Mental Health in Children Part 1: Why we are no longer at ease

When little John Wayne Odongo and George Opiyo were placed in Maureen Abura’s arms eight years ago at Yirol hospital in South Sudan, she was the happiest mother on earth.

She was relieved to have two babies even though she was living in a foreign country, badly needed family support, and had faced trying circumstances. She doesn’t fully understand what happened, but she developed high blood pressure, so her twins had to be delivered when she was just six months pregnant. John and George weighed 2kgs and 1.8kgs respectively. 

After their birth, at a Doctors Without Borders facility, she kept them alive wrapped tightly against her to maintain a healthy body temperature using the Kangaroo method as means of incubation. 

Meanwhile a fight ensued in the part of South Sudan where they were living, following the controversial referendum, which forced her to run for dear life with the children. While still struggling to survive, the children found themselves in Kisauni, a sprawling estate in the city of Mombasa Kenya. Months later, Maureen noticed that the two boys were developing slowly. 

 

happy children living with mental health problems
Joy Wayne Odongo with his brother George Opiyo

 

They failed to sit up until they turned one, crawled at one and a half years, started speaking at three and only started walking at four. By then, Maureen had learned that little George’s limbs were disabled, and John was autistic.

He would get very upset, hit his head on the wall, scratch his face until he bled, become wild and uncontrollable. This really scared me.  It was not normal. As days and months passed, I realized that John also experienced memory loss and would be seen murmuring while talking to unseen people and objects. His speech also was slurred, and he stammered. In addition, both my boys experienced epileptic attacks for a whole year. They still do when they get severe bouts of malaria,” said Maureen.

The difficulties experienced by John, George, and their mother are not unusual. But all too often cases like theirs go unnoticed by the larger society around them. While many people assume that mental health problems don’t arise until children become adults, the fact is they frequently occur in children as well, right from birth.

Environmental factors, especially family-related and mistreatment arising from stigma, can aggravate the mental conditions. But with effective screening, diagnosis, and treatment, children who suffer mental health problems can become healthier and happier.

This article, the first in a series, will address the overall mental health situation for a better understanding.  The subsequent articles will examine how Kenya and its neighbor, Uganda, are seeking to address the challenges – including the special issues arising from the continued practice by many in the two countries of relying on traditional healers to address the problem.

 

mother addressing a mental health forum
Maureen Abura speaking at a mental health for children public forum held in Nairobi on 27th November 2018

   

Diagnosis of Mental Health Problems is the first step

Ideally, an enlightened public can spare people like Maureen Abura and her children years of pain, as they suffered without understanding and then struggled to get help. The search for healing began when the two children reached eight years of age after Maureen confided in her neighbors. They were of the view that her children were possessed with majini (demons)  and advised her to see a traditional healer for help.

“When we got to the medicine man in Likoni, he tried his medicines on the little ones. Everything seemed okay for some time, but after a few months, we were right where we started. I resorted to visiting a faith healer, but that did not seem to be working as well. I got very frustrated and decided to visit the Coast General Hospital where they were diagnosed with autism, ” said Maureen.

A friend would later refer Maureen to the Mary Immaculate Hospital, where both children go for physical therapy and little John further seeks therapy to help in managing autism. However Maureen, a single mother, is unable to raise all the money needed for his therapy, so he just attends when she can afford it. A session costs Ksh. 1000.

Living with autism has not been easy for John either. His caregiver constantly struggles to keep him calm. That is no easy job, as he plays with other children who do not understand his condition. His mother and caregiver just have to hope that he does not harm himself while playing. At the same time, stigma and the resulting isolation from his friends are a huge challenge. He does not eat sugary foods as this can send him to hyperactivity.

In school, he bites others. He sometimes he refuses to attend class, and when he does go to school, he may refuse to enter the classroom, eventually going home with his mother. He lives in his own world most of the time and the teachers have to work extra hard to get him to work like the others or even stay in class. Since his mother cannot afford a special school, he has to stay in the kindergarten where the twins joined at seven years old. His performance in school is not so good – recognizing and remembering numbers and letters are his main problems.

 

Kenyan children outside their home
Daudi Kimorgo and Joseph Gatimu

 

The Extra Burden of Poverty 

Mental health problems are not confined to the poor, but people without assets have the most difficult time addressing their challenges. Miles away from the coastal town, we meet two five-year-old boys, Daudi Kimorgo and Joseph Gatimu whose experience with mental health challenges is different. They were not born with any obvious mental health issue, but they started having difficulties and were unable to speak properly after living with their mentally-challenged mother in the streets of Narok town.

After watching them for some time, Bishop Dr. Patrick Kamau of the Full Gospel Churches of Kenya in Narok town decided to investigate. They found out that the boys’ only other living relatives are aged grandparents and two uncles who are mentally challenged as well. Their mother, Anne Siamanta, very protective of her children, opted to walk around with them in the town centers where they would collect scrap materials, sleep on the streets and feed on disposed left-overs. 

 

street children going to school

 

I felt compassionate when I saw them staying with other street boys, so I decided they could come and stay with us in the school. They were so frustrated and stressed that they would talk with a lot of fear. When they came here and mingled with other kids they started feeling well and they can now talk properly,” acknowledged Peter.

