Spotlight Interview with Dr. Babawale Ojediran
Location: Monrovia, Liberia
Bio: Dr. Babawale Ojediran is a consultant psychiatrist and Chairman of the Faculty of Psychiatry at the Liberia College of Physicians and Surgeons (LCPS). He is also Head of Psychiatry at John F. Kennedy Medical Center.
The Global & Local Center is engaged in an ongoing partnership with the University of Liberia A.M. Dogliotti College of Medicine to increase mental health capacity and improve the quality of mental health care in Liberia. This partnership, led by Drs. Henderson and Borba, initially began in 2009 when Dr. Henderson and colleagues collaborated with Liberia’s Ministry of Health and Social Work to develop the country’s first national mental health policy. In 2016, the Global & Local Center supported the placement of Liberia’s second psychiatrist, Dr. Babawale (Wale) Ojediran, who joined Dr. Benjamin Harris, Chair of the Dept. of Psychiatry at the A.M. Dogliotti Medical College.
Dr. Ojediran did not hesitate to get to work upon his arrival in Liberia in September 2016. Originally from Nigeria, Dr. Ojediran provided an enthusiastic update on his variety of experiences thus far, from addressing overcrowding in Liberia’s sole psychiatric hospital, E.S. Grant Mental Health Hospital, to testifying as an expert witness in a homicide trial.
Where to begin?
Noticing that Grant Mental Health Hospital was filled beyond capacity, Dr. Ojediran immediately began an assessment every single patient at this facility. He quickly realized that some patients had been living in the hospital for months or even years. As he began discharging those patients stable enough to return home, he discovered a simple reason for their extended hospital stays: a lack of transportation. Families were unable to arrange for transport for their loved one to return home. With the support of Dr. Benjamin Harris – Chairman of the Dept. of Psychiatry at A.M. Dogliotti Medical College in Liberia and until Dr. Ojediran’s arrival, Liberia’s only psychiatrist – a bus was arranged to transport many of those discharged back to their homes.
“Thereafter, we pursued a more aggressive approach to management to get the patients healthy and reunited with their loved ones as quickly as possible. This approach has not only helped encourage family to pick up their patients on time, it has also improved the turnover rate, as vacated beds can be filled with new admissions.”
– Dr. Ojediran
The challenges
Starting fresh in a brand new country, Dr. Ojediran was bound to encounter a few challenges. Some of those included the acquisition of the much too expensive new generation drugs. He also identified a need for EEG and ECT machines for the hospital. Though most would easily become overwhelmed by the challenges and new environment, Dr. Ojediran said, “Despite the fact that resources are scarce and the facility is in need of renovations, we are making lemonade with what we have.”
Early ideas for collaboration
Dr. Ojediran appeared in court as an expert witness to discuss the case of a mentally ill man who committed homicide. At the conclusion of the trial, the Judge expressed his wish for the hospital and the criminal justice department to establish better collaboration. This led to Dr. Ojediran writing a proposal to conduct a detailed mental health assessment of all inmates in Monrovia Prison. Not only does he expect this to strengthen collaboration with the justice system but to also, “Provide needed mental health services for prisoners, create opportunities for residents [from the A.M. Dogliotti Medical College] interested in forensic psychology and also allow us to contribute to research by publishing our findings.”
“I believe research work must be ongoing at every point in time in the department as this not only aids our work, it also provides a good learning experience for students and residents.”
– Dr. Ojediran
Future psychiatrists in Liberia
With a psychiatry residency program currently in development, it appears that Liberia is on track to have their first cohort of psychiatric residents in two years’ time. Until then, Dr. Ojediran expressed gratitude for his opportunity to work in Liberia saying, “This is an opportunity to immerse myself in the service to humanity in a field I love and enjoy… the feeling of being a part of history here is indescribable.”
Continuing to overcome barriers
As we connected with Dr. Ojediran online in late April 2017, his smile was wide and his excitement was palpable. He explained how he had submitted requests to multiple organizations asking for basic bedding and equipment, including EEG and ECT machines, for the patients at Grant Mental Health Hospital in Monrovia, the only mental health hospital in Liberia. The first organization to respond was the World Health Organization (WHO) who subsequently donated truck-loads of brand new mattresses and bedding for patients among other items. Dr. Ojediran repeated many times that the patients were just as excited as he was for this extra level of comfort.
