Mental health in developing countries

During my decade long career as a nurse, I came across various people with different mental health issues. This is one of the cases that I found would be interesting to share with my colleagues. Nurses Announcements Archive Article

Mental health in developing countries

I grew up in a small village in South Asia where many people don't have access to basic healthcare. On top of that mental health is such an issue that nobody seeks help for. If someone is mentally ill, the family members and the society will go to the traditional healers (who do not have any training), visit many temples and sacrifice animals (as an offering to god), worship different ghosts and gods asking them to help with the recovery of that mentally ill person. If nothing works out, they lock the mentally ill person (if he/she is extremely violent) in a room or in a small hut on the farm, far from the village, the person will eat, sleep and defecate in the same room for weeks and sometimes even months. Sometimes the mentally ill person breaks the lock and starts wandering around naked or wearing rags, and the local police will beat them up, catch them and lock them inside the prison. A large percentage of mentally ill people spend their life in jail or some kind of seclusion. Many studies (in my country) showed that only one to two percent of the mentally ill people receive help. We have one tertiary hospital to treat mentally ill, and less than seven facilities in the whole country where there is psychiatric help available.

This is a story about Jasmine (name changed), a very intelligent girl with a pleasant personality. At the age of eighteen, she fell in love with a young man, who was temporarily visiting her town. The man was from a different social and economic background than that of her. Therefore, her family didn't approve this relationship. However, after a few month of affair she decided to marry her boyfriend despite the family's resistance. After marriage she moved to her husband's house in another town few hundred miles away from her parents' home.

Jasmine's life took a different turn after marriage. Her husband's family wasn't as affluent as her parents. They had a joint family. More than ten people lived in a small house, and ate in the same kitchen. Adult members of the family would work on the field, women would cook, clean the house, wash clothes, take care of children, take care of their cattle and help others on the farm. Men would do heavy works on the field and collect firewood from the forest. In addition to all day long hard work, there always was scarcity of food in the house, and half of the time the female members of the family would go to bed without satisfying their hunger. Even with all those hardships, Jasmine was happy and adjusting with her new surrounding.

After a couple of months in her married life, Jasmine found out that she was going to be a mother. Jasmine was happy that she was having a baby, but again she was very much worried about the baby's future. She was concerned about how she will take care of the baby, what she herself will eat during pregnancy, and feed the baby after birth, who will do the household chores if she becomes tired or sick. The family already had economic problem, and having another baby meant additional burden to the frail economic condition of the family.

Jasmine was a high-school drop out (she got married before completing her school), and had no other skills. In that society women weren't allowed to work outside their home. Even if she was allowed to work, it was impossible to find any job with her qualification. Jasmine and her husband discussed this issue, and her husband decided to go abroad for employment, and support the family. They sold their land (because they needed money to arrange for her husband to go abroad), and sent him abroad with a dream to be able to sleep with a full-stomach in the future. Jasmine had to deal with more harsh conditions, she was having many problems with her pregnancy, and her in-laws were also unhappy with her because she wasn't able to work hard. Jasmine's parents didn't want to support her and instead sent a message that they would rather see her dead than help her.

Another misfortune hit Jasmine when she got news about her husband's accident abroad. He tripped on the machine while operating it, and was severely injured. Jasmine was already having labor pain for three days but there was nobody to help her, and take her to the hospital. Her in-laws had arranged for few local women to help Jasmine give birth. On the fourth day, after much bleeding as well as physical and mental trauma, Jasmine finally gave birth to a beautiful healthy little girl. But, after two days of giving birth, Jasmine started experiencing mood swings, and started ignoring her newborn baby. She would not care even if the baby cried; she would remain aloof, not caring for herself or the baby. Most of the time, she was seen tearful and crying. Jasmine tried to kill the baby because she thought her newborn daughter was a devil, and was responsible for her husband's accident.

Her in-laws thought that Jasmine's condition was due to some evil spirit, and tried to worship many gods, ghosts, and other supernatural beings. They even had a spiritual healer come to the house and whip her with a burning rope (with the belief that the devil was residing in her body causing those symptoms). When the spiritual healer would perform the ritual, Jasmine would murmur few sentences, everybody thought that the devil was talking. Jasmine's whole body was wounded, her situation worsened than improve.

Jasmine was brought to the hospital in unconscious state. She was dehydrated, was very anemic, was in sepsis (due to those wounds and also from the perineal injury/infection during delivery) and as a result, was having acute renal failure. After the immediate stabilization of her medical conditions, a group of mental health personnel (including myself) were involved in her care. I followed up on her case for more than three years. She fully recovered from her illness; her husband broke both his legs but is able to perform normal activities. They moved to a different apartment, and are in a better economic condition. She is expecting second baby in few months. I am again concerned about her health.

starbin

About starbin, BSN, RN

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Starbin

A moving situatiion. Are you in any postion to be an advocat for mental health in your country?

To all of us to whom you have exposed this Jasmin I feel like it is an action alert, was that your intention ?

I was aware that in so many undervelopped countries mental health has a terrible stigma & shame.

safta24

Specializes in Nephro, ICU, LTC and counting.

Hi, Thanks. I am not in any position to bring change in big level. When I was there, I volunteered for an NPO that focused on women's health, specially in rural area. With my special interest and some experience in Mental Health, I was able to mobilize a group of mental health professionals and support this lady. The situation is alarming and sad. The country is struggling to deal with decades long political instability, and mental health is of the least priority for law makers and those who have voice. The NPO I volunteered for had to stop the programs because of security threats.