“He dropped out of school because he was receiving messages from God,” said Lucy, the veteran nurse in the Psychiatric Unit in Embu. “But his family thought this was very strange because he didn’t even go to church.”
Just off the main Nairobi – Meru Highway, close to the Isaak Walton Hotel, is the only psychiatric unit in Embu County. It is a square building with an internal courtyard, built in “Public Works Department 1960” style. To gain access, one has to pass through a locked gate by the nursing office. It has two wards, one with twelve male beds and another with six female beds. Adjacent to the female ward, there is an outpatient consulting room. The seclusion room has a steel door secured with a large padlock. There is a recreation room with a caged television and a broken pool table.
According to a national newspaper, there are only six psychiatrists working in the public sector in Kenya. One of them works here in Embu. Each time I have visited the unit, I have only seen Nurse Lucy, as the psychiatrist spends a lot of time doing medico-legal assessments for the courts. There is only one other psychiatric nurse, who manages the inpatients. Student nurses do placements here, but few of them want to make mental health nursing their career.
On my first visit to the unit in May, all the student nurses were huddled in the nursing office by the gate. No nurses were in the open courtyard where some patients were walking around in the winter sunshine. I asked why the student nurses were not mingling with the patients. It was suggested to me that they found it too cold to leave the office.
Lucy told me that drug-induced psychosis was common. “Embu is the catchment area for khat,” she said. (I am not sure she got the right word; “epicentre” would have been my choice.) The shrub khat contains two mild stimulants which are released when the fresh leaves are chewed. It is commonly grown in East Africa, where it is known as “miraa“. To get the best price for the leaves in the markets of Nairobi, drug traffickers drive like maniacs from Embu down the A2 highway in the early morning.
Although amphetamine psychosis is well-recognised, I had never heard of khat causing psychiatric disturbances such as hyperactivity, mania, hallucinations and, with prolonged misuse, psychotic depression. I learned that khat is used with other drugs, such as cannabis, to calm down as the feeling of elation recedes.
Lucy regularly visits schools to talk about mental health and the dangers of drugs and alcohol. She supplements this activity by health promotion using social media. Sadly, outreach clinics in the community have ceased. She has no vehicle and there no community mental health workers. Many people think that mental illness is caused by being bewitched. Rural communities tolerate people with severe mental illness until they start breaking things or attacking goats. Then they bring the person to Embu for a psychiatric consultation. During my previous visit, I saw a woman whose hands had been tied with rope sitting calmly in the outpatient waiting area.
Lucy also said that puerperal psychosis, schizophrenia and severe depression were common in patients attending the clinic. If she could not manage patients suffering from these conditions, she would refer them to Mathare Mental Hospital (formerly known at Nairobi Lunatic Asylum) in Nairobi.
It was obvious from visiting the unit that the patients were cared for with compassion. Lucy was a true champion for people with mental health problems. Unfortunately, she has plans to retire in 2022 and at present, there is no one being groomed to be her successor.