Nigerian academic psychiatry has a distinguished history. Prof Adeoye Lambo’s revolutionary ideas about treating people in the community, and important early epidemiological studies made Nigeria the most important centre for research in Africa for several decades.
In December 2008, Professor Oye Gureje was awarded the Nigerian National Merit Award. This distinguished honour, given alongside Prof Wole Soyinka and Prof Chukwuemeka Ike, recognised his work in successfully reasserting Nigeria’s position of leadership in African psychiatry.
In this interview, he explains what inspires him, and what his vision is for the future of mental health services in Nigeria.
From an early age, Oye Gureje, who hails from Ilesha in Ogun State, showed a flair for writing. He attended schools in Akure, Oshogbo and Lagos (Federal School of Science). Even though he wrote an unpublished novella and poetry, he had some uncertainly about the direction he should follow.
His main motivation was a desire to enter into a profession that would allow him the freedom to be his own person, and he considered studying law or accounting. He even started a geology degree before settling on medicine, which he completed at the University of Benin.
Psychiatry is an unusual choice of sub-specialty in medicine, what made him choose this area for a career? At this he laughs;
“I was very rational about it. I drew a grid with all of my options, and rated them according to what I wanted out of life. How challenging, rewarding or interesting the different specialities were. I was even surprised when psychiatry won. I suppose it was the fact that it combined philosophy and science, and it was an area where I would be able to use my writing skills”
He seems very happy with his choice in hindsight;
“What I am doing now is fulfilling all the dreams that I had back then”.
Prof Gureje is quick to acknowledge his influences, saying that he was lucky to be in a very stimulating learning environment while he was at Aro Hospital in Abeokuta, where he did his specialist training.
This was partly due to the mentoring he received from the late distinguished neurologist, Professor Kayode Osuntokun, and the presence in Aro at the time of Prof Olatawura who was on sabbatical there.
A number of other visiting professors, including especially Professor Alan German from Australia, gave him a broader view of psychiatry which added a more biological-scientific perspective to his training.
There were also opportunities to learn from major figures in world psychiatry when he was invited to study in Britain under a programme developed by the distinguished Professor David Goldberg in Manchester, and the then head of the Mental Health Department at the WHO Professor Norman Sartorius. He became the first Fellow of this programme.
By the time he came back from these influential trips, he already had a series of publications under his belt, and took up a post as a lecturer in the University of Ibadan which allowed him to carry on with his research activities.
This includes a survey of mental health problems in primary care settings, studies into the connection between mental and physical symptoms, and clinical studies of schizophrenia, which led to his PhD. He also developed his research skills while on a sabbatical from Ibadan in Australia, where he participated in that country’s first national prevalence survey.
In 1995, he was made Professor of Psychiatry at Ibadan, and has continued to build an internationally respected department, recently successfully steering it towards being re-designated as a WHO research collaborating centre with a raft of important studies under way.
So what is the current situation in Nigeria as far as services for people with mental illness is concerned? Sadly, he says, what he found in his studies in the 1990s remains much the same now; that although mental health problems are common, only a very small proportion of people (less than 20%) receive the basic care that would help them.
This treatment gap is partly due to a lack of resources. There are only around 130 psychiatrists in the country, and nowhere near enough facilities to care for the number of people who need care.
The lack of any effective policy related to mental health means that the resources that are available are not well used.
What is his vision for services in Nigeria?
“Ordinary Nigerians need to realise that mental illness affects almost every family....it is about ‘us’ not just ‘them’. We should stop thinking of this as someone else’s problem, and start demanding that good quality services are available across the country. “
The Professor realises that and what about the government’s role?
“We want to have services that have high standards, but that are realistic in the Nigerian setting. Funding certainly needs to be increased. This funding all goes to big hospitals at the moment. Although they play an important role, we also need to develop services in the community, and integrate primary, secondary and tertiary services well. For example, we need to steadily increase the number of professionals trained, but we also need to make sure that there is a system that allows them to have fruitful careers in the system so that we don’t lose them to the brain drain”
He points out that there are more Nigerians working as psychiatrists in Britain alone than in the whole of Nigeria. He recognises that they can lend a hand, but ultimately it is the professionals and institutions in Nigeria, as well as altered attitudes among the population that can really change things for the better.