One in four South African employees are diagnosed with depression annually. There are ways you can seek help while your identity is protected by law.
You find your life spiralling out of control. There is an overwhelming feeling of helplessness and the things that used to interest you do not anymore. If this is what you are going through, you are not alone.
In South Africa, 4.5 million people suffer from depression, costing the country $16.6 billion of its Gross Domestic Product due to lost productivity, either due to absence from work or not attending work citing sickness.
These are figures by the IDEA study of the London School of Economics and Political Science in 2016.
According to the South African Depression and Anxiety Group (SADAG), depression is among the prevalent mental disorders in South Africa, resulting in one-in-four South African employees diagnosed with depression annually.
Meet Mfuneko Mthi, a prison warden from Kokstad, a little town nestled between South Africa’s KwaZulu-Natal and Eastern Cape provinces. Today, he sounds upbeat and has a positive outlook on life but this was not the case two years ago.
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He suffered from depression. It all started when he and his childhood friend were shot at by a gang leader in their community.
Mthi escaped death but the trauma manifested as depression.
The two years took a toll on his personal and professional life.
As a prison warden, he had to work closely with prisoners and at times, their correctional services uniforms would bring back painful flashbacks of his offender.
From then, it progressed to the perpetual submission of medical certificates, one after the other, as he desperately tried all means to run away from his inner demons.
“I started reporting sick from work on a regular basis, even though I was not sick. I could not face the correctional services uniform after I had seen my offender, during the victim-offender dialogue (VOD),” Mthi says.
“The VOD is a voluntary process, where the offender and victim are able to talk about the effects of the crime. Through the VOD program, victims of crimes… engage with offenders and communities so that relationships can be restored and forgiveness sought,” states a report by the Department of Correctional Services.
During the times that Mthi was present at work, leaving early also became a regular practice and isolation was his best-kept secret to maintain sanity, he says.
I would leave early to go to my place and consume alcohol. I used up all my leave and sick days at work just to avoid being around people.
Mthi needed to go back to the root of the problem in order to get the help he needed.
He details how he and his friend were attacked by the same perpetrator on two separate occasions.
“When I was in my teens, a gang leader who was feared in our community, used to recruit the youth to commit crimes. When my friend and I refused, he assaulted us. It is then that our parents opened a case of common assault with the police,” Mthi says.
The unexpected happened.
“On the day we got back from his bail hearing, he shot my friend and I, saying that nobody presses criminal charges against him.”
Mthi suffered multiple gun-shot wounds but his friend did not survive the onslaught.
As the wounds healed, the internal scars continued to bleed; life’s problems rubbed salt into Mthi’s wounds.
“A friend of mine committed suicide in 2017 and till this day, we do not know what led to him doing that.
“But he did make us aware that he was experiencing a series of problems, and his job as a prison warden was taking a toll on him due to the number of traumatizing things that happen in prison,” Mthi says.
He would drown his sorrows in alcohol when the waves of depression were unrelenting.
“I would drink a lot to help me sleep most of the time. Even though I would go out sometimes, I got to a point where I was overdoing it and that led to me being broke and that created a cycle which would lead to more depression.”
Mthi realized he had a problem and he took the first step towards healing.
He called SADAG, an organization in South Africa at the forefront of patient advocacy and educating society on mental illness.
“They told me that I had depression symptoms and advised that I go see a nearby clinical psychiatrist,” Mthi says.
According to Charity Mkone, a clinical psychologist, the societal stigma associated with depression makes it difficult for it to be warranted an illness.
“It is something that is not seen as a real illness…people think that it is something that you can control and that you choose whether to be depressed or not. They also think that because of certain circumstances – such as being a prominent figure – you do not have a right to be depressed,” she says.
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However, that is not true. Most people, according to Mkone, have had some form of depression in their life, where they present SIGMECAPS symptoms (as defined in the box-out).
