Book Review: “Homicide, suicide and mental illness in Africa”

(Princeton University Press. 1960)

                                                                          By Osefame Ewaleifoh

It is remarkable that the most comprehensive review of mental health and suicide in Africa was written in the 1960′s. This fact underscores how little we know today about the reality of mental health need and suicide in Africa.“Homicide, suicide and mental illness in Africa” was compiled and edited by Paul Bohannan, a Rhodes Scholar and professor of Social Anthropology at Oxford in 1960 and provides a rich ethnographic assessment of mental health,  homicide  and suicide in west Africa at the end of European colonial rule of the region.

This timeless must read volume work was conceived after Dr. Bohannan and his colleagues stumbled into a cache of judicial and police documents belonging to the British Colonial Lords in East Africa. This discovery prompted Paul and his collaborators to compile and analyze similar data sets from other regions of the continent from Uganda, to Kenya and Nigeria. This regional ethnography on mental health and suicide provided the first descriptive empirical report on homicide, suicide and mental health in West Africa. Among other things the authors asks  questions such as how do suicide rates in Africa compare with other parts of the world, what factors drive homicide, suicide and mental health in the region and finally what is the response and impact of suicide on the local community.

Among other things the author makes the interesting observation that homicide rates among Africans in Africa were significantly less than Africans living in the United States and Europe, emphasizing the need for a contextual consideration for homicide. On the other hand the authors’ studies suggest that suicide in Africa was not as rare as previously assumed.

Data on suicide rates were particularly difficult to obtain in the region since it was considered such a taboo subject among local communities and thus rarely formally reported. Despite these limitations, the authors make the interesting observation that suicide in the region was driven by such factors as loss of status, childlessness, impotence, adultery and vengeance. Furthermore unlike in the west, African communities perceive suicide as having major negative spiritual ramifications in the communities. Thus tribal leaders go to great lengths to prevent suicide, making it an effective bargaining chip between dissatisfied citizens (who might threaten suicide) and tribal leaders. Unfortunately, this particular volume fails to explicitly capture or address the role of mental health in driving suicide in the region.

Beyond giving a global overview of the role of homicide suicide and mental health in West Africa, the authors focus on specific local communities to explore specific trends and patterns unique to those communities. In Ghana, the authors reported similar forms of mental illness as those observed in Europe. The authors make the argument that witchcraft in the region makes it difficult to fully study mental health, since a lot of classic mental health cases are typically ascribed to witch craft in the region. Thus, the authors spend considerable time contemplating the similarities among the symptoms observed in the mentally ill in the region and those thought to be possessed by evil spirits.

So much has changed in Africa since 1963 when this volume was originally published still the thematic relevance of the subject has only become more pressing. The Colonial governments are long gone, geographical boundaries have been redrawn and most of the countries in the region have all won their independence since 1963 completely altering the social and geopolitical landscape of the region. Still the mental health need remains largely the same. More significantly it is remarkable that there has been almost no follow up study to this volume. The lack of widespread interest in mental health in Africa is understandable- it neither seems like an urgent or important need. With limited resources to devote to all the health concerns in the region, funds naturally get allocated to health concerns perceived as more urgent and important. Unfortunately, mental health care in the region has not been thus prioritized.

While there are clearly limitations and weaknesses with the current volume- the most obvious being how dated the information in it is- this ethnographic study provides an important historic foundation for health workers and researchers interested in mental health in the region.

Mental health is a complicated and notoriously difficult public health challenge- even in the west with all the available resources. Still as a first step it is time we allocate some resources to simply understand the current status of mental health need in Africa at least as a prelude to future action.

Public Health in the News – August 17, 2014

Global

National

Illinois

Chicago

Northwestern

When Prevention Fails: Life After an STI

By Osefame Ewaleifoh, PhD/MPH Candidate

As health workers, our default position in the fight against sexually transmitted disease is prevention – as it should be. This focus on prevention influences everything we do. From health policy, to health education and health outreach, our entire vocabulary on sexually transmitted diseases is rooted in the prevention of disease. Still, despite our best efforts, we must accept the reality that prevention programs and campaigns don’t always work. Accepting this reality is not a submission to failure to ending the spread of sexually transmitted diseases. On the contrary, it is a step toward approaching the conversation on STI more holistically – focusing on both prevention and management. As a result of the current focus on prevention, a lot of young people know “how to prevent an STI” but very few know where to even begin “if” they get an STI, almost as though no one actually ever gets infected. Perhaps while we continue to focus on prevention it might be worth asking – what do you do when prevention methods fail or were just never applied?

