Essential Grace July - 1st Anniversary Edition

JULY 2021 | VOLUME 1 | ISSUE 12

ANNIVERSARY ISSUE 1|Es s en ti al Gr a ce Mag azi ne

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Welcome to the 1 Year Anniversary Edition!

Essential Grace Magazine has come a long way and finally reached a milestone of 12 publications! I honestly can’t believe the time has flown by so fast.

There are many people who work behind the scenes to make each publication possible. From those that submit their articles – free of charge while offering time out of their busy schedules – to those that suggest topics for us to focus on each month. There are some who go out of their way to conduct and write up interviews, as well as others who are ready to spend several hours out of their day editing long transcripts for us. Not forgetting those who share our PDF version of the magazine far and wide so that those who cannot access our online platform can also enjoy their monthly issue of Essential Grace.

We are truly grateful for each person who contributes, we cannot do what we do without you! As illustrated on our cover page as well as on page 7, we have come a long way from the first publication. Here’s to the next 12 months of mental health and wellness promotion, may we keep growing and learning, and may you grow with us on this journey towards a healthier Malawi.

In this issue, we shine a light on Sarcoma Awareness and World Population Day both commemorated in the month of July. We also highlight the issue of counselling therapy for adolescents as well as the mental health challenges that they face. On page 21 Taonga Nkosi, a therapist based in West Africa shares some insights she has learned in her experience with adolescents and mental health problems. Please make use of the resource section especially if you can relate to any of the issues mentioned. Once again, thank you for your readership.

Much love and blessings to you!

Julie Soko Managing Editor Essential Grace Magazine essentialgrace@zoho.com / @essentialgracemagazine2020 instagram.com/essentialgracemagazine2020 www.issuu.com/essentialgrace

Essential Grace is a free online publication and registered magazine focused on promoting mental health and wellness in Malawi and beyond through different online mediums.

Follow and subscribe to the magazine at www.issuu.com/essentialgrace to get notified when your monthly publication is available.

Comments and feedback on any of our articles or contributors can be addressed to essentialgrace@zoho.com or through the contributor’s personal contact information.

Contact us for information at 0991 938 203 2|Es s en ti al Gr a ce Mag azi ne

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Monthly Theme Features Sarcoma Awareness Month World Population Day Independence Mental Health Features

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Schizophrenia Awareness Day (UK) Therapy for Adolescents

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Health and Wellness Features The Value of a Good Breakfast Nutrition and Mental Health Resources

List of Mental Health Professionals in Malawi

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Julie Soko

Naomi Msusa Editorial Art and Design @nanamsusa

Managing Editor @thc.zomba2020

Special Thanks to: Mtendere Kishindo

Thandi De-Jong

Sub-Editor

Editorial Assistant

@tendyalize

@ndipita_konko ©amfion photography

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Sarcoma Awareness

World Population Day

The Beauty of Personal Independence

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Sarcoma – Cancer of the Connective Tissues

muscles to bones), fibrous tissues, fat, blood vessels, nerves, and synovial tissues (tissues around joints).

Treatment options for sarcomas include surgery, radiation therapy, and chemotherapy.

Sarcomas are cancers that arise from the cells that hold the body together. These could be cells related to muscles, nerves, bones, fat, tendons, cartilage, or other forms of “connective tissues.” There are hundreds of different kinds of sarcomas, which come from different kinds of cells.

Malignant (cancerous) tumors that develop in soft tissue are called sarcomas, a term that comes from a Greek word meaning “fleshy growth.” There are many different kinds of soft tissue sarcomas. They are grouped together because they share certain microscopic characteristics, produce similar symptoms, and are generally treated in similar ways. (Bone tumors [osteosarcomas] are also called sarcomas, but are in a separate category because they have different clinical and microscopic characteristics and are treated differently.)

Treatment

Sarcoma is a rare cancer in adults (1% of all adult cancers), but rather prevalent in children (about 20% of all childhood cancers). It is made up of many “subtypes” because it can arise from a variety of tissue structures (nerves, muscles, joints, bone, fat, blood vessels – collectively referred to as the body’s “connective tissues”). Because these tissues are found everywhere on the body, Sarcomas can arise anywhere. Thus, within each site of the more “common” cancers there is the occasional surprise sarcoma diagnosis (e.g., breast sarcoma, stomach sarcoma, lung sarcoma, ovarian sarcoma, etc.). The most frequent location are the limbs since this is where the majority of the body’s connective tissue resides. They are commonly hidden deep in the body, so sarcoma is often diagnosed when it has already become too large to expect a hope of being cured. Although a lot of the lumps and bumps we get are benign, people should have them looked at by a doctor at an early stage in case it is sarcoma.

Sarcoma is sometimes curable by surgery (about 20% of the time), or by surgery with chemotherapy and/or radiation (another 50-55%), but about half the time they are totally resistant to all of these approaches—thus the extreme need for new therapeutic approaches. At any one time, more than 50,000 patients and their families are struggling with sarcoma. More than 16,000 new cases are diagnosed each year and nearly 7,000 people die each year from sarcoma in the United States.

Sarcomas can invade surrounding tissue and can metastasize (spread) to other organs of the body, forming secondary tumors. The cells of secondary tumors are similar to those of the primary (original) cancer. Secondary tumors are referred to as “metastatic sarcoma” because they are part of the same cancer and are not a new disease.

There are two categories of sarcomas: Soft tissue sarcomas The term soft tissue refers to tissues that connect, support, or surround other structures and organs of the body. Soft tissue includes muscles, tendons (bands of fiber that connect

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Non-soft tissue sarcomas Non-Soft Tissue Sarcomas – The most common type of bone cancer is osteosarcoma, which develops in new tissue in growing bones. Another type of cancer, chondrosarcoma, arises in cartilage. Evidence suggests that Ewing’s sarcoma, another form of bone cancer, begins in immature nerve tissue in bone marrow. Osteosarcoma and Ewing’s sarcoma tend to occur more frequently in children and adolescents, while chondrosarcoma occurs more often in adults.

The Sarcoma Foundation of America has attempted to create location for patients, caregivers, and healthcare professionals to quickly learn about a particular sub-type of sarcoma. The number of subtypes of sarcomas is often debated. We have attempted to create a list that encompasses most of the sarcoma subtypes.

