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Sunday
Feb032013

Medication side effects in Ghana

The article was published by Dr Ursula Read in Transcultural Psychiatry: Read, U. (2012). ‘‘I want the one that will heal me completely so it won’t come back again’’: The limits of antipsychotic medication in rural Ghana.Transcultural Psychiatry, 49438–460.

The full article can be found at http://tps.sagepub.com/content/49/3-4/438

We have also posted the summary on our Facebook page, tweeted it and sent a link by SMS to practiintioners in Ghana

The aim of this is to honour mental health research in Ghana, to assess it, help familiarise everyone with it and to see how the findings can be used to help patients and practitioners.

''I want the one that will heal me completely so it won't come back again'': The limits of antipsychotic medication in rural Ghana by Dr Ursula Read

There has been a big focus on the development of appropriate mental health services in low income countries using the models practiced in developed countries which emphasises medication as a huge part of the treatment of mental illness.

In doing this it seems that campaigners, prescribers and all those that offer “medical” treatment of mental illness do not discuss the limitations and perhaps the side effects of these medications with the patients and their families and certainly do not appear to acknowledge that it does not “heal completely”.

This lack of transparency seems to encourage non-compliance with treatment and strengthens the notion that mental illness is a spiritual illness and as such it cannot be cured completely by medical treatment.

“Health “is clearly defined by WHO (1948) and this definition is universally acceptable but in practical terms it means different things to different people. One of the factors that influence a person’s concept of health is their economic power hence the concept differs between low income and high income countries.

In Ghana and other such countries , health equates to strength- strength to wake up at the break of dawn, clean one’s surroundings, walk for miles to work, do intensive jobs such as farming , earn a living and look after one’s family.

Experiences such as visual and auditory hallucinations are not deemed to be particularly troublesome as they can occur even in the absence of mental illness. In any case it is not uncommon for people who attend churches and traditional places of worship to have visions in the absence of mental illness.

It was side effects of medication such as tiredness and the subsequent reduction in productivity that is deemed to be most troublesome for the individual and for their families. As soon as these individuals realise that medication could not deliver their desired outcome of “health = strength “they refuse to tolerate it despite the immediate positive effects.

It is therefore not surprising that there would be a preference to seek “healing “from spiritual churches and traditional healers whose treatment is perceived to be “side-effect free and long- lasting”.

Dr Read looked into the experiences of people with mental illness and their families in rural communities within and around Kintampo in Ghana.

These individuals had long standing mental illness which had led to a severe disruption of social functioning and frequently displayed behaviours such as talking nonsensically, acting aggressively, roaming around, and dressing in dirty clothing.

She recounted the story of Ibrahim- A promising young man who had recurrent episodes of mental illness characterized by hostility and aggression and who had to be chained to a log of wood by his family due to his uncontrollable behaviour.

He took antipsychotics which calmed him down considerably and helped him reintegrate into family life but he chose to stop his medication due to the unacceptable side effects. He “chose” to seek treatment elsewhere.

This article also proposed that people with mental illness and their families do not necessarily attend hospital when all else has failed. Sometimes they choose to do this at the start of the illness but may revert to traditional healers and spiritual churches due to unbearable side effects and/or after a relapse.

In African countries such as Ghana ,there is a strong belief in the supernatural- witchcrafts, gods etc and it is believed that orthodox medicines cannot cure illnesses caused by supernatural powers. The belief is that a spiritual illness is any illness which is recurring or prolonged.

Basically the rule is that if it is a medical illness, use medication and if supernatural or spiritual = church, mosque or traditional shrines. 

Mental illness by nature is reoccurring and this weakens the argument that mental illness is not a spiritual illness. That medication does not cure it further enforces this belief system.

It is also common for Ghanaians to believe that only God can heal. They are willing to “wait and see” knowing that no-one method can guarantee a result. They start to mix and match treatment.

In concluding, the study showed that Ghanaians are aware of the existence of mental health services and how to access this service.

They choose when they want to engage and if they want to. Sometimes they mix this various modalities of treatment in a bid to find a “cure “ and “recover “ which is defined as getting back into a social role and being able to work.

When patients choose to seek medical help and it is helpful, they may still end their engagement because of side effects of medications and the lack of long term therapeutic effects. This is similar to the pattern in high income countries including the UK.  However, in the UK there are other initiatives and alternatives such as community treatment, psychological therapy, wellbeing centres and wellness recovery action plans which provide a safety net for patients who choose to reduce or stop their medications.

What are the implications of Dr Read’s findings to us?

As the present and future work force, we need to ensure that we have transparent discussions with our patients about the limitations of antipsychotics, educate their families about the illness and address their expectations. Now that it is clear that social functioning is THE desirable outcome measure, we should start thinking about social reintegration, work opportunities, trade workshops etc for our patients right from the time of their first presentation to us.

We should also keep ourselves up to date about relevant local initiatives to signpost our patients as appropriate.

In order to gain and maintain the trust of our patients and their families, we must strive to provide the best possible care for our patients by maintaining an adequate depth and range of knowledge, reading and commenting on articles such as this one and accessing training whenever possible.