2007年VOA标准英语-Underdevelopment, Conflict Plague Mental Health

By William Eagle
Washington
06 June 2007

The World Health Organization says mental health disorders² make up more than 12 percent of all diseases, and will likely rise to 15 percent by 2020. Researchers see a link between mental illness and income. They say poverty may increase the risk of mental disorders. Among the areas of the developing world working on establishing better mental health systems is Africa. From Washington, reporter William Eagle describes some of the challenges to improving mental health on the continent, where economic and political instability are common.

Experts say the range of mental illness is roughly the same in the developed and developing worlds - hitting rich and poor, from Hollywood to Bollywood, and from London to Soweto.

The World Health Organization says one in four people will develop at least one mental or behavioral disorder¹ in their lifetime. Sometimes these illnesses are genetic³, passed down from generation to generation. And sometimes they may be triggered by traumatic events, including conflict.

Dr. Frank Njenga is the president of the African Association of Psychiatrists⁵ and Allied⁶ Professions in Nairobi, Kenya.

"[Some of] the biggest challenges in Africa are really the relationship and connection between poverty and mental health," said Dr. Njenga. "The factors that drive poor mental health in Africa are the same as those that drive poverty - wars, internal displacement⁷, HIV/AIDS and the fact that 60 percent of Africans live below the poverty line."

"There's also the fact that so many people who are afflicted⁸ by infectious disease, and [there] are so many wars and displaced across Africa. These are the main drivers to depression, post-traumatic stress disorder [PTS], alcohol and substance abuse," he added.

Children are a special concern for Njenga. At least 10 percent of all African children are AIDS orphans⁹ or child soldiers. He says the traumas¹⁰ that they suffer in their youth will stay with them long into their adulthood¹¹.

"Anyone who tries to project what may happen to the neglected African child who is a victim or survivor¹² of post traumatic stress disorder, as a result of seeing parents, teachers or siblings¹³ mutilated in war … would be guessing," he said.

"One begins to project and understand that in the course of time children who witness genocide in Rwanda are likely to become adults with unresolved grief, PTS disorder, substance abuse issues, depression. In fact, just thinking about the likely consequences of the traumatic events the African child is going through, we anticipate in 30 years time, we are going to have [a] large African population of deeply traumatized and unstable¹⁴ [people]," he continued.

Getting treatment for any kind of illness is difficult in many parts of Africa, and it is especially hard in the case of mental illness. Njenga says there is, on average, about one psychiatrist⁴ for every half million people in Africa. In Zimbabwe, he says there are only two psychiatrists for every 20 million people. Some countries have none at all.

But work is being done to make the most of scarce resources. Efforts are being made to integrate mental health into overall national health care systems. Efforts are also being made to decentralize services and bring help to local communities. This means training nurses, health care workers or volunteers to help monitor the mentally ill or prescribe simple medications.

At least two models for improving community mental health care have been tested in Africa.

Dr. Fred Kigozi is the executive director of the Butabika National Referral and Teaching Hospital in Kampala, and an adviser¹⁵ to Uganda's ministry¹⁶ of health.

He says one model, which has been tested in Nigeria and Tanzania, placed the mentally ill in what were called rehabilitation¹⁷ villages. Kigozi says in Tanzania, the villages offered psychiatric services similar to those in hospitals. Also on staff were agricultural and livestock¹⁸ officers, nurses, traditional healers and occupational therapists. A psychiatrist and medical social worker would make weekly visits.

"These were based on the concept that mentally sick people will be shunned¹⁹, marginalized with no access to opportunities. So some researchers asked but why keep them in a hospital when they're symptom free? So, the concept of rehabilitation villages came in. It was confinement²⁰ in a demarcated area [a separate village] and they were assisted maybe to do some gardening. But [the idea] never spread. That's because it was transferring stigmatization²¹ from the hospital setting to an [isolated village] which was a no-go area [for those who were not ill]," said Dr. Kigozi.

Another model being used in Ghana, Tanzania, Uganda and Kenya is called the "sustainable livelihood²²" approach. The mentally ill are not removed from their home villages, and are supported with consultative workshops and self-help groups. Government and NGO partners provide micro-financing and other training to help patients get back on their feet and regain²³ a measure of stability and independence.