Diagnosis The only reliable way to determine whether a tumor is benign or malignant is through a surgical biopsy. Therefore, all soft tissue and bone lumps that persist or grow should be biopsied. During this procedure, a doctor makes an incision or uses a special needle to remove a sample of tumor tissue. A pathologist examines the tissue under a microscope. If cancer is present, the pathologist can usually determine the type of cancer and its grade. The grade of the tumor is determined by how abnormal the cancer cells appear when examined under a microscope. The grade predicts the probable growth rate of the tumor and its tendency to spread. Low-grade sarcomas, although cancerous, are unlikely to metastasize.

High-grade sarcomas are more likely to spread to other parts of the body.

In general, treatment for sarcomas depends on the stage of the cancer. The stage of the sarcoma is based on the size and grade of the tumor, and whether the cancer has spread to the lymph nodes or other parts of the body (metastasized).

Surgery is the most common treatment for sarcomas. If possible, the doctor may remove the cancer and a safe margin of the healthy tissue around it. Depending on the size and location of the sarcoma, it may occasionally be necessary to remove all or part of an arm or leg (amputation). However, the need for amputation rarely arises; no more than 10 percent to 15 percent of individuals with sarcoma undergo amputation. In most cases, limb-sparing surgery is an option to avoid amputating the arm or leg. In limb-sparing surgery, as much of the tumor is removed as possible, and radiation therapy and/or chemotherapy are given either before the surgery to shrink the tumor or after surgery to kill the remaining cancer cells.

Radiation therapy (treatment with high-dose x-rays) may be used either before surgery to shrink tumors or after surgery to kill any cancer cells that may have been left behind.

Chemotherapy (treatment with anticancer drugs) may be used with radiation therapy either before or after surgery to try to shrink the tumor or kill any remaining cancer cells. If the cancer has spread to other areas of the body, chemotherapy may be used to shrink tumors and reduce the pain and discomfort they cause, but is unlikely to eradicate the disease. The use of chemotherapy to prevent the spread of sarcomas has not been proven to be effective. Patients with sarcomas usually receive chemotherapy intravenously (injected into a blood vessel).

Doctors are conducting clinical trials in the hope of finding new, more effective treatments for sarcomas, and better ways to use current treatments.

Helpful Links

http://www.youandsarcoma.com/en-src/home for an animated patient guide to understanding sarcoma http://www.inspire.com/groups/sarcomaconnect/ to join an online support group for people affected by sarcoma around the world www.curesarcoma.org for more information on sarcoma awareness

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This report by the United Nations Population Fund (UNFPA) focuses on women and girls' agency to make choices about their bodies without fear of violence or having someone else decide for them. Women enjoy only 75 percent of the legal rights of men and nearly half of women in 57 developing countries are denied the right to decide whether to have sex with their partners, use contraception, or seek health care.

Outside of the tremendous harm to women and girls, lack of bodily autonomy can depress economic productivity, undercut skills, and incur serious costs to the health care and judicial systems.

The report examines the three dimensions of bodily autonomy; the multiple and diverse ways bodily autonomy is denied; the legal instruments and policies that support the right to bodily autonomy; and the social norms that must evolve to support the most marginalized women and girls.

In addition to the downloadable publication, an interactive report website offers narratives and multimedia features. Accompanying the report is the UNFPA Data Portal, a data visualization tool with the most current global population data drawn from UNFPA and other U.N. agencies.

The World Population Dashboard includes information about numerous demographic, social, and health indicators, including fertility rate, maternal and newborn health, gender parity in education, information on sexual and reproductive health, and more.

Data can be filtered by country and topic, and results can be downloaded as PDFs or Excel files for further analysis. The portal also includes country pages and additional “dashboards” for specific populations and topics, including female genital mutilation/cutting, midwifery, and adolescents and youth.

The State of World Population is an annual report published by the UNFPA, the leading U.N. agency for delivering a world where every pregnancy is wanted, every childbirth is safe, and every young person's potential is fulfilled. Previous years’ editions can be found in the UNFPA’s publications library.

Source: The State of World Population 2021 – My Body is My Own: Claiming the Right to Autonomy

and Self-Determination. United Nations Population Fund 2021. https://www.unfpa.org/sowp2021 Download the report using this link: https://www.unfpa.org/sites/default/files/pub-pdf/SoWP2021_Report_-_EN_web.3.21_0.pdf

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World Population Day in the COVID 19 Season

By Steveria Kadangwe

11 July was World Population Day, commemorated annually since 1989 to raise awareness.

The global pandemic has had a serious impact on various areas – tourism, health, mortality, jobs, incomes and economies. Due to COVID-19, it has been difficult to obtain sexual and reproductive health data, and therefore quite difficult to quantify the impact globally. This is compounded by the fact that countries are being hit at different times, with different intensities and duration. In addition, COVID-19 response has varied across the globe and the socio-economic status of countries have determined the response and the severity of the impact and recovery. (Source: United Nations Population Fund (UNFPA)) COVID-19 has also led to an increase in gender-based violence across the globe as countries went into lockdowns and people lost their livelihoods. It has also increased the number of child marriages and therefore younger girls are having children. We have seen this even in Malawi – teen pregnancies have increased during the pandemic in different districts and the statistics are alarming. Africanews.com quotes an Oxfam report and the Ministry of Health that in 2020 Phalombe registered 2782 teen pregnancies while Mangochi had 7274.

35% of all pregnancies in 2020 were girls between the ages of 10 and 19. There were 7 million unplanned pregnancies due to the pandemic globally. This is due to lack of access to family planning methods as lockdowns disrupted supply chains, focus of health services was on the pandemic and closure of schools.

Child marriages increased as parents who lost their livelihoods have married off their children. Reliefweb reports that there were 13,000 child marriages and 40,000 teen pregnancies in Malawi. Ironically, in several European countries, many who were planning to give birth postponed the decision to conceive, due to availability of family planning methods and 11 | E s s e n t i a l G r a c e M a g a z i n e

information – birth rates are expected to drop by up to 500,000.

This is a gloomy picture as the consequences are numerous – girls stop their education and therefore their ability to support themselves, resulting in an increase in population, increase in sexually transmitted infections as just some of the many results. Empowering women and girls academically, economically and socially would help mitigate some of these effects.

