Jesse Gyasi flashes me a well-lit smile. He is referring to the scores of mental health patients who are chained to the walls in the sanatorium of Mount Horeb Prayer Centre in Mamfe, a village in the mountains in Ghana’s Eastern Region.
“But sometimes” he says, “When you put them on fasting you cannot see anything. But with medicine they become well.”
The fact that a prayer camp attendant believes that medicines can also perform miracles is a significant step forwards says Dr. Angela Ofori-Atta, a professor of psychology at the University of Ghana.
Dr. Ofori-Atta and her staff are piloting a study where, following a clinical assessment, anti-psychotic medicines are administered to patients at Mount Horeb. The initiative aims to deliver much needed care to the patients, while simultaneously weening the camp staff off the commonly accepted dogma that mental health issues are purely spiritual in nature.
“It’s the first systematic, randomised study of patients in prayer camps,” says Dr. Ofori-Atta.
And the initiative, Joining Forces: integrating medication into the care of people with psychiatric illness in a prayer camp setting, seems to be working.
“Some of them need fasting and prayers, whereas others need drugs,” says Nathanial Teye, 37, a Mount Horeb camp attendant for eight years. “The University of Ghana program helps. We need both [prayers and drugs].”
Prior to being an attendant, Teye was a patient at Mount Horeb. He was admitted to the sanatorium after hearing voices in his head telling him someone was going to kill or arrest him. At Mount Horeb he was forced to fast and was chained to a wall for long periods of time. However, he says, through both prayers and fasting, he was cured. Teye says that now, with drugs, patients who can’t be cured through purely spiritual means now have the opportunity to get well thanks to the medicines administered by Dr. Ofori-Atta and her team.
The benefits of the program are potentially positive not just for prayer camp patients, but also for the stigma surrounding mental health in Ghana. Peter Yaro of Basic Needs, an NGO dealing primarily with mental health issues in sub-Saharan Africa, says patients, attendants and Ghanaian culture stand to benefit.
“It’s going to bring closer formal services to the prayer camps; it will reduce mutual suspicion in the sense that traditional practitioners feel that [doctors’] techniques are bogus, and [vice versa].”
Once doctors are able to break down the barriers to treatment, the state of mental health patients in Ghanaian prayer camps will improve significantly. Or at least so is the hope.
Ghana’s treatment of people with mental health issues has been cited as a grave human rights violation. Following a much publicised Human Rights Watch report in 2012, the Special Rapporteur for the United Nations on Torture, Juan Mendez, stated in November 2013 at a press conference in Accra that prayer camps’ treatment of patients amounts to cruel and unusual punishment, and is therefore a breach of the United Nations Human Rights Convention, an agreement to which Ghana is a signatory.
He is right.
Mount Horeb’s sanatorium consists of two buildings, each housing patients in varying degrees of psychiatric illness. This is where I met Mr. Patrick Boni, a 38-year-old from Sierra Leone. He, along with several others, were chained by their ankles to the wall, sleeping in concrete cubicles with a narrow gutter at their feet, into which patients urinate.
“You have to improvise” says Mr. Boni, “bathe where you are…it’s very hard too, there is not enough to eat.”
Mr. Boni says he has been at Mount Horeb since May 2013. After suffering a long-standing crack addiction and sleeping rough for the better part of eight years, a pastor brought him to the camp.
As he relates his story a patient who was asleep rolls over towards the gutter and urinates. It trickles past my feet.
“You have to go through fasting which is okay. It’s a religious kind of a way. [Normally] if you want medicines you have to pay. Some of us are unable to pay.”
Even though Dr. Ofori-Atta’s initiative is subsidised by the Ministry of Health, the future administration of drugs to patients could prove expensive for them, with medication costing anywhere from 15 to 30 cedis a month.
Although Boni declined to accept treatment at the hands of Dr. Ofori-Atta and her team, he remains aware of the poor care he is currently being given, “If there is a way people around the world can help us out it would be very nice… [Find people] who can take care of us,” he says, pointing to the chain that is wrapped around his ankle.
