Bipolar Disorder Uganda

In the past bipolar disorder (BPD), was known as manic depression. BPD is a mental health disorder characterised by periods of depression and periods of elevated mood. When the mood is elevated a person behaves or feels abnormally energetic, happy or irritable. In the elevated mood a person can often make poorly thought out choices with little regard to the consequences. Sleep is often reduced when the mood is elevated. A severe episode of elevation can result in distorted beliefs about the universe known as psychosis. Depression commonly follows a period of elevation, Wikipedia continues:

During periods of depression there may be crying, a negative outlook on life, and poor eye contact with others. The risk of suicide among those with the illness is high at greater than 6 percent over 20 years, while self-harm occurs in 30-40 percent. Other mental health issues such as anxiety disorders and substance use disorder are commonly associated.

The mechanisms of BPD are poorly understood. However with the correct medications and management strategies the person with BPD can lead a useful and productive life.

It is hard to find data on the prevalence of BPD in Uganda. A study of the Zay people Studies on Affective Disorders in Rural Ethiopia indicates that 1.8% of African people may have BPD.

A study Epidemiology and Burden of Bipolar Disorders in Africa: a Systematic Review of Available Data From Africa suggests there is a lifetime prevalence of between 0.1 and 0.6% of developing BPD based on results from Ethiopia and Nigeria. The report concludes:

Despite the heterogeneous methodologies, samples and dearth of adequate representative evidence from Africa, we have identified bipolar disorder as a major mental health issue. There still exists a dearth of evidence regarding the epidemiological, clinical, social, and economic burden of the disorder in Africa.

If the 1.8% estimate of Zay people with BPD is applied to the people of Uganda then there are an estimated 101,268 PWDs with BPD based on the 2014 calculation of of PWDs in Uganda (see Number of Persons With Disabilities (PWDs) in Uganda). However more conservative estimates of the Epidemiology and Burden of Bipolar Disorders in Africa: a Systematic Review of Available Data From Africa report indicate 0.1-0.6% of the population, 5,625 to 33,750 PWDs may be affected by BPD.
The study Prevalence and factors associated with depressive disorders in an HIV+ rural patient population in southern Uganda, besides showing a high prevalence of depression (46.4% with any depressive disorder), also shows 3.6% of people with HIV/AIDS have bipolar depression and therefore BPD. This is not surprising because BPD is associated with reckless and impulsive behaviour when the mood is elevated. This finding may be of significance for persons with disabilities (PWDs) because of the suspected high prevalence of HIV/AIDS within the community (see HIV/AIDS and Disability in Uganda).

"Lutalo" Warrior - Luganda & Uganda © 2002, 2009 by the bipolar artist John Poole

This is a report, Uganda: One Journalist's Brave Battle Against Bipolar Disorder about Angela Nsimbi who was diagnosed with BPD in 2009:

