Wednesday, October 21, 2020

Botswana witnesses the changing face of PTSD

Very few Batswana have heard of Kefalotse Dithole, Gloria Thupayagale-Tshweneagae and Tennyson Mgutshini. The three trail-blazers however made history seven years ago as pioneer researchers on Post Traumatic Stress Disorder in Botswana (PTSD).

The trio not only explored the unbeaten path, they also stood up to the dauting task of coaxing twenty-eight distressed participants of the research to talk about traumatic memories they were trying very hard to erase.

In their research report: Posttraumatic Stress Disorder among Spouses of Patients Discharged from the Intensive Care Unit after Six Months”, the three researchers remember how “fifteen spouses reported intrusive memories of ICU and avoided reminders of the experience six months later. Ten spouses reported feeling anxious for a short while after their spouse’s discharge but that they had come to terms with the experience.”

The research revealed that,PTSD, commonly associated with war veterans was showing up among Batswana men and women who had never been to war.  This was Botswana’s first indigenous scientific knowledge on PTSD.

To mitigate the trauma experienced by spouses the study suggested that “pre- and post-counselling for close relatives, especially spouses, should be implemented at the point of hospitalisation, during admission, and after discharge for a period of at least six months.”

Dr Sophie Moagi, clinical psychologist in Gaborone told Sunday Standard Lifestyle that, “initially, PTSD was solely focused on soldiers in that when they came back from war, they would exhibit a cluster of symptoms. As time went, there came a realization that is a disorder that is traumagenic. Any traumatic experience can put someone at risk of PTSD. Any traumatic experience triggered by death, serious injury and even sexual violence can result in PTSD, for a person to be diagnosed with PTSD they have to either have witnessed the event or directly experienced it. Also, by virtue of learning that the experience has happened to someone close to you is criteria enough to warrant it as exposure. Usually symptoms begin after the traumatic event has occurred, they usually range from nightmares, flashbacks, or even vivid memories of the traumatizing event or events. Feelings of numbness, distance, or isolation from others. Jumpiness or being easily startled. Avoiding people, places, or things that remind you of the traumatizing event(s). Dreams (recurrent and disturbing), the content of the dreams are almost similar to the traumatic event. These symptoms may keep the affected from holding down a full-time job, or even leave them unable to work at all. Relationships with family and friends may deteriorate, leaving the person feeling more isolated and less able to seek help. Non-combat PTSD and its effects are very real, and seeking treatment is essential to recovering your ability to function in daily life.”

A growing body of Botswana’s indigenous scientific knowledge on PTSD confirms Dr Moagi and the 2013 ground breaking study’s conclusions on the changing face of the mental condition initially associated with war veterans.

Another research paper published two years ago: “Post-traumatic stress disorder among the staff of a mental health hospital: Prevalence and risk factors by Anthony Olashore Oluyemi O. Akanni, Keneilwe Molebatsi and John A. Ogunjumo from the University of Botswana Psychiatry Department turned up the condition among Sbrana mental hospital nurses in Lobatse.

Most of the study participants, about 121 were general nurses who are frequently exposed to stress and violence in the line of duty. Thirty-seven of the participants met the criteria for PTSD, “exposure to violence in the past 12 months and a high

neuroticism score was significantly associated with the diagnosis of PTSD among the participants.”

The study concluded that “Post-traumatic stress disorder could result from stressful events encountered in the course of managing patients in mental health institutes and departments. Pre-placement personality evaluation of health workers to be assigned to work in psychiatric units and post-incident trauma counselling of those exposed to violence may be beneficial in reducing the occurrence of PTSD in mental hospital health care workers.”

Dr Poloko Ntshwarang, senior Social Work lecturer at the University of Botswana says, “Post-Traumatic Stress Disorder can happen to anyone at any time, no one is exempt. It involves exposure to extreme direct personal experience. It can be a threat to one’s psychical integrity, witnessing a death, unexpected violence etc. PTSD usually leaves one fear stricken and helpless and often recalls the event/experience time and again. In kids, they start having nightmares and can even dream about it. Some people get hallucinations as well as flashbacks. We are living in times where gender-based violence is on the rise and with this comes traumatic experiences. For children who grow up witnessing such they are seriously affected. There are a lot of traumatic experiences people go through every day which leave immense scars. We seriously need to take mental health seriously and not only deem people who are thought to be ‘psychotic’ to be the ones who are challenged while other people are also suffering but aren’t acknowledged” she said.

Keneilwe Molebatsi who was part of the quartet responsible for the 2018 “Post-traumatic stress disorder among the staff of a mental health hospital: Prevalence and risk factorsis currently working on another research paper sponsored by the University of Botswana in collaboration with the University of KwaZulu.

“The purpose of this study is to culturally adapt a brief psychological intervention for Post-Traumatic Stress Disorder (PTSD) and assess its efficacy, feasibility, and acceptability in a pilot trial. The intervention has been shown to be efficacious among individuals with comorbid severe mental illness (SMI) and PTSD.

“The study will be conducted in three phases. The first phase will determine a description of trauma and responses to traumatic experiences among patients with severe mental illness. The first phase of the study will also determine participants’ and mental health care providers’ perceptions of suitable PTSD interventions in this middle-income context. The findings will then be used to culturally adapt the brief intervention in the second phase. A pilot trial will be conducted in the third phase of the study.

“Participants with comorbid SMI and PTSD will be randomized into two groups (n= 20 intervention group, n= 20 control group). Outcomes of the intervention such as the severity of PTSD symptoms, knowledge about PTSD will be assessed at baseline and at different timelines during the study.

This study will fill the knowledge gap on trauma and its consequences among individuals with severe mental illness in Botswana, it will also contribute to the improvement of clinical practice in the management of PTSD and SMI”, states a brief summery of the study provided by Molebatsi.

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