Reality: STI’s (including syphilis) still happen.

First, we must establish: STI’s do happen.  From more moderate conditions like yeast infections, to more complicated situations like HIV, gonorrhea and syphilis, young people still do get infected. To drive this point home, in 2012 there were 18,501 cases of gonorrhea, 1500 cases of syphilis and 67701 reported cases of chlamydia in Illinois (figure 1). Yes syphilis is still a real threat – even in 2014. On a much local level there were 172 cases of gonorrhea in Lakeview and Lincoln Park  Chicago alone for men and women between the ages of 15 and 44. These numbers are worth emphasizing for several reasons – first, the fact that you have not heard of someone you know getting infected does not mean infections don’t happen.

STI IllinoisData: City of Chicago: https://data.cityofchicago.org/browse?q=sti&sortBy=relevance&utf8=%E2%9C%93

Second, if you are infected with a sexually transmitted disease, you are not alone. While seemingly trivial, this knowledge is important because it affects your approach to seeking treatment and care knowing that others have walked the same road and there are tools and resources to guide you to recovery. This is assurance is important because, while STI’s can dramatically change your life, life does go on and an STI is not a death sentence.

Briefly, we here consider specific steps to both know your STD status and to manage that knowledge. We begin by listing the advantage of getting tested and providing a list of local centers and clinics where you can get tested. Next we review the cost associated with getting tested, insurance options and follow up treatment. Finally we briefly outline available support resources, your rights and privileges (to employment and privacy), as well as your responsibilities (partner disclosure and City Department of Public Health STI tracking) to help manage and contain the STI in your community.

Reality: Stuff happens.

Most people never have to think of the multi-layered consequence of getting a sexually transmitted disease – they don’t have a reason to. For many however, the reality of sexually transmitted diseases begins perhaps with a fun summer night out in the city. A glass of wine, maybe some shots here and there. Hung over the next morning, fuzzy memories from the night before that might include a broken condom and end with strange looking rashes a few weeks later. For the really brave this all leads to a nervous call to the doctor’s office and the awkward waiting room silence and sweaty palms. And then the long lonely wait for the test results. Three days or more of wondering – what would I do if I am actually infected?

For most people this awkward wait is eventually resolved with a negative test result and a deep sigh of relief – all clear! Occasionally, however, the dreaded call from the doctor’s office comes with a positive STD test result. For most, this call marks a major inflection point in life as suddenly everything changes. Relationships, career, school , family, everything that matters seems suddenly uncertain as hope rescinds into the dark distance, where do I go from here, who do I talk to?

Starting at the very beginning – “know thy status”

A few studies on credit score knowledge suggest that people who know their credit scores are more likely to make smarter financial decisions. While there is currently no empirical public health corollary to this study, it is reasonable to speculate that knowing your comprehensive STD status might provide increased incentive to protect your health. This point is particularly relevant to men who almost never go for annual health checkups, unlike women who have annual physicals. Fortunately for most people the result of a comprehensive STI checkup will be negative. A negative empirically confirmed test can provide a powerful incentive to protect your greatest investment – yourself.

Convenience: An STI center next to you

For most people a major limitation to getting an STI test done is simply convenience. Considering the awkwardness involved in dealing with any sexually centered health conversation, most people would just rather not deal with it. To get around the convenience challenge, the City of Chicago has distributed several clinics throughout the city (see our list below). In the city alone there are 5 specialized sexually transmitted disease centers. These STI centers are different and unique from clinics in three major ways: 1) Speed of care – you don’t need an appointment; you can just walk in at any time. 2) Cost of care – all services are free. 3) Specialization and privacy – unlike your typical doctor’s office they focus on just STI’s – testing, tracking, and counseling, and no one will ever know you were there. In addition these centers often offer freebies like free condoms!

