When people get mental stress, they seek help from a psychiatrist or a psychologist. Others going through life’s upheavals see their spiritual leaders – pastors, priests and prophets. But where do these professionals seek help when they reach the end of their human tethers?
Kenyans who console, offer guidance and counselling sometimes go through breaking points that cause mental trauma. Think first responders who include ambulance paramedics, firefighters, first aiders, the police, humanitarian and social workers.
Then there are morgue attendants who daily have to deal with the waking reality of our mortality. Like Mary Nzilani, a morgue attendant at Machakos Level 5 Hospital mortuary. She often plants or tends to flowers to cope with mental stress of dealing with the bereaved.
“Although I am used to it now, it is never easy facing dead bodies each day of your life,” says the 47-year-old mother of one.
It was initially an uphill task, but she trained herself to live through it, including rationalising issues: “I tell myself these are dead people and their spirits are on the other side while I am on this side of life and that is how I find my balance.”
Nzilani became a morgue attendant by helping during the construction of a private mortuary in Machakos before learning on the job the art of cleaning, treating and dressing the dead.
Nightmares were one challenge Nzilani overcame by separating work from her personal life and “this has enabled me to survive in this kind of a job, because it is never easy.”
Most morgue attendants appear drunk, and Nzilani acknowledges. “I know some of the morgue attendants drink alcohol to forget some scenes, but sometimes the chemicals used in preserving bodies affect attendants to a point of appearing high.
“I have found better ways to cope as whenever I visit the flower beds, I get relief just by looking at the fresh flowers and sometimes weeding the garden helps me calm down,” she explains. “I know there is hope and life.”
Reading the bible and singing when she needs a distraction also help, as is support from her spiritual leader who also offers guidance and counselling when necessary.
For a morgue attendant, she says, her lowest moments that deeply affect her mind are coming across relatives at the mortuary or dressing a young person aged below 20 years and she asks herself, “what would have become of this young person if they had lived longer?”
Nzilani calls on medical institutions to ensure morgue attendants get counselling services, as most hardly open up on issues affecting them mentally.
Pathologists also go through mental distress, watching families go through bereavement and pain from unfavourable laboratory results.
Dr Noelle Orata, a pathologist, says, “We still have the humane side, we are empathetic, and we are left asking if there was anything else that could be done to help them.”
She recalls being mentally disturbed when a child’s postmortem revealed chocking as cause of death and that the mother had lost three other children under similar circumstances, as “she had never been taught how to burp the baby, and this really startled me.”
The woman’s husband later left her.
Dr Orata says societal isolation from a fast-paced world was such that we hardly connect with families and this mother “ought to have been taught how to burp her babies after feeding them to make them comfortable.”
She says pathologists bear the brunt of emotions from other human beings, and cumulatively that can affect their own health. Therefore, they ought to take care of their mental health.
“Seeking care for one’s mental health should not be a one-off session, but a continuous process, whether you are in the ward doing rounds with the teams as a consultant or registrar, in the laboratory, or even doing postmortems,” she advised, adding that mental health of a pathologist is also for the good of their families, friends, patients and caregivers.
Dr Orata says pathologists have mentors and when necessary “we reach out to psychiatrists and psychologists when need be, for them to help us cope by debriefing through therapy”, besides having a strong support system like family, friends and community.
She also reckons one should have a life outside of work and be able to put down their tools and interact with family and friends.
“Taking care of my mental health allows me to be the best version of myself, for myself and everybody who I interact with,” she adds.
Psychiatrists and psychologists are the other lot who have to deal with case studies in society.
According to a psychiatrist, who sought anonymity, the greatest challenges are dealing with emotional suffering and pain, carrying people’s deepest secrets and solving terrible problems that come with emotional anguish.
“We see people in depression, hopeless people who are mentally ill and get very distressed, people who have run out of money, those suffering from stigma and people who are suicidal. For instance, I have lost at least four of my patients to suicide,” says the psychiatrist. “It is extremely depressing.”
He recalled a woman client with whom he had just talked to. Shortly after there were screams “and when the door was opened, she was there, hanging; it was very traumatising to have those images playing over and over in my mind.”
Guilt follows when families of the patients blame them for not doing their best when they know they did their best.
“We also feel like there was something we have not done, or we could have done differently, the guilt takes you a while before you feel better,” he says.
Most psychiatrists have learnt the importance of self-care, having enough sleep, and not waiting for stressful moments to seek help.
“We should have mental health promotion activities and make them part of our daily lives, finding balance between work and life; talking to people you love,” he says. “But some people take alcohol to numb the pain, which is not a good way of coping.”
Scarcity of psychiatrists also increases workload, as besides seeing patients, they do a lot of research to find better treatment.
The expert calls on the Kenya Psychiatric Association to supervise and do monthly debriefings.
Besides psychiatrists, there are also psychologists like Jackie Gathu, who explains that her profession does not mean practitioners have resolved all their issues, rather, most have a ‘resilience toolkit’ just in case disaster strikes.
“I go through my breaking points mostly when I see a client who is going through stuff I have gone through, which is a trigger point,” says Gathu, adding, “there is temptation to try relating with your client on that level, which is not professional.”
She says psychologists have a strong emotional support system from fellow psychologists for professional peer counselling.