is evidence that pre-conceptional exposure to severe starvation (malnutrition) and other life-threatening stress situations of both mothers and fathers has a critical impact on sex determination in favour of male offspring. We found an enormous excess of male births that has never before been reported in the scientific literature. The following prenatal and early postnatal exposure to malnutrition of these babies obviously has a critical impact on the development of their brains with persisting antisocial personality traits and liability to addictive behaviors in adulthood, including aggressive and violent behaviors.

 

 

The health care challenges in Nigeria can be traced to the government and lack of medical personnel and infrastructure. As an expert in this field, where do you think Nigerian government is failing in its duties to either provide or improve health care in the country?

The budgets for health care are very low and health care institutions are mostly concentrated in big cities. Falling ill is for most people a catastrophe and a fall in even deeper poverty. Suffering from normally good treatable diseases is often life-threatening. There are no proper health insurances and if you do not have money, doctors will not treat you. This means many people die from treatable and preventable diseases. The mortality rate before age five years is about 20 per cent while in western societies the mortality rate before age five years is mostly below one per cent. The mean age of the common people is far below 60 years, lowest in the Delta region (about 50 years) with its severe environmental degradation as a consequence of crude oil mining through multinational companies. A great proportion of doctors who have finished their studies leave the country and start working in the US, Europe or UK, because of much better payment and working conditions.

Almost none of them ever goes back to work for his/her own people.  In Nigeria, mental health care is completely lacking outside big cities. Traditional healers and the church are treating severely psychiatrically ill people. As a doctor who cares for (mentally) ill people, I feel very sad about this situation.

 

As you may know, we have shortage of trained mental health doctors in Nigeria and most top doctors have left the country to seek greener pastures abroad. What is your advice on how we can deal with this situation?

As I already mentioned above, this phenomenon is called brain-drain. Young doctors leave the country because they find better working conditions and better salaries in other countries. The money doctors are getting for their hard work in Nigeria is not attractive for them. Working in the health care sector at all is not attractive, because health care has only a low status in politics in Nigeria. Politicians go outside the country when they need medical treatment, because they do not trust and rely on doctors and facilities of their own country. Again, as a doctor who cares for (mentally) ill people, I feel very sad about this situation.

The government must commit increase funding in the health care sector and review the salaries and wages of health care workers. The starting point should be setting up a committee to review the various purpose of increased brain-drain in the country. If the working environment is improved, it will not only lead to decrease in brain-drain, it will also attract Nigerian health care workers abroad to return to the country.

 

Many of several health care cases in Nigeria is termed “spiritual” or consequences of evil act which several experts say are not true. What can you say about this and how do you reconcile the role of religion in dealing with mental healthcare in Nigeria?

The role of religion has to be redefined when it comes dealing with mental healthcare in Nigeria. The lack of scientifically based treatment of the mentally ill people has led to the situation that traditional and religious healers take over the treatment of even severe mentally ill patients. They do their best to improve the suffering of those patients, but often worsen their suffering and creating inhuman procedures like chaining up these patients.

It will become a special task to adequately communicate with and educate the traditional and religious healers with modern and scientific based treatment methods. Mental illness is never a punishment from God, or a consequence of devils or witch craft. Mental illness must not be stigmatised but looked at and treated as equally to somatic diseases.

The government must embark on public enlightenment campaign to educate the general population on the need to change this general mindset among the people particularly in the rural areas of the country.

 

Will your organisation be working with government agencies and local Nigerian NGOs?

Our organization will be working together with both government agencies and local Nigerian NGOs. Nigeria has to build up her own (primary and secondary) healthcare system with and for local people. The aim has to be getting independent from charity and independent also from NGO’s located in foreign countries providing charity. Charity does not help to improve life conditions of poor people but just keep them dependent and vulnerable. Child work has to be banned, primary and secondary education need to be compulsory, the position of women must be strengthened and forced marriages have to be banned.

These are additional areas we shall be offering our services of corporation among critical stakeholders in this sector. We are hopeful that with the resources and human capacity that Nigeria possesses, the country can achieve the United Nations Sustainable Goal of Health for All.

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