When a relative loses it

When a relative loses it

…Mohlomi battles to cope with huge influx of patients…

MASERU – WHEN Mojalefa Selialia speaks, his voice betrays little emotion. But bottled inside are feelings of anxiety and depression caused by having to deal with mental illness.
With two close relatives suffering from mental illness, Selialia says the condition is taking a toll on his family.
Authorities say there is little they can do to help due to lack of adequate resources, leaving people with mental illness and those who care for them at the mercy of a hostile society.

“This is heart-breaking,” says Selialia, referring to the condition of his nephew and niece – both who are mentally ill.
His nephew has been enduring the condition for more than two decades.
Because of lack of space and experts, Selialia’s nephew could not be kept in hospital for long.
“If it was up to us, he would be staying at the hospital right now,” says Selialia. “His situation is saddening.’’
‘‘Being admitted at Mohlomi (Mental Hospital) puts him at ease,” Selialia says.
Selialia says it pains him “very much” to see his 40-year-old nephew walking around naked and no longer taking a bath.

‘‘The only time he gets dressed is when a group of people force him to cover his body,” he says.
“He wears the clothes until they become so dirty that you cannot recognise their colours. At times those clothes get torn and he would not mind. His complexion has changed as well. Now he looks darker,” says Selialia.
“We saw things getting worse day-by-day.’’
He has been in and out of Mohlomi Mental Hospital but nothing has changed.
“This is heart-breaking.”

Selialia says his nephew rarely goes home and in most cases refuses to eat home-cooked meals.
Many times, he disappears from home for months, leaving family members worried about his safety.
Being out in the public leaves mentally ill people vulnerable to abuse, says Selialia.
‘‘They just do not accept his problem and at times some people tease him and end up beating him. That is not something he lets go. He fights back,’’ says Selialia of his nephew.
“This has been hurting me badly for so many years.”

Regarding his niece, Selialia says she started facing mental challenges after testing positive for HIV.
Ordinarily the HIV results should not have been a problem, given the general availability of low-cost and, at times, free life-prolonging medicines.
What “broke the camel’s back” was when her husband deserted her after learning about her HIV status, says Selialia.
The husband’s status is not known.
In denial of her HIV status, Selialia’s niece has failed to religiously take her medication as stress took a toll on her.
Selialia says his niece was admitted to Mohlomi Mental Hospital in Maseru for about a month. She was discharged when she seemed to get better.

Out of hospital, her condition often takes a turn for the worse.
‘‘She looks better when she is at the hospital,’’ Selialia says.
‘‘It has been some time fighting it. Luckily she is not a threat to other people,’’ he says, adding that the condition had affected his niece’s marriage life.
Selialia says the niece and nephew’s situation has affected their elder brother, as they are primarily his responsibility after the death of their parents.
‘‘He as well looks like his mind is slowly getting affected,” Selialia says with a calm voice, although his face betrays the sadness bottled inside.

‘‘It is very painful to have two siblings going through the same illness.”
In Lesotho, mentally ill people are increasingly becoming a common sight in every town.
In 2016, Partners-In-Health reported the study of Dr Daniel Vigo of the Harvard School of Public Health, which revealed that one in five people suffer from mental illness in Lesotho.
“That’s the highest rate of mental illness of any country in which Partners-In-Health works — but mental health is a need that crosses every border,” the report reads in part.

Authorities have tried to act, but they too are severely limited by lack of resources.
Four months ago, the Maseru district administrator, Mpane Nthunya, with the help of the police and Maseru City Council, took the initiative to round up mentally ill people in the city and took them to Mohlomi Hospital.
As they soon found out, the problem required more than a round-up of affected people.
A critical shortage of facilities and experts are some of the country’s biggest challenges in providing clinical help to mentally ill people.

The small hospital could only take in 60 patients and was overwhelmed by the huge numbers.
Sister ’Mampolai Tsemane, from the Department of Nursing at Mohlomi Hospital, says space was limited as the institution was initially built with the purpose of being a referral hospital.
The Director of Mental Health in the Ministry of Health, ’Moelo Ramahlele, says Mental and Treatment Observation Units (MTOU) in the district hospitals are facing severe staff shortages while facilities are dilapidated.
‘‘The units need to be rehabilitated or refurbished for them to be able to do the work well – broken windows, no more beds or mattress,’’ Ramahlele says.