There are currently two chapels at Mount Horeb and a third being built. In the smaller of the two, patients undergoing the study are assessed by Dr. Ofori-Atta’s team and receive their medication.
It’s a peaceful place, Mount Horeb. Birds sing from the trees. The chapel itself is clean, breezy, painted a pale yellow. A cock crows. Outside, large, leafy trees provide ample shade for residents and attendants.
Seated next to a door and overlooking the sanatorium, 23 year old Daniel Baaku reflects on the treatment he receives at the camp. Mr. Baaku was admitted to the prayer camp in November after becoming certain that people were spiritually attacking him. For Mr. Baaku, prayer and faith is as important as medication and Western medicine.
“I have to increase spiritually. I have to seize the opportunity. God and medicine will make me better. I believe that as I continue to pray, things will change. Its all about my faith.”
The belief that spirituality can not be separated from Western medicine is strongly held throughout Ghana.
“Much of our culture is based on this traditional religion, based on the spirit world” says Dr. Stephen Owoahene Acheampong, a professor of religion at Ghana University Legon. “When you look at traditional religions and divinity or deities, deities are the intermediaries…the custodians of morality. They’ll punish you if you do something wrong. They administer God’s will.”
If someone falls sick, it is a sign that that person is being punished. In Ghana, sickness has a strong spiritual dimension. Those who seek help at prayer camps often believe that treatment by a doctor is insufficient and that they require spiritual help to get well.
Western medicine divorces health from the spirit, whereas in Ghana, the body, life itself, is inseparable from the spirit.
Dr. Ofori-Atta doesn’t look away from the potential impact of spiritual guidance.
“It should be important” she says, “People on medicine do better with psycho-social treatment, but this has to include teaching and transfer of thinking. With mood disorders one can do a lot with restructuring people’s thoughts. If there is true spiritual thinking, that might do it. I’m talking about the teaching of God’s word, it can change [patient’s] mind[s].”
In other words, people with mood disorders often have the idea that the world is a negative and unchanging place. The influence of faith can potentially lighten the mood and enable a patient to think and act more positively.
The problem with treatment at prayer camps however, is that it is often so severe that patients see a breaking of the spirit, which in turn causes a loss of desire to improve.
To be chained to a wall is a trauma in and of itself, and in many ways only exacerbates a patient’s symptoms says Dr. Akwasi Osei, Director of Accra Psychiatric Hospital. Furthermore, patients only grow increasingly upset at being chained for long periods of time.
“The fact is that restraining them in chains is dehumanising” says Dr. Osei.
Furthermore, placing a patient who is suffering from psychosis under forced fasting can serve to worsen his or her psychosis.
Unfortunately, there are few alternatives to placing mental health patients in prayer camps. In Ghana, the requisite infrastructure to treat people with psychological problems simply doesn’t exist. With 11 practicing psychiatrists and three psychiatric hospitals servicing a population of 25 million, the need is immense.
“The alternative is just family support and counselling. The choice is very limited” says Mr. Yaro of Basic Needs. “[The belief is that] once you become mentally ill, you are no longer fully human. We need to reorient people to understand that mental issues are not entirely spiritual.”
Despite maintaining a faith in God, Mr. Baaku is, due to his experiences at Mount Horeb, finding himself questioning these very beliefs.
“Sometimes when you tell me to believe in God I can’t, because these things I see here are contradicting it” he says.
Dr. Ofori-Atta agrees that the human rights abuses at prayer camps are a serious cause for concern, but stresses that through medicine there is room for hope.
“There is a lot of sadness when you see someone in chains…but then there is the great joy you see when someone who wasn’t able to function now radiating a smile.”
Working at Mount Horeb isn’t easy, but in order to change the conditions at the camp she must work with them.
“We’ve gone to [Mount Horeb] without an attitude of judgement….with the hope that the chains will come off. Its a work in progress and [we] are very clear about that.”
By: Kristian Jebsen