Mental health specialist: It is a complex yet rewarding path to get patients back on their feet

HealthCare Middle East & Africa Magazine had the privilege of interviewing Dr. Pius Akivaga Kigamwa, a distinguished medical doctor, board-certified consultant psychiatrist, and senior lecturer at the University of Nairobi’s School of Medicine. Dr. Kigamwa’s notable achievements extend beyond his extensive expertise, as he holds the esteemed Moran of the Order of the Burning Spear (MBS) title and is an international fellow of the American Psychiatric Association.

As a co-founder of the Nairobi Rakusei Mental Hospital, a private institution established three years ago in Karen, Dr. Kigamwa plays a pivotal role in delivering comprehensive mental health care in a serene and dignified environment. Located in Nairobi’s prominent suburb, the hospital offers a wide range of effective services, including pharmacotherapy, electroconvulsive therapy, psychotherapy, and occupational therapy. Additionally, the facility specializes in addiction counseling, providing detoxification, group therapy, and addiction treatments. Looking ahead, the Nairobi Rakusei Mental Hospital aims to offer training opportunities for individuals through rotations at the facility.

During our interview at the hospital, Dr. Kigamwa shared valuable insights, highlighting the fulfilling aspects of specializing in psychiatry, his professional motivations, and emphasizing the critical importance of mental health.

 HCMEA: What are some of your notable life accomplishments so far?

 Dr. Kigamwa: My greatest career achievement is graduating from the UoN School of Medicine as a young doctor. In the past decades, you went to med school because you are passionate about the field and to come out as a doctor was a big deal. After medical school, you did an internship, worked as a medical officer, and got signed off as a proper, qualified, and well-trained doctor. This period of training after medical school is another key milestone.

I returned to the University of Nairobi School of Medicine to specialize in mental health. Upon completing the graduate program, I earned a Master of Medicine Degree in Psychiatry and achieved consultant status. Shortly after graduating, I was employed as a lecturer by the University of Nairobi.

After three years, I embarked on a fully-funded attachment at the University of the Free State (UFS) in Bloemfontein City, South Africa. During this time, I obtained a Certificate in Community Mental Health and Psychiatry, which enhanced my expertise after gaining one year of experience. Following a productive professional fellowship, I returned to Kenya and transitioned from lecturer to senior lecturer.

As a senior lecturer, my primary role is to provide mental health education to university students. We train these students who will eventually become doctors, and mental health is a crucial component of their professional development.

Additionally, as a medical doctor, I hold a consultant position at major public health facilities in Nairobi, such as the Kenyatta National Hospital (KNH) and the Mathari National Teaching and Referral Hospital. Apart from these medical responsibilities, I operate a private practice clinic at Nairobi Hospital. Furthermore, I serve as a mentor to a large number of young individuals, guiding them in various aspects of life.

HCMEA: What inspired you to choose psychiatry as a medical specialty?

 Dr. Kigamwa: It is a winded path. My paternal grandfather was a very clever man, for lack of a better word, and was a sort of jack of all trades. He possessed many attributes and qualities but what set him apart was that he was quite conversant with the use of herbs available in the village. In the nineteen-fifties, he was sought after as a person whom you could go to when you had a troublesome affliction ailment.

The herbalist would be able to identify what plant root, tuber, or leaf in the farms could be pounded and mixed with water, honey, or whatever substance it took to give relief to the villagers. Taking that into consideration, when I was a young boy and lived with my maternal grandmother, I watched her practice the same kind of traditional medicine.

Decades later, I was enrolled in the Starehe Boys’ Centre and School. The founding director Geoffrey William Griffin introduced an educational program for students. Under this program, students would be placed in different types of organizations to provide free-of-charge services during the school holidays. You were free to choose what you want to do and I found myself gravitating towards the hospitals.

With the official holidays at our disposal, I would take on little tasks at either the Nairobi Hospital or Kenyatta National Hospital. All these tasks and decisions, cumulatively, allowed me to observe a lot and learn a lot first-hand. I felt for certain medicine is my calling.

What’s more, Mr. Griffin would invite guests from different professions to have career development talks with the students. I got intrigued, listening to the doctors takes on their paths. True to form, I chose to study Medicine and become a doctor afterward. When my A-level results exams were published in the national newspapers, I was placed at the University of Nairobi School of Medicine.

At the UoN School of Medicine, rigorous training precedes the internship program. During the internship, I rotated through various departments in a hospital, and it became apparent to me that patients in surgical specialties were quite similar across the board. However, it was the patients with mental illness in the field of psychiatry who presented unique challenges.

Unlike other specialties, each mental health patient is different from the next, requiring interactive sessions and a psychiatrist’s clinical expertise to determine appropriate treatment based on diagnostic criteria and underlying pathology. I saw this as a personal challenge and an opportunity to make a difference.

HCMEA: How have your core values shaped your purpose?