“To some degree, we have all expressed these feelings at a point in our lives. But it is usually a phase. But for someone struggling with depression; that becomes a dominant way of feeling, as opposed to someone who is feeling like that because of the circumstances, and once the problem has disappeared, they are fine. A depressed person would still feel depressed,” she says.
According to SADAG, rural-based studies have found a prevalent rate of 18% depressive symptomatology and 27% rate of depression, as opposed to the urban settings where as much as 25.2% of the population is depressed and in peri-urban settlements where 34.7% of the people have postpartum depression.
There are 23 known suicides in South Africa per day, making it approximately 8,000 suicides each year. Based on research from SADAG, for every person who commits suicide, 10 have attempted it.
In South Africa, even though women are two times more likely to suffer from depression, men are more prone to committing suicide. This is often because men in South Africa battle to come forward with mental health problems due to the stigma attached to mental health.
“It has a lot more to do with the stigma and that men don’t actually come out to say that they are depressed. It makes them feel that they are weak people because one of the symptoms of depression is deep overwhelming sadness,” Mkone says.
Men are five times more likely to be successful at suicide then women
Suicidal thoughts normally manifest when depression goes untreated for a long time.
Mkone says that when men commit suicide, they are found to do it in a more lethal manner.
One of the first steps that could be used within communities in order to assist people suffering from depression is to be more aware of the symptoms.
The more measures are taken to educate people in the workplace and in communities concerning depression, Mkone believes this would alleviate the number of suicidal deaths because persons suffering from depression would get the help they need at an early stage.
It is, however, important to note that depression may be caused by a number of problems such as external factors, genetic inheritance, an imbalance of brain chemicals, certain medical conditions, substance abuse as well as other various medical conditions.
This is why mental illness is a treatable condition and, as a result, 80% to 90% of people have had a good response to medical care.
Depression in the work place
Depression in the work place is becoming more visible.
“According to the medical ethical code of conduct that all clinical psychologists sign and are bound to, the sessions that you have with the client are strictly confidential unless the client gives you written consent to divulge information about their sessions,” says Mkone.
“In terms of a patient requiring a written letter for work, we can provide a medical certificate,” she says.
One in six employees are willing to disclose their mental illness, according to a 2017 survey by SADAG.
Nadine Mather, who is a senior associate at law firm, Bowmans, says: “An employee is not obliged to disclose to their employer that they suffer from depression or any other mental condition. An employee may, however, voluntarily choose to do so.”
She added that should there be a case where the employer is aware that the employee suffers from depression and it affects their performance at work, then they may address the matter following the correct procedures, and it would be illegal if they dismiss the employee without that.
Depression is regarded as a sub-category of “incapacity” and is recognized as a fair reason to terminate an employee’s employment under the South African law should they no longer be fit to perform their duties.
“In this regard, our law places an obligation on employers to investigate the cause, degree and effect of the employee’s depression or mental condition thoroughly, in order to ascertain the impact that it might have on the employee’s work,” says Mather.
If the employer can prove without reasonable doubt that the business or company cannot function without the duties of the employee within a certain time period, then that could result in the termination of their duties.
“Only when an employer has followed a fair process and can show that there is no prospect of an employee recovering sufficiently to justify their continued employment, or improving within a time period during which an employer could cope without suffering significant loss as a result of an employee’s absence, would termination of the employee’s employment for depression or a mental condition become justifiable,” Mather says.
“On the other hand, where the employee is too ill to work and the employer fails to follow a fair process, the employee may, in certain circumstances, be awarded compensation up to a maximum of 12 month’s remuneration,” she says.
When an employer realizes that their employee is suffering from depression, they are obligated to support them.
In Mthi’s case, the employers were supportive.
They tried to accommodate him by removing him from traumatizing environments that made him feel uncomfortable.
Mthi is no longer on medication for his depression, but along the way, he has found the positive aspects of life.
“I go to the gym during my spare time and I also sell t-shirts. With the money I make from selling them, I assist the less fortunate in my community, by buying them school uniforms,” Mthi says.
He is also working with some of his colleagues to build houses in his community.
