A Patient's Cure: Michael Galvin, LCSW, MPH
Global Mental Health Impact Story of the Week – March 2nd 2020
A Patient’s Cure
During the summer of 2019, I received a fellowship to evaluate a program, by the international Non-Governmental Organization Save the Children, at the intersection of gender-based violence and mental health in Côte d’Ivoire, West Africa. It was here that I met a young doctor, Losseni Koné, training in psychiatry at a rural hospital in the southeast of the country. Dr. Koné spoke to me about the complete dearth of any mental health services outside of the capital, Abidjan, and how even there – in a city of more than 5 million people – the services are few and far between. As global mental health is my primary field of study, I asked him if he could put me in touch with someone working in mental health treatment in Abidjan. This is how I had the opportunity to meet Dr. Stéphane Ipou, a psychiatrist at l’Hôpital Psychiatrique de Bingerville – by far the largest psychiatric hospital in the country.
Situated next to the brand new steel and glass l’Hôpital Mère-Enfant de Bingerville, named after the country’s current president’s wife, the psychiatric hospital is in stark contrast. Founded by the French in 1957, just three years before independence, the low-slung hospital has received few updates since that period, Dr. Ipou tells me as we stroll through the dark corridors. A spicy smell wafts through the corridor as we approach the large kitchen where large pots bubble with soups that patients and their families can purchase. With little to no government funding, patients here are not only responsible for paying for their stay – a fee of around $15 per day, a significant amount for the average Ivoirian – but are also responsible for paying for their daily needs. Divided into five sections, two for women and three for men, the roughly 100 patients housed in the hospital live largely in communal open spaces with many beds lacking mattresses and several patients sleeping on the concrete floor. He shows me the two empty isolation rooms, one for men and one for women, with dark fingerprints imprinted on the walls. Patients with florid psychosis walk the corridors and follow us as we make our way through the different wings.
My primary interest in mental health treatment, I tell Dr. Ipou, is cross-cultural psychiatry. “So how do you treat patients who have different explanatory models for their illness?” I ask him. Dr. Ipou leads me directly into the office of Dr. Amani N’Goran, an ethnopsychiatrist trained by the last French psychiatrist present shortly after Côte d’Ivoire’s independence from France in 1960. Dr. N’Goran is a tall and welcoming figure, and asks me to have a seat in his office. We sit in a circle together with two other psychiatrists from the hospital in addition to my research assistant. After introductions and some discussion of the history of the hospital, I pose the same question to Dr. N’Goran: “so what are the different explanatory models that you see among patients at this hospital and how does that affect treatment?” Dr. N’Goran, a self-proclaimed skeptic of Western medicine, answers me with a story of a young man he treated in the 1980s. This young man was from Burkina Faso and had migrated to Abidjan, like many thousands of others during the economic boom in Côte d’Ivoire, to work in construction. One day when he was down by the lagoon with a friend, he witnessed his friend drown. Dr. N’Goran describes how, in this man’s culture, seeing a person die from drowning was a serious taboo. The man, he tells me, immediately fell into a deep depression, unable to eat, sleep, or work. After being treated at the Bingerville psychiatric hospital for several months, Dr. N’Goran said the man began to improve and stopped coming. However, a few months later the depression reoccurred and the man returned for several more months of treatment. This cycle repeated itself many times over before Dr. N’Goran asked the man how they could break the chain of mental anguish and suffering. The man told him of a purification ritual in his village back in Burkina Faso that would erase the curse hanging over him from having witnessed the drowning. Dr. N’Goran wrote the man a prescription, ordering his work to provide him one month of leave so he could return to his village and perform the ritual. Upon returning to Abidjan, Dr. N’Goran said the man never needed to come back for further treatment and was effectively cured of his depression.
Dr. N’Goran’s story highlights the unique approaches that psychiatrists working in West Africa, and around the world, need to understand in order to ease the suffering of those around them. While Western psychiatry has a place there, Dr. N’Goran says, there are other considerations that need to be taken into account as well. This story stuck with me, with its deep understanding of the power of culture and belief over human illness and behavior, and the importance of providing space for individual needs. Every culture has fears, taboos, and stigmas that can tip us over the edge into panic and emotional collapse and this must be incorporated into psychiatric care wherever we are in the world. An important part of treatment is therefore asking patients what it is they need, as Dr. N’Goran did. After the story we continued speaking for nearly three hours, discussing the intersection of politics and history and culture related to psychiatry and mental health treatment. As I was leaving, he called me his American son, and said he looks forward to my next visit – as do I.
Edited by Louisa Hudson, MSc, Research Assistant, Department of Global Health and Social Medicine, Harvard Medical School