A country as rich in secrets and decadence as it is in culture and history, Ethiopia has existed for many years with more troubles simmering just beneath the surface than most people can imagine. Already the second most populous country in Africa, Ethiopia’s population is growing at an alarming rate and is projected to increase by 120 percent by the year 2050. The addition of nearly two million people per year can only exacerbate the plethora of health and educational problems that affect daily life in Ethiopia, and bring to the surface, long buried troubles. One such issue, hidden within the deep religiosity of Ethiopian society is the taboo subject of mental health.

Children are viewed as God’s blessings by both the large Christian and Muslim populations of this East African country. Whether Muslim or Christian, the birth of a child who displays any kind of perceived mental deficiency or behavioral abnormality, is immediately attributed to the wrath of an all-powerful God. Perhaps the mother has a great sin she herself is not aware of, perhaps she committed this blasphemy while carrying the child, perhaps it is not God’s wrath but the Devil’s trickery. In a country where the majority lives below the poverty line and most of those above and below this line are uneducated, mental health has a history of receiving little to no medical or learned attention. The children are dragged to one of the multitudes of churches littering the country to be dunked in holy water and exorcised of their demons. When this fails, these children are shut away, an unspoken shame, a mother’s failure; or they are taken to Amanuel Hospital, a facility in the capital city set up to function loosely as a psychiatric ward. These practices were largely observed until very recently, and even now, continue to be the approach to mental health care by a majority that remains unaware of other options.

A study by the World Health Organization (WHO) shows the prevalence of mental disorders in Ethiopia is 15% for adults and 11% for children with the psychiatrist-to-population ratio at 1 : 6,000,000. Though the majority of the country’s population is rural, the only facilities (two at last count) providing psychiatric services by specialist doctors are in the capital city and largely inaccessible to the people who need them most. WHO has assisted in training over 150 psychiatrist nurses in the past decade which has allowed the integration of psychiatric care into the general health care system. Psychiatry postgraduate training for doctors began in Ethiopia in 2003.

My first encounter with anything remotely unusual about the way parents treat the children they deem “different” was at the age of ten when I began to realize that my older brother was not like other children. I did not realize until my teenage years how different my parents were from the majority of those who find themselves in a similar situation: having a child with an unexplained mental illness. My parents, both educated, used the limited resources they had at their disposal to try and find out why my brother, who had been developing along what are considered normal lines for a child, suddenly stopped talking, stopped walking and began to crawl; like someone had rewound his development. The doctors they went to referred to my brother’s condition as mental retardation. Dissatisfied with this explanation my parents educated themselves, reading all that they could access and speaking with Ethiopian families living abroad. Eventually, they found the answer they have been looking for: autism. My mother spoke with other families that she knew had a child born with some developmental or mental issue. Together these parents formed SOOM, Support Organization Of the Mentally handicapped. While this organization was aided by some NGO’s, it had no substantial support from anyone else and functioned more as a day care of sorts for these children, but could not address the needs of individuals who were aggressive or unresponsive. In the past few years, another parent has strived to create a center for autistic children but again the lack of resources has a crippling effect on any endeavor.

This is just a brief example of how underequipped and understaffed the Ethiopian health care system is to deal with developmental and mental issues. Down Syndrome, autism, mental retardation, all are one and the same here, clumped into an indistinguishable mass, simply labeled as retardation. No effort is made to delve deeper, to understand. Parents like mine, who are determined to seek answers and alternate solutions are a small bright spot. When the majority is uneducated, unemployed and living in abject poverty, you cannot be surprised that mental health remains a major dilemma in this country. I have met many families like mine who have found a way to assimilate their children into society instead of alienating them. However, I have also met families who still believe in hiding their children away; the latter far outnumber the former.

On October 15, 2008, Ethiopia’s Ministry of Health reported that the government of Ethiopia has directed special attention towards expanding mental health services. Under the theme “Scale up services for the mentally ill”, Dr. Tedros Adhanom said, “The stigma connected with mental illness is among the serious problems the mentally ill persons are facing in Ethiopia.” General Manager of the Amanuel Specialized Mental Hospital, Dr. Kesetebirhan Admasu on his part said the hospital has been undertaking various activities aimed at reducing the burden of mental illness. Efforts are being made to increase training and awareness so that the relevant expertise can be offered to professionals in the health care field. Ethiopia still has a long road ahead of her in the pursuit of proper healthcare and management for her people; it is an issue that both government and media – which is ultimately controlled by the government – need to address continuously in an effort to reach the population. How can we effect change without talking to the people who need the information the most? It is a painfully slow climb to enlightenment, but hopefully the times when children are simply locked away will be fully superseded; replaced by a necessary period of research, understanding and ultimately proper medical and psychiatric support for those who need it most. 

References:

http://www.voanews.com/english/archive/2006-03/Ethiopian-Population-Expected-To-Grow-by-More-than-100-Percent.cfm

www.moh.gov.et/index.php?option=com_content&task=view&id=163&Itemid

http://www.who.int/countries/eth/areas/mentalhealth/en/index.html