Proving that Mthi is no longer the bleak and lost man he was two years ago, he initiated a Facebook page last year called Depression is Real.
The page provides a platform to those who would like to talk about depression.
As depression is on the rise in the country, so are those that have won the war over the illness, like Mthi.
The trick is to seek help – before it’s too late.
How Virtual Therapy Apps Are Trying To Disrupt The Mental Health Industry
Millions of Americans deal with mental illness each year, and more than half of them go untreated. As the mental health industry has grown in recent years, so has the number of tech startups offering virtual therapy, which range from online and app-based chatbots to video therapy sessions and messaging.
Still a nascent industry, with most startups in the early seed-stage funding round, these companies say they aim to increase access to qualified mental health care providers and reduce the social stigma that comes with seeking help.
While the efficacy of virtual therapy, compared with traditional in-person therapy, is still being hotly debated, its popularity is undeniable. Its most recognizable pioneers, BetterHelp and TalkSpace, have enrolled nearly 700,000 and more than 1 million users respectively. And investors are taking notice.
Funding for mental health tech startups has boomed in the past few years, jumping from roughly $100 million in 2014 to more than $500 million in 2018, according to Pitchbook. In May of this year, the subscription-based online therapy platform Talkspace raised an additional $50 million, bringing its total funding to just under $110 million since its 2012 inception.
The ubiquity of smartphones, coupled with the lessening of the stigma associated with mental health treatment have played a large role in the growing demand for virtual therapy. Of the various services offered on the Talkspace platform, “clients by far want asynchronous text messaging,” says Neil Leibowitz, the company’s chief medical officer.
Users seem to prefer back-and-forth messaging that isn’t restricted to a narrow window of time over face-to-face interactions. At BetterHelp, founder Alon Matas notes that older users are more likely to go for phone and video therapy sessions, whereas younger users favor text messaging.
“Each generation is getting progressively more mobile-native,” says John Prendergass, an associate director at Ben Franklin Technology Partners’ healthcare investment group, “so I think we’re going to see people become increasingly more accustomed, or predisposed, to a higher level of comfort in seeking care online.”
The ease and convenience of virtual therapy is another draw, particularly for busy people or those who live in rural areas with limited access to therapy and a range of care options.
Alison Darcy, founder and CEO of Woebot, a free automated chatbot that uses artificial intelligence to provide therapeutic services without the direct involvement of humans, says that with Woebot and other similar services, there is no need to schedule appointments weeks in advance and users can receive real-time coaching at the moment they need it, unlike traditional therapy. The sense of anonymity online can also lead to more openness and transparency and attracts people who normally wouldn’t seek therapy.
Along with stigma, the cost of therapy has historically acted as a barrier to accessing quality mental-health care. Health insurance is often unlikely to cover therapy sessions. In most cities, sessions run about $75 to $150 each, and can go as high as $200 or more in places like New York City. Web therapists don’t have to bear the expense of brick-and-mortar offices, filing paperwork or marketing their services, and these savings can be passed on to clients.
BetterHelp offers a $200-a-month membership that includes weekly live sessions with a therapist and unlimited messaging in between, while Talkspace’s cheapest monthly subscription at $260-a-month, offers unlimited text, video and audio messaging.
But virtual therapy, particularly text-based therapy, is not suitable for everyone. Nor is it likely to make traditional therapy obsolete. “Online therapy isn’t good for people who have severe mental and relational health issues, or any kind of psychosis, deep depression or violence,” says Christiana Awosan, a licensed marriage and family therapist.
At her New York and New Jersey offices, she works predominantly with black clients, a population that she says prefers face-to-face meetings. “This community is wary of mental health in general because of structural discrimination,” Awosan says. “They pay attention to nonverbal cues and so they need to first build trust in-person.”
Virtual therapy apps can still be beneficial for people with low-level anxiety, stress or insomnia, and they can also help users become aware of harmful behaviors and obtain a higher sense of well-being.