This model, social workers say, is closest to the one encouraged by the World Health Organization. The sustainable livelihood approach, Kigozi says, brings psychiatric support down to the village level, where medications and other simple assistance can be provided by trained nurses and others working under a psychiatrist.

"Instead of having patients in hospital or coming back to the hospital to get drugs, [the scheme asks]: can you organize nearby health centers or through civic²⁴ leadership, help people access drugs in an easier way. Can you assist them with microfinance so that through their own initiative but with the assistance of a development worker [can] be able to set up an income generating activity? Can you organize them so there is a revolving²⁵ fund, where some can put in money and buy drugs," said Dr. Kigozi.

He says the system allows the mentally ill and their families to serve as role models, encouraging others to get mental help if they need it.

Another benefit of the sustainable livelihood approach is that it avoids what has become an unpopular holdover of colonial policy - institutionalizing the mentally ill. In many cases, institutionalized patients live in sub-standard conditions, often without treatment or legal recourse to leave. Health care advocates compare that solution to incarcerating²⁶ a patient - and throwing away the key. They say advances in mental health care since colonial times have made institutionalization outdated²⁷, and unwanted.

1 disorder   

n.紊乱，混乱；骚动，骚乱；疾病，失调

参考例句：

• When returning back,he discovered the room to be in disorder.回家后，他发现屋子里乱七八糟。
• It contained a vast number of letters in great disorder.里面七零八落地装着许多信件。

2 disorders   

n.混乱( disorder的名词复数 )；凌乱；骚乱；（身心、机能）失调

参考例句：

• Reports of anorexia and other eating disorders are on the increase. 据报告，厌食症和其他饮食方面的功能紊乱发生率正在不断增长。 来自《简明英汉词典》
• The announcement led to violent civil disorders. 这项宣布引起剧烈的骚乱。 来自《简明英汉词典》

3 genetic   

adj.遗传的，遗传学的

参考例句：

• It's very difficult to treat genetic diseases.遗传性疾病治疗起来很困难。
• Each daughter cell can receive a full complement of the genetic information.每个子细胞可以收到遗传信息的一个完全补偿物。

4 psychiatrist   

n.精神病专家；精神病医师

参考例句：

• He went to a psychiatrist about his compulsive gambling.他去看精神科医生治疗不能自拔的赌瘾。
• The psychiatrist corrected him gently.精神病医师彬彬有礼地纠正他。

5 psychiatrists   

n.精神病专家，精神病医生( psychiatrist的名词复数 )

参考例句：

• They are psychiatrists in good standing. 他们是合格的精神病医生。 来自辞典例句
• Some psychiatrists have patients who grow almost alarmed at how congenial they suddenly feel. 有些精神分析学家发现，他们的某些病人在突然感到惬意的时候几乎会兴奋起来。 来自名作英译部分

6 allied   

adj.协约国的；同盟国的

参考例句：

• Britain was allied with the United States many times in history.历史上英国曾多次与美国结盟。
• Allied forces sustained heavy losses in the first few weeks of the campaign.同盟国在最初几周内遭受了巨大的损失。

7 displacement   

n.移置，取代，位移，排水量

参考例句：

• They said that time is the feeling of spatial displacement.他们说时间是空间位移的感觉。
• The displacement of all my energy into caring for the baby.我所有精力都放在了照顾宝宝上。

8 afflicted   

使受痛苦，折磨( afflict的过去式和过去分词 )

参考例句：

• About 40% of the country's population is afflicted with the disease. 全国40%左右的人口患有这种疾病。
• A terrible restlessness that was like to hunger afflicted Martin Eden. 一阵可怕的、跟饥饿差不多的不安情绪折磨着马丁·伊登。

9 orphans   

孤儿( orphan的名词复数 )

参考例句：

• The poor orphans were kept on short commons. 贫苦的孤儿们吃不饱饭。
• Their uncle was declared guardian to the orphans. 这些孤儿的叔父成为他们的监护人。

10 traumas   

n.心灵创伤( trauma的名词复数 )；损伤；痛苦经历；挫折

参考例句：

• She felt exhausted after the traumas of recent weeks. 她经受了最近几个星期的痛苦之后感到精疲力竭。
• Conclusion: Safety lens of spectacles can protect the occurrence of ocular traumas. 结论：安全镜片可以预防眼镜碎片所致的眼外伤。 来自互联网