Complications that come with STI’s

While most will never deal with the dread of getting a sexually transmitted disease, for those who do we now have incredible amount of resources to track, treat and manage sexually transmitted diseases. With a few exceptions, most sexually transmitted diseases are now either completely treatable or manageable. What is more, there are now laws to protect you from discrimination based on your health status. While these laws vary by states the basic provisions are mostly the same. While protecting you from discrimination based on your health status, each state in turn expects you to play a part in reducing the spread of sexually transmitted diseases. To this end states have made laws to both track and curtail the spread of STI’s. While these laws vary from state to state, the basic objective is the same: to track disease spread and to prevent or reduce deliberate spread of disease. If you suspect you might be exposed in any way, it is essential that you familiarize yourself with both the tracking and reporting regulations around STI’s in your state.

Beyond treatment – Finding support

While the obvious first step and immediate need following an exposure is treatment, exposure to a sexually transmitted disease often leads to chronic conditions that might need extended care. To this end it is essential that you seek and invest in a solid support network, which may or may not include your friends or families. Dealing with a sexually transmitted disease is inherently a very lonely experience that is only confounded by the associated stigma and shame. These factors make a solid support network absolutely essential to navigating the days and weeks ahead. Often your primary care provider can make recommendations about available support groups and sessions that might be helpful during your treatment. Ultimately as health workers and consumers, it is increasingly essential that we approach the conversation on sexually transmitted disease on both a prevention and management front – focusing on preventing infections but also making sure that people know what to do when they become infected.

Additional resources:

According to the city of Chicago: The following CDPH clinics are drop-in specialty clinics that diagnose and treat sexually transmitted infections (STI) including HIV, Syphilis, Gonorrhea and others. They also provide information about condom use and other prevention methods. Services are offered at no cost, and on a first-come, first-serve basis, no appointment is necessary.

Englewood STI Specialty Clinic
641 W. 63rd St., Lower Level
Phone: 312.747.8900
Fax: 312.747.5275
Mon., Wed., Fri.: 8 am – 4 pm
Tue., Thu.: 9 am – 5 pm

South Austin STI Specialty Clinic
4958 W. Madison
Phone: 312.746.4871
Fax: 312.746.4637
Mon. and Wed.: 8 am – 4 pm
Tue., Thu.: 10 am – 6 pm

Lakeview STI Specialty Clinic
2861 N. Clark, 2nd Floor
Phone: 312.744.5507
Fax: 312.744.2573
Mon., Wed., Fri.: 8 am – 4 pm
Tue., Thu.: 10 am – 6 pm

West Town STI Specialty Clinic
2418 W. Division
Phone: 312.744.5464
Fax: 312.744.5516
Fri.: 8 am – 4 pm

Roseland STI Specialty Clinic
200 E. 115th St.
Phone: 312.747.2831
Fax: 312.747.2841
Mon.: 8 am – 4 pm
Thurs.: 9 am – 5 pm

Services eligibility:
Individuals 12 years of age and older are eligible for services. No one is turned away if unable to pay- when fees exist. Fees are on a sliding scale basis.

Services provided at the clinics:
• Evaluation, testing & treatment for sexually transmitted infections & HIV
• HIV Counseling
• HIV Rapid Testing (same day results)
• STI & HIV Education
• Partner Notification (without implicating you)
• Treatment Services
• Free Condoms
• Rapid on site lab testing and dispensing of medications

In addition free condom distribution sites in the city can be found at https://data.cityofchicago.org/Health-Human-Services/Condom-Distribution-Sites-Map/jytx-u9

References:

http://www.cityofchicago.org/city/en/depts/cdph/provdrs/sti_hiv_aids/svcs/get_yourself_evaluatedforstihivaids.html

Public Health in the News – August 10, 2014

Global

National

  • Twenty-nine state attorneys general on Friday urged the Food and Drug Administration to strengthen its proposed regulations on electronic cigarettes, a business that has exploded into a $2.5 billion industry with virtually no regulatory oversight.
  • Researchers trying to conduct research to determine the effectiveness of medical marijuana on treating various ailments find it extremely difficult to conduct research due to federal restrictions.

