This weekend, the All Peoples Congress Party of North America held a fund raiser in Maryland. In the interest of full disclosure I am not a member of APC North America, but I planned to buy a ticket and support the event. Unfortunately, something came up at the last minute and I didn't make it. Still, I am rather curious to know which Sierra Leonean cause they will donate to. A few that come to mind: Income generating projects for youth, sustainable empowerment of women, adult literacy, job skills training, educational improvement and health care.

See, some months ago, the APC of North America announced that in support of President Koroma's "Agenda for Change" APC-North America would embark on what it called “unprecedented fund-raising efforts to renovate Kissy Mental Home.” A news article reported that the North American branch of the APC party had donated the sum of US$10,000 for the renovation of the psychiatric hospital. Two former members of APC-NA, Martin Bash Kamara and Khadija Sesay, were said to have oversight of the funds and to ensure the completion of refurbishment work at the mental institution.

I think more by happenstance than design, Kissy Mental Home was under the spotlight in a British documentary series. In last Friday’s Channel 4 broadcast of "Sierra Leone: Insanity of War" Unreported World's Seyi Rhodes and director George Waldrum found what the world already knows: a population of more than six million people, hundreds of thousands of which have witnessed rape, torture and executions is served by just one psychiatrist.

Dr. Edward Ali Nahim has been a consultant psychiatrist at the Kissy Mental Hospital since 1981. As the head of the hospital, he treats all patients. They include, according to his biography, 100,000 patients with problems of drug abuse, 40,000 with either epilepsy or mental disabilities, 20,000 people suffering from PT-SD (post traumatic stress disorder) and 100,000 patients with symptoms of major depression and schizophrenia.

The amputees interviewed in "Sierra Leone: Insanity of War" said that despite being treated for their physical injuries horrific memories still haunt them. They find it hard to express themselves. All they know is that sometimes things get so bad; their lives just grind to a halt, the filmmakers said.

In Kailahun, where the notorious “Killing House” still stands as testament to the bloodiest period in our contemporary history, Rhodes and Waldrum were told by a charity worker that 50 per cent of those he helps have attempted suicide. Sayon, an ex-child solider, who was forced to kill at just 10 years old, said he hears the screams of the people he murdered - and last year he tried to take his life.

Back at the Kissy Mental Home, we saw sights that could have come right out of the medieval times. Most of the patients are chained to their beds and heavily sedated.

For someone who has been closely following the life and times of Kissy Mental Home, it seems not much progress has been made. The scenes in "Sierra Leone: Insanity of War" were much like those I had seen in a similar documentary shown on Al- Jazeera television in September 2007. One viewer who watched the same program said the experience was "most horrifying and most depressing," adding, "The camera showed patients chained to their beds and interviews with Dr. Nahim, who says 40 percent of the [Sierra Leonean] population is in need of psychiatric treatment and that the stench of blood will remain with many for the rest of their lives."

The Al Jazeera reporter repeatedly lamented the treatment and conditions of the hospital observing that chaining of patients was outlawed as early as the eighteenth century. "Mr. Kabbah calls it a modern psychiatric hospital, but should any of his best friends or members of his family be in need of psychiatric treatment he would surely not send any of them there," observed the viewer wryly.

At the reopening of Kissy Mental Home in December 2006, President Kabbah said “The hospital is now a modern psychiatric hospital and the best constructed in Sierra Leone today. It is supplied with all the basic psychiatric drugs necessary to treat patients, two vehicles, four hundred beds and mattresses, hospital furniture, computers, photo copiers and a good kitchen. The mental patients will now enjoy their stay while receiving treatment.”

Facelifts don’t always provide a complete makeover

When author and commentator, Aminatta Forna, visited the hospital to do research for a book she told a British newspaper afterwards that the one question that fascinated her was whether one can diagnose an entire country as suffering from PT SD. She wondered, too, whether Sierra Leone’s colonial experience had induced a form of madness.

Perhaps it's time for us to wonder whether the eleven-year war left all Sierra Leoneans crazy. In the words of that haunting Gnarls Barkely song: Does that make me crazy? Possibly. One moment I can remember losing my mind was when Ken Moore was killed during a botched demolition exercise at a squatter settlement. Moore's hands were tied. He was gagged, and was reported to have stab wounds in parts of the body that must have caused him unimaginable pain.

In his outgoing address, President Tejan-Kabbah spoke about the large proportion of young people who are suffering the consequences of the war where some of them were cruelly exploited and forced to serve as brutal soldiers. Tejan- Kabbah also said rapid urbanization has produced unsettled youth among whom unemployment and substance abuse are common. In 2004, the nation concluded demobilization and disarmament of ex-combatants and reintegrated more than 71,000 ex-combatants, including 6,845 child soldiers, into active community life.

In her first interview as first lady of Sierra Leone, Sia Koroma, who is a British trained psychiatric nurse, said she intended to use her status to focus attention on the Girl Child and adult literacy, as well as on mental health. With an estimated 400,000 mentally ill people in Sierra Leone the first lady has her work cut out.

A World Health Organization (WHO) study released in March 2009 said that although the violence that nearly tore Iraq apart in 2006-2007 has largely subsided many Iraqis remain traumatized by those years. The study, which surveyed 4,332 adults, found that 16.5 percent of Iraqis have mental health problems but only 2.2 percent of those had received medical treatment. The survey also found anxiety and behavioral disorders had afflicted Iraqi women more than men.

According to Dr. Nahim, nearly 80 per cent of those in need of help in Sierra Leone believe mental illness is caused by evil spirits; it’ll take a sustained information and awareness campaign to change traditional attitudes to mental health and the causes of mental illness. But if Sierra Leone’s war made psychiatry a medical emergency, our government doesn’t appear to treat it as such. "Sierra Leone: Insanity of War" is saying it’s time political leadership engaged the nation—carers, healers, medical practitioners and Kissy Mental hospital in a conversation on mental health; which brings me back to the APC – North America.

What if APC- NA could oversee a drive for a multidisciplinary team to help upgrade care at the woefully understaffed Kissy Mental Home? Across the Diaspora there are Sierra Leonean psychiatrists, nurses, occupational therapists, social workers, and community care workers ready to be part of change at the old mental institution.

To borrow a line from the Transition Team Report: It’s time Sierra Leone's Mental Health Service is brought into the 21st Century. Sierra Leone is possibly the only country in the world that chains mental patients to their beds."


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