This also speaks to the need to increase focus on child protection services, dealing decisively with violence including sexual assault. Monitoring of the calls received through the Malawi National Child Helpline for 14 days in October 2020 showed the following calls included 162 related to gender based violence and child protection calls including 48 child marriage cases, 37 defilement cases, and 30 emotional abuse cases. (Source – UNICEF). These were referred to relevant authorities including the police, the judiciary as well as health providers, but resources are limited for adequate follow up and mental health care. Many cases are not even reported at all, making it difficult to maintain accurate statistics.

What do we make out of all this then? Much as there is a lot of focus on environmental sustainability due to the exponential population growth globally, and a lot of discussion about relatively high fertility in Africa and Asia versus the rest of the world, the COVID-19 pandemic has shown an underbelly of issues to do with population control that cannot be ignored. The economic disparities are having a significant and lasting impact on girls and young women which requires focus and needs to be addressed. Maybe a different approach to population issues is required in countries like ours, where there are fundamental issues to do with culture, traditions and beliefs, which greatly disadvantage girls and where the pandemic has had a lasting and devastating impact.

 There are 7.8 billion people in the world as at March 2020.  Global population has grown by 6 billion in only 200 years, and by 1 billion over 12 years  The highest birth rates in a decade were in the 1980s, totalling 139 million.  Asia has 4.6 billion people, which is 36% of the global population while Africa has 1.35

billion people, which is about 17% of the world’s population.  Antarctica has only 1200 people, who are mostly researchers.  China is the most populous country with 1.3 billion people, followed by India and the

United States.  Nigeria is Africa’s most populated country and 7th in the world, with 161 million people.  Cairo in Egypt is Africa’s most populated city, with 20 million people.  The Han Chinese are the largest ethnic group, making up 19% of the world population  Most spoken language is Mandarin Chinese, spoken by 12% of the world. English is only native to 4.8% of the world  31% of the world practices Christianity, which is the largest religion and Islam is the second largest religion at 24%

 Global fertility is declining but European countries are declining rapidly and do not reproduce enough annually to maintain their current populations.  One quarter of the world’s population is under 15 years of age.

 71% of the world’s millennials (born between 1981 and 1997) live in Asia and Africa, and there are 2 billion millennials in the world  For half a century, China has been the most populated country in the world. This will

change, as India is expected to overtake China by 2022. Additionally, the United States will lose its third-place spot to Nigeria.

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World Population Day: Encouraging men to make healthy choices about their bodies

How is vasectomy done?

Your doctor will discuss with you the reasons why you want the vasectomy and will then examine you. The procedure will be done once the doctor and client are both satisfied with the assessment.

The surgery is usually a 20 to 45-minute procedure. It is done under local anesthetic (which means you are not put to sleep).

The doctor will put an injection in the area where they would want to work on, which is usually the upper part of the scrotum. A very tiny cut is made to access the tube and cut it. Immediately after the operation there might be a bit of swelling and bruising on the area but you will be allowed to go home the same day. You can return to work two or three days after that.

It is very important to know that you are not sterile immediately after the procedure. Ideally, your doctor would advise you that you need to use other forms of contraception for another 12 weeks or for the next 20 ejaculations whichever comes first.

What are the benefits of a vasectomy?

It's very effective with low failure rates It is permanent. So you can forget about it because it's done and dusted.

My name is Dr. Charles Mabedi. I'm a Consultant Urologist working in Lilongwe, Malawi. I practice at Kamuzu Central Hospital. I'm also available for private consultations at UroMed Clinic in Area 17.

As we celebrate the World Population Day this month of July. I'd like to take some time to share some information regarding vasectomy. It is always pleasing to hear men taking a leading role in planning the future of their families regarding how many kids they want to have. Traditionally this role in Malawi has been left to women who sort of carry the responsibility of ensuring that the family do not conceive unintendedly. Vasectomy offers men a chance to take a leading role in planning the future of their families. This may allow them to focus the available resources on the kids that they already have I will discuss the following; what vasectomy is, what are the benefits and how it is done.

What is vasectomy?

A vasectomy is a permanent male sterilization procedure, which involves cutting the tubes that carry sperm from the testicle to the outside world. It should be considered a permanent procedure.

And it's mostly offered to families who are satisfied with the number of children they have. It is important to note that men who have never conceived, or families who are still pregnant are discouraged from undergoing this procedure. I should also mention that vasectomy is very, very effective. In fact, it is the most efficient form of permanent contraception with failure rates of less than 1%.

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There are very minimal side effects.

What are the possible side effects of a vasectomy?

Immediately after the surgery, there'll be some swelling and bruising on the scrotum, which should settle down with regular painkillers after a few days.

vasectomy to be reversed. This is usually done by consultant urologist working with special equipment. The success of the reversal depends on how long it has been since the patient had a vasectomy procedure done.

Someone who is willing to undergo vasectomy needs to be prepared mentally and accept that this is a permanent procedure.

We always encourage our clients to take more time to decide on this method of family planning, and that they are sure about not wanting to father any more children.

How is the uptake of vasectomy in Malawi, compared to the rest of the world?

I think there are very, very few men in Malawi who are willing to or who have undergone vasectomy. This could be due to traditional beliefs, or some misconceptions that men have had over the past. I have interacted with different men, informing me of their concerns that they will lose their libido and performance in bed should they undergo this procedure. This is not true, it’s a myth. In fact, in some parts of the world such as in the UK for example, the uptake of vasectomy is quite high. It is probably the most common operation done in the UK. It is my hope that as we continue to share accurate information regarding vasectomy, more Malawian men will come forward to demand and access the service.

I would like to encourage all men who think that they have a complete family to consider vasectomy as a permanent family planning method.

There's a small risk of wound infection and if that happens you will need some antibiotics. Normally you're not given antibiotics after a vasectomy.

Avoid home remedies! Please see the resource

In the long term, some people may experience some scrotal discomfort. This usually happens in less than 1 in 20 people. It can easily be controlled with a painkiller where necessary.

section for more information on services

And finally, vasectomy does not increase your risk of testicular or prostate cancer nor affect your sexual desire, strength of your erection, and the volume of your ejaculate.

provided by Dr Mabedi as well as how to get in

Where can one get a vasectomy done in Malawi?

touch with him

Most clinics across the country would offer a vasectomy, however, since the uptake of vasectomy in Malawi is low you may need to contact your doctor or your nearest health facility to inquire about vasectomy services.

at Uromed Clinic, Lilongwe.

Can a vasectomy be reversed?

