Dr Hussein Dia. Credit: MLK / Mozaikrim
Dr. Dia. A name that resonates in the consciousness of most atavistic of Nouakchott. First psychiatrist practicing in Nouakchott in 1975, then returned to his medical studies in Dakar, where he continues with psychiatric studies, from 1963 to 1973. At the end of his studies, he obtained a WHO fellowship for a development in France of three years. Internship in several hospitals awarded this academic cycle. A retired for 11 years, he returned to the interview on the genesis of his discipline in Mauritania, the pitfalls encountered the difficult cohabitation with traditional medicine, and the future of his profession.
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Since when can we speak of psychiatric medicine in Mauritania?
Psychiatry has begun upon my return studies in November 1975. At the time I was alone, and to be explicit, even the first specialist in question. There was no Psychiatry at all; patients were supported mainly by traditional healers, or sent to Dakar; those who had more means continuing to Rabat, or Europe.
Have you faced difficulties in your return for the implementation and dissemination of this discipline?
There is first the aspect of the information on psychiatry. People do not know that there was a specialist in Mauritania. Make themselves known by people, and recognize the authorities took a few months. During those early days, more medical authorities, who helped the discipline to emerge. The director of the National Hospital of the time, a colleague, I ease my installation in the grounds of its structure, with its own means. This is where I started to work. There was a project to build a service for the mentally ill; the director assigned me an area of the hospital where I started providing consultations.
GPs and nurses, I remember, are quite incongruous my presence on "their" places. When I went to the general medical ward, the staff often had a rather terse response, repeating to myself the urge: "Doctor, you do not have patients here."
Eventually what happened is that they receive a patient who had particular symptoms and refused to eat. Several balance sheets have been made, and no organic disease has been detected. After several days in hospital on a drip, they call upon my services. I acceded to their request, but after seeing it, I asked to see my room. I asked the parents of the sick to settle a tent at the same place where motherhood today is. It was an empty place at the time. And then I put on treatment; three days after she started eating and talking. It was a complicated case of personality disorder, a schizophrenic psychosis precisely.
From there, people started gradually to come to me, especially since people are quite curious about these beginnings. Moors especially our fellow citizens, who have a great ability to adapt to a new context. They learned that it existed, and they came: After dragging for years in marabouts, and the disease did not disappear, or do not atténuyait, they came to test this new scientific methodology. The results are relatively positive, word of mouth, it has spread pretty quickly. I started hospitalized in tents in the courtyard of the National hospital. The administration was not against, but good the majority of the medical staff was made up of French. It went pretty fast; within months I could sometimes up to 30 patients hospitalized in tents. It was a real psychiatric camp in the middle of the courtyard of the hospital!
The psychiatric hospital will be built when?
A psychiatric ward will be completed in 1978. We started some patients are hospitalized in the rooms, while keeping parallel tents in the hospital.
What was the nature of your relationship with the first patients who came to you?
Obviously people are divided: some have gone through these therapists, and have had some positive results but ephemeral because some diseases are durable, chronic, and healing is temporary. Often there is no real cure, and it is these frustrated people who came in large numbers to see me, after 10 or 20 years of a relative disease. To this is added the new psychiatric cases. From there I consulted up to 40 patients daily. It was a lot.
Is it that there are now bridges between modern psychiatric medicine, and traditional therapy?
It is normal that many patients consult traditional; it is not particularly Mauritania. The difficulty is how to tell the difference between those who have some practice adapted to the Mauritanian culture, who manage to make the difference between simple diseases, serious or fatal, and those who do not have this fiber traditional therapists, and do it for purely financial reasons. They have a narrow view of science and medicine. For them the psychic diseases are the jinn and spirits-related diseases. The prism of traditional medicine is very varied.
We spend informed marabouts who are willing to conduct their patients in psychiatric care, to those mired in ignorance and leave helpless, the sick patients get worse, even forbidding them to take modern medicines. These are very dangerous. They do not know the difference between science and traditional treatment, which exists everywhere in the world for that matter. These tradtions may be related to religion, to splus or less occult knowledge. But it is essential to distinguish between serious, chronic, and that will not heal with simple psychological treatment, because the traditional treatment is psychotherapeutic treatment in general, or many mental illnesses have biological origins, even organic. Some are deadly. Epilepsy is one of those cases.
