Exclusive: Zambia’s Dr Naeem Dalal on understanding mental health

Doctor Naeem Dalal is a Zambian Medical Doctor, Mental Health and Preventive Health Advocate. He freelances as a local journalist and social media blogger advocating for mental health tailored to Zambia. He has featured on several episodes as a panellist on the ZNBC National Health TV program called “Doctor on AIR” advocating for common mental health topics faced by Zambians.

He holds a Bachelor of Medicine and Surgery, Bachelor of Natural Sciences in Human Biology from the University of Zambia. He is currently pursuing his Masters of Medicine in Mental Health and Psychiatry whilst practicing at Chainama Hills College Hospital and University Teaching Hospital.

In this exclusive interview with Afro Mum in commemorating World Mental Health Day, Dr Dalal gives insight on mental health in Zambia and  Africa.

Naeem Dalal, MD
What is your field of expertise?

Psychiatry resident at the University of Zambia, School of Medicine practicing as a physician psychiatrist at the University Teaching Hospital in Lusaka Zambia.

How long have you been practicing?

3 years – 1 and a half year as a medical intern  in all four disciplines and 1 and half year as a psychiatry registrar.

Which institution/s are you affiliated with? 

The University Teaching Adult Hospital- Psychiatry department  and placement at Chainama Hills College Hospital which is the tertiary mental health hospital in Lusaka Zambia.

What is your understanding of mental health?

To define mental health, you need to understand what Health is. Health is a complete state of physical, mental and social well-being, which includes spirituality. Often when we speak of mental health, we think of it as being “mad” or “crazy.” However, that’s a stereotype as mental health defines the functionality of an individual, how one thinks, acts and behaves. An individual’s mood, sleep and appetite patterns all fall under the context of mental health. It solidifies an individual’s emotional intelligence coupled with psychological awareness and well-being.

What has been your most profound experience thus far as a mental health practioner? 

I wish to share a personal reflection, a shared experience. A few years ago, a patient was brought to the emergency room from a remote village. A 16 year old who had drunk battery acid to try and take her own-life. WHY? But there was no answer. The community attributed her behaviour to one possessed by an evil spirit. After she passed on, her mom said  to me, “thank you very much.” I was lost for words. Her mom explained that she saw her daughter smile just by my words. She said that her older sister had also taken her own life because of abuse.

In a cultural setting like ours, it is not easy to speak and address emotions and stressors. This explained why I never once questioned the motives behind the self-harm attempt as I was taking care of her.

Suicide is a convergence of risk factors and it does not just have one cause. Suicide has claimed many lives of individuals who have shown bravery throughout their lives. It is not about being weak and much more to do with how severe the factors are. When framed in terms of recovery, treatment and hope, discussing suicide is one of the most helpful things you can do. Many people do not know who to speak to. And this is why I am in pursuit of advocating for mental health in a community where culture and religious beliefs are a barrier to seek help.

Have you ever been affected directly by mental health – could be yourself, family member or friend. 

I wish I could say that I am immune to falling mentally ill however, that’s not true. I have had occasions of work burnout, where I go out of my way to make sure I continue work. Unfortunately, due to the overwhelming nature of my profession, I have had episodes of occupational stress get to me which lead to burnout. I am blessed to have a good support system that helps me get by my episodes and I move on stronger. However, due to the 4th industrial revolution and change in the jobs market, many individuals are at risk of burnout and this is why the theme for 2017 world mental health day was centred on the work place.

As a mental health care provider, what recommendations/advise would you give to caregivers, policy makers, community, survivors, etc.? 

I would like to echo the definition of health which is a complete state of physical, mental and social well being. We often neglect mental health but it’s high time we start the conversation around mental health and not shy away from it. In pursuit of advocating for mental health care, I carry out community outreach to understand grass root knowledge of the communities I work with. I believe that mental health is preventive health. And preventive health is having strong mental strength.