Sean Luo, a psychiatrist whose consultancy work focuses on machine learning techniques in mental health technology, says: “This why some of these companies are getting very high valuations. There are a lot of commercialization possibilities.” He adds that from a mental health treatment perspective, a virtual therapy app “isn’t going to solve your problems, because people who are truly ill will by definition require a lot more.”
Relying on digital therapy platforms might also provide a false sense of security for users who actually need more serious mental-health care, and many of these apps are ill-equipped to deal with emergencies like suicide, drug overdoses or the medical consequences of psychiatric illness. “The level of intervention simply isn’t strong enough,” says Luo, “and so these aspects still need to be evaluated by a trained professional.
– Ruth Umoh, Diversity and Inclusion Writer, Forbes Staff.
No Seat At The Global Table For Indigenous African Cuisine
Gastronomic tourism based on African food could easily increase and create new value chains that unlock billions in untapped wealth for the continent, but what is stopping us?
Food and tourism are an integral part of most economies, globally. Food is undeniably a core part of all cultures and an increasingly important attraction for tourists. To satisfy their wanderlust, contemporary tourists require an array of experiences that include elements of education, entertainment, picturesque scenery and culinary wonders. The link between food and tourism allows destinations to develop local economies; and food experiences help to brand and market them, as well as supporting the local culture and knowledge systems.
This is particularly important for rural communities, where 61% of sub-Saharan Africans live, according to the World Bank last year. These communities have often felt the brunt of urbanization, which has resulted in a shift away from rural economies. If implemented effectively, Africa could get a piece of the gastronomic tourism pie, which was worth $8.8 trillion last year, according to the World Travel & Tourism Council.
However, there is currently very little public information to pique the interest of tourists about African food. World-renowned South African chef Nompumelelo Mqwebu sought to remedy this with her self-published cookbook, Through the Eyes Of An African Chef.
“I think where it was very clear to me that I needed to do something was when I went to cooking school. I trained at Christina Martin School of Food and Wine. I thought I was actually going to get training on South African food and, somehow, I assumed we were talking indigenous food.
“I was shocked that we went through the whole year’s curriculum and we didn’t cover anything that I ate at home; we didn’t cover anything that my first cousins, who are Sotho, ate in Nelspruit (in South Africa’s Mpumalanga Province); we didn’t cover anything that would come from eSwatini, which is where my mother is from,” Mqwebu says.
By self-publishing, she has ultimately contributed to a value chain that has linked local food producers and suppliers, which includes agriculture, food production, country branding and cultural and creative industries.
“I am a member of Proudly South African, not only my business, but the book as well. Part of the reason is that the cookbook was 100% published in South Africa. So, everybody who worked on the cookbook, and printing, was all in South Africa, which is something quite rare these days because authors have their books published abroad.”
The Proudly South African campaign is a South African ‘buy local’ initiative that sells her cookbook on their online platform as its production adheres to the initiative’s campaign standards. Self-publishing has allowed Mqwebu to promote her book for two years and to directly communicate with her audience in a way she thought was best, while exposing her to a vast community of local networks. She recalls her first step towards creating her own body of work.
“I was in culinary school when I wrote the recipe for amadumbe (potato of the tropics) gnocchi. We were making gnocchi and I thought, ‘so why aren’t we using amadumbe because it’s a starch?’ and when I tasted it, I thought, ‘this could definitely work’. I started doing my recipes then.
“And there was talk about, ‘we don’t have desserts as Africans’. I did some research and found we ate berries, we were never big on sugar to begin with. That’s why I took the same isidudu (soft porridge made from ground corn) with pumpkin that my grandmother used to make and that became my dessert. “I also found that when I went to libraries looking for indigenous recipes, I couldn’t really find something that spoke to me as a chef. I found content that looked like history books. It was not appealing. It was not something, as a chef, I could proudly present to another chef from a different part of the world, so I knew I had to write my book,” Mqwebu says about the award-winning recipe book that chronicles African cuisine.