Men and their families should always consider vasectomy as a permanent solution. That said, it is sometimes possible for a Vol.1 Issue 12

THE BEAUTY OF PERSONAL INDEPENDENCE

Independence is freedom from outside control or support: the state of being independent. Now, who is an Independent person? An independent person is someone or something that is free from the influence or control of another. In today's world, there are so many outside/environmental factors that can have a significant impact on your mental health. These include everything from the house, city you live in to the weather in your area, the social climate, and your work environment, childhood experiences, poverty, etc. However, there are other factors that are from within.

These stressors are internal; stress-inducing thoughts or behaviors.

These thoughts come from one's psychological mindset or expectations. Examples include putting pressure on yourself to be perfect or fear of public speaking, comparing oneself with others etc. In more serious cases, internal stressors may lead to feelings of depression and anxiety.

For most people, stress is a part of life. We feel it, complain about it and think about how we can get rid of it. But do we really understand what stress is and what we should do about it? Simply put, stress is a physical response to a feeling, situation or event that interferes with your sense of well-being. The factors or emotions that cause you to feel anxious, tense or afraid are called stressors. Perception of stress is based on individual response.

What may be stressful for one may be thrilling and challenging for another.

Both internal and external stressors can have the same physical and psychological effects. You may have trouble sleeping, lose your appetite or lose interest in daily activities. You may be irritable, have headaches or stomach pains, or find that you cry easily. Over time, chronic stress can be even more damaging. As your body stays in a state of alert, your immune system may be weakened.

You could be more at risk for heart attack and stroke. Chronic stress may upset your reproductive and digestive systems.

In this article I will concentrate on the internal stressor of comparing your life with others. I am sure you have ever heard the statement comparison is a thief of joy. Well, whoever discovered that was right. Once you take that route, you cease to live and enjoy life as you should. You start wishing you were like them, you did things the way they do, you had what they have, hence you end up living a life of worry and stress. You see, each one of us was created in the image of God (Gen 1:26-27), but God made sure he also made each one of us unique in our own ways. So that in as much as collectively we are like Him in nature, individually we were formed uniquely according to his purpose for our lives.

Independence Day is a public holiday in Malawi observed on July 6th each year. The day is also known as Republic Day. This is Malawi's National Day and it commemorates independence from Britain on this day in 1966. As we celebrate this independence, it is also important to reflect if we are completely independent even from forces within that still hold us in bondage.

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the same). Social comparisons often elicit negative emotions, which, in turn, may lower individuals’ self-esteem.

If you have a tendency of always looking at what is happening in other people’s lives and how it seems better than yours, you will never live a fulfilled life. The truth is, you can never have what everyone else has and you can never be able to do what everyone else is able to do. This is where the issue of uniqueness and purpose comes in. Learn to embrace and appreciate everything you are; learn the things you can learn, attain the things you can attain and live the best life you can live as YOU. You are special and valuable in your own way. Don’t let anyone make you miss out on the great opportunity of being the best you that you can ever be. Psalm 139: 14 says, “I praise you because I am fearfully and wonderfully made; your works are wonderful; I know that full well.”

The Psalmist had discovered this truth and lived in perfect peace, joy and gratitude. You can enjoy them too if you truly accept yourself and discover the uniqueness of your path and assignment in this world.

In the digital world we are living in, social media has enhanced social comparison. Let me be honest with you and help you, not everyone is as happy and fulfilled the way the show it on social media. Not everyone has the things they pretend to have on social media. So do not be too hard on yourself over things that are not even a reality. Even if some of those things were true, appreciate what God is doing in other people’s lives and trust him for your own good things and progress according to his will and purpose. So as we celebrate our independence as a country, where we became independent as a member of the Commonwealth of Nations on July 6, 1964, may we also strive to become truly independent from our own negative thoughts that weigh us down and gladly become the best version of ourselves. It is only then that we shall live fulfilled lives.

It is important to figure out the sources of your stress so you can start working toward a healthier and relaxed mental state. And it is helpful to learn coping skills to deal with stress. Sometimes that coping mechanism may look like adjusting your thinking to a more positive attitude.

HAPPY INDEPENDENCE TO YOU ALL!!

This instinct to self-evaluate, to look to other people for information about ourselves, is deeply wired into our species. But you can notice the tendency to self-compare, and just by noticing it, refrain from doing it when it's not truly productive (look out for my article in the next issue, I shall explain why people involve themselves in social comparison, its benefits if handled well and the consequences of

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Schizophrenia Awareness Day

Therapy for Adolescents

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Schizophrenia Awareness Many people in the world do not have a clear understanding of what schizophrenia really is. There are so many misconceptions and assumptions applied to this condition, here are a few facts vs fiction just to give you an idea.

Fiction

Fact

Schizophrenics have multiple

While the behavior of a schizophrenic in the grip of a psychotic episode—expounding on bizarre beliefs, talking in a strange way, and

personalities

responding to auditory and visual hallucinations—can seem like the manifestation of a new personality, the root consciousness of the individual never actually goes away.

Schizophrenics Have Identical Schizophrenics are generally classified into one of several subtypes, such as Paranoid Schizophrenia (the most common subtype), Catatonic Symptoms

Schizophrenia, and Residual Schizophrenia, which is diagnosed when a patient no longer displays prominent symptoms. Due to the mercurial nature of the disorder, it is not uncommon for patients to be re-classified into different subtypes throughout the course of their lives.

Furthermore, there is growing controversy within the psychiatric community and general public about whether the wide range of symptoms that fall under the purview of schizophrenia can even be classified as a single disorder. What’s not in doubt is that every individual suffering from the illness requires a specialized treatment plan tailored to his/her symptoms and life situation.

All Schizophrenics Know That While the outward symptoms of schizophrenia often leave little doubt as to the severity of the illness, one of the major hallmarks of the They Have An Illness

disease is the fact that those affected can sometimes go months, and even years before realizing they’re ill.

Schizophrenics Are Usually

People with schizophrenia are no more predisposed to violence than any other group. However, particular symptoms of the disorder, such as

Violent

delusions of persecution, can trigger violent acts if left untreated. Lost in the headlines that these acts generate is the fact that the vast majority of cases involving violence with a schizophrenic are self-directed.

