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.
Measles: Should Vaccinations Be Compulsory?
Following a measles outbreak in Rockland County in New York State, authorities there have declared a state of emergency, with unvaccinated children barred from public spaces, raising important questions about the responsibilities of the state and of individuals when it comes to public health.
Measles virus is spread by people coughing and spluttering on each other. The vaccine, which is highly effective, has been given with mumps and rubella vaccines since the 1970s as part of the MMR injection. The global incidence of measles fell markedly once the vaccine became widely available. But measles control was set back considerably by the work of Andrew Wakefield, which attempted to link the MMR vaccine to autism.
There is no such link, and Wakefield was later struck off by the General Medical Council for his fraudulent work. But damage was done and has proved hard to reverse.
In 2017, the global number of measles cases spiked alarmingly because of gaps in vaccination coverage in some areas, and there were more than 80,000 cases in Europe in 2018.
The World Health Organisation has declared the anti-vaccine movement one of the top ten global health threats for 2019, and the UK government is considering new legislation forcing social media companies to remove content with false information about vaccines. The recent move by the US authorities barring unvaccinated children from public spaces is a different legal approach. They admit it will be hard to police, but say the new law is an important sign that they are taking the outbreak seriously.
Most children suffering from measles simply feel miserable, with fever, swollen glands, running eyes and nose and an itchy rash. The unlucky ones develop breathing difficulty or brain swelling (encephalitis), and one to two per thousand will die from the disease. This was the fate of Roald Dahl’s seven-year-old daughter, Olivia, who died of measles encephalitisin the 1960s before a vaccine existed.
When measles vaccine became available, Dahl was horrified that some parents did not inoculate their children, campaigning in the 1980s and appealing to them directly through an open letter. He recognised parents were worried about the very rare risk of side effects from the jab (about one in a million), but explained that children were more likely to choke to death on a bar of chocolate than from the measles vaccine.
Dahl railed against the British authorities for not doing more to get children vaccinated and delighted in the American approach at the time: vaccination was not obligatory, but by law you had to send your child to school and they would not be allowed in unless they had been vaccinated. Indeed, one of the other new measures introduced by the New York authorities this week is to once again ban unvaccinated children from schools.
With measles rising across America and Europe, should governments go further and make vaccination compulsory? Most would argue that this is a terrible infringement of human rights, but there are precedents. For example, proof of vaccination against yellow fever virus is required for many travellers arriving from countries in Africa and Latin America because of fears of the spread of this terrifying disease. No-one seems to object to that.
Also, on the rare occasions, when parents refuse life-saving medicine for a sick child, perhaps for religious reasons, then the courts overrule these objections through child protection laws. But what about a law mandating that vaccines should be given to protect a child?
Vaccines are seen differently because the child is not actually ill and there are occasional serious side effects. Interestingly, in America, states have the authority to require children to be vaccinated, but they tend not to enforce these laws where there are religious or “philosophical” objections.
There are curious parallels with the introduction of compulsory seat belts in cars in much of the world. In rare circumstances, a seat belt might actually cause harm by rupturing the spleen or damaging the spine. But the benefits massively outweigh the risks and there are not many campaigners who refuse to buckle up.
I have some sympathy for those anxious about vaccinations. They are bombarded daily by contradictory arguments. Unfortunately, some evidence suggests that the more the authorities try to convince people of the benefits of vaccination, the more suspicious they may become.
I remember taking one of my daughters for the MMR injection aged 12 months. As I held her tight, and the needle approached, I couldn’t help but run through the numbers in my head again, needing to convince myself that I was doing the right thing. And there is something unnatural about inflicting pain on your child through the means of a sharp jab, even if you know it is for their benefit. But if there were any lingering doubts, I just had to think of the many patients with vaccine-preventable diseases who I have looked after as part of my overseas research programme.
Working in Vietnam in the 1990s, I cared not only for measles patients but also for children with diphtheria, tetanus and polio – diseases largely confined to the history books in Western medicine. I remember showing around the hospital an English couple newly arrived in Saigon with their young family. “We don’t believe in vaccination for our kids,” they told me. “We believe in a holistic approach. It is important to let them develop their own natural immunity.” By the end of the morning, terrified by what they had seen, they had booked their children into the local clinic for their innoculations.
In Asia, where we have been rolling out programmes to vaccinate against the mosquito-borne Japanese encephalitis virus, a lethal cause of brain swelling, families queue patiently for hours in the tropical sun to get their children inoculated. For them the attitudes of the Western anti-vaccinators are perplexing. It is only in the West, where we rarely see these diseases, that parents have the luxury of whimsical pontification on the extremely small risks of vaccination; faced with the horrors of the diseases they prevent, most people would soon change their minds.
–Tom Solomon; Director of the National Institute for Health Research (NIHR) Health Protection Research Unit in Emerging and Zoonotic Infections, and Professor of Neurology, Institute of Infection and Global Health, University of Liverpool
New Ways Of Thinking On Health, Arts And Humanities Are Emerging In Africa
Imagine bringing the best of all academic disciplines, artistic creations, activist experience and health care knowledge to bear on understanding and addressing current health care concerns. Rather than silos of people working in their specific areas of interest, imagine collaborations committed to listening and learning from all participants.