Dr. Ojediran continues to work to bring newer generation psychiatric medications to the hospital, while recognizing the necessity of establishing a consistent, sustainable medication supply program to support these new medications. He says, “Getting the drugs is one thing, but sustainability of these drugs is very important. It is frustrating to start a new drug in a patient and after they have been doing really well on it, the supply is suddenly cut off. They must be consistently stocked in the hospital for success.” Furthermore, these psychotropic drugs are very expensive when purchased in pharmacies outside of the hospital. From a policy level, Dr. Ojediran reflects that these challenges in obtaining accessibly priced psychiatric medications may be connected with a national policy aimed at reducing the inflow of other prescription psychiatric drugs with addictive qualities, like diazepam.
Trends at Grant Mental Health Hospital
Currently, Dr. Ojediran says he sees mostly younger people between 15 and 35 years old at Grant Mental Health Hospital. He hypothesizes that this trend is in part due to family members’ particular concern for the health of younger generation. Dr. Ojediran also commented on the trend in seeing many patients with substance abuse, which is an issue that affects several age ranges and both genders, and also has a particularly detrimental effect to Liberia’s school system. He says that people are using a wide array of substances from cocaine and heroin, to drugs known primarily by their street names like “Italian white” and “tar.” He asserts that this high burden of substance use can be attributed to several factors, saying, “on the one hand, you have people having to cope with the experience of war and the Ebola epidemics, and on the other hand, you have the harsh realities of a disrupted school system and poor economic indices with a very high level of unemployment and poverty.” Dr. Ojediran dedicates each Monday to seeing patients specifically struggling with substance abuse, around 50 individuals each week, with whom he runs group therapy sessions. The hospital is also able to support detoxification and individual counseling.
Interestingly, since Dr. Ojediran began working at the hospital, he has seen a significant number of original psychiatric diagnoses being revised. After clinically assessing each patient, he found that the majority of these patients were highly medicated (without always needing to be) and sleeping most of the time. He says, “I make it a point of duty to give detailed explanations of how I arrived at a different diagnosis and explain my choice of management to the nurses and physician assistants while acknowledging their input… this has stimulated a lot of questions and discussions with other staff members and has opened up a channel for continuous training and transfer of skills to other workers in the hospital.” He also maintains a regular psychiatric outpatient program where he sees approximately 15 to 20 outpatients each day.
Mental health stigma
Other hurdles Dr. Ojediran faces includes the stigma surrounding mental health within the community and the family. When some families suspect mental illness among a family member, they will sometimes abandon them completely, leaving them to wander the community. Other times they are brought to the hospital and then abandoned, when all they need to be discharged is approximately $0.50 – $1.00 USD per month of medication to live a healthier, productive life.
When Dr. Ojediran was asked about any ideas to stop or reduce the stigma of mental health he replied that, “I believe the major problem is with the lack of education surrounding mental health and mental illness. More education and more awareness programs could help lessen stigma.”
In one instance that stood out to Dr. Ojediran, he described a woman who came into the hospital after living on the streets for 6 or 7 years. After a psychiatric assessment, proper medical care and psychiatric treatment, Dr. Ojediran discovered just how intelligent she was, including the asset of being fluent in French. She now works at Grant Mental Health Hospital where he says, “She is not only a beautiful person, but a great employee.”
Vision for the future
Dr. Ojediran says that developing mental health services in Liberia “is a marathon and not a sprint.” While ultimately, Liberia will need an ultra-modern mental health facility with readily available supplies, he is committed to making Grant Mental Health Hospital the best it can be. He hopes that research initiatives will grow in the near future, as he recognizes the important link between research and obtaining additional financial and human resource support. He is currently committed to, “creating structures, like laying the foundations for various subspecialties and promoting research… When we begin to publish our research findings, our limitations notwithstanding, it will stimulate further interest in our practice and attract more needed help.” One such research opportunity is with the Ebola survivor study, who recently approached Dr. Ojediran and Dr. Benjamin Harris, Chair of the Dept. of Psychiatry at the A.M. Dogliotti Medical College at the University of Liberia, as the research participants are beginning to show symptoms of various mental illnesses and need to be referred for treatment. While the study did not initially include psychiatric illnesses in the list of conditions being assessed, Dr. Ojediran is working with the study team to hopefully amend the protocol to begin capturing this critical information on the mental health impacts of the Ebola epidemic.
Posted on Thursday, December 7th, 2017