 Dr. Kigamwa: The single most important value that a person must possess is a work ethic. A work ethic demands that every morning when you rise, you identify how you’re going to change the world positively. Inevitably, you must have identified goals and objectives that guide your path as you try to navigate the complex medical field of psychiatry.

As an automatic consequence, I am a firm believer in doing good, being just, and doing the right thing. Steer away from taking shortcuts. It is my conviction that we should respect all individuals, regardless of their status, whatever conditions afflict them, their religious persuasions, and their lifestyle choices. I suppose we all have freedom of choice that must be recognized and respected.

If you hold a Master’s Degree in Psychiatry, you are no longer just a person who just clears queues at mental health facilities: You are a teacher, a leader, an opinion leader, a mental health advocate, and a role model wherever you go. You must also dispense your medical duties in a Hippocratic manner per the oath of ethics taken by psychiatrists.

As an automatic consequence, I am a firm believer in doing good, being just, and doing the right thing. Steer away from taking shortcuts.

Dr. Kigamwa

Tweet

HCMEA: What are the most rewarding and challenging aspects of your work?

 Dr. Kigamwa: During my stint at the University Health Services of the University of Nairobi, we provided mental health services to students and academic staff, and their families. Some students would visit the university clinic looking completely broken with no will to continue pursuing their academic studies. As the health team, we would embark on a journey to help the afflicted students to complete their selected courses.

We treated these learners and a majority of them are clear-headed responsible members of society after finishing their studies. These moments are meaningful because what looked like an impossible situation turned into a new possibility and we steered the university students to actualize their dreams. Another precious, rewarding moment of that kind is anytime I run into former students whom I trained at the University of Nairobi. I cross paths with these previous trainees who still refer to me as “Mwalimu!” after they’ve grown into influential adults.

All in all, mental illness is very challenging. Sometimes, you are brought somebody who is completely mute, completely unable to look after themselves, and totally unable to care for themselves. You examine them, you make a well-thought-out diagnosis, you start the treatment, and slowly, the person transforms, and they get out of their stupor.

Gradually, the patient starts talking to you and it makes sense. They get out of the mental health hospital and move on with their lives. It is a complex yet rewarding path to get them back on their feet. Psychiatrists’ engagements with patients are more or less lifelong engagements as we form relationships with patients, their families, and their significant others. Over the years, I have built multiple strong relationships with different patients and their families.

 HCMEA: As a specialty doctor, what is your assessment of the current state of mental health in Kenya?

 Dr. Kigamwa:  The World Health Organization describes health as having normal mental health and not merely the absence of disease. Mental health is the wholeness or completeness of a person’s physical being, thought processes, behaviors, both internal and external moods, and interactions with other individuals.

 Despite the lack of standard data sources, the history of mental health in Kenya dates back to the early 1900s when the European settlers set up a smallpox isolation center in Nairobi, which was converted later into a mental health facility, the present-day Mathari Mental Hospital.

The inpatient facility was typical of all mental hospitals around the world. In the former times, mental hospitals were large old buildings situated at the edge of a city whose main mode of treatment was by restraint. It was just an isolation place with no actual treatment going on. The measure aimed to protect society from the patients and to protect the patients from society.

In the current scene, the World Health Organization has defined all medical facilities as mental health facilities. All medical facilities are obligated to have the capacity to manage the mentally ill. The purpose of the action is to deal with stigma and roll-up essential health services. Nonetheless, the Mathari Mental Hospital operates as a purely psychiatric facility providing mental health services in the public sector.

The government-supported hospital also serves as a teaching and referral hospital for the University of Nairobi’s students. Alternatively, there are several private psychiatric service providers in Nairobi County. These privately operated facilities include the Avenue Hospital, the Chiromo Lane Medical Center, the Royal Victory Hospital and, the Nairobi Rakusei Mental Hospital. Although there are not many standalone psychiatric facilities, all hospitals provide mental healthcare and psychiatric services.

Still, the difference between public and private mental health facilities is like day and night. The government facilities exhibit numerous shortcomings such as poor physical infrastructure, lack of access to sophisticated psychiatric drugs, inadequate hospital chairs in waiting rooms, and unhygienic conditions in the hospitals. Overall, these overcrowded hospitals often struggle with limited financial resources, making it challenging to provide appropriate compensation to staff, resulting in low morale among healthcare professionals.

HCMEA: Could you provide an overview of the current initiatives and strategies being implemented to address and bridge the existing gaps in mental health care?

 Dr. Kigamwa: Currently, Kenya is home to nearly 200 consultant psychiatrists, with approximately 100 of these specialists based in Nairobi. The remaining psychiatrists are unevenly distributed throughout the country, including those serving in the Kenya Armed Forces. While the total number of psychiatrists may appear substantial, it is disproportionate to the country’s demographic size, considering the soaring demand for mental health services.

As a result, Kenya stands out with one of the highest numbers of psychiatrists per capita in the African region. Even when combining the licensed psychiatrists from Eritrea, Ethiopia, Sudan, Uganda, Somalia, Tanzania, Zambia, Malawi, Lesotho, Botswana, and Namibia, their collective count still falls short of surpassing the number of psychiatrists in Kenya.