Seeking knowledge, even science is an aspect of Islam yet ...
Of course ! But this is not just specific to Psychatrie. But tradtionnel therapist that were not all NECESSARY balance sheets, not knowing any medicine, with a limited approach, as anyone otherwise, he always attributed to the sacredness disease and wants to treat exclusively by sacred formulas . It's always good when you're good believer to consult this type of people, but there are organic diseases. And our Islamic religion prohibits us not, on the contrary even, deepen our technical knowledge, our knowledge for our use. It's part to me of religious duty of a Muslim, to be saying that there is nothing besides Allah, and His Creation. All we can find and use in this Creation is therefore under His eyes, and His rules. Science is just another way of detailing and discover His creation. Science is a gift from Allah so. This is a simpler and inclusive understanding. Both can be associated as it does not interfere with the healing of the sick.
We had an example of this type Gassambery, who drained monsters crowds. It emerged from nowhere and claimed to treat diabetes hypertension, and people threw treatments followed to see him; there were many dead. This is an extreme case showing the dangers of this type of treatment with a therapist and ignorant megalomaniac claiming cure everything without opening on science, and the world. These people do terrible damage.
What the government can do to curb these negative effects?
The feeling I have is that the authorities show a certain laxity. There are not enough rigor to channel that. I know there was an attempt to create an association of traditional healers; but I do not know his focntionnement. It's a good thing, but this association should be checked a minimum. It must give its most capable members, indications: they must have modern medical references, and possibly have more extensive information on the types of diseases encountered. This would be the beginning of effective cooperation. The association would control its members and prohibit certain exclusive practice of traditional therapy; it would make its own police.
Credit: MLK / Mozaikrim
What are the most chronic mental illness in Mauritania?
There were no comparative scientific study, but the general feeling shared by experts in the field, is that our society has its customs (consanguineous marriages, inter-tribal, inter ...), there are many genetic factors predisposing a significant portion of the population to certain diseases. So, we have a situation where we find families with many patients.
Worldwide, 1% of the population is schizophrenic, Mauritania comparison was not made. Bipolar disorders (depression, maniaques- ed) seem slightly more common in Mauritania, that what I saw in France or Senegal. Now the most common diseases, statistically, some studies converge toward the figure that 35% of the world population could have psychological disorders, but only 5% are really serious and are clinical cases. The others are relatively benign diseases (anxiety, depression ...).
Objectively, it does not seem to be a Mauritanian specificity of this point of view, if not a plethora of families where there are too many mentally ill as people marry each other.
You're retired since 2004. Do you think that the succession is assured? What is the evolution of psychiatric staff in recent years?
Today we have three graduates assets psychiatrists (two others are present but are not stable in their operation profes- sional ed). If we compare this number to the neurologists for example, there are at least seven such for neurosurgeons, maybe even a little more, though some are at the end of training. Yet these disciplines were not performed until 1990 for neurology and 1998 for neurosurgery in Mauritania, but they believed faster in their specialized staff. The difference is even more striking compared to specialists in general medicine, such as gynecology, pediatrics, gastroenterology, etc. Succession in psychiatry has been very slow; I recently learned that three people are being trained in Dakar, and should be ready in two years.
A final word?
(He thinks long) I said at the beginning of this interview that the administration has been relatively positive towards me for my installation, but I think she has remained too rigid in his attitude: it is more neutral, an active acceptance of this new medical reality in Mauritania. We had to make the effort to my level to encourage young people to study in the way in which psychiatric Mauritanian need. Now it's up to the state to plan the medical needs of its people, and to deduce the appropriate training to which push some of his students.
I was able to train nurses in the state, as senior technicians in mental health: there are 30-35 today; some have advanced in Morocco, a few in Algeria, and three promotions formed in Mauritania same. They occupy positions of responsibility in the regions. There is a lack of planning at this level. This is due to some negligence of the authorities.
Each October 10 was inaugurated a day of global mental health, but it is quite formal: a screed in local administration, and the next day we forget the issues of the day. There are needs in areas that are not covered: even the nurses who had been successfully placed there were used for other purposes, in general care, some have been neglected and are oriented to more remunerative activities like opening of pharmacy deposits or provide personal consultations. Hopefully the next generation of Mauritanian psychiatrists will encourage more young people to turn to this discipline. The country needs.
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