Illinois/Chicago

  • New requirements for school vaccinations have been introduced by the Illinois Department of Public Health, due in part to the recent mumps outbreak in the state.
  • Illinois will receive $1.3 million as part of a $35 million settlement with a Pfizer Inc. over the illegal marketing of Rapamune, an organ-transplant drug to Illinois doctors.

Northwestern

  • Women in the United States who have cesarean sections are less likely to continue childbearing than those who deliver vaginally, according to a new Northwestern Medicine study. Notably, this relationship weakens for women living below the poverty line.

Public Health in the News – August 3, 2014

Global

National

  • The anti-vaccination movement has become an anti-vitamin movement – some parents are refusing shots of vitamin K for their newborns, which can lead to brain damage and strokes.
  • A recent court ruling makes it possible for the F.D.A. to allow continued use of an animal feed antibiotic even when that antibiotic has been shown to be unsafe.
  • A new project called MakerNurse hopes to document and highlight nurses’ DIY contributions to health care.
  • Parents of children with developmental issues have higher rates of depression and anxiety. A new study shows that these can be reduced when parents learn techniques such as mindfulness training.
  • We’ve previously mentioned that there can be benefits of using technology such as smartphone apps to promote personal health, but some people are becoming increasingly worried about apps that may give people incorrect information about their health. No, your iPhone can’t read your blood pressure.
  • The F.D.A. is considering whether some early clinical trial data should be kept under wraps, in order to avoid biasing the final results.
  • The Affordable Care Act has changed the way in which health insurance companies keep individual premiums low; now, more companies are saying they’ll only pay for certain doctors and hospitals.
  • Chronic pain causes brain changes that make it harder to focus and be motivated.

Chicago

Northwestern

  • Prostate cancer cells that express high levels of the PIM1 protein die when another cellular protein, PLK1, is blocked, shows a new study from NU Urology professor Sarki Abdulkadir, MD, PhD.
  • A new study from NU professor Scott Budinger, MD, shows that exposure to air pollution is linked to increased levels of lung inflammation and blood clots, which in turn can increase an individual’s risk for heart attacks and stroke.

“Public Health Through Pictures” – Tell Your Story!

The Northwestern Public Health Review invites you to share your stories and experiences of health and public health through pictures during our annual Public Health Matters seminar series and reception. The theme of the poster session this fall is “Communicating public health through pictures”. Along these lines we invite you to submit photographs, artwork, graphics or other images that communicate local, national or international public health stories.
art by Elise Walker
Art from the latest print issue of the NPHR, by Elise Walker, BME Graduate Student, Northwestern University
Accepted images will be displayed during the public health matters reception and will be featured in future published issues of the Northwestern Public Health Review.
Entry Criteria:  Public health or medically centered images of any form. All submissions must be the author’s original work. As always, please ensure you have your subject’s permission before submitting any image including people.
Deadline: All submitted entries should be received by the 30th of August 2014. Please include a very brief description of your entry.To submit your image or to contact us for more details, email the editor of The Northwestern Public Health Review at nphr@u.northwestern.edu or Claire Vernon at cgvernon@u.northwestern.edu.

For more information on the NPHR and our mission, visit www.nphr.org.

Public Health in the News – July 26, 2014

Global

  • Speaking to delegates at the AIDS 2014 Conference, Singer and activist Bob Geldof took donors to task for their “preposterous reluctance to fund the last mile,” calling it a disgrace.
  • Dr. Sheik Umar Khan, one of the main doctors in Sierra Leone treating Ebola patients has been reported to have caught the virus. He has been put in isolation and is being treated by Doctors Without Borders.
  • Women and girls are less likely to undergo female genital mutilation, or FGM, than 30 years ago. That’s the encouraging news from a UNICEF report on the controversial practice, presented this week at London’s first Girl Summit.

