Now I realise there is nothing like 'appropriate time'
I learnt a lot from his article and I hope someone someday also gain something valuable from this great piece of work.
Enjoy Excerpts from the gifted Ike Anya's: 'People dont get depressed in Nigeria' I learnt a lot from his article and I hope someone someday also gain something valuable from this great piece of work.
I open the newspaper and the word ‘Nigeria’ catches my eye. It’s a feature on the young British Nigerian novelist Helen Oyeyemi in which she speaks of her struggle with depression in her teenage years and the difficulty her parents faced with understanding it. ‘Because people don’t get depressed in Nigeria,’ she says. ‘They were like, “Cheer up, get on with it.”’
The black words sliding over the page carry me back in time to another place, where I too, like Helen’s parents, believed that people don’t get depressed in Nigeria.
I wake up to a clucking sound outside my bedroom window. It is guttural, low-pitched, and there is a rustling in the fields of guinea corn that stand sentry immediately outside our low-eaved modern bungalow. I walk to the window and peer through the grimy glass louvres, past the hole-ridden metal mosquito netting, and see a herd of cattle making its gentle, almost silent way through the fields.
I walk out into the living room that I share with the other occupant of the small two-bedroomed house set on the edge of the hospital compound and head for the bathroom. There I retrieve my battered metal bucket and head out to draw the water for my morning ablutions. At the well, there is a gaggle of young children, chattering rhythmically in Hausa as they deftly throw the black rubber guga into the well, hauling it up to fill the buckets and jerry cans surrounding it. As they see me make my way along the path lined with bowing neem trees, they shriek their greetings, laughing, excited.
‘Sannu, Likita, sannu.’
I am likita – Hausa for doctor – and I am twenty-seven years old, freshly qualified from medical school in southern Nigeria and posted to this small northern village for my national service.
One of the children rushes to grab my bucket and, despite my protestations, runs to the well to fill it up and deposit it back at my feet. I thank him and head back to the house, leaving the children to continue their chatting and fetching.I walk down the tree-lined mud path that leads from the grandly named staff quarters to the hospital, pausing on the way as I meet colourfully dressed and veiled women heading for the market in the next village, who greet me in the elaborate formal ritual of the Hausa culture.
Ina kwana . . . ina kwana, I echo as they enquire after my well-being, my work, my family.
We finish off with a madalla and I make my way along the low-ceilinged corridors to the clinic where, as usual, there is a large mass of people of all ages and sexes already gathered. Looking into the distance, I notice that work seems to have started again on the wall that is being built around the hospital by the Petroleum Trust Fund. It isn’t clear who has decided that this is what we need most – a generator to stop us doing surgery by lantern light might have been good, as would some equipment for Wilson’s fledging laboratory – but the contracts have been awarded in faraway Abuja and Kano, and so I suppose we must be grateful that the contractor at least seems to be making a good fist of building the wall, which is supposed to provide us with additional security. And he has employed local labourers to do it, so we must be grateful for that as well.
Muttering angrily to myself, I settle into my chair and ask Sani, the cheerful youth who, with his smattering of English, has bagged the role of interpreter, to summon the first patient. I hear him calling out a woman’s name, having first, with an air of self-importance, bid the crowd to be quiet and to listen well. I have soon learned that everyone who works in the hospital is highly revered in the village. We all, apparently, are called likita and there are rumours that the theatre cleaner, the hulking Kaka, runs a thriving sideline in low-price hernia surgeries performed after hours in his living room. Considering how bare the theatre itself is, his living room may perhaps not be that much more under-equipped for the purpose.
bearded young man, perhaps twenty-five years old, dressed in a blue riga, walks into the room, carrying a toddler in one arm and with the other solicitously leading a young woman, a girl really, dressed in the simple wax-print wrapper and blouse with a loosely tied headscarf that is the common dress of all the female folk here. He greets me respectfully but with an air of distraction as Sani ushers the girl into the seat. The young man stands guard beside her, holding the baby and focusing on my face. She sits listlessly, head bowed, silent.
I look at the blank sheet of paper, torn out of an exercise book, that lies before me and serves as a consultation sheet. I ask her name, her age and what has brought her to the hospital. I do not bother to ask for an address, swiftly amending the history-taking technique learned at my medical school in Enugu. Her husband answers as she continues to look down, despondent. He says her name and volunteers that she is perhaps fifteen years old. Having by now spent over a month in the village, I can already pick out his answers from the rapid-fire Hausa without Sani having to interpret and am not surprised that a girl that young is already married with a baby. It is the way here and one of the nurses has explained to me that in their culture a woman is not supposed to see her second menstrual period in her father’s house. He cites the Quran as his source and I tell him of the many Muslim northern Nigerian girls that I knew while at secondary school, many of whom remain unmarried and are pursuing careers. He is silent but I sense that he refrains from challenging me out of respect rather than out of any acceptance of my counter-argument. Returning to the patient before me, I ask again what has brought them to the hospital. My question, once Sani has translated, elicits a burst of animated utterance from the man, his wife remaining silent, her head still bowed.
