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The Ghosts of Africa: PTSD on the African Continent

A sound, A movement, a color, or a feeling, and suddenly you find yourself in a different time and place reliving a moment. You become anxious, your palms become sweaty, start to tremble, and no matter what you do you can't get out. Many people experience some, if not all, of the above and more. Most times they don't even know what is going on, they don't know that their reactions are a result of some traumatic event that their brain hasn't worked out or recovered from. Many suffer in silence without knowing better. In this article, we look at the phenomenon of PTSD breaking down what it is and its effect, especially on the African continent.

What is PTSD?

Post-traumatic stress disorder (PTSD) is a psychiatric disorder that may occur in people who have experienced or witnessed a traumatic event or who have been threatened with death, sexual violence, or serious injury. The disorder has been known by many names in the past, such as “shell shock” during World War I and “combat fatigue” after World War II. It is important to note that the disorder does not only happen to combat veterans and can occur in people, of any age, ethnicity, or nationality.  The symptoms can vary from person to person and are generally grouped into four types:   Intrusive memories may include: Recurrent, unwanted distressing memories, flashbacks nightmares or Severe emotional distress, or physical reactions to something that reminds you of the traumatic event Avoidance may include: Avoiding thinking or talking about the traumatic event, Avoiding places, activities or people that remind you of the traumatic event Negative changes in thinking and mood may include: Negative thoughts about yourself, other people or the world, Hopelessness, Memory problems relating to the traumatic event, Difficulty maintaining close relationships. Changes in physical and emotional reactions may include: Being easily startled or frightened, Always being on guard for danger, Self-destructive behavior, Trouble sleeping, Trouble concentrating, Irritability, angry outbursts or aggressive behavior, Overwhelming guilt or shame.  

PTSD in Africa

At least 100 million Africans are estimated to have PTSD caused by wars, terror attacks, natural disasters, sexual abuse, and chronic violence. In countries like the Democratic Republic of Congo, Rwanda, and South Sudan, as much as half of the population may suffer from PTSD. “PTSD blocks the education process, it blocks the creativity, it blocks family relationships… When you spend 100-150 dollars... you will have people able to study better, run their own businesses, and live a happy life,” These are the words of David Shapiro, President of African PTSD Relief. Little has been done to identify and treat PTSD in low-resourced sub-Saharan African (SSA) settings where multiple civil and tribal wars, social strife, and natural disasters have led to mass exposure of the population to traumatic events.  Several reasons could explain the poor identification and treatment of PTSD in SSA. First, some patients have spiritual and cultural beliefs that are different from conventional psychiatry and find meaning in the process of consulting traditional healers. Some individuals don’t volunteer information to health care workers due to stigma and a general lack of knowledge that PTSD is a medical condition.  Moreover, comorbidities such as substance use disorders which may have progressed from substance use as a coping strategy by individuals suffering from PTSD may negatively impact the clinician’s ability to diagnose PTSD. The considerations of efficiency are especially critical in a context of Africa where millions of people need immediate help, yet governments are severely constricted by resources. Furthermore, access to mental health care and severe shortages of trained mental health care staff hampers the identification and treatment of PTSD. An average of 1.4 mental health workers are available per 100 000 persons in Africa compared to the global average of 9 per 100 000. Progress has been made over the last few years as a result of global trends that recognize the importance of good mental health. Psychiatrists and other medical professionals have had success in treating PTSD using a variety of treatment methods to help people who suffer from the disorder. Some of these methods include: Medication. This is the most famous form of therapy. This is because of the bad reputation it gets as a result of reports of prolonged substance abuse to additive medications. However, when administered correctly This form of therapy can help to control the symptoms of PTSD. Antidepressant medications are particularly helpful in treating the core symptoms of PTSD. An added advantage is that these medications are non-addictive and help treat PTSD even when depression is not present. Cognitive-behavioral therapy (CBT). This treatment focuses on coping with the PTSD sufferer's painful and intrusive patterns of behavior by teaching them relaxation techniques and examining their mental processes. Discussion/Support Groups. This method encourages survivors of similar traumatic events to share their experiences. In doing so, group members offer support to help each person realize that they are not alone in their reactions or emotions. Counseling and Debriefing. Trauma counseling is another effective way of coping with the experience. The person may go for individual sessions where he or she can talk through the experience and work through the painful feelings such as anger, sadness, and guilt. Ways of coping with the symptoms can be explored. Debriefing is a form of crisis intervention that is used when a group of people have been through a traumatic event together. It is a structured group meeting that allows for each group member to vent their feelings and reactions to the event(s). Family therapy. The behavior of the spouse and children has been shown to affect the individual suffering from PTSD. Family members often report their loved ones don't communicate, show affection, or share in the family life. By working with the family, the members can learn to recognize and cope with the range of emotions felt by the sufferer and the spouse and children.  
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