Individual, family and societal stressors here are exacerbated by poverty and disease, but mental health services -- in rural areas, at least -- seem absent. We see extreme anxiety, alcoholism, violence, depression, unwanted pregnancies and "broken" (usually by death) families. We also see a nude woman just outside the hospital gate who advertises herself to the "tsk-tsks" of the women and the embarrassment of the men. She is not a Nairobi prostitute, "just" a local married woman whose inexplicable exhibitionism has stigmatized her family. Another woman babbles pleasantly, but incoherently, to the patrons of a nearby duka. The local people attribute her behavior to "something that happened during her 4th Caesarean section. She was an educated woman, a teacher, before that."
We also see physical stoicism beyond belief, from patients in the operating theatre to children in the orphan programs. Perhaps that extends to emotional issues, as well? Actually, Jessica was prescribed an antidepressant fairly early in her hospitalization, but her mental state and weeping were probably the result of encephalopathy and the disease process itself. Otherwise, we've seen no psychotropic drugs prescribed, and the only "counseling" seems to be about HIV/AIDS transmission. When we inquired, the nurses at our hospital described a large mental hospital in Nairobi by saying, "You wouldn't want to work there or ever send a family member there." Community health programs exist, but community mental health programs do not. We need another Milton Mazer -- and a lot more resources -- here. Meanwhile, the clergy, family and friends who remain alive are doing their best.
A whole generation in Africa has been wiped out by AIDS and opportunistic infections. Kenya itself, a comparatively small country in eastern Africa, is about one and a half times the size of California, with a population of 30 million, most of whom live in the cities. Is the apparent denial of shock and grief a sort of continental coping mechanism? Or is it that people have enough to do to simply stay alive in this generation, and must leave the mental health issues to the next? I am reminded of Tillie Olsen's words, "The problem is too large for anger. It is more like sorrow."