Angela Nsimbi remembers that Saturday morning in 2011 when her world temporarily stopped.
When she woke up, "something" had taken over her mind.
"I started hearing voices and I switched off. I disconnected from everybody. I did not shout at anyone. I did not breastfeed [her then four-month-old son]. I [just] stood in one position for hours," Nsimbi says. "I was sedated and I collapsed; but not immediately."
Following the collapse, she was taken to hospital and there, she spent four days, unconscious.
"I was being fed on a saline solution when I was unconscious. The doctors said if I did not start eating [after the four days of unconsciousness], they would have to put tubes through my nose so I could be fed. I got up and I remember feeling groggy," says Nsimbi, who did not want to be intubated because it makes one look rather ill.
But what was Nsimbi suffering from? Bipolar disaffective disorder.
HOW IT STARTED: In 2009, following feelings of restlessness, insomnia, paranoia and speaking rapidly, Nsimbi was diagnosed with bipolar disaffective disorder at Mulago hospital by Dr Ssegane Musisi.
"I remember having late nights. There is a time I stayed awake, in bed, till 6am. I also felt that the whole world was against me and wanted to harm me and my children. I wanted them to be around me all the time," the journalist and mother-of-five says of some of her symptoms.
She was so paranoid about her children, she says, she woke them up one day and bathed them.
"They [some] were big at that time but they allowed me. They suffered," she muses with a smile.
Following her diagnosis, her family, including her husband and sister-in-law, sought to have her admitted to Butabika national mental health referral hospital.
"The date was January 26, 2009. I remember my sister-in-law running around Butabika and me holding on to my daughter, who was then nine months old, and thinking, I am not like the people here. I do not deserve to be here," Nsimbi says.
If you have been to Butabika before, you will know that the hospital actually boasts a serenity about it, and does not necessarily have mentally-ill people running around throwing things; however, the social stigma is that once one's illness requires a stint in Butabika, then one is "too far gone for redemption".
Nsimbi could not voice her thoughts, because "when you have been declared mentally ill and you speak up, your caretakers say you are sicker".
Nsimbi, who stood under a mango tree awaiting admission, was returned home that day because being a public holiday, doctors were unavailable to admit her. Because she was not admitted, she started receiving medication as an outpatient from hospitals including Mulago and Nakasero.
Nsimbi says as a child, she did not experience symptoms that pointed to a mental illness. Since her 2009 diagnosis, she has relapsed twice, experiencing a minor episode when she was seven months pregnant with her last-born son.
STIGMA: "Auntie, nga walaba n'obulwadde [sorry about the illness you faced]," Nsimbi's nephew told her following an eight-day hospital stay.
The rest of her family was quiet and she says that silence spoke louder than any word; her husband and two sisters were supportive, however. This was not the first time Nsimbi was being treated with stigma.
"I remember in 2009, Dr Musisi was going around [Mulago psychiatric wards] with some students because I think they wanted to learn. He asked me how I was feeling and as I talked, this girl started laughing. I was actually offended and asked why she was laughing. The doctor told her if she did not stop, she would be sent away," Nsimbi says.
When she was diagnosed in 2009, she also was not told what disease ailed her.
"I think they told my husband. I remember being sedated, but I did not know what I was being treated for. I was only told when I asked the doctor, 'but what are you treating?'" Nsimbi says.
Her experience shows that sometimes, individuals with mental illness are treated like they have no ability to understand their condition; like they are too out of it to be accorded the same dignities and rights as patients without mental illness.
"At Butabika, patients are marked. They are given uniforms and their hair is cut off. I did not want to be admitted there because I did not want to be marked. The environment in which one is treated also determines treatment outcomes and I do not like the environment at Butabika," Nsimbi, who is a fashionable woman with beautiful, long hair, says.
Uganda also has old laws that encourage stigma against individuals with mental illness.
"The old laws referred to mentally-ill people as imbeciles without the right to have children," Nsimbi says.
COPING: Nsimbi is has always looked well-groomed when I have seen her at church every Sunday.
How does she, a 41-year-old mother of one secondary-school-attending child, three primary-school-going-children and a four-year-old, cope with bipolar?
"Mental illness is a stressor," Nsimbi says.
However, with her husband's and two of her sisters' support, she has been able to cope.
Interacting with other mental health patients at Heartsounds also helped Nsimbi cope. Heartsounds is a support group for individuals with mental illnesses that is led and managed by people with mental illnesses to help improve access to mental health care in Ugandan facilities.
"A patient who had seen us at hospital told my husband about Heartsounds," Nsimbi says.
Of all her sources of support, Nsimbi says that her faith in God has been her biggest strength.
"I listen to gospel music, because if you listen to other music and swear words are being used, how does that help your mental state?"
When a negative voice speaks to her, she counters it with scripture.
"If I have a thought that says I am ugly, I tell myself I am fearfully and wonderfully made," Nsimbi Says.
She lists the scriptures, "I will live to see the goodness of the Lord in the land of the living" and one which says "God has not given you a spirit of fear but that of love and a sound mind" as other scriptures that help strengthen her.
"I am a wife and mother and my children are young. I don't want another woman to raise my children," Nsimbi says of her inspiration to stay positive and be well.
She says she has told her children, particularly the eldest, that her illness is not a crisis; so, they are better able to cope. Since May 2014, she has not taken any medication and has not relapsed.
CHALLENGES: Nsimbi says she stopped taking the medicine because it had side effects such as stopping her periods and making her gain weight.
"Some people also end up getting diabetes because of the medicine," Nsimbi says.
The medicine is also expensive.
"I used to spend [Shs] 2,000 per tablet for only one type of medicine yet I had to take three types. That meant I spent [a lot of money]," Nsimbi says.
It is also difficult to access treatment, because Uganda has too few psychiatrists treating many patients. Queues to the psychiatrists are long and Nsimbi remembers feeling like she was being punished for being sick.
Stigma and unsupportive policies are the other previously-mentioned challenges, yet, Nsimbi says, mentally-ill people deserve to be treated with love because they understand what is going on and even remember things that happened when they were ill.
"[Getting better] starts from home," Nsimbi says. If a mentally-ill person is hidden away during family events and they are treated badly, their mental health deteriorates.
In true testament to not letting bipolar disorder have an upper hand, Nsimbi leads a productive life as a freelance journalist affiliated to Vision Group. She is also the national coordinator of Heartsounds Uganda and a personal shopper and housemaid procurer under her company, Abba Home.

The Basic Needs organisation describes the situation for those with mental health problems in Uganda, in their article Basic Needs, Basic Rights, Uganda:

With a population of 35 million, the country has only 30 psychiatrists, that’s less than one per million. Currently lack of access to treatment, poverty, stigma, discrimination and human rights abuses are major constraints to the rehabilitation of people with mental disorders. Studies conducted on the mental health system in Uganda suggest that a key challenge is that health workers do not want to specialise in psychiatry due to the stigma associated with mental illness.

For more information on all mental health issues contact Basic Needs, Basic Rights, Uganda. For support with mental health issues see Heartsounds on Facebook.