An Irish brother has established an array of mental and other health services for some of the most vulnerable people in Malawi including those in jail. Eithne Donnellan, Health Correspondent, visits to find out more
IT’S A prison built to hold 180 inmates. It now houses almost 600. Welcome to Mzuzu city jail in Malawi, one of the poorest countries in the world.
Malawi in southeast Africa isn’t alone in having overcrowded prisons of course. Regularly we hear references to Mountjoy in Dublin holding 670-plus inmates even though numbers held there should not exceed 540. But the overcrowding in this African jail is on a different scale.
One yard surrounded by high concrete walls holds well over 550 men, some of them on remand for years. From 3.30pm each day, they are crammed into two small buildings, not individual cells, at either end of the yard and are locked up until sunrise the next day.
So tight is space they cannot lie down. Instead, they sleep sitting spread-eagled on the floor to make space for other inmates. The majority are HIV positive.
Their crimes vary from stealing chickens to armed robbery and murder. Some are in white uniforms, others their own bedraggled clothes, most wear vacant expressions.
They have little to look forward to but the outreach services from a nearby centre set up by an Irish missionary from the St John of God order in an attempt to make the lives of at least some of them more bearable.
Tipperary-born Brother Aidan Clohessy arrived in this northern Malawian city 16 years ago; his goal to establish a mental health service in a country of some 15 million people which had just one State-run mental hospital.
Since then, with money raised in Ireland, the Netherlands and the US, he has set up an impressive network of health services for local people, including a 39-bed acute inpatient psychiatric facility, a rehabilitation and vocational training programme for those recovering from mental illness, a very successful residential addiction treatment programme – believed to be the only one in Malawi – counselling services and outreach clinics.
There are also programmes for abandoned street children, which feature music and dance classes as well as football, and a new third-level training college for healthcare workers including mental health nurses, clinical officers (similar to our doctors) and counsellors, as well as lodgings for up to 40 students while they attend classes.
The extra graduates the college produces are badly needed in a country where there is just one nurse for every 4,000 people and one doctor for every 55,000. In the absence of these professionals, many rely on local healers and traditional midwives.
These are first world facilities in a Third World country, all built to high specifications and kept immaculately clean. There are umpteen signs in clinical areas urging staff to wash their hands to prevent the spread of infection – something we in Ireland have only started doing over the past few years in the fight against MRSA and other hospital superbugs.
Clohessy has provided the leadership to spearhead these developments, but all the health services are now being run by local Malawian people, many of them trained by the St John of God order, so as to ensure the services are sustainable.
Majid Lungu, the team leader in the counselling department, visits Mzuzu prison three times a week to offer individual and group counselling sessions. Support is also provided by the St John of God order for education programmes in the prison. “But we are unable to reach many in prison who could access our services because there are so many inmates,” he admits.
Within the local community, the need for counselling is growing too. Lungu sees “a good number” of young people who have started abusing alcohol. It’s becoming a big problem as plastic sachets of gin are now being sold in the city for the equivalent of about 5 cent each.
He also provides pre- and post-HIV test counselling sessions, and counselling for those who are stressed. Stress is not just prevalent in the recession-hit western world, it seems.
“Stress is a big issue. Sometimes it is caused by too much work for too little pay. Women can be stressed because of big families and they can’t afford to send their children to government secondary schools. In Malawi, poverty leads to stress,” he says.
“We are the only people offering psychosocial counselling services in Malawi, so people travel all the way from Zambia to see us,” he adds.
Despite the daily stresses and challenges Malawians face such as having to walk long distances carrying huge water cauldrons on their heads; ensuring their families have enough to eat; giving birth in rural areas by the light of paraffin lamps; and frequent petrol shortages, the Malawians come across as a warm, friendly and happy people who live for the most part on a diet of maize.
While “Irish potatoes”, giant size tomatoes, onions and live chickens are commonly found at the market, they would be unaffordable for many locals.
Mental health is often described as the Cinderella of the Irish health service with less and less of the overall health budget being devoted to it in recent years.
That being the case, it’s not surprising to find it even more neglected in a country such as Malawi where 49 per cent of children under five are chronically malnourished and where the average life expectancy, according to St John of God staff, is just 43 years.
But arguably the need for good mental health services is even greater among a people who have to deal with abject poverty – Malawi from where Madonna has adopted two children is ranked 164th out of 177 on the United Nations’ Human Development Index – and with relatives frequently dying from Aids. More than one million people in Malawi are living with HIV/Aids.