11 adulthood   

n.成年，成人期

参考例句：

• Some infantile actions survive into adulthood.某些婴儿期的行为一直保持到成年期。
• Few people nowadays are able to maintain friendships into adulthood.如今很少有人能将友谊维持到成年。

12 survivor   

n.生存者，残存者，幸存者

参考例句：

• The sole survivor of the crash was an infant.这次撞车的惟一幸存者是一个婴儿。
• There was only one survivor of the plane crash.这次飞机失事中只有一名幸存者。

13 siblings   

n.兄弟，姐妹( sibling的名词复数 )

参考例句：

• A triplet sleeps amongst its two siblings. 一个三胞胎睡在其两个同胞之间。 来自《简明英汉词典》
• She has no way of tracking the donor or her half-siblings down. 她没办法找到那个捐精者或她的兄弟姐妹。 来自时文部分

14 unstable   

adj.不稳定的，易变的

参考例句：

• This bookcase is too unstable to hold so many books.这书橱很不结实，装不了这么多书。
• The patient's condition was unstable.那患者的病情不稳定。

15 adviser   

n.劝告者，顾问

参考例句：

• They employed me as an adviser.他们聘请我当顾问。
• Our department has engaged a foreign teacher as phonetic adviser.我们系已经聘请了一位外籍老师作为语音顾问。

16 ministry   

n.(政府的)部；牧师

参考例句：

• They sent a deputation to the ministry to complain.他们派了一个代表团到部里投诉。
• We probed the Air Ministry statements.我们调查了空军部的记录。

17 rehabilitation   

n.康复，悔过自新，修复，复兴，复职，复位

参考例句：

• He's booked himself into a rehabilitation clinic.他自己联系了一家康复诊所。
• No one can really make me rehabilitation of injuries.已经没有人可以真正令我的伤康复了。

18 livestock   

n.家畜，牲畜

参考例句：

• Both men and livestock are flourishing.人畜两旺。
• The heavy rains and flooding killed scores of livestock.暴雨和大水淹死了许多牲口。

19 shunned   

v.避开，回避，避免( shun的过去式和过去分词 )

参考例句：

• She was shunned by her family when she remarried. 她再婚后家里人都躲着她。
• He was a shy man who shunned all publicity. 他是个怕羞的人，总是避开一切引人注目的活动。 来自《简明英汉词典》

20 confinement   

n.幽禁，拘留，监禁；分娩；限制，局限

参考例句：

• He spent eleven years in solitary confinement.他度过了11年的单独监禁。
• The date for my wife's confinement was approaching closer and closer.妻子分娩的日子越来越近了。

21 stigmatization   

n.描绘，陈述

参考例句：

22 livelihood   

n.生计，谋生之道

参考例句：

• Appropriate arrangements will be made for their work and livelihood.他们的工作和生活会得到妥善安排。
• My father gained a bare livelihood of family by his own hands.父亲靠自己的双手勉强维持家计。

23 regain   

vt.重新获得，收复，恢复

参考例句：

• He is making a bid to regain his World No.1 ranking.他正为重登世界排名第一位而努力。
• The government is desperate to regain credibility with the public.政府急于重新获取公众的信任。

24 civic   

adj.城市的，都市的，市民的，公民的

参考例句：

• I feel it is my civic duty to vote.我认为投票选举是我作为公民的义务。
• The civic leaders helped to forward the project.市政府领导者协助促进工程的进展。

25 revolving   

adj.旋转的，轮转式的；循环的v.（使）旋转( revolve的现在分词 )；细想

参考例句：

• The theatre has a revolving stage. 剧院有一个旋转舞台。
• The company became a revolving-door workplace. 这家公司成了工作的中转站。

26 incarcerating   

vt.监禁，禁闭（incarcerate的现在分词形式）

参考例句：

27 outdated   

adj.旧式的，落伍的，过时的；v.使过时

参考例句：

• That list of addresses is outdated,many have changed.那个通讯录已经没用了，许多地址已经改了。
• Many of us conform to the outdated customs laid down by our forebears.我们许多人都遵循祖先立下的过时习俗。