Med­i­cal Bytes with Dr. K

mailife - - Contents - with Dr. K

It’s a beau­ti­ful sunny day. Most peo­ple are out­doors en­joy­ing the weather while 15-year-old Mere is in her room. Dur­ing the past eight weeks Mere has be­come with­drawn. She has not been out­side for a whole week and has re­fused to speak to any­one at home. Mere did not pass her Year 10 ex­am­i­na­tion and is ex­tremely dis­ap­pointed. She has been teary most of the time and re­fus­ing to have her meals. Her par­ents had high ex­pec­ta­tions of Mere as their el­dest child and she feels that she has let them down. She feels like a fail­ure and has been think­ing about end­ing it all. She takes her bed sheet and de­cides to hang her­self from the fan in her room. Mean­while, it’s been seven weeks since 26-year-old Seema had her first child - a beau­ti­ful baby boy. Seema is feel­ing ex­hausted, teary, and find­ing it hard to sleep. She feels over­whelmed with the care that a new­born baby re­quires. She is even scared of hold­ing her baby be­cause she is afraid she may drop him. She feels pet­ri­fied of be­ing left alone with this lit­tle be­ing that de­pends on her for ev­ery­thing. It’s been ex­tremely dif­fi­cult for Seema be­cause her hus­band works long hours and her par­ents live over­seas. She knows that she should be happy, but she feels mis­er­able. So mis­er­able that she wants to jump off the bal­cony. Then there is 65 year old John, who re­tired a few years ago and lost his wife Mary to breast can­cer three months ago. John now lives alone and greatly misses his wife. Since her pass­ing he hasn’t been out­side the house and he’s taken to drink­ing half a bot­tle of whiskey ev­ery night to ease his pain. He’s lost over 10 kilo­grams, wakes up at 3am and thinks con­stantly of Mary. John’s doc­tor gave him some sleep­ing pills to help him through this dif­fi­cult time. It’s been very tempt­ing for John to over­dose on his pills so that he can end his life with­out Mary. Com­mon to all these sce­nar­ios is the Black Dog that is for­ever lurk­ing in the back­ground that just can­not be shaken off, con­sum­ing a per­son from within -- de­pres­sion. Some would claim it is the plague of our mod­ern so­ci­ety. April 7 marks World Health Day. This year it is on the theme ‘De­pres­sion - Let’s talk about it’. An es­ti­mated 350 mil­lion peo­ple of all ages suf­fer from de­pres­sion (World Health Or­gan­i­sa­tion, 2017). That is 5% of the world’s pop­u­la­tion – more than the en­tire pop­u­la­tion of the United States of Amer­ica. De­pres­sion is the lead­ing cause of dis­abil­ity world­wide, and is a ma­jor con­trib­u­tor to the over­all global bur­den of dis­ease. De­pres­sion is a mood dis­or­der, the ex­act cause of which is un­known. But we know there are sev­eral fac­tors that in­crease the risk of it de­vel­op­ing. Stress­ful life events such as be­reave­ment or a re­la­tion­ship break­down can trig­ger it. Cer­tain per­son­al­ity traits such as low self es­teem and be­ing overly crit­i­cal may make you more vul­ner­a­ble to de­pres­sion. There is a ge­netic pre­dis­po­si­tion. The risk in­creases if a fam­ily mem­ber has a his­tory of de­pres­sion. If you’re a woman you are more likely to suf­fer de­pres­sion. Women are par­tic­u­larly sus­cep­ti­ble af­ter preg­nancy due to hor­monal and phys­i­cal changes as well as the added re­spon­si­bil­ity of look­ing af­ter a baby (post­na­tal de­pres­sion). The use of il­licit drugs and al­co­hol may spi­ral the ef­fects. About 1 in 4 peo­ple in Fiji have men­tal health is­sues, and de­pres­sion is the most com­mon form of men­tal ill­ness. There is no doubt de­pres­sion is a huge prob­lem world­wide, so why don’t peo­ple seek help for it? Why is there so much stigma when it comes to men­tal health? In my ex­pe­ri­ence as a Gen­eral Prac­ti­tioner in Aus­tralia and now in Fiji, I have seen greater aware­ness of men­tal health in re­cent years. At least in de­vel­oped coun­tries peo­ple are start­ing to re­al­ize the im­por­tance of vis­it­ing their doc­tor when they are not cop­ing with life, when they are feel­ing blue or de­pressed. Help is avail­able in the form of coun­sel­ing, med­i­ca­tion, fam­ily sup­port, helplines, re­lax­ation ther­apy and healthy diet and ex­er­cise. With ther­apy, most peo­ple im­prove and are able to lead a nor­mal life. In Fiji how­ever, the sit­u­a­tion is still very dif­fer­ent. Very few peo­ple visit a doc­tor when they are de­pressed and most times the ill­ness goes un­rec­og­nized by fam­ily mem­bers. Some think that their loved one is pos­sessed by a spirit and they go to a witch doc­tor. The name St. Giles hos­pi­tal evokes images of be­ing locked away in a cell, never to emerge again. We need to change this at­ti­tude by ed­u­cat­ing peo­ple to un­der­stand that men­tal health is real and is just as im­por­tant as phys­i­cal health. Over the past few years, the rates of sui­cide have in­creased tremen­dously. Ac­cord­ing to Uni­ver­sity of Texas psy­chi­atric ex­pert Dr Cheryl Per­son, Fiji’s sui­cide rate is the third high­est in the world, with 34 sui­cides per a pop­u­la­tion of 100,000. Ev­ery 36 hours, one per­son com­mits sui­cide and far more at­tempt it (Fiji Po­lice Force, 2017). Chil­dren as young as 12 years old are part of these statis­tics. Alarmed? So am I. What’s caus­ing these peo­ple to take their lives? Re­la­tion­ship break­downs, chronic dis­ease, poor grades, and the in­abil­ity to meet fam­ily ex­pec­ta­tions are some of the rea­sons. What can we do to pre­vent sui­cide? Let’s start by rec­og­niz­ing the symp­toms of de­pres­sion – whether you’re ex­pe­ri­enc­ing them your­self or some­one in your fam­ily is. The most com­mon signs to look out for in­clude a per­sis­tently low mood, loss of in­ter­est in ac­tiv­i­ties, poor sleep, re­duced en­ergy lev­els, dif­fi­culty con­cen­trat­ing, feel­ings of hope­less­ness, help­less­ness and at the more height­ened level - thoughts of sui­cide. Most peo­ple who com­mit sui­cide have a his­tory of de­pres­sion.