Imagine a shift in health care. A future where you see a doctor not because you are sick but because you want to avoid the possibility of falling sick.” ~Ganizo @Naeem Dalal, MD.

What are some of the myths that surround mental health in Africa?

The major myth that is affecting treatment is that mental health is a spiritual disorder or that an individual is possessed. People do not believe that mental health has treatment. There is treatment yet many still believe it is nonexistent.

What has been done to educate the public with information that gives the correct perspective on mental health?

Unfortunately, Having a Mental health disorder is one the most expensive diseases to have. Yet, very little preventive measures are invested into it. Health is an ever changing field and evidence proves that mental health leads to functional disability. Due to stigma and false information with respect to mental health, very little is done to correct it. Believe it or not, but there is also stigma in the health field against mental health where many health care providers do not feel that Africa needs mental health services.

Dr Dalal serving under his community outreach initiative – Ganizo
What does the Zambian mental health care provision/centers/policies picture look like? Is it improving? Getting worse? Needs a lot of work? Or non-existent? 

Zambia is not ideal when it comes to provision of mental health services. However, there is a change in service provision for the better. There is need for a lot of work to improve the field of mental health with more specialist’s health care providers. There’s also a need of change in shift from communities to seek help early and not wait till the disorder has worsened.

Do you feel the government is doing enough to provide mental health care? This is in terms of policies, information dissemination, as well as infrastructure development such as health centers or hospitals.

The Ministry of Health is lobbying efforts to promote mental health services. There is room for improvement.

How do the poor fair in terms of access to mental health care?

In my experience, there is delay in seeking help. This is a two-fold situation: on one hand citizens do not understand mental health. On the other, there is a poor ratio of patient to health care provider so this acts as a disadvantage.

Is there any mental health education provided in schools? If affirmative, is the curriculum thorough? Could more be done?

There is no mental health curriculum. However, there is a direct correlation between psychological well-being and emotional intelligence. If individuals have good emotional intelligence then it acts as a preventive measure to falling mentally ill. I believe a curriculum promoting emotional intelligence skills and emotional hygiene would be of benefit to prevent mental illnesses.

Do you have any statistical information depicting the true nature of mental health in Zambia? 

Unfortunately, there are no prevalent studies. However, from my practice, substance use disorders are the highest  in number of admissions. Especially alcohol related admissions. These are followed by Brief Psychotic Disorders, Schizophrenia, Mood disorders and HIV Psychosis. Post natal mood disorders are also a common occurrence.

Would you say that mental health is a social type of illness…affecting only a certain class or group of people? 

This depends on which mental illness we speak of. However, individuals that are exposed to recurrent chronic daily stressor are more prone to fall mentally unwell. Individuals from a low socio-economic class are exposed to recurrent daily stressors and hence are often more at risk. However, from my practice, I have seen a variety of individuals who come from all socio-economic classes.

Who would you say then, is most affected by mental health? (Affected in terms of on average, who is more likely to suffer from the illness – young, old, rich, or poor?)

This year’s theme for World Mental Health Day is Mental Health in Youths in a Changing World. Youths are at high risk of falling mentally ill.

Mental health can be mild, moderate or severe and because it is not understood by many, individuals seek help when it is severe and this is when they are no longer in their youthful years as the disease has progressed. However, 50% of mental disorders appear by age 15 and more than 75% by age 24.

Is there anything else you would like to add that I have not addressed in the questions?

In my free time, I carry out community outreach tailored to Lusaka youths trying to advocate for mental health. I call it the Ganizo Initiative. Ganizo means “thoughts.” It  aims to promote preventive health by empowering mental health through emotional intelligence. Tools include research and information, workshops, advocacy meetings, youth peer mental health clubs, and promotional materials such as fliers.

It is also aimed at encouraging public action and commitment to strengthening school and community preventive health and mental health knowledge. Ganizo is based on the principles of empowerment, peer support, community support, and youth participation and involvement.

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