A ground breaker in Mental Health service in Ethiopia : Dr. Asmeret Andebirhan Birhane

08 Oct 2017

Today’s guest is Dr. Asmeret Andebirhan Birhane. She was born and raised in the heart of Addis Ababa. She is currently working at Lebeza Psychiatry Specialized clinic. She is founder and CEO of Lebeza Psychiatry consultation P.L.C. She completed her primary and secondary school at Cathedral Nativity Girls School and Nazareth School respectively. She did her post graduate training in psychiatry at Addis Ababa University. At this moment in time, she is Secretary General of Ethiopian Psychiatric Association (EPA).

She started her carrier at Aksum University by establishing college of health science by Collaborating with different neighboring universities for assistance. Later she was transferred to Mekelle University Ayder Hospital College of Health Sciences, Department of Psychiatry. In Mekelle university, she managed to lead the team in the establishment of the first substance rehabilitation center in the country apart from working as a psychiatrist and clinical director at the Substance Rehabilitation Center.

In Mekelle she worked in the expansion of the psychiatry service and staff development programs. She was given certificates for training in Substance Use Disorder, Volunteer Work at Entoto, Forensic Psychiatry, Clozapine Prescription and Treatment Guideline, among others.

The Ethiopian Herald had a short stay with Dr. Asmeret with the purpose of acquainting her personal and professional life with its readers. Excerpts:

Would you please enlighten us with your educational background?

After finishing high school, I joined Jimma University, School of Medicine to pursue medical science. I stayed there for about six and half years. In fact, my mother, who was in the medical field, was my main source of inspiration. At that specific juncture, my teacher who was a psychiatrist at that time inspired me to go for psychiatry.

What was your childhood like for you ?

We were highly devoted to academic excellence, hard work and discipline-virtues we inherited from our parents who were employees of governmental organizations. Our parents used to advise us to make meaningful changes in people's life and contribute to community. My mother contributed significantly by her service to governmental institutes like the Federal Ministry of Health and other International Nongovernmental Organizations in this way she inspired me to go to the medical field and contribute my share to the society.

How did your carrier started ?

After graduation, I was assigned at Aksum University. There were very limited staff at that time. The college was newly opened. Through Collaboration with a range of neighboring universities for assistance, we managed to establish the College of Health Sciences fulfilling the required material and manpower. A year after I established the college in Aksum University, I was transferred to Mekelle University. In my stay at Aksum university, I realized that mental illness was very much prevalent in our society. Worse still, there was a dearth of psychiatrists. Hence, my inclination towards psychiatry began mounting by the day. I was observing depression and anxiety among the university students. Sadly, we did not have anywhere to refer them. The dramatic improvement that patients showed was inspiring me to join the field of Psychiatry. I became very much satisfied with the outcome of treatment. Therefore, I decided to join the post graduate program in Addis Ababa university.

What did you do after Aksum university ?

After Aksum I came to Mekelle University and joined the Department of Psychiatry. After working in the Department for a couple of months, I came up with the idea of establishing a rehabilitation center. At that time, I was a staff of Ayder College of Health Science, Department of Psychiatry. At this point I had to go to a post graduate program in psychiatry in Addis Ababa to study psychiatry for three years. After finishing my studies, I came back and started working in the department as a full fledged psychiatrist. After a while I led the team in the establishment of the first Rehabilitation Center on top of working as a psychiatrist and clinical director at the Substance Rehabilitation Center. More to the point, I zealously worked in the expansion of the psychiatry service and staff development program, among others. To be honest, there was only psychiatric inpatient unit, we didn't have the facility to treat addiction problems which had a very complex psychosocial need.

How was the process of establishing a substance rehabilitation center ?

I had figured out beforehand what I could do specifically in the center. At that point the Medical Director, Dr. Amanuel was very much keen towards the establishment of the Rehabilitation Center. At the end of the day, we managed to establish the first substance rehabilitation center, though the task was very much challenging.