Financial and health benefits
According to the World Travel & Tourism Council, in 2018, the tourism sector “contributed 319 million jobs, representing one in 10 of all jobs globally and is responsible for one in five of all new jobs created in the world over the last five years. It has increased its share of leisure spending to 78.5%, meaning 21.5% of spending was on business.”
To narrow in on how lucrative food can be, the World Food Travel Association estimates that visitors spend approximately 25% of their travel budget on food and beverages. The figure can get as high as 35% in expensive destinations, and as low as 15% in more affordable destinations. “Confirmed food lovers also spend a bit more than the average of 25% spent by travelers in general.”
However, there is a widely-held view that the African continent is not doing enough to maximize its potential to also position itself as a gastronomic tourism destination, using its unique edge of indigenous knowledge systems (IKS).
“We are not a culinary destination and we will never be while we are still offering pasta as the attraction for our tourists,” Mqwebu says.
Dr George Sedupane, who is the Coordinator of the Bachelor of the Indigenous Knowledge Systems program in South Africa’s North-West University, echoes Mqwebu’s sentiments.
“I often cringe when I go to conferences and there are guests from all over the world and we serve them pasta. Why would they come from Brazil to eat pasta here? They can have pasta in Italy. Why don’t we serve them umngqusho (samp and beans)?
“We need to be creating those experiences around our culture. We are failing to capitalize on our strengths. There is a lack of drive to celebrate what we have,” says Sedupane, who also teaches modules and supervises research in indigenous health and nutrition.
Writer and historian Sibusiso Mnyanda says current innovations in African food technology are born out of necessity, rather tourism and cultural ambitions.
“Food security is becoming an issue that is leading to IKS around farming being prioritized. In Nigeria, they are innovating dry season farming, because of deforestation and soil being de-cultivated.
“So those indigenous knowledge strategies are being used in countries where it is a necessity and where there are enough advances related to the fourth industrial revolution. The traditional ways of producing food are not only much more organic, they are also crop-efficient,” Mnyanda says.
Nigeria may have inadvertently innovated a health solution related to colon cancer through its diet. Sedupane tells FORBES AFRICA an anecdote.
“There was a study where the colons of an African country that did not consume a lot of meat was compared to Europeans. The Africans had a much better profile as a result and there are people who want to buy African stool to get that kind of rich bacteria, that you get on an African plant-based diet.”
The study Sedupane is referring to was conducted in Nigeria and it states that: “Nigeria showed the average annual incidence of colorectal cancer was 27 patients per year. This shows that even if it seems that incidence rates are increasing in Nigeria, such rates are still about one-tenth of what is seen in the truly developed countries.”
In a bid to find reasons for this rarity of colon and rectal cancer, the study concluded that, among other reasons, the protective effects of Nigeria’s starch-based, vegetable-based, fruit-based, and spicy, peppery diet, and geographical location which ensures sunshine all year round, played a role in the country’s colon health.
Interestingly, it seems the potential value of African food could not only be based on what goes in but what also comes out as healthy faecal matter is big business globally. In 2015, The Washington Post published that one could potentially earn $13,000 a year selling their poop.
The American-based company OpenBiome has been processing and shipping frozen stool to patients who are very sick with infections of a bacteria called C.difficile. It causes diarrhea and inflammation of the colon, leaving some sufferers house-bound. “Antibiotics often help, but sometimes, the bacteria rears back as soon as treatment stops. By introducing healthy faecal matter into the gut of a patient (by way of endoscopy, nasal tubes, or swallowed capsules), doctors can abolish C. difficile for good… And yes, they pay for healthy poop: $40 a sample, with a $50 bonus if you come in five days a week. That’s $250 for a week of donations, or $13,000 a year,” the publication stated.
Sedupane is of the view that a diet which includes indigenous foods could vastly improve one’s quality of life.
He says small changes could be made, such as including more of indigenous greens, namely sorghum and millet, to breakfast. The grains are gluten-free and produce alkaline which boosts the pH level of fluids in the body and reduces acidity.