This is the vision of Medical and Health Humanities in Africa. It’s a field that grew out of the medical humanities in the US and UK. It brings together academics, researchers, practitioners, creative artists, health care seekers and providers.
Essentially, it straddles disciplines and practices in an effort to address health concerns. Artists compose music to open up understandings of health care and specific conditions, such as delirium. Some academics open up new conversations about existing health concerns like AIDS or use everything from yoga to photography to observation and drawing to help educate health sciences students. Others pair academics and artists to help young people talk about sex and sexuality or tuberculosis.
At its core, Medical and Health Humanities is about conversations and collaborations between people who are interested in health. This encourages new understanding, practice and knowledge. It also seeks to provide “translators” who can make often complex ideas in science and humanities accessible. They can also use creative arts to change perceptions, frame new questions and direct new discussions that result in more nuanced answers to health issues.
While still a relatively new field on the African continent, it is growing and gaining momentum. The latest milestone is the first English-language special issue of the globally respected BMJ Medical Humanities Journal to deal exclusively with work on and about medical and health humanities in Africa.
The special issue came out in December 2018. It showcases work from various countries in Africa, among them Nigeria, Malawi, Kenya, Tanzania and South Africa.
The projects profiled in this special issue, and others elsewhere on the continent, reveal the vital role Medical and Health Humanities can play across Africa in bridging the gaps between disciplines to improve people’s experiences of health care.
Beyond disciplinary boundaries
One of the Medical and Health Humanities projects highlighted in the BMJ’s special edition deals with digital storytelling and antiretroviral adherence in KwaZulu-Natal, South Africa. Another article shows how opium, thalidomide and contraceptives contributed to the making of modern South Africa.
The projects and articles themselves are, of course, important. But another critical element that must not be overlooked is how the field exemplifies inter-, trans- and multidisciplinary research and practice. It removes people from their disciplinary silos.
This is becoming increasingly important across academia. In the worlds of medicine and health, people often work on similar concerns in familiar ways; in doing so, they miss out on new perspectives. Working across disciplines and practices is a way to learn from each other and reflect on how things could be changed for the better.
And, crucially, it creates conversations about how we might improve our collective understanding of health and wellness.
On the African continent, the Medical and Health Humanities community is also trying to do things differently when it comes to how research is conducted and presented.
If a field is genuinely committed to collaboration, collective engagement, building networks and relationships, it must do more than work quickly to “produce measurable outcomes” limited to academic articles. It must spend time building connections that extend beyond one event or “outcome”.
We attempted to do this during the writing of the special issue of the BMJ Medical Humanities journal. We were among a group of practitioners in South Africa who pooled resources from two universities to bring as many people who were working on the special issue together as possible. We wanted to ensure that experienced and emerging writers from multiple disciplines and practices had a chance to benefit from each other’s knowledge and experiences.
A workshop was held in 2017 at the Wits Institute for Social and Economic Research (WiSER). Participants came from Zimbabwe, Kenya, Nigeria, Tanzania, Malawi, Swaziland, South Africa, the UK and Canada and presented and discussed their work.
From this, people put together a range of material for the journal and the blog linked to the special edition. Some of this material took the form of academic articles; there are also podcasts, photographs, pieces of music, images and poetry.
This allowed us to present creative and academic work in a format that was more accessible to those with digital access and moved beyond academic journals. After all, part of what the field is concerned with is maintaining critical, intellectual rigour while making information available to people in a number of ways. In doing this the field tries to break down some of the barriers that prevent people from sharing work or ideas.
There is more to come for the Medical and Health Humanities field in Africa. A group called the Medical and Health Humanities Africa networkhas been established. CODESRIA, the Council for the Development of Social Science Research in Africa, among others, has been drawn into discussions about growing the field’s networks on the continent. The second conference organised by the Malawi Medical Humanities Network will be held in Zomba, Malawi in August and a workshop in Johannesburg in March called State of Dis-ease will continue these exciting new conversations.
-Carla Tsampiras; Senior Lecturer in Medical Humanities, University of Cape Town
-Nolwazi Mkhwanazi; Senior researcher, Wits Institute for Social and Economic Research, University of the Witwatersrand
Organic In The Concrete Jungle
Geologist-turned-entrepreneur Brad Meiring uses an online delivery service in South Africa to get people to reconnect with their food.
Pile of empty wooden crates are ready for packaging, stacked up in a scullery. As the morning mist dissipates in the lawn, a pick-up van parks near the doorway.
There is an enterprising hustle and bustle between the van and the kitchen door. Men hurriedly create an impromptu conveyor belt offloading supplies from the van into the scullery.
The daily work rituals progress, and Brad Meiring, the 37-year-old founder of Munching Mongoose, casually engages in a conversation with the supplier.
From starting his business with 12 boxes, the online delivery service established in 2014, now dispatches about 150 boxes a week in Johannesburg.
Meiring sells customizable grocery boxes filled with organic produce, from fruits and vegetables to staple foods such as milk, cheese and breads. His business has a turnover of R450,000 ($31, 241) a month.