Isolation is the Only Way to

According to a recent World Health Organization study, schizophrenics in developing nations like India, which tend to have a much stronger

Handle Schizophrenia

sense of community and shared responsibility when it comes to caring for the mentally ill, showed significantly higher rates of recovery than in the United States and England. Some of the key differences include access to low-stress jobs and close involvement by families during doctorpatient discussions, whereas in the West the mentally ill are typically excluded from the workplace and doctor-patient conversations are kept strictly confidential. It points to the enormous role social factors play in the recovery of schizophrenics, as well as the potential to improve their lives through adopting a new, community-based approach.

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Understanding Schizophrenia Perspective from a Mental Health Professional

Psychosis is a part of the schizophrenia illness. Symptoms of psychosis may include delusions, disorganized speech, trouble with thinking, and hallucinations.

In short, psychosis is a set of symptoms characterised by a loss of touch with reality. The person will exhibit symptoms of living in their own world and experiencing another reality different from what the average person would experience, pointing to the fact that their thoughts and perception are disturbed. We know that such an individual may have difficulty understanding what is real and what is not. Therefore, when we are looking at the delusions, we consider it to be associated with a fixed false belief about something. They may describe a particular scenario but when you look at the evidence, it is completely contrary to what the person is describing.

Most of the time, people with schizophrenia will have what we call persecutory or violent delusions where they believe that they are being harmed or harassed by another person or a group of people.

My name is Chitsanzo Mafuta. I am a professional mental health practitioner with more than 15 years’experience in mental health care as well as advanced mental health research. I have been working almost my entire career with people living with all forms of mental illness in various levels of severity. I work with mental health and wellness issues. In regards to mental illness specifically schizophrenia, there are quite a number of things that the Malawian context (and people in general) do not understand fully.

In general, many people do not fully understand this condition perhaps because of how it translates in the local language. We categorise everything to do with mental illness as misala. But basically, when you look at the forms of mental illness, there are quite a number of them and schizophrenia is one of the chronic brain diseases that we see. Looking at the statistics, one in every 100 people co-presents with this illness known as schizophrenia.

Here are a few factors to help us understand what schizophrenia is.

It is a condition which can present as an active illness with symptoms or signs which include delusions, hallucinations, disorganized speech, having trouble with thinking, and lack of motivation. What people should actually know is that it is a chronic brain disease, meaning there will be continued episodes of sickness.

But with treatment, people with schizophrenia can improve and even live their life in a productive way. Comparing it to other conditions like Malaria, there's no definite cure for schizophrenia although the current treatments available do lessen the symptoms that a person is experiencing. Such a person is able to live a relatively normal life while taking the medication that was prescribed to them.

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Another factor which is linked with schizophrenia is hallucinations.

A person would be experiencing increased or sensitive senses, for example through hearing, seeing, smelling, and tasting things or feeling things which are not there. However, the most common symptoms which we see in people with schizophrenia is hearing voices. They might hear somebody telling or commanding them to do things, or they will just hear noises or voices of people saying things in their mind. Due to this symptom, other symptoms such as disorganized thinking and speech may become evident. It becomes difficult for someone who is hearing voices to be coherent or to think in a clear manner.

Hallucinations may also be linked to disorganized behavior. This is evident in some behaviours such as purposeless repetitive movements. Sometimes, it may be what is called “catatonic”. This is where the person adopts a fixed posture, not moving in any way or standing in one place or gazing at something for a long time.

There are times where people do not present with hallucinations or delusions. In such cases, some may present with what we call negative symptoms. Negative symptoms are those which are a bit similar to depression. For example, they might have impaired emotion expression; decreased speech output; or they might not even have the desire to make social contact or engage in any activity. They often do not express any pleasure in whatever they do. They appear completely withdrawn. These are some of the presentations which are often confused with depression.

Unfortunately, the most common understanding among Malawians whenever they see somebody for example, in the streets displaying strange behavior, the conclusion is usually that the person is suffering from one illness - as is described in the vernacular - misala.

However, there are quite a number of things that we do not know.

For instance, most people will not display a clear picture of whether they have schizophrenia or another type of mental illness. Thus, most people often conclude that anyone displaying disturbed behaviour is mentally sick without understanding exactly what is going on. Because of that, there are a lot of issues to do with stigma and discrimination towards the victims.

One thing I would want most people to understand is that there is a 1% chance that somebody might get sick from schizophrenia. There are other risk factors as well which may contribute to the illness.

The genetic component can play a part. If a family member has had this kind of illness, it may raise the chances of another family member inheriting it down the family line. This is why family history is covered during assessments. Besides genetic factors, environmental factors also contribute to this illness.

However, what people should also know is that this illness will develop during early adulthood from the late teens to early 20's.

Most men will experience this age onset but for women, it tends to start developing in the 20s and early 30's.

One thing to take note of is that this age group is when people develop social skills, in school, or exploring their careers and life goals. The symptoms may be evident in: troubled relationships, not being able to form or maintain relationships, poor school performance and reduced motivation. Therefore, it is really important for people to start understanding the adolescent as well as people in their 20's and early 30's. This helps those around them to notice early if there is some abnormal behavior as that can be an onset of schizophrenia or other types of mental illness.

There is some good news, despite the risk of chronic illness. Having schizophrenia can mean you have multiple episodes, but if you are consistent with treatment and the various products that we have, most people do better and live productively with this illness. In Malawi the good news is that we have people who are well trained in handling such illnesses. We have facilities for example, within the public health care system. Almost all of the district hospitals and tertiary centers have qualified or professional mental health practitioners. And not only that, almost all health workers such as nurses, psychologists, doctors are trained in how to respond when somebody is experiencing mental illness. It is important to know that once you visit a health center you will be attended to by knowledgeable people who will know how to help you, and where to send you for referral where necessary - such as to a district hospital.

For those who need the long-term care, inpatient care is offered at Zomba Mental Hospital and other facilities in the Central and Northern Regions such as St John of God Hospital (a private Mission hospital).

Over the past decade, Malawi has made quite a lot of improvements in terms of mental health care. People are trained in provision of mental health services, and they are deployed in district hospitals, and other tertiary centers. More people are still in training to make sure that we close the gap of mental health care services.

Another thing that should be noted is that not everyone experiencing this illness is violent. Most people assume that people with mental illness are violent and they tend to abandon them. But what I should emphasize is that not everyone with schizophrenia is dangerous or violent. With proper management, we can reduce their Vol.1 Issue 12

chances of living in the streets and even reduce their chances of having multiple episodes that require hospitalization.

