It is a Saturday, early in the month of May, and the Postpartum Support Network is holding its annual public event to raise awareness on the mental health of pregnant and recently delivered women.
Gathered at the Oriental Hotel venue are a well-dressed crowd of mostly young people, many of whom are clearly drawn to the event by social concern. In an adjoining room books, bags and other items related to mental health and maternity are on display.
The Postpartum Support Network is a Lagos-based NGO which is passionate about achieving good mental health for women in the period surrounding pregnancy and delivery. According to its pamphlet, the work is focused on five simple steps – education and the creation of awareness in pregnant women and new mothers about postpartum depression, training nurses who work in maternity facilities on emotional intelligence, conducting screening among pregnant women and the recently delivered, offering therapy and home visits to patients, and offering support groups and a road to recovery (R2R)n to victims.
The realities surrounding mental health in the generality of the Nigerian population remain very grim indeed.
The period of pregnancy and the months after it is a time of especial vulnerability to mental health problems – most commonly depression. More than one out of every ten, perhaps up to one in seven mothers will experience such symptoms. The most common symptoms include a feeling of sadness, tearfulness, unusual anxiety and worry, excessive crankiness or irritability, eating or sleeping more or less than usual, difficulty in concentrating or making decisions. Other, more serious developments, may include loss interest in self-care and grooming, a feeling of not being up to everyday tasks, withdrawing from the baby and from loved ones, fear of hurting the baby, loss of interest in caring for the baby, and a feeling of guilt in the woman about her ability to care for her baby.
For many mothers experiencing ‘Baby Blues’, the symptoms are transient, disappearing within a few days. The real problem is with mothers who suffer symptoms that are severe and long-lasting. Anyone whose symptoms last for two weeks or more is suffering from depression and should be recognized and treated.
In Nigeria, currently, almost invariably, they are not.
It is a situation that causes much pain and suffering to individuals, and to loved ones. Ignorance about the condition puts a strain on families and relationships.
The illness is much misunderstood. Although some episodes follow pregnancies that are attended by the stress of disturbing life events or physical difficulties, illness can occur following even the most normal and uneventful of pregnancies.
On this day, the first major offering is a lecture delivered by Dr Gbenga Okulate, a Psychiatrist and retired General in the Nigerian Army. His topic is ‘Navigating the risk of perinatal mood disorders in a setting of pregnancy loss and stillbirth’.
At the heart of the general failure in the Nigerian environment to recognize and help women with perinatal mood disorders is a cultural reluctance to accept that he problem even exists. Pregnancy is supposed to be a happy, longed-for experience, and to feel a sense of inability to look after one’s baby in an ambience where a woman’s mother in law is apt to make critical, disparaging, even threatening comments about the ‘laziness’ of her daughter in law must be double jeopardy for the affected person. Husbands, not understanding that it is illness, are often unable to sympathize or assist beyond a certain point andwould usually urge their ailing partner to ‘pull yourself together’. This, of course, just makes matters worse.
The medical community are not as aware of the condition as they ought to be. Nurses, mostly women themselves – who are the ones who interact often with women during pregnancy, are unable to recognize the condition, not to speak of participating in its treatment.
The youthful volunteers of the PSN, some of whom have themselves experienced Postpartum Depression, inform the audience that, in the past year, they have helped in treating almost two thousand women suffering from depression in various maternity facilities in Lagos, and have trained more than one hundred nurses on how to be sensitive to the emotions of women in their charge.
It is a lot of work, deserving applause.However, in reality, it is a drop in the ocean, given the scale of the problem out there in society.
A lively discussion ensues,focused on pregnancy loss, grief, and the special challenges they pose for the woman’s emotional wellness.
You are invited, with others, to hold a panel discussion on how to improve maternal mental health in Nigeria, and to make a pronouncement on who owns the responsibility to bring about that improvement.
It is a crunch topic. Beyond the enthusiasm of the volunteers who have cobbled together a field force of Psychologists, Social Workers, Occupational Therapists, Life Coaches and an assortment of other enthusiasts, powered by generous support from sponsors such as Tonye Cole, who is sitting self-effacingly in the back of the crowd, along with his wife Sylvia, it is necessary to figure out how the human resources on the ground could be most efficiently utilized.
The responsibility belongs to everybody – government, private sector, concerned individuals, you aver. A system of task-shifting, with good training, would help to activate the hidden potential of the staff who deal with pregnant women. Nurses and other staff could be trained to work with protocols to recognize women who need help. Some of them could also be trained to offer basic counselling to the patient and her family. For many sufferers, that might be all they would ever require. Those who are seen to have deeper symptoms, needing the care of specialists, would be identified and referred ‘upwards’ by them. It is a similar journey, you tell the panel, and the audience, to the ongoing effort to make mental health care available at the primary care centre, close to the citizens, as a way of maximizing the effectiveness of the few psychiatrists in the country.
On a final note, you advise the PSN ‘warriors’ to put most of their effort and limited resources into public enlightenment and training on ‘task shifting’, run by competent trainers, as a way to achieve scale and impact.
Many new ‘converts’ are eager to volunteer, you observe as you depart.
It is a sign, you reason, that there is hope, yet, at least for the Nigerian woman.
Femi Olugbile
