Testimony project - South Africa
Name: Mike Thompson. Age: 48
Diagnosis: bipolar 1 disorder, rapid cycling.
Onset: diagnosed in 1985 – definitely present before that.
Family/career: Married with 2 children. Previously senior corporate position. Disability for the past 7 years.
My Story:
My
bipolar disorder has been fairly refractory with a poor response to
most medications - and most medications have been tried. My condition
deteriorated slowly over the years up to 1999 when it became impossible
to work and I was boarded from a senior position in a large
corporation. Although there have been a number of major depressive
episodes the dominant feature for me has been mania/hypomania. The
underlying need to achieve and be recognized has been the probably
driver of this behaviour. I have just been running hypomanic for nearly
a year and it is a long time since I had a lengthy depressive episode.
I was on six to seven meds but my Psychiatrist has now cut to three:
Lithium (level 1.1), Sodium Valproate (Epilim) 2000mg and Clonazepam
(Rivotril) 3mg. The hypomania has stopped and I am very slowed. A
limiting factor is a bad tremor. What is rather sinister (good now but
a shame for my past life) is the fact that Lithium and Epilim are
probably the simplest, best options, come after 20 years of trials of
medication that did not often help me, and leave me unable to work due
to being stress vunerable.
South Africa, a local perspective of bipolar disorder:
Let me start by saying that the quality of training for Doctors and Psychiatrists is generally very high.
Let
me start by saying that the quality of training for Doctors and
Psychiatrists is generally very high. I believe it can in most cases
equate to the UK. The medicines available in the UK are in most cases
available here. In fact, some psychiatric medicines are released here
prior to them being available over there.
Now let me cover 1st
world (becoming more multi-racial) and third world (mainly black). The
population that is 1st world has access to private psychiatrists,
private clinics, private nursing, private psychologists and the latest
medications. They have what is called Medical Aid (or medical insurance
- which they pay for) and they generally pay nothing for the services
they receive – unless it is a long stay in a clinic. The treatment is
very good and up-to-date. Most of the private psychiatrists attend
conferences around the world and are up to date with new methodology.
In addition the drug companies are educating all the time.
In
South Africa there are many support organizations and groups that are
open to everyone. Mostly the more affluent use them. They range from
weekly support groups through to phone-in support. People who are
disabled by bipolar are supposed to get preferential treatment when it
comes to opportunities for basic employment. This is a joke, and the
chances of getting menial work if you are mentally ill are close to
zero as the stigma is still there.
Third world people are
commonly unemployed and are forced to go to state hospitals (which are
free). State hospitals don't always use the latest medication. I don't
know how far behind they are but you may find drugs like Quetiapine
(Seroquel) or Lamotrigine will probably not be in use yet. The income
of doctors in private practice is determined by the amount and quality
of work they do. In state hospitals Doctors generally work on fixed
incomes. Some choose this environment as they do not like the pressure
of a private business. Most of the Psychiatrists can't speak the
languages and therefore much is left in the hands of the black
psychiatric sisters, who are wonderful and very patient. I have worked
as a volunteer in such an environment and therefore have experienced
the support that is given. The workload however is often very high.
"Support systems for third world people who are psychiatrically ill are in a sorry state."
In
general terms unfortunately third world people allow their illnesses to
become VERY advanced before seeking help due to a total lack of
knowledge – they become outcasts with mainly witch doctors trying to
help them. Dagga (cannabis) abuse is a serious problem, not helping
people with mental health problems and inducing some illnesses. The
trauma that an average third world person sees is very disturbing. Rape
and abuse is rife. Aids is common and as you are aware it has it's own
set of complications (including psychiatric). Pure drug treatment is
probably adequate but support systems for third world people who are
psychiatrically ill are in a sorry state. One finds in many state
hospitals a dedicated group of Psychiatrists and Nurses trying to cope
with a wave a illnesses. One also needs to realise that the country is
vast and staff have to travel to outlying areas to provide people with
treatment.