Thus, for most people, when they are well managed, they can live with their family and go back to their lives as productive community members.

People should know that we can easily approach any person experiencing these symptoms, as long as we remain calm and respectful. They have all the rights to be treated with respect and human dignity. Negative attitudes or pushing them away is unhelpful. Such attitudes and behaviour may limit their access to hospitals or community support.

such as those listed in the resource section. However, due to the current

We stand for hope and recovery by promoting peer-based support

COVID 19 pandemic, it may be impossible for some to access this support.

programs, accelerating scientific research, identifying effective treatments, and promoting productive public policies.

It would be ideal for family and friends to use this example of social support strategies:

We envision a day when the reclassification of schizophrenia as a neurological brain disease allows every person living with this condition to

We suggest the following online support groups where one can access information, shared stories/testimonies. Tips, guidelines, and even modern

receive respect, appropriate treatment, and an opportunity to live a meaningful life in a compassionate community free from discrimination.

Our organization has a proud history of serving as a guide point for those living with schizophrenia and psychosis, and we work every day to provide

In some instances, the negative attitude directed to sufferers of this chronic illness, schizophrenia, may lead to other physiological diseases such as diabetes or heart disease. Patients may end up not receiving the adequate treatment. Sometimes the medical conditions might come as a result of the medication they are receiving for the schizophrenia, which makes it vital that we do not neglect or avoid people suffering from such mental illness but rather help them to take better care of themselves.

the right resources, support, and awareness.

Schizophrenia & Psychosis Action Alliance stands for hope and recovery through the promotion of education, peer-based support programs, and better public policy.

Contact:

I believe that it is time for us as individuals, as organizations, as practitioners, and other agencies and private groups to say that people that are suffering from schizophrenia can live a good and productive life once they get the right support and care. With awareness and support, a good and productive life is possible.

Lastly, Malawi has been struggling over the years in terms of use of cannabis. Recently, there have been discussions around legalising industrial cannabis. Research has shown that the psychoactive cannabis puts a risk of developing schizophrenia on people especially when they start to use it at a very young age. A message to the young people would be that when you are being discouraged from using cannabis, it is because we are considering the long- term effects of this practice. As we have already seen, schizophrenia is one of the long-term outcomes of cannabis use.

To conclude, there is a positive aspect, that is, help is available in Malawi through trained practitioners and medication.

Phone Number: 240-423-9432 800-493-2094 (Toll-Free) Email: info@sczaction.org www.sczaction.org research being conducted in the field. The Schizophrenia and Psychosis Action Alliance is one such group.

It’s easy to get lost in mental illness especially when there is little support for them. Life can be hard for friends and family as well. You don’t have to suffer alone; you can get in touch with a mental health worker through our resource section.

Schizophrenia & Psychosis Action Alliance is on a mission to save lives by There are many families across Malawi (and the world at large) who need support as they care for family members that have schizophrenia. Some

changing the treatment paradigm for all people affected by schizophreniarelated brain diseases which involve psychosis.

support structures are there within our communities to offer this support

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Vol.1 Issue 12

July 18 | 1, E s2015 s e n /t Christine i a l G r aDene ce Magazine

Vol.1 Issue 12

From Suicidal to Stable, Recovery of a Person with Schizophrenia

BY VICTORIA ALONSO

It started all very strange… The delusions, the special love I felt for a dear priest, the voice of God and others.

I was in a world of my own. Yet, somehow, I maintained a family, husband and three children, and walked around like an ordinary person unless you were on my list of people that I shared the wonderful things I was experiencing. I knew I was special. God had told me this at a young age. Therefore, everything I did seemed like I was on a mission from God on this magical journey.

Then it all turned upside-down. I began to share with people who did not believe my delusions and bad things started happening. My world was falling apart and I was in extreme agony about this special mission I thought I was on - that was not working out.

Somehow, I knew something was not right. I began researching my symptoms online and discovered I was suffering from many of the symptoms of Schizophrenia.

My functioning level was deteriorating. Simple tasks like going to the store became exhausting experiences at times. I was diagnosed in 2008 with Schizophrenia by a team of doctors from UCLA and put on anti-psychotics which worked almost immediately.

Fast forward 6 years later and I am a different person post -psychosis. I went on to earn my Bachelor’s and Master’s Degree in Psychology from an accredited university. I am now working in the mental health field as a therapist and actually have a few clients with psychotic disorders that I am helping.

I have accepted that I have Schizophrenia and that I am not on a special mission for God. This has not come easy and at times I have lapsed back into delusional thinking mainly due to stress. I have a high functioning level and although my life has changed drastically, I feel I am a better person prior to my psychotic break with reality although now I also accept that I do have some limitations. Social engagements are still difficult and at times I am very unmotivated to do the daily tasks that lie before me each day.

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Suicide When I was extremely psychotic, I was suicidal. I wanted to jump in front of a car and watch the hand of God protect me because I believed I was so special. I did not do it, but it was a strong thought of wanting to die and being willing to take my own life.

Since being on medication, I have only been passively suicidal. That is, basically wishing I was dead but with no plan to take my own life. This happened one time in particular when I went off my medication to try to see if I really needed it or not. After being put on medication again I no longer felt this way. I am lucky that I have many protective factors which keep me going, mainly my husband and three children. I know that many people with this disorder do kill themselves and I can understand why. Being on medication is no fun and being psychotic can be even worse.

Being honest with one’s psychiatrist is the best way to

this article. I am a functioning person who happens to have Schizophrenia. As long as I remain on my medication and avoid stress, I do not suffer from psychosis. Those who may not recognize they need the medication or allow stress to take over their lives, are putting themselves in danger of relapse of all symptoms.

Partly through my work and naturally due to my interest in this disorder, I have educated myself on how to treat Schizophrenia mainly with the use of Cognitive Behavior Therapy (CBT). CBT is tremendously helpful to conquer remaining symptoms and to bring further relief to those on the road to recovery. I have written a blog which journals my path to recovery from Schizophrenia. On my blog I have an active link where people are encouraged to write in and share their experiences as well.

You can find her blog at http://mypersonalrecoveryfromschizophrenia.wordpress.com/ Or download the book and read on Kindle for $5.99

deal with all symptoms. I have done this from the start to the best of my ability and have not been sorry. I guess it helps that I completely trust my psychiatrist.

