The mentally ill, ghosts of the city of Goma
A person with a mental disorder in the streets of Goma. Photo Charly Kasereka.
There has been no recent count there but experts agree that people with mental disorders are more likely to roam the streets of Goma. Men and women, but also children all denied even rudimentary care in a city ravaged by war.
They are close to markets, at a street corner sitting behind a low wall, eating what they can find on their way. Some have traveled the same areas for years, sometimes barefoot. Others, traumatized by war, are joining the ranks of those left behind after the last armed conflict that ended in autumn of 2013.
Charly Kasereka, photojournalist and blogger in Goma went to meet several of them.
"Looking at them, I wondered how they managed to survive. They spend all their time in the same corner, day and night. I photographed a little boy on the shoulders of a man visibly affected by mental disorder. It is the child who told me that it was his father. After his episodes occurred, he was kicked out by his wife. Looking at them, I wondered how they managed to survive.
There is also an old gentleman who lugs around piles of garbage bags. He picks constantly rocks on the ground. He told me he wanted to throw them all to the bottom of Lake Kivu in the hope that one day the body of water disappears. This one I had already met in 2012, but others arrived with the recent events. Some are former soldiers, two of them that I met repeatedly are particularly aggressive.
For Anicet Murwani Kibweke, center coordinator for Tulizo Letu, the only psychiatric facility in Goma, some factors have been instrumental in increasing incidence of mental illness which he has observed in Goma in recent years. He cites the natural disasters that the city experienced, extreme poverty, but also the suffering of war that pushes people into the abuse of psychoactive substances like hemp or corn alcohol, which has long-term destructive effects.
Young living in the street in Goma smoke hemp. Photo Alain Wandimoyi.
Most often, those who find themselves on the street have been abandoned by their families. This is particularly true of children, when they show the first signs of trouble are treated as witches and ostracized from society says Fakage Baganda specialist psychosocial issues in Goma for the CIF Health.
The prejudice that exists in our society means the mentally ill are viewed with contempt. Most ignore them but others throw stones when they become aggressive. Regularly, there are mentally ill people tied to trees because passersby could think of nothing better to control them. They remain there until a good soul comes and releases them.
Many do not realize that no one is immune to such diseases and especially in an area that has seen much violence. These disorders can occur just after the violence but also manifest much later.
Convinced that their relatives are possed by a demonic spirit, families prefer to turn to pastors or priests, thinking they can exorcise the sick. Thus, people with mental disorders are sometimes sequestered in prayer rooms, an action that only delays the recovery of the patient, the doctor Anicet Murwani Kibweke is concerned
To counter these reactions and bring patients modern medicine, our center in Goma decided to work with a parish. We have educated the priest to help convince families: he explains, that it is important to continue to pray but in parallel, it is essential that the patient takes medication.
In 2013, Anicet Murwani Kibweke said they followed nearly 6,000 people through the Center for Mental Health Tulizo Letu or "quiet place" patients who had received medication. Meanwhile, nearly 700 mental patients were hospitalised for periods ranging from several weeks to several months.
We were helped by the organisation Fracarita based in Belgium. They provide us medicines but for the rest, we rely on the payment from family caregivers. Now, when a patient receives several successive treatments, the family pays first but does not take long. The first consultation costs a significant $ 6.50 [€ 5] payment. Then the family must pay $ 1 [0.75 euros] per visit, plus medicine. So we do what we can to continue despite the problems but inevitably there is a lack of resources and this is contributing to relapse of patients.
The doctor recalls that the family structure is also an essential element for the success of treatment.
It is requires that the patient be supported because when released, the family must take over. So, when some are collected in the street by residents or the police bring them in, we do everything we can to reconnect with relatives of the patients. Care of patients living in the street, without any connection to their loved ones are more difficult to treat relates the specialist.
Lawlessness: difficult to fight against discrimination
Professionals agree that the current Congolese legislation does not ensure the protection of persons with mental disorders when they are victims of violence, or deal with them appropriately when they are the perpetrators. For the patients who manifest aggressively from the disease and who are not treated often have no ability to avoid committing acts of violence.
No specific treatments exist. We draw on medical ethics and the Belgian and French experiences, particularly in terms of criminal responsibility of the mentally ill, said Dr. Sala.
When a patient has committed a crime, doctors work with the police in the investigation which may help to establish that the patient was not aware at the time of his act. It is then for the magistrate to determine liability.But this system is obviously not enough. We need legislation that would protect the patient, the victim, and also the medical staff.
In 2011, the World Health Organization recorded 44 psychiatrists and 10 psychologists in the Congolese population of 68 million.
Think about that last statistic. That is less than one mental healthcare professional per million people. When you bitch about the foreign