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    Public health and psychiatry in Africa.

    Collomb H

    In: World Health Organization (WHO). Regional Office For Africa (AFRO). Biomedical lectures, 1970-1971 series. Brazzaville, Congo, AFRO, 1972. p. 61-70

    Focus is on psychiatry in Senegal as an integrated activity closely linked with all medical care agencies and involving all the basic health services. To comply with World Health Organization (WHO) requirements concerning beds and psychiatrists, Senegal with its population of about 3,500,000 would require some 5000-6000 beds and 350 psychiatrists. Nearly all psychiatric facilities in Senegal are concentrated in Dakar. There are virtually no facilities elsewhere. Alongside the official services in which "modern, scientific" psychiatry plays a small role, exists a traditional, primitive and popular psychiatry which accounts for virtually all the care provided to the mentally ill. All the patients hospitalized or treated at the Fann hospital in Dakar have previously consulted 1 or more healers, and they come to the center only when they have exhausted the possibilities of traditional treatment or when their family has rejected them. The proportion of healers of some repute is about 50 per medical officer. To the traditional healer mental illness is seen as the result of a bad act. This viewpoint has important considerations; the sick person is not held responsible for his condition, and his illness is a matter of concern to the community. Because of this, the mentally ill individual is not rejected. The traditional cures and bush hospitals are the mainstay of the mentally ill, and the methods and institutions are very effective. Psychiatry could be incorporated in the organization of basic health services. A number of general guidelines may be proposed and measures for implementation at all levels envisaged. The general guidelines concern training of physicians, nurses, and all social workers who have direct contacts with the mentally ill and their families; information for the authorities, families and the public; and institutions other than hospitals. The role of traditional psychiatry presents a difficult problem; currently, it is desirable not to discredit this form of treatment.
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