“Unfortunately, mental health worldwide remains undervalued, underfunded, under-resourced, shrouded in outdated beliefs and prejudice, and often viewed as a luxury or non- essential health service,” says Clohessy, who started out in life as a psychiatric nurse before training as a special needs teacher.
He was principal of St Augustine’s special school in Blackrock, Co Dublin, for 23 years before going to Malawi in 1993.
The stigma of mental health is the same in Africa as elsewhere. “People who are mentally ill here are referred to as invalid. That is the general attitude of people, that they are ‘non-people’. And their concept of mental health is the worst possible concept – people who are behaving very strangely. They don’t realise any of us could have mental health problems at any time,” he says.
The only government-run psychiatric hospital in Malawi is in Zomba, in the south of the country. Johanna Homberg , a German clinical psychology student who incidentally spent one year of her secondary education in Banagher, Co Offaly, had been on work experience there.
But when she travelled to the St John of God facilities in Mzuzu, she couldn’t believe the contrast. “The two facilities are very different. In Zomba, they have just one psychiatrist. They don’t have enough trained staff. And it is overcrowded. It has about 260 beds and more than 300 patients. They don’t have the time for individual care like they have here,” she says.
“It can be like this here because there is funding and there isn’t in Zomba, so it’s not really fair to compare them,” she adds.
Clohessy may be in his early 70s now but he’s still not content to rest on his laurels. He wants and needs to do more.
His order has just bought a house down south in the Malawian capital Lilongwe and from this new base he plans to start all over again developing further services for local people in a country often referred to as the “warm heart of Africa”.
HELPING HAND: HOW ONE MAN GOT HIS LIFE BACK ON TRACK THANKS TO THE ST JOHN OF GOD MENTAL HEALTH SERVICES
It is customary among certain tribes in Malawi for men to pay a lobola to the family of a woman they plan to marry. Sometimes, the lobola or dowry equivalent, usually a few cows, is paid upfront before the wedding, but more often than not part of it is paid later when the newly married couple have built up sufficient resources to discharge the debt.
When in 2001 Bina Msiska’s sister-in-law and mother of three died of pneumonia, aged just 23 years, his brother Vincent had only paid her family part of the lobola they were due. They demanded one more cow before they would give permission for her burial.
A stand-off between the families ensued for three days, bringing shame on the Msiska family as everyone then knew they couldn’t afford the extra cow. Eventually before nightfall on the third day, neighbours clubbed together sufficient monies to pay off Vincent’s in-laws.
It all became too much for Msiska who suffered a nervous breakdown. His father took him from their home in the Rumphi district to the acute mental health service run by St John of God in Mzuzu, where he spent two months as an inpatient.
“I don’t remember going into the hospital. I was very sick at the time,” he recalls.
“When the problem started, some people said I had HIV or was smoking marijuana or something, and that it was this which was disturbing my brain. In our culture, they think it must be something like that.”
After he recovered, he continued to attend St John of God services where he studied horticulture, and now works full-time as a “plant propagator”, sowing apple, mandarin and many other plants on a farm near Mzuzu funded by the Wells for Zoë organisation run by Irish couple John and Mary Coyne.
They have overseen the construction of cheap but effective water pumps in many surrounding villages and also recently funded a two-bed birthing clinic for one rural community to replace a straw-roofed shed with a stone slab, the only facility local women previously had when going into labour, unless they undertook the journey to a city hospital.
Thirty-five-year-old Msiska, now married with five children, has managed to make a living out of his horticultural skills, which earn him around 13,000 kwacha (€65) a month.
This and his earlier work for St John of God has been sufficient to enable him buy a little plot of land on which he has built a temporary home with clay bricks and a thatch roof for his family.
Using his entrepreneurial skills he has also built a second temporary home on the site which he rents out for 1,000 kwacha or €5 a month.
He attributes his current health and lifestyle to the services run by St John of God. “They have done great for me,” he enthuses.
At first when he was discharged from hospital, people would run the other way when they saw him coming. “They would say you are a mad one. But in the hospital they taught us to educate them and point out mental illness is like any disease and it can happen to anybody. Then they will not do that again.”
Venture Malawi, an initiative to raise funds for the street children’s programme run by St John of God in Mzuzu and an educational programme for Mzuzu prison, is now in its fifth year and has to date raised over €200,000.
Anyone who raises €5,500 can be part of the next venture which takes place early next year. It involves a 10-day trip to Malawi once the fundraising is complete. For more information, contact John MacManus on 085-7305593 or e-mail john.macmanus@sjog.ie