Her problems started, Sani translates, perhaps a year or so ago, soon after the birth of the little boy, their firstborn. She would spend almost the whole day lying on the mat asleep, she had stopped smiling or singing while she cooked, she now cried a lot, and had ceased doing all of her household chores. I can see the concern on the husband’s face as he recounts the many ways in which the girl has changed from the cheerful industrious woman he married, to this lifeless bundle of misery draped floppily on the chair beside me. He swears that he has been good to her, that he does not beat her, even though he is only a poor farmer, and I can see it in the newness of her cheap wax-print outfit and in the rows of bangles that adorn her wrists. They have taken her to see a number of traditional healers but the maganin gargajiya has failed to work its magic and so, against the advice of his family and hers, he has brought her here to try Western medicine.
My first thought is of post-partum depression and yet my doubts remain. In spite of our psychiatry lectures and placements, the hours spent in the wards and outpatient clinics at the psychiatric hospital in Enugu, many of my classmates, myself included, still look at depression as a largely Western illness. The few cases that we have seen in the clinics in Nigeria have been mostly among the relatively affluent, and so we imagine that it is a luxury for those who can afford to ignore their more pressing immediate problems – what to eat and how to keep a roof over their heads – to indulge in afflictions of the mood.
And so I probe a little more, asking more questions, trying to disprove the evidence of my own eyes. How, I wonder, can a young woman who has grown up in this harsh environment, waking up early to fetch water, cook, clean, farm till late in the day, be suffering from depression?
And yet, the more I probe, the more the husband, through Sani, proffers evidence to confound my theory. I am conscious that time is passing and that there are still a slew of patients to see on the morning ward round and so I embark on more rapid-fire questioning. Is she eating? No, she has had a poor appetite since the illness began and has consequently lost a lot of weight. She has also stopped visiting her friends and family and takes little or no interest in her child or, indeed, in anything.
The more I try to discount it, the more conscious I am that this is looking more and more like a classic case of post-partum depression. I look up from my scribbling on the page and meet the eyes of her husband, staring, his gaze almost boring into my face, his countenance steady, earnest and hopeful. He has come to us against the wishes of his family and the village and I feel that I owe him something. I must not let him down.
Finally, with an inward sigh, I reach for a pile of neat slips of paper, which Sani has meticulously cut up before I arrive, to serve as prescription forms. The recommended treatment for depression is either therapy or medication. I look through my formulary, flicking through the well-thumbed anti-infective agent section to the pristine antidepressant section, trying to decide which antidepressant might be most easily available in this remote place. The question of going to the hospital pharmacy does not arise as they have struggled in the past to fill prescriptions for simple antibiotics. Knowing the limitations of the pharmacy, I opt for Amitriptyline, the cheapest and most basic of the antidepressants, and ask her if she is still breastfeeding.
‘No,’ her husband says, she has not really breastfed at all and the baby is being suckled by his brother’s wife who has a toddler of her own.
I scribble quickly and hand the paper to the husband, explaining through Sani how the medication is to be taken. I know that he will probably have to send someone to Kano, a good hour’s bus ride away, to buy the medicine. I wonder what it will cost him – this is the lean time between harvests. Perhaps he will need to draw on the last few naira saved from the previous year’s cotton crop, reserved for the ram meat for the impending Sallah festivities. Or perhaps he will join the throng of supplicants squatting outside the Hakimi, the village head’s palace each morning, bringing their needs and concerns.
Whatever the cost, I sense that he is determined to do whatever it will take to restore his wife to him. I pray that I am not sending this young man on a wild goose chase.
I ask them to come back in two weeks, fearful of giving a later appointment, just in case I have got the diagnosis wrong. I do not want to leave her for too long on medication she does not need. They leave the room the same way they came in, a ragged chain of three, her battered plastic slippers dragging on the rough concrete floor.
Two weeks later, I am sitting in the clinic again and my head is reeling.
Sani calls the next patient and she marches forward, her gauzy headscarf tied at a jaunty angle. She carries her toddler in her arms, cooing soothingly to him. Behind her is the bearded husband, a broad smile splitting his expansive face. As she takes her seat beside the consulting desk, he falls to the ground, wanting to grasp my feet in gratitude. I ask him to get up and laughingly begin to scribble on her sheet. I do not need to ask if the medicine has worked.Nearly a decade later, I sit in a white-panelled meeting room, beneath harsh, bright fluorescent lighting. I look out to the rooftops of west London, the arch of Wembley Stadium barely visible in the distance. My colleague responsible for mental-health provision is explaining the challenge of getting more people to use the new ‘talking therapy’ service for those with low-level mental-health problems. We have invested hundreds of thousands of pounds, but uptake has been slow.
As we debate how to address this, my mind wanders back to a small, bare consulting room, in a hospital in the northern Nigerian savannah, and I wonder how my patient is faring.
Mena: Again above are Excerpts from Ike Anya's: 'People dont get depressed in Nigeria'
I learnt a lot from his article and I hope someone someday also gain something valuable from this great piece of work.