It was a conversation at a dinner with a friend in Nelspruit that planted the seed of opportunity. It turned him from geologist to entrepreneur.
As a geologist, he had been against the commercial exploitation of the environment.
“In geology, it is about how we can put a big hole in the ground to make us some money. That didn’t sit well with me and that is why I geared away [from it]. You are very much in touch with the ground and so is farming. I suppose you could link the two. When I shifted from geology, I tried to get into the environmental field using that knowledge,” the entrepreneur says.
Operating from a pomegranate farm, in the picturesque rural area of Muldersdrift, 27 kilometers from Johannesburg, the calm of the place is an obvious contrast to the hustle and bustle in the economic hub of big city Johannesburg.
It is a contrast he sees changing with time, as people have become more open-minded to experimenting with healthier options, his packaged organic food one of them.
“There are guys farming on rooftops, finding small plots of land in and amongst the buildings. There are guys using vertical walls to grow so they are turning the concrete jungle into farm scapes.
“There is a whole farm movement where guys are just maximizing the space they have to make their produce. As the awareness grows, hopefully, the fast food lines will also start considering the produce they use to make food. This will give more options,” he says.
A grey hatchback pulls into the driveway; we look on as a man unloads two bags from his boot and makes his way to the kitchen.
“We have built amazing relationships with the suppliers and farmers. The deeper you go, you can just see the networks of guys who are just hustling. There is value far beyond what we see in the shops,” he says.
Focused on delivering boxes in Johannesburg, the business has customers varying from the high-end to the health-conscious.
According to Meiring, high-end consumers are more accustomed to purchasing the bigger boxes because it is in line with their budget whereas health-conscious and dual-income families opt for more affordable options.
Grocery boxes range from R499 ($34) to R799 ($55) with various nutritional options.
Through his Munching Mongoose business model, he aims to create a difference.
“For us, where the real passion lies is being able to play our small part in getting families around the table. Getting people to reconnect with the food they eat. More importantly, it is to build relationships. It sounds silly, but if you ask anyone, some of their best memories are around the table,” he says.
Nudged by his love for family, relationships have become a core value he practices in the corporate space.
“Relationships are the business. Without them and without the people doing the hard graft and toiling, we wouldn’t have a business. I am not a farmer or artisan. Even down to the team; we built it slowly,” he says.
“The lucrative nature is based on who is behind the wheel and how you can run it as a business. The opportunities are big, and there is a big global mind-shift towards being more environmentally conscious, towards health and to understanding relationships and where your food comes from. There are a lot more people questioning and not just accepting what is given to them on the shelves. You can’t just greenwash.”
His subscription-based model is an experience different from grocery-shopping.
“Organic produce is still expensive. Small farmers have limited access to resources, and that goes to the economies of scale,” he says.
This results in higher costs to sell and purchase naturally-produced foods and so it’s expensive and inaccessible to the lower-income markets.
Although the organic food market mostly targets high-end consumers who have the means, every business should be open to trends in various markets.
Meiring argues that African markets differ from developed regions in the lack of infrastructure and access to support from local government.
“Digital adaptions for marketing and transactions between the consumer is a priority,” says Sigqibo Nonhonho, who manages the digital aspects of Munching Mongoose.
“There are a lot of systems that you have to come to grips with. Being able to understand the back-end of the website, what the customers will be seeing and the numbers (interactions) behind that.
“Having an IT background allowed me to understand that quicker. In IT, being organized is something that you to do, and in food, you have to do that too. In food, there is more freedom, you can be more creative and design your solutions,” Nonhonho says.
Gracious Nhloko, who has taken it upon herself to farm organic produce in her free time, administers the daily operations, and she says Wednesdays are her favorite day of the week because suppliers are moving in and out as they deliver the fresh produce.
“When different suppliers are bringing their fresh produce, just looking at those vegetables, sometimes, looking at the sizes of some of the produce is so amazing… It just brings me joy,” she says.
Meiring says that defining organic in South Africa is a grey area that has not been legislated properly.
At times, he has to cross-check that suppliers are being truthful.
The term ‘organic’ is often used in a broader sense and that is a complex issue that needs to be dealt with caution.
“In fact, often people have a negative perception when they see something marketed as organic because it is considered as someone just using [the label] organic,” he says.
Moving at a gradual pace towards expansion, for Meiring, ensures that quality and sustainability remain beneficial for all parties involved, and sometimes this means problem-solving is done on the spot.
“We are looking at other product lines. Adopting a model for corporate and office spaces and bringing in something for families… There are the meal kits for companies that are doing well globally but there are good examples in South Africa.
“I love the journey of starting people back in the kitchen, and we hope that we can evolve people’s mind-sets to get them to want the fresh produce. It is about expansion in a way that is, excusing the pun, organic,” he says.
“Being organic in the concrete jungle is a thing and it is growing… People are changing, and others are saying they don’t want to lawn anymore and will [instead] plant a vegetable garden.”
In due time, Meiring’s wooden crates will cross the oceans to New Zealand as promising global ventures are also under way.
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