What were the core challenges ?

The awareness of substance addiction as mental illness was very low. Let alone this, mental illness is not considered as an illness. Still, a shuddering stigma is attached with it. We faced some constraints. But with the support of the University and some colleges, we succeed in organizing tripartite agreement between Mekelle University particularly Ayider Hospital's,a local NGOs ( hope community service )who were providing us with physical spaces and Meqoamia Community Development Organization,a local non-governmental organization, was working on addiction. In this fashion, we were able to establish the Rehabilitation Center. The Center, having a ground plus two building, is found a way from the heart of Mekelle City. It has rested on a 2000 SQ meter area. It has its own cafeteria, 30 beds, a garden and spots for sports activity.

The whole idea was gradually making the Rehabilitation Center a place where a holistic physical, mental and spiritual healing care could be effected. Therefore, after establishing the rehabilitation center, the next phase was engaging stakeholders. As I said, awareness about the disease was very low. So we used Maqoamia, as a platform for awareness creation, promotion and case identification. After identifying cases, they refer it to the hospital. In the hospital training for local nurses was given regarding substance addiction and also the center made a link for visiting psychiatrists from St Paul Medical College. They send to us psychiatrists every month. At the same time, we engage other stakeholders pending the service.

What was the next step after you came back from Mekelle?

In 2016, when I came back to Addis Ababa, I managed to open Lebeza Psychiatry P.L.C. The objectives of the company are promoting mental health in the prevention aspect as well as providing consultation service including a various training. After I did consultation for one year, we opened the clinic which provides efficient services. We mainly focus on mental illness and addiction. Finding a remedy for it is my passion and interest. We also address other psychiatric disorders.

What is all about mental illness?

Basically, when we say mental illness it is a disorder. That means it is a group of symptoms that occur in an individual to impair the functionality of that person. The impairment could be social, personal or occupational. There are more than 400 mental disorders. We make use of diagnostic specific criteria. If somebody exhibits symptoms under a specific criteria, we claim that person has a certain type of mental disorder. Mental disorders can be categorized depending on the severity and the impact they have on people’s life. They can be categorized as common mental disorder, which is commonly seen in the population like anxiety and depression. Another category is sever mental illness like schizophrenia severe enough to cripple that person from functioning fully in his personal, social, occupational, and holistic life. We always say that there is no health without mental health because the brain handles the main function of our body. It governs our behavior and metabolism. It also controls our every activity physically and emotionally and also our behaviorally. As a result, if there is any damage it manifests itself either in physical or mental

In general, mental disorder is a common illness in any population. Many people wrongly attribute mental illnesses to curses and spiritual causes. And because of that, the treatment, prevention and promotion of it are basically hindered.

What are the relationship between migration and mental health? And what do you think about Middle East migrants in our country from mental health perspective ?

Basically, when we talk about the Middle East countries, we have to have a very good picture about why migration is causing mental illness. Migration by itself does not cause mental illness. It is the migration process that causes mental illness. Hence, we have pre-migratory factors as well as post migratory ones. The pre-migratory factors are associated with mental illness that mostly surface when people lose their social ties and their families, among others.

The International Labour Organization (ILO) estimated that there are around 20 million migrants working in the Middle East countries, of which, one third are from Ethiopia, Philippines, Bangladesh and other Asian countries. Actually, there is a specific profile of these women going to the Middle East countries. Most of them are uneducated, very young and unskilled with limited exposure. Hence, their adoptive capacity to the disagreeable and very demanding work style proves deficient. Language barriers, cultural differences also pose hurdles on them.

Agencies lures them with a rosy future in salary and work conditions down the road, if they go abroad. This way they will be illegally trafficked. In the first place, it is the poorest of the poor who migrate.

