In Ivory Coast, a psychiatrist on mission in the “prayer camps”

With its cob houses and its wooden temple decorated with a crucifix, Brobo looks like an ordinary bush village in the center of the Ivory Coast. But at the edge of fields of eggplant, cassava and corn, tiny wooden shelters covered with black tarpaulins catch the eye. Inside, on mats, men and women sit or lie down. Most are free to move, some chained by the ankles. The place is unsanitary. Here, the only thing that matters, “it is prayer that heals”, loves to repeat Jeremiah, a Bible in hand.

The one who calls himself ” Prophet “ Where “pastor” opened this “center of prayer, deliverance and healing” in 1999. Located thirty kilometers from Bouaké, the second largest city in the country, it welcomes people suffering from mental illness and epilepsy. No medication is prescribed, just rely on God. An unstoppable method assures its promoter, listing the donations and gifts sent to him by former patients today “healed”to thank you.

Families must pay an entrance fee of 8,000 CFA francs (about 12 euros), to which are added other “donations”. The patients, on the other hand, have to work in the field to produce the food that they eat or that the pastor sells in the market. The sick can stay in the camp for a few days or several years. Some have been there since the opening. “Only God can decide the release date”, justifies Pastor Jérémie. At the same time village chief, spiritual guide, financial manager, the one who presents himself as a “called of God” has long ignored conventional medicine. He must now deal with it.

For eighteen months, the patients of Brobo have been regularly visited by Professor Asseman Médard Koua and his teams. Director of the psychiatric hospital of Bouaké, the doctor created in 2019 Samentacom, a community mental health program, supported by the German foundation Mindful Change.

The caregivers’ objective is simple: to identify the sick in the camps, to make a diagnosis of their suffering, to provide care for the most problematic cases and, above all, to convince the “pastors” to transfer their flock to primary health centers where the Professor Koua and his teams have trained general practitioners and nurses in the care of psychiatric patients.

“Taking into account the spiritual dimension”

As a psychiatrist, Asseman Médard Koua does not recognize any therapeutic efficacy of “treatments” taught by Jeremiah. But they “have an indisputable sociological and community legitimacy that it would be counterproductive to conceal, justifies the doctor. We cannot cure a disease, a fortiori mental, without taking into account the spiritual dimension.. This is also one of the reasons why these “healing camps” are always full, despite the many abuses that are committed there – physical and sexual violence, deprivation of food, chaining and long-term isolation, extortion .

In an unpublished cartography carried out in 2020, the teams of the psychiatric hospital of Bouaké identified 541 “unconventional structures in mental health” throughout the Ivory Coast. Most are religious in nature: 60% evangelical and 6% Islamic. The others, around a third, are similar to traditional medicine or phytotherapeutic services.

Faced with these centers which accommodate between ten and a hundred people each, only 35 conventional psychiatric care structures exist for 26.4 million inhabitants. A delta that pushed Asseman Médard Koua to “reconciling these two a priori antagonistic worlds of care”.

In town as in the countryside, these unconventional structures are the first resort for families who offer themselves, by placing their sick loved one there, social and financial respite. An observation which justifies, according to Nicolas Koffi Kouadio, a structuring of the collaboration between the local health centers and the prayer camps, the latter being “a gateway to patients and their community”.

For this community health worker who shuttles between the two types of structures, the “reintegration” of the patient within his community is the main challenge in the management of mental health. However, going to a conventional psychiatric structure – such as a hospital – remains very stigmatizing for the sick, unlike staying at a prayer camp or at the local health care center where people go to treat a cases of malaria or stomach ailments.

“There is no point in waging war on these prayer camps, because it is the sick who will come out the loser, believes Nicolas Koffi Kouadio. We need local psychiatry that respects all actors in mental health. » The ultimate goal is to move towards community hospitals with mobile mental health teams. A deployment that involves overcoming certain resistance, psychiatrists and pastors sometimes showing reluctance at the idea of ​​losing part of their authority.

Regularly singled out by associations which accuse them of mistreating the sick and of being guilty of violations of human rights, the prayer camps are nevertheless increasingly monitored. In March 2020, Pastor Jérémie even received a court summons. Due to the global pandemic, this has ” faded away “, he specifies. If he sees a ” miracle “ granted “thanks to prayer”the fear of seeing the authorities close his camp now pushes him to put on a good face and collaborate with the teams of the community mental health program.