However, it remains crucial for the country to address the gap in mental health training by increasing the number of psychiatrists, psychiatric nurses, occupational therapists, psychiatric social workers, and other mental health professionals.

The Kenyan government should also consider introducing various mental health specialties, such as clinical psychology, in universities. Clinical psychology encompasses different branches, including educational psychology, industrial psychology, and psychological research, among others. Clinical psychologists specialize in a wide range of psychotherapies, such as interpersonal therapy, cognitive-behavioral therapy (CBT), dialectical behavior therapy (DBT), exposure therapy, addiction therapy, couples therapy, and marital therapy.

Additionally, the country should develop strategies to counter the factors contributing to brain drain in the field of psychiatry, ensuring that trained professionals are retained and incentivized to practice within Kenya.

In addition to addressing the numbers, Kenya is under increasing pressure to enhance the national budget allocation for the mental health sector. Currently, less than 1% of the total funds allocated to the Ministry of Health, the primary body responsible for financing psychiatric training, is spent on mental health services.

Considering Kenya’s disease burden, where one in every four patients seeking care at health facilities has a significant psychiatric disorder or morbidity, the national health expenditure contradicts the World Health Organization’s recommendation that around 15% of government health budgets should be dedicated to mental health.

Stigma presents another obstacle to accessing mental health care in Kenya. Mental health is often accompanied by prejudice, discrimination, and stereotypes, particularly among those who lack awareness about mental disorders.

To bridge the mental health gap, the country must establish well-managed rehabilitation centers. The epidemic of drug and substance abuse among youth in Kenya necessitates government investment in training teachers on mental health and integrating mental health into the primary school curriculum. Moreover, providing mental health education to adolescents will help combat stigma associated with mental illness and addictions.

HCMEA: What measures can governments take to promote good mental health?

 Dr. Kigamwa: Kenya has reiterated its commitment to mental health with the launch of the Mental Health Policy (2015-2030). The first-of-its-kind document in Kenya will guide the provision of mental health services across the county governments. The policy also sets out recommendations on how to allocate mental health budgets as endorsed by the World Health Organization.

In order to enhance access to mental health care, outgoing President Uhuru Kenyatta signed the Mental Health Act 2022 into law. This new legislation will oversee the delivery of mental health services in the country, including the repeal of outdated laws. Furthermore, the previous administration established a high-level commission on mental health, tasked with assessing the mental health status in Kenya.

The commission produced a significant report, commissioned by former President Uhuru, which led to the reorganization of the administrative structure of public mental health facilities. Implementing the recommended measures, the government initiated the construction of a new mental health hospital in Ngong to complement the existing public psychiatric facility, Mathari Hospital.

Notably, the Kenyan entertainment industry has also embraced mental health discussions in its shows, showcasing the valuable contribution of media personalities to the field of psychiatry.

However, attempted suicide remains a criminal act in Kenya, which is an archaic way of thinking about mental health. The country continues to face challenges in implementing the new legal reforms and legislations, in particular resource allocation problems and lack of political goodwill.

HCMEA: What is your perspective on the future of mental healthcare?

 Dr. Kigamwa: Technology plays a huge role in the way mental health services are delivered today. In the wake of the COVID-19 pandemic, technological advances made it possible for psychiatrists to engage with their patients through telemedicine and to work remotely via digital platforms. We were able to roll out mental health services to patients, treat patients and prescribe medications virtually.

On the research side, genetic engineering is gaining momentum in the scientific world and healthcare industry. We recognize that a wide range of mental health disorders are genetic in nature. Through the “Human Genome Project” led by former American President Bill Clinton, an international group of researchers identified all the genes in the human DNA, and ascribe them their positions. Scientists are leveraging this scientific discovery to ascribe what specific human genes contribute to different illnesses including mental health and cancer. In the mental health field, gene editing shows promise in the management of mental health illness in the coming years.

Scientists are also utilizing technological innovation to accelerate the development of vaccines for drug abuse and addiction. A case in point is the ongoing vaccine development to curb alcohol addiction. After this innovative shot is administered, the body will generate an immune reaction that is specific to alcohol and generate antibodies against the highly addictive drug. Once you drink, the alcohol will be quickly captured by the alcohol-specific antibodies preventing it from reaching your brain. After vaccination, consuming alcohol will not make you high – it will be like drinking water.

Another topical issue is the role of artificial intelligence in training individuals with behavioral modification techniques. Under the behavioral modification approach, doctors will study parenting practices and skills and look at which models seem to work best. A psychiatrist will package the evidence-based models and train parents on these parenting styles to avoid future complications related to mental health. These strategies focus on preventive mental health care rather than curative.

Ultimately, technology could help us develop cures for mental illnesses. It presents us an opportunity to steer the mental health conversation away from the management of disorders to developing novel cures.

This feature appeared in the June 2022 issue of Healthcare Middle East & Africa. You can read this and the entire magazine HERE