This relationship is very important to me. I want to be as well as I can be so I heed all his advice. I also take my medication faithfully. I know I need it to stay sane and am not willing to risk relapsing back into a psychotic state.

In my job, only one other person knows I have Schizophrenia. At my last job I shared with my boss and as soon as I did or shortly after, my judgment was questioned and I feel like I was pushed out of my job due to my disclosure. I could not prove anything, but learned to be very careful who I share this information with. All my close friends and family know, although I am often stigmatized by my family to this day, despite working and earning my degrees.

I believe this is because many people fear the S word due to misinformation about this disorder and because of how media portrays those afflicted. I am here to say that just because one has this diagnosis it does not mean they are dangerous or unable to function in society.

Many of the people I have shared with are really surprised by my disclosure.

I feel more education is necessary for those who do not understand it. This is part of the reason I chose to write Vol.1 Issue 12

Therapy for adolescents Although it may be hard to imagine, children and adolescents have emotional and psychological needs that can become a hindrance to their lives. Adolescence is the stage between childhood and early adulthood, and it is a vital stage because this is when social, emotional and mental functions are developed and maintained. So, habits such as healthy sleep patterns, problem-solving skills, communicating with others, and learning to manage one’s emotions are birthed and nurtured during adolescence.

The development of these vital functions can be interrupted or disturbed when events related to stress bear negatively on them. Stress may be through unpleasant family life, pressure to fit in with peers, lack of a sense of security, substance abuse, surviving traumatic experiences, exposure to violence, negative media influence, and more.

It is usually the parents and care-givers who notice the changes in their adolescent and may realise that something is wrong. Teachers and other adults may also notice the change. When the adolescent’s behavior changes or they begin to show signs of poor mental or emotional health, what happens next?

First of all, let us look at the different types of mental and/or emotional problems that can develop in adolescents Emotional Disorders: many adolescents with emotional disorders may suffer from depression and/or anxiety. These may be acted out through irritability, anger, emotional outbursts, and often through physiological symptoms such as re-occurring headaches, stomach problems, and nausea. Emotional disorders can have a negative impact on daily functions such as school work, socializing with friends or family, and may lead to negative coping habits such as addiction and self-harm.

Childhood behavior disorders: conditions such as attention deficit hyperactivity disorder (ADHD) sometimes presenting with difficulty paying attention, being overly active, and recklessness. Conduct disorder is another one to be aware of. It may present with symptoms such as destructive or challenging behavior which may lead to problems with school, problems with social interactions, and in extreme cases criminal behavior.

Eating disorders: adolescents may develop eating disorders which have very negative impact on their growth and development. Although it is mostly females who struggle with this type of disorder, many boys can be affected. Eating

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disorders include anorexia nervosa, bulimia nervosa and binge eating.

Psychosis: symptoms of psychosis can develop in adolescents and have the potential to limit growth and healthy development., as well as their daily functioning. Early detection of psychological disorders is very important at this stage because it will allow for the condition to be controlled with the right treatment while making room for the child to live a somewhat normal life.

Risk-taking behavior: many adolescents may go through stages of rebellion and bad behavior, however for others it may be in the extreme. Behaviours such as substance abuse, alcoholism, risky sexual choices, violence, and exposing ones-self to dangerous situations. Such behaviours may be engaged in to cope with poor mental health even though they contribute to poor health, poor growth and development, and avoidance of addressing the root problems the child may be trying to cope with.

Suicide and self-harm: most of the above mentioned challenges faced in the adolescent years need to be addressed at the earliest opportunity. Lack of intervention and treatment may in the extreme case lead to self-harming behaviours and even death by suicide. The WHO estimates that suicide is the third leading cause of death in older adolescents between the ages of 15 and 19 years. Risk factors for suicide include substance and alcohol abuse, stigma against seeking help (therapy/counselling), lack of resources for the challenges they face, lack of knowledge on matters such as self-awareness and self-esteem that may help with developing healthy coping mechanisms.

What can be done to help? The WHO suggests the following factors: - Early detection that will inform on the right diagnosis and treatment - Reducing over-medicalization and institutionalization of young people - Promoting non-medical approaches - Respecting the rights of children in line with the United Nations Convention on the rights of the Child There are guidelines and strategies made available on the WHO official website to help those who are invested in working with mental health issues in children and adolescents.

- Global Accelerated Action for the Health of Adolescents (AA –Ha!) Guidance to support country implementation.

- Global Strategy for Women’s Children’s and Adolescents Health 2016 – 2030 - Mental Health Action Plan 2013 – 2020 - Mental Health Gap Action Programme (mhGAP) Should you need tools for treatment of children or adolescents, you can access the following at www.who.com/adolescentmentalhealth - Assessments - Psychological first aid - Clinical management of mental disorders - Mental health system recovery Getting help for your child does not have to be a scary or complicated process. Most professionals are trained and skilled in helping both parent and adolescent when faced with mental health challenges. The best step to take is the first step!

Remember the following: Your child’s illness is not a sign of your failure as a parent. Your response to their illness and how you fight for their wellbeing is what determines your character as their parent.

Your child asking for help does not make them weak, it means they are smart enough to realise something is wrong, and to seek help rather than burry it away.

Seeking mental health care for your child will not mean that you expose your family drama to the world. Most therapists and psychiatrists work on the strong ethics of confidentiality and discretion.

Deciding not to help your child with the right mental health care is not a wise choice. They need your guidance, support, and love as they engage with a professional in order to heal.

Be a listener.

If you or someone you know needs to speak to a mental health professional for their child, please refer to our resources section for contact details.

Vol.1 Issue 12

where they need to humble themselves. It is no longer enough to tell a teenager because I said so! but rather change the approach and explain as well as allowing room for growth while facing consequences. Culturally, we are taught that grownups are always right, but as we all know, all human beings can be wrong. Holding on to this belief has had a negative impact on modern parents because of what they experienced in childhood, and it is also damaging to the next generation.

Adolescents and Mental Health A discussion with Taonga Nkosi where she shared some insights on some of the challenges adolescents are faced with Interview by Steveria Kadangwe Many adults regard teenagers as difficult and sometimes act like they were never teenagers, forgetting the emotions and feelings that teenagers go through. Due to cultural factors, many parents are not open with their children on topics such as teen experiences or menstruation. Instead of youngsters being prepared for their teen years, the end up being traumatised when they go through experiences they know nothing about. *Parents often avoid talking about relationships or giving advice that can help teenagers.