While things seem better for the boys, they initially had trouble warming up to other children, and have not integrated into the school as seamlessly as one would hope.

We had issues of adjustment, especially the social parts; you know, the school has rules as well. Other pupils would also view them as outcasts, and they were also very harsh to others. My teachers did a good job, they would talk to them instead of punishing them.”  

Although the children are now in school, Bishop Kamau says the shelter situation remains the same. They still have a problem getting food, and their mum also comes to the school to sleep with them.

There are many children in the community with similar problems, with orphans as the most vulnerable. While it would be better for the children to be kept in school as boarders, the school faces financial constraints. They are forced to charge a minimum of Ksh. 10,000 which some children and parents can’t afford. 

We met Daudi’s and Joseph’s grandmother Cecilia Wangari outside her one-roomed, dark house. She tells us that she has suffered a lot with the children. Her husband is a manual laborer who cannot do much, and she already has her hands full taking care of her mentally ill grandsons. The frail octogenarian is thankful that the school has taken charge of her grandchildren. 

 

grandmother in a house with grandchildren
Joseph Gatimu and Daudi Kimorgoo with their grandmother in their house

 

Kenya is not Alone

Mental health challenges in children are not just a Kenyan affair. Namjiri Esther, a businesswoman in Uganda, told us in an interview that she noticed a change in her son when he was four years old.

“I noticed that my child had a problem at the age of four but it was at ten that we could establish the real cause of her episodes. She would stare in one place for a long time and sometimes she would talk to herself, but her words were incoherent. When she started having convulsions, I thought I should bring her to hospital. Now she is undergoing treatment for epilepsy. The neurological complications that she had are being taken care of as well,” she added.

Mental health in children within Africa is largely a grey area even for the few people who actually know about it. The majority of the population remains quite ignorant about it. This was revealed in a public forum that was held in Nairobi, by Mind Mirror.com. Most of the participants did not know that children as young as one-year-old are grappling with serious mental issues. In some cases, it was only when a child committed suicide that people realized that there was a big problem.

Even more troubling is the realization that some mental problems experienced by children start in the womb. 

 

Kenya’s case is different

According to David Ndetei, a Professor of Psychiatry, University of Nairobi and founding director, Africa Mental Health Research and Training Foundation (AMHTRF), most of the studies in Kenya on depression in pregnant and post-delivery mothers and in Intimate Partner Violence (IPV) result in all sorts of complications.

We found a high prevalence of perinatal (the period immediately before and after birth) depression in Kenya similar to the global data. The difference in Kenya is that these are not routinely screened for, diagnosed nor managed, though there are attempts made in this direction. The effects of unmanaged depression in perinatal mothers and on the developing child are monumental with adverse effects on the overall trajectory of child development,” he added.

School children from primary school all the way to high school in Kenya have their share of mental challenges. According to Ndetei, some of the prevalent conditions include anxiety, depression, Post-traumatic stress disorders, suicidal behavior, bullying, and substance abuse. The difference between Kenya and other countries is that they, as with peri-natal cases, are not diagnosed here, and therefore not managed. 

 

Types of prevailing mental health illnesses in children

According to the Centre for the Developing Child at Harvard University, significant mental health problems that can occur in young children in addition to neuro-developmental disabilities like autism. These include:     

a) Child anxiety- a condition of persistent and uncontrollable nervousness, stress, and worry that is triggered by anticipation of future events, memories of past events, or ruminations over day-to-day events, both trivial and major, with disproportionate fears of catastrophic consequences.

b) Depression – it can interfere with energy, concentration, sleep, and appetite. Children with depression may lose interest in activities and schoolwork, seem tired, give up easily, or withdraw from friends or family.

c) Epilepsy – a seizure disorder affecting the nerves. The child gets convulsions with recurring sensorimotor attacks.

d) Down syndrome – a chromosomal condition associated with intellectual disability, a characteristic facial appearance, and weak muscle tone (hypotonia.) Age is a contributing factor.  (too old or too young mothers)

e) Fetal alcohol syndrome (FAS) – arises from heavy alcohol consumption by mother during pregnancy.

f) Attention Deficit Hyperactivity Disorder (ADHD) – a condition that makes it difficult for a person to pay attentionand control impulsive behaviors. He or she may also be restless and almost constantly active. ADHD is not just a childhood disorder. Although the symptoms of ADHD begin in childhood, ADHD can continue through adolescence and adulthood. 

g) Dyslexia – experiences problems with reading, pronouncing and understanding written words. The child has word spelling difficulties such as “rat” – “tar”, “no” – “on”,etc, or even difficulties differentiating right from left. The child is usually intelligent and talented in skills-based careers. 

h) Enuresis – inability to control the flow of urine in older children.

i) Autism – Logical reasoning, communication &social interactions are poor. It manifests with multiple learning disabilities, excessive aggression, repeated body movements, obsession tendencies, inability to follow instructions, poor eye contact, and poor memory. This is a lifelong disability. The child may also have language difficulty and delayed echolalia(hearing echo – not original sound) or may indicate exceptional talents e.g. music, art etc.

j) Substance Abuse – substance abuse can start from occasional use and gradually escalate to dependence. One is said to be dependent when they rely on the drug of choice to function normally. Substance abuse can be alcohol, cannabis, cigarettes heroin, cocaine or prescription medications.

 

 

 

 

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