And then let’s talk about it: at school stu­dents need to dis­cuss is­sues that they’re fac­ing with teach­ers. In ad­di­tion, schools should not place too much pres­sure on stu­dents. At the work­place, we should en­cour­age di­a­logue and dis­cour­age bul­ly­ing which is a very com­mon oc­cur­rence. All of us in so­ci­ety need to be­come more tol­er­ant, non­judg­men­tal and com­pas­sion­ate to­wards the psy­cho­log­i­cal needs of in­di­vid­u­als. And let’s seek help for it: As med­i­cal pro­fes­sion­als, gen­eral prac­ti­tion­ers can also play a huge role in iden­ti­fy­ing peo­ple who may be de­pressed - re­fer­ring peo­ple for coun­sel­ing and if needed, pre­scrib­ing an­tide­pres­sants. Have a reg­u­lar GP and if you’re ex­pe­ri­enc­ing any symp­toms of de­pres­sion, talk to your GP about it. There is also a Na­tional Chil­dren’s helpline, which is avail­able 24 hours for peo­ple who are dis­tressed (they also help youth and adults.) Whilst we have these great fa­cil­i­ties, we des­per­ately need a clin­i­cal psy­chol­ogy pro­gram in Fiji so that we can train psy­chol­o­gists lo­cally. There is a huge gap with vir­tu­ally no qual­i­fied psy­chol­o­gists avail­able. We also need more psy­chi­a­trists in Fiji – doc­tors who spe­cial­ize in Men­tal Health. With­out ap­pro­pri­ate trained spe­cial­ists we have a very slim chance in mak­ing progress in rec­og­niz­ing and treat­ing the is­sues. We all need to work to­gether to give men­tal health a voice. We need to break the si­lence and speak up so that it be­comes a part of our lives and is not a tabu sub­ject. Let’s ac­knowl­edge the black dog and learn to deal with it. Let’s not run away from it. One day, we may be able to un­friend the black dog, stand up tall and look into the hori­zon with a clearer and hap­pier state of mind. An or­ga­ni­za­tion called Em­power Pa­cific pro­vides coun­sel­ing ser­vices based in Suva, Nadi, Lau­toka and Labasa. If you are feel­ing de­pressed, please make use of these avail­able fa­cil­i­ties.

“About 1 in 4 peo­ple in Fiji have men­tal health is­sues, and de­pres­sion is the most com­mon form of men­tal ill­ness. Why is there so much stigma when it comes to men­tal health?”

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