Once they migrate, they face post-migratory factors such as working long hours. They face difficulty in getting social and psychological support and lack of how to protect their right and so forth. What is more, they do not know how to defend themselves. They have no idea about how they are recruited and the Kafala system, in which only the employer will be responsible for visa and for ticket makes it more difficult .If a domestic worker is intolerant to the harsh condition she faces and wants to leave, her entry visa will be revoked or she will suffer deportation or she has to run away illegally. As a result, the conspiracy of all these factors predispose people specially women for mental illness. So it is not only the mere migration but also the pre-migratory and the post migratory factors that trigger mental illness.

What do research findings on women returnees indicate?

Few researches are done on mental illness of migrant returnees. At one point, a certain qualitative research was done. They called returnees and interviewed them about the commonest stressors in their working environment and how victims coped with the stressing situations. Five major stressors were singled out in the study. The first one was the partial isolation. Because of their cultural uniqueness, the Ethiopian migrants attributed their problems to align culture, a new environment and foreign background. They as well ascribed the challenge to isolation, unequal treatment, mistreatment by employees. Some also suffered sexual and verbal abuses. Without their consent, they were also being transferred from one family to another and what have you. Most of the time they were not aware what they were going to face in advance because they were conditioned to be optimistic expecting rosy futures.

In other similar researches the findings were similar. Tragically,what migrants expect and what they face prove completely different. So, pending expectation was identified as one of the overarching stressors.

They were forced to work long hours without adequate rest. This threatens their physical and mental illness.

There was one research done in 2015 Abudabi, United Arab Emirates specifically in Alen Hospital. The research shows correlation between a rise in mental illness and Ethiopian migrant workers.

Returnees,in a state of utter confusion, are received by NGOs at the Airport. Often,they are unable to communicate. They arrive hungry and drowsy..

We observe a pattern of cases on those coming from the Middle East. They appear in a very bizarre manifestation. Usually they find it hard to talk and sleep. Moreover, they suffer communication barrier. After a couple of treatment, they start to recount and describe the harrowing experience they went through. And some would recover and join their families. They would be taken in by local NGOs for rehabilitation process.

What support do you give them?

We first help them to be emotionally stable. Mostly, among the returnees, those who have better awareness about their state are given counseling service when they come to our centers. Most of them go to public hospitals.

What do you think about the current event of Ethiopian migrants coming from Saudi Arabia ?

There are 400,000 illegal migrants estimated to live in Saudi Arabia, out of which, few have legal documents. They are expected to go back to their country in various mental states. As professional in mental health what we are trying to do is, participate in consultative meetings with local NGOs pertaining to how to address this issue apart from making an effort to support these organizations. We also facilitate in ways how the public and non-government organizations can come together to address this issue.

Are you achieving the intended target?

We are in the process. A consultative meeting was held. Afterward we established a technical working team involving psychiatrists, psychologists and NGOs. Subsequently, the plan is how to develop strategies on how to rehabilitate these migratory returnees. Migration and mental health were also the focus of the Ethiopia Psychiatry Association annual meeting this year. Stakeholders from Social Security and experts in migration from ILO were invited in the panel discussion. The discussion was revolving on migration and what our professional contribution can be. I am the security general for the Ethiopian Psychiatric Association. As professionals and individuals, we are highly interested in advising the government and supporting citizens professionally seeing that once mental illness occurs, treatment and rehabilitation are very much expensive. So, the primary target has been prevention. Together with stakeholders, we are very much committed to achieve the intended goals.

As a final point, is there anything you would like to convey?

Whenever a country grows, the urbanization increases. We all expect various advantageous, technologies and advancement in economic growth. At the same time, we should be able to have a way of maintaining our mental wellness. If there is any mental distress, we should be able to address it as early as possible. Because, as a nation grows, the level of stress too could increase. With urbanization, citizens are going to have less social ties, family support system and the like. The possibility of using substance as a way of coping with stress is rising high. We should all have an eye on our mental well being and make sure that we have a healthy life style apart from knowing the fact that substance abuse predisposes for various mental illness. All stakeholders should come together and work collaboratively to prevent mental illness and addiction because the cost of treatment and rehabilitation are very costly.



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