Africa’s Big Five typically refers to the great African lion, elephant, buffalo, rhinoceros and leopard. I’ve got a different sort of Big Five to share with you from my day of traveling dirt roads in Kenya with colleagues from the Africa Mental Health Foundation. Thanks to the vision of Drs. David Ndetei and Victoria Mutiso, mental health screening is being integrated into primary care in health centers that serve the remote communities around Nairobi. In rural towns of Makueni County (only 100 km NW of Nairobi but more than 2 hours drive), I learned a few things about mental health today.
Kenya’s “Big Five”:
If you don’t want to know, don’t ask. Like other low-middle income countries, with less than $1.59 median mental health expenditure per capita, Kenyan health care providers have not focused on mental health historically. Following training provided by Africa Mntal Health Foundation, nurses, and community health workers at participating clinics have already screened more than 2000 individuals this year, and rates of mental health problems exceed 10%.
Integration of mental health screening in primary care is a double-edged sword. Finally, people with mental ill health are getting assessed and identified, but now what? There is an urgency to expand the mental health workforce in Kenya to meet the needs of the population.
Theresiah Ndunge Jonathan and Paul Ngau Muia did not know the term “depression” a year ago; today they are primary health care workers who know it, recognize it, and treat it. The idea that mental health is not a priority among low and middle-income countries and that such communities are not interested in addressing mental health needs is a nefarious myth emanating from arrogance and ignorance among people in high-income countries.
Distribution, distribution, distribution. With his new found knowledge, Paul wants to prescribe medication for the grocer who is depressed but the cupboard is bare. There are no meds in the dispensary where he works despite appropriate requisitions. At the clinic less than 10 km away, the dispensary is stacked from floor to ceiling with a cornucopia of medications. A major 21st century riddle is distribution.
The sages teach that in the face of social injustice and human suffering it is not incumbent upon us to finish the work, but neither are we free to desist from it. With the steep climb ahead for mental health in Kenya, it is easy to understand why this path is not well worn. But David Ndetei, Victoria Mutiso and their team are undaunted, and they have begun to establish a model of integrated care for mental health in Kenya that should be the envy of all Americans.