The need for mental health rehabilitation treatment in Malawi
Flomina Mawindo stands in front of the dilapidated house she plans to rebuild as a strategy to keep the chronic stress and depression that initially caused her mental illness at bay. Photo by Karissa Gall.
A building remodel is not typically “what the doctor ordered” to stave off chronic stress and depression.
But in Malawi there is a shortage of doctors with orders, and for Flomina Mawindo, a single mother of five in the Che Mboma village, rebuilding a dilapidated house is her best shot to ensuring her own rehabilitation after being discharged from Zomba Mental Hospital.
Mawindo was admitted to the hospital after family and financial stress set off a downward spiral into anxiety and insomnia. She struggled with a husband who, until his death in 2004, encouraged thieves to steal from her to ensure she did not have the means to divorce him; in-laws who cursed her and her children and a son who stole from other villagers and skipped town leaving her to pay outstanding debts.
She began walking the streets at night, talking to herself and became increasingly violent when her children attempted to restrain her. She was admitted to the hospital in November 2011.
Mawindo was discharged in February, and is able to recall, with a shaking voice and haunted eyes, her experience at the hospital as one of “trouble and pain.”
“In the first ward, it was not good at all,” Mawindo remembers. “There were four or five patients in one room. The others would bite me, abuse me, and grab my food. I could not protect myself.”
Mawindo said the problems that made the hospital “like a prison” were caused by a shortage of doctors and nurses - an issue that was confirmed by a nurse at the hospital who said “the nurses are always there, but for example today we are only two nurses, and we have...53 patients."
Due to the shortage of doctors and nurses, psychological treatment has not been institutionalized and instead the provision of drugs takes priority.
Mawindo has been prescribed sodium valproate, a mood stabilizer which causes side effects including include fatigue and shaking. She is no longer strong enough to walk to the market to do business and has not returned to work since being discharged. Her daughter Tadala left primary school to care of the family until the Jacaranda School for Orphans stepped in and hired a caretaker.
Beyond the caretaker and maize meal donations provided by Jacaranda, Mawindo said she is not aware of any other community-based services able to help support her and her family.
In the absence of government-funded, community-based aftercare and rehabilitation services, Mawindo said she plans to make repairs to a dilapidated house on her property and open it up to renters or turn it into a chicken farm.
She derives her motivation from the time spent at the mental hospital.
“I was going through trouble and pain at that hospital,” she said. “I’ve decided I will never go back there again.”
According to Draft III of the Malawi Health Sector Strategic Plan for 2011-2016, in March 2011 when the plan was published there were no mental health activities at community level, primary health care units did not provide mental health services, the treatment services provided by tertiary institutions were mainly for people with severe or acute mental health problems and the provision of psychological rehabilitation was limited.
The same report found that in 2011 only 1.5 per cent of the national health budget was being spent on mental health and except for one or two districts, most districts spent none of their budget on mental health services apart from the procurement of drugs.
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