“Moving to our legumes, we have indlubu (Bambara groundnut) which is very rich and helps in the secretion of serotonin in the brain. This so important nowadays with the increase of depression. It’s easy to digest, and is great for cholesterol and moderating blood sugar,” Sedupane says.
Mnyanda is also of the view that food is imperative to health and medicinal properties. He says traditional healers primarily use natural herbs in their practice. “These are used in pain relief and healing. Things like cannabis, camphor, African potatao and red carrots. So, food is not just used for nutritional purposes.”
Other African superfoods include, Baobab fruit, Hibiscus, Tamarind, Kenkiliba, Amaranth, Moringa and pumpkin leaves.
Cultural and historical benefits
Gastronomic tourism also includes the promotion of heritage sites that are known to revolve around dishes that are of historic importance. They enhance the travel experience, they encourage the acquisition of knowledge and a cultural exchange.
There is a unanimous view that vast amounts of knowledge have been lost to history and there is a huge knowledge gap in African societies as a result of colonization and urbanization.
“Part of the colonial agenda was to make sure food security did not belong to indigenous groups. Therefore, archiving of these knowledge systems was not a priority. Especially during industrialization, where people moved from their villages to the city you found that the knowledge got left behind,” Mnyanda says.
He offers a contemporary example of how modernization continues to push African practices to the fringes: “To this day, abathwa (the San people) hunt their meat, but you find that because of changing agricultural practices and land reform on the Kruger National Park, they are being forced to move into the cities and industrial areas, therefore they are no longer able to practice their culture of hunting. As a result, their diet is changing.” Sedupane shares the view that the fundamentals of farming and astrology have also been exiled from public knowledge.
“The fundamentals of IKS were based on the understanding of the laws of nature – how and when things were done. Harvest cycles were linked with understanding astrology. They would not harvest until certain stars were visible in the sky. There was a dependence on nature.
“With industrialization, rather than working with nature, humans are seen as being above, as controlling, as directing it. The natural cycle is often tempered with rather than trying to work with it.”
Not all is lost however. There are historical practices that have stood the test of time and continue to be a part the few foods that are internationally associated with South Africa. Mqwebu says that, “historically, we ate more plants than meat because our ancestors had to hunt and the game back then was not tame. So, there were no guarantees that you would return with meat. And that’s where things like umqwayiba (biltong) come from. They had to preserve the meat, because wasting was not part of the culture”.
According to a 2015 exploratory research project conducted under the guidance of research institute Tourism Research in Economic Environs and Society director Professor Melville Saayman, biltong contributes more than R2.5 billion ($163 million) to the South African economy.
Perhaps, like the faecal transporting company, Africa will soon realize the ‘wasted’ opportunity and that there is loads of money to be made in gastronomic tourism for all its inhabitants, whether they are rural or urban, technological or indigenous.
Potential Cases Of Vaping-Related Illnesses Are Climbing
The number of potential vaping-related illness incidents under investigation by health federal authorities keeps climbing, as officials narrow their search on counterfeit vaping products, according to a report from the Washington Post.
- The Federal Drug Administration and the Centers for Disease Control said Friday they are investigating 215 potential cases of respiratory illness reported after use of e-cigarettes across 25 states. That’s up from 153 last week.
- Health officials say patients reported a gradual start to symptoms, such as breathing difficulty, shortness of breath and chest pain before hospitalization. Some cases reported vomiting, diarrhea, fevers or fatigue.
- According to the Washington Post, the investigation is focusing on counterfeit or black-market products that use potentially mislabeled solvents that consumers buy themselves.
- The announcement comes a week after the first vaping-related illness death was reported in Illinois.
Key Background: Although scientists are still unsure of vaping’s long-term health impact, most believe that e-cigarettes are a less dangerous nicotine source than tobacco cigarettes. The CDC recommends that all nonsmokers stay away from vaping.
The CDC warned users Friday of buying e-cigarette products off the street or adding any substances to products that are not intended by the manufacturer.
-Rachel Sandler; Forbes
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