Neuroscientist and researcher in neurocardiology, Prof. Chidi Njemanze, speaks to TOBI AWORINDE about the peculiarities of dealing with mental health issues in Nigeria
How would you define mental health?
Mental health is a state of mental well-being. If the cognitive processes, which is how people think, are intact without any disease process, an individual will be adjudged to be mentally healthy.
What are some of the manifestations of lack or loss of mental health in people?
In childhood, one of the commonest manifestations is what we call Attention-Deficit/Hyperactivity Disorders. These conditions are quite prevalent in children up to adolescence. But one major problem we have in Nigeria is lack of mental rehabilitation centres for very subtle conditions. So, children with Attention-Deficit/Hyperactivity Disorders are often just neglected. Nothing is really being done in such cases.
Also, manifestation is dyslexia, which is the inability to read correctly. These people are also left without any real proper schools to train them. But dyslexia is not a disease condition per se; it is rather a disorder from the conventional order that needs a different type of approach in teaching and taking care of people. So, people with dyslexia lack the ability to learn but they can be taught in a different way.
Then the other big one is the Autism Spectrum Disorder. There are a huge number of people who are affected by this, both children and adult. These borderline conditions, outside madness or psychosis, are not really being taken care of in Nigeria properly and that is a deficiency of the health system. Therefore, there is a need to make a systemic correction of the entire health system.
What kind of corrections will you prescribe?
Every level of government should have a surgeon general, for example, that will focus on disease prevention. The surgeon general should be on the ground, telling people: “For your good mental health, this is the amount of red oil that is sufficient to add to your food so you don’t have too much. This is the amount of salt, the type of fish that is nutritious.” He would tell you, “Our water is polluted because we have too much heavy metals in it.” He would assess the water in the community and advise residents appropriately. The surgeon general would set normalcy standards and it is a whole ministry on its own with doctors, nurse, inspectors and other health professionals. They have other departments, including internal medicine, mental health and so on.
If you look at countries with high per capital income, you will see that they have good mental health structures. It is a direct pursuit of economic growth when you invest in health.
How common is mental illness in Nigeria?
Twenty to 30 per cent of Nigerians suffer mental disorders, and the biggest and most important causes are environmental. For example, we have unregulated disposal of refuse. Batteries are everywhere and wherever you see a battery, it takes your mind to lead poisoning and lead poisoning will surely result in a mental deficiency. Refuse disposal is a science. In Nigeria, contractors will just carry refuse from anywhere and dump it anywhere without sorting. In all our gutters, you see engine oil and that is lead and heavy metals.
These things are all sinking into the water aquifers because we have a high water table here. So, we end up drinking the lead and every other thing. The biggest problem we have is unregulated refuse disposal. If we are going to have any reform in the health system, it is to create an inter-ministerial relationship between the ministries of environment and health, so that both of them are involved in the constant monitoring of the environment and we know what the situation is in the different localities.
What are the symptoms of mental illness?
The symptoms could be from subtle to severe, usually if they come out with what they call focal neurologic deficits – things like tremor of the hands or seizures. Those are the big ones people see, like when somebody falls and is foaming in the mouth. In some cases, you give something to a child who has spent three to four years in school to read and they cannot read. It is not because they can’t see it but they can’t put the sentences together.
Also, it could just be forgetfulness. Somebody is talking to you and, all of a sudden, it becomes incoherent and can’t follow the sentence. It might just be a child answering a question and all of a sudden they blank out for brief periods. That might be a seizure the small kid is having. It could be from these subtle signs to the ones everybody recognises when people have depression. Those ones have become very obvious, but most times, for a very long time, there would be very subtle changes that occur which are usually focal.
It could just be one hand tremoring or one eye blinking from time to time. It could just be some numbness in one hand or the other. It also could be that a child is not doing well in school, which otherwise he is supposed to; maybe he is lagging behind by one or two years.
How early should one look out for these signs?
Basically, as early as possible because mental conditions only degenerate. That means it doesn’t get progressively better if you don’t do anything about it. It will only get progressively worse. Once you start noticing things – for example, a child cannot pay attention to what you’re teaching, or the child, all of a sudden, is not doing well in school – you can start suspecting some signs of mental ill-health.
There are also cases of mental conditions such as Alzheimer’s disease in adults. How early should one look out for those signs?
Those ones come much later in life and they are easy to identify in the sense that, one, the person is old and you wouldn’t associate remembering with very old people. So, for a very long time, we haven’t treated it as anything extraordinary, except when the onset is one or two decades younger, so you start seeing a 50-year-old or 60-year-old forgetting things like an 80-year-old or 90-year-old. But we wouldn’t see a lot of Alzheimer’s because, unfortunately for us, life expectancy is not as long as those people who live longer in developed countries. So, we would have a smaller cluster of the population spread of these dementias generally.
If, for example, a person becomes incoherent in speech, either the speech is slurred or slow, that could be a sign of stroke. The stroke warning signs are very subtle. A person can complain they have a numbness of the hand. That is also a sign; it could mean blood flow problems relating to what is called ischemia of the brain. That can be a stroke warning sign; it could also be a peripheral nerve disorder. So, depending on what it is, it is just an awakening call to get to your doctor as soon as possible.
Can any of these mental conditions be fatal?
Yes, mental health conditions are debilitating. In other words, they don’t allow you to function. But in very serious cases such as stroke, it can end up in mortality. I think one thing I need to add is that there is a very important health factor in causing mental ill health in our environment and that is food. For example, crayfish is a delicacy and it is supposed to be eaten in small amounts. Because of the taste and because people don’t want to use bouillon cubes or any of those additives, they then cook crayfish in large amounts.
There is an insulin-like protein called crayfish-binding protein which causes the blood to clot. So, most people who eat a lot of crayfish in their diets have serious blood clots, which could lead to heart attacks and strokes. They go into the kidney and block the vessels there and can cause very high blood pressures. If you check the riverine areas of Nigeria, such as Rivers and Bayelsa states, you will see very young people with very high blood pressures and the life expectancy is so short. The reason for that is just because of the seafood, especially if they eat it in large amounts; they could have crayfish-binding protein that could result in strokes.
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