Nonetheless, the hospital continues to take in patients well above its carrying capacity.
“We cannot reject mental disorder patients,” says Ramahlele.
Under “normal conditions”, a patient has to go to their nearest clinic first before being referred to Mohlomi.
‘‘Everyone goes to Mohlomi. But if things were done properly, it wasn’t supposed to be like that,” Ramahlele says.
Awareness is also key to detecting the condition early, she says.
Many times, people only start noticing the signs of mental illness when someone commits a crime or starts walking naked. Yet, mental illness starts way before these signs.

She says her department is embarking on mental health education programmes targeting Village Health Workers (VHWs) who are instrumental in ensuring early detection and referring patients before their illness gets out of control.
Village Health Workers are also vital in helping patients adhere to their medications to avoid regression.
‘‘There is a dire need to come up with laws that will address issues of mental health because some people simply regress due to starvation,’’ she says.
‘‘Without this kind of knowledge, people get help… if they got help while it is still at an earlier stage it would be easily manageable and treatable,’’ she says.
However, financial resources are a challenge to VHWs, who also have to deal with “dangerous” people who sometimes become violent.

Ramahlele says the ministry is working on a policy to improve the conditions of VHWs first, before rolling out the programme to nurses, doctors and pharmacists.
‘‘This would help to develop mental health for universal health coverage and reduce overcrowding at Mohlomi,’’ she says.
She says the Ministry of Health is supposed to build centres that will act as the “middleman” between the community, clinics and Mohlomi Hospital.
Mohlomi has a bed capacity of 30 beds for females and 30 for males.
The forensic ward has a capacity of 35 beds but in most cases it takes close to 60 patients.
She says the hospital currently does not admit children, who can only be treated as out-patients.

‘‘We do not have facilities for children. The one that was extended for accommodating children is not appropriate as it is combined with that of the elderly,’’ she says, adding that adequate funding is needed to cater for children.
“It is the ward of specialty as it needs experts of mental disorders for children,” she says.
For the adults admitted at the hospital, overcrowding is leaving them at risk of infecting each other with communicable diseases.

‘‘Infection control is therefore compromised as some patients are forced to sleep on mattresses,’’ she says.
Forensic mental health services provide assessment and treatment of people with mental disorders and a history of criminal offending, or those who are at risk of offending.
Ramahlele says the number of forensic patients keeps rising because there is no advisory committee which checks on patients due to the lack of psychiatrists.
Ramahlele says there are no psychiatrists at the hospital, a problem that has haunted the ministry for years.
She says her department is in talks with a Mosotho psychiatrist working abroad who can offer his services via teleconferencing free of charge.

‘‘We cannot afford and retain a psychiatrist because it is an expensive specialty,’’ she said.
Ramahlele adds: ‘‘We ought to be careful with these patients in order to adhere to international best practices.’’
Mohlomi Mental Hospital’s Clinical Psychologist, Serialong Mokitimi, says most of the patients admitted usually get discharged once they get better.
‘‘Eighty percent or more of our admitted patients go home but that doesn’t mean they are cured. They still have to come back for check-ups and counselling,’’ Mokitimi says.
Mokitimi says the hospital still has lots of cases of patients who got re-admitted.
‘‘Sometimes it is caused by not accepting that one has such illness and they end up not taking their medication, which leads them to relapsing,’’ Mokitimi says.

She clarified that mental illness can be caused “by so many things including genetic illness, stress, excessive use of alcohol and drugs”.
She said it is very unfortunate that Lesotho has no laws that protect children from substance abuse.
“Until there is a proper regulation, we will continue to have high rates of substance abuse. It may seem like it’s not important but it is a major problem that needs to be addressed,’’ she adds.
A psychologist, Calvin Motebang, says those whose mental illness is caused by marijuana or alcohol can be helped by putting them in a place where they have no contact with the substances.
‘‘We would only be able to help them when they are sober,’’ he says.
Mokitimi says social problems are the major cases dealt with by the hospital.

Domestic violence, especially against women, and substance abuse by men are some of the causes of mental illnesses.
Mokitimi says people with mental illness get abused “every day” without recourse.
‘‘Justice is never served for the victims and them not being protected when bad things happen to them is also a challenge,’’ she says.

’Mapule Motsopa



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