National

  • Many American kids don’t realize they’re overweight or obese, but knowing can help them change, according to a new CDC report.
  • Michael Farrell, head of the troubled CDC anthrax lab has resigned after some anthrax leaving the lab was found not to have been deactivated.
  • Researchers have found some evidence of a connection between the use of a nicotine patch by pregnant women and ADHD in their children.

Illinois/Chicago

  • Chicago Bulls star Joakim Noah has created a new PAS against gun violence. The “Chicago Stand Up” PSA campaign urges Chicagoans to put down the guns and stand up for peace.
  • Dr. Steve Whitman, who served as Chicago Department of Public Health’s Director of Epidemiology for many years, died Sunday. After leaving CDPH, Dr. Whitman directed the Sinai Urban Health Institute, where his groundbreaking research fully documented alarming differences in breast cancer mortality among African American women compared to white women in Chicago and other cities across the nation.

Northwestern

  • A multi-disciplinary team of scientists from Northwestern Medicine and the University of Chicago investigated how lymphocytes, a type of white blood cell, increase inflammation in the body during colon cancer. The results were published in Science and Translational Medicine.
  • A new Northwestern Medicine study, lead by Dr. Seema Khan, investigated a gel form of tamoxifen, that when applied to the breasts of women with noninvasive breast cancer reduced the growth of cancer cells to the same degree as the drug taken in oral form but with fewer side effects that deter some women from taking it.
  • Northwestern University Feinberg School of Medicine has been selected to join a new research network funded by the American Heart Association (AHA) to promote cardiovascular health and prevent death from heart disease and strokes. The AHA has awarded the center a four-year $3.7 million grant for this work.

Public Health in the News – July 20, 2014

Global

  • Among the victims of the Malaysian Airlines plane that was shot down this past week was Joep Lange, a prominent AIDS researcher.
  • “After malaria is controlled, what’s next?” Science blog The Mermaid’s Tale discusses this question and talks about the different mindsets needed for malaria control vs. elimination.
  • Many scientists have signed an open letter calling for reforms of Europe’s Human Brain Project, a large-scale neuroscience initiative. Here’s why.

National

Chicago

  • After adopting a Medicare expansion proved to be more costly than expected, the Cook County health system is facing a $63.5 million deficit by the end of the year.

Northwestern

  • Niacin, a drug prescribed to fight heart attack and stroke, may not provide any benefit while increasing risk of death, according to a new study and an accompanying editorial by NU cardiologist and chair of the Department of Preventative Medicine, Dr. Donald Lloyd-Jones.
  • NU professor Dr. Seema Khan and colleagues have released a study indicating that the breast cancer drug Tamoxifen may have fewer side effects when used as a gel.
  • Dr. Shyam Prabhakaran, NU neurology professor, was interviewed on Chicago Tonight regarding strokes in women.

Public Health in the News – July 13, 2014

Global

National

  • After two incidents, federal health officials announced Friday that they had temporarily closed the flu and anthrax laboratories at the Centers for Disease Control and Prevention in Atlanta.
  • Sad news to report – the “Mississippi baby,” thought to have been cured to HIV as an infant is now showing signs of infection, according to new reports.
  • According to a recent vote by the Berkeley City Council, those considered poor (making less than $32,000 per year) will be entitled to free marijuana related to their treatments so that no one goes without medical care.
  • AIDSVu, a new project out of Emory University, presents fascinating graphics of the spread of HIV throughout the U.S., including Chicago.

Illinois/Chicago

  • The Chicago Department of Public Health has been named “Public Health Department of the Year” by the National Association of County and City Health Officials (NACCHO). Way to go CDPH!
  • MedCity News presents a report on the $56 million dollars of the Affordable Care Act funds that have been given to new Illinois health initiatives.

Northwestern

Public Health in the News – July 6, 2014

Global

  • When researchers studying ways to solve global food issues needed a cheap, modular, transparent material in which to grow plants for their experiments, they turned to Legos.
  • A new test that can diagnose tuberculosis much more quickly than other methods has been developed by scientists at Stanford University.
  • People infected with malaria give off odors that attract more mosquitos, a new study finds. This may help researchers develop new ways of detecting people who have been infected.

National

Northwestern