Aira Hospital

Psychiatry is the most neglected area of health care in this country. In the whole country with 80 million inhabitants there is only one mental hospital and 10 psychiatrists. The hospital, Amanual Hospital, is situated in the capital city, Addis Abeba, as well as all the 10 psychiatrists. The hospital trains nurses who run satellite psychiatric clinics in the countryside. The nearest to Aira is Nekemte.

I believe that Aira is the only hospital outside Addis Abeba which offers treatment with ECT - Electro Convulsive Therapy. This is a very efficient, atraumatic and cheap treatment option without any serious side effects and immediate response. Unfortunately it has come into disrepute in the western world, due to completely irrational and false accusations. Much harm was done by the false propaganda presented in the popular movie “Someone flew over a Cuckoo’s nest” where Jack Nicolson got his fame as an actor.

The indications for ECT are first and foremost endogenous mental depression. But even mania, post partum psychosis and severe Parkinson’e disease (a disease which the famous boxer Mohammed Ali gave a face) can be treated successfully.

Patients with severe depression suffer tremendously, and are often driven to commit suicide. There are efficient drugs available, but that treatment option is not realistic in the countryside of Ethiopia. The drugs cause very disturbing side effects, and take several weeks before starting to work. None of our patients will comply with the treatment, which is anyhow too expensive to be of use here. Since ECT has no side effects and gives immediate result, very many patients with recurrent severe depressions prefer that treatment. It is even almost without any costs.

With the use of anesthesia and muscle relaxing drugs, the treatment is totally without any dramatic effects. Not all al like the torture scenes falsely presented in the above mentioned and other similar propaganda movies.

ECT given for a patient with severe depression	ECT given for a patient with severe depression
Scar after previously attempted suicide	Patient and husband after successful  treatment

 

Recently it has been reported that the anesthetic drug Ketamine (Ketalar) has a previously unknown profound effect on depression. One intravenous dose of the drug is followed by immediate – an hour or so- improvement. The drug has become very cheap, and is easily available even in the third world. We have taken this new information in practice, using Ketamine as anesthesia for ECT, hopefully to potentiate the effects. The use of Ketamine intravenously alone could be an excellent treatment option for clinics without facilities for ECT.