Although times are changing, it seems adults are not ready to be open about such things.

As children are growing up, parents also have an opportunity to parent themselves as they parent the children. Parents can choose to be more self-aware and pay attention to their children and how they react to life. They may have children who irritate them, perhaps due to the parents’ past experiences or negative events that can be triggers and cause them to take out their frustrations on their children instead of being supportive or helping them overcome challenges. Parents therefore need to build skills to deal effectively with their triggers and focus on personal growth while striving towards parenting better.

When children reach teenage years, they no longer look at parents as superheroes and they do not always believe what they are told.

They challenge and question parents and test everything they were taught. They try to see what they can get away with. Children reaching teen years is a call to humility for parents and a place 21 | E s s e n t i a l G r a c e M a g a z i n e

If an incident happens, instead of asking a teenager or child to explain, many parents often do not even listen. They interrupt and start berating and verbally abusing the child, telling them they should listen and invalidating their experience. Sometimes parents hear other adults talk badly about their children, and go straight to yelling, instead of giving the child a chance to explain. The adult’s perspective is believed above one’s own child. Even if parents do not agree, it is important to validate children’s feelings and experiences. As children or teenagers under our care, they need to know that feelings are normal and parents and grownups should help them deal with them and express them in a health way. It is not healthy for parents and adults to continue invalidating the feelings of children and then suddenly start recognising them when the child is a grown up.

The other challenge is that parents do not invest time and effort in emotionally helping children and rarely approach them with love.

Some parents speak to children only when there is need for discipline, but parenting is not just about discipline. Parenting is about giving love and attention and filling a child’s emotional tank.

Discipline without love is abuse.

Parents get caught in the cycle of not really speaking to their children and only talk to their children when they do something wrong. Parents are too absorbed with phones, work, books, cooking, events and do not pay any attention to anything or give focus on their children. Once a child fails or does something wrong is when a parent calls their name (often in anger) and notices them.

Instead, parents need to spend time nurturing children and telling them stories, engaging them and participating in mutual activities.

Parents should help children feel like they are seen. In addition, parents should not just say no to everything that a child asks.

Parents should not just share negative stories like if you do that, this (bad) thing will happen to you. Instead, they should inspire children and become vulnerable about their own experiences so that children can learn from them.

When parents build this kind of relationship with their children, they in turn will open up. This will help build and strengthen the parentchild relationship. There are so many parents, for example, who assume a girl is having a relationship with any boy they see her with. Or, parents respond to peer pressure from other parents who say your child is hanging out with such and such ‘bad’ kid. When parents do not listen, the children and teens will shut down and not say anything. This should not be the case when parents talk to children, they should have already built a relationship so that the

teen or child can open up and tell them what is happening in their life. Sometimes, parents need to practice self-restraint and only listen without offering advice even if the situation is complicated or difficult - they can give their children tools to solve some challenges they are facing.

One thing that causes damage is silent treatment. The silent treatment can be abusive. Yes, there may be instances when a parent is heartbroken or hurt, or have nothing to say. Sometimes a child or teen can trigger past traumas that a parent has not dealt with and force them to start facing the triggers and the parent feels the best way is to keep quiet to avoid being abusive. It is difficult but as a parent, one needs to be conscious about one’s own reaction.

It may even help to share those feelings and what a parent is trying to figure out. The experience can change from a negative to a positive one and cause both sides to learn from the other, creating an enriching experience. When parents share as human beings, children feel like they can approach their parents and be vulnerable, but parents need to resist turning their child’s shared stories and experiences against them. Parents should share from their own negative experiences with honestly and love.

When talking to kids it is important to use I statements, for example you can say when you went out and stayed out late, I felt anxious and uncomfortable. Do not say you made me feel anxious and uncomfortable. Chose to have conversations that put you and your child on the same wave-length so that neither of you is misunderstood.

Teen suicide rates have been increasing and one of the causes is due to substance abuse. Alcohol and drugs alter perception and leads to the user losing touch with reality. The other aspect is that adults may think that teens are committing suicide due to petty reasons, but usually, suicide comes out of a culmination of issues.

Some may be feeling neglected, alone and not cared for. This is especially true nowadays when everyone has such busy lives and parents are giving things to children while pursuing successful lives instead of spending time with their children. As a result, when something happens, children may feel hopeless and kill themselves.

Parents need to be intentional about making their children feel special and that they matter. It is very easy to give off the effect that the teenagers or children are an inconvenience and they do begin to feel like a burden and an inconvenience.

In addition, constant criticism against a child does not make them hate the parent, but they start hating themselves. If parents are just critical and only speak to them when they do something wrong, children will react. Attempting suicide is one way they can use to get attention because they have such a deep need to connect with the parents. Parties and lavish gifts do not communicate love to the children. Parents need to listen, really listen to their children and build relationships. *parents include guardians and care-givers

Vol.1 Issue 12

…

The Value of a Good Breakfast

Nutrition and Mental Health

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Vol.1 Issue 12

BREAKFAST, THE MOST IMPORTANT MEAL OF THE DAY.

My name is Madalitso Mgunda. I am a Nutritionist for Emmanuel International Malawi under the World Food Programme Integrated Resilience Management project. I have been working with the team since 2018. For 3 years now into my profession, I have used my knowledge and experience gained in my career, and day to day life to help individuals make the right choices about what they eat, how to improve their health and well-being, and how a person can have access to a healthy diet and lifestyle with resources within their reach.

My profession has allowed me to work within a community setting and with local authority public health teams, where I primarily focus on health promotion using social behavior change communication methods. Throughout my career, I have supported individuals, communities and workforces to make positive, practical changes to their food choices and general health, I have provided specialist advice on healthy eating to particular client groups’ such as pregnant and lactating women, adolescents and the elderly. Through advocacy for behavior change using nutrition information, education and communication, today dear reader I would like to briefly tell you the importance of having breakfast each day.

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‘Breakfast’, as suggested in its name is meant to break the overnight fasting period, as you stay for long hours without eating. During the night your body uses up glucose that was gained during the day to keep blood sugar levels stable, which is so important for your brain and other organs as they rely entirely on glucose for energy. Once the glucose stores have been depleted, your body will utilize stored fatty acids to produce energy which lowers your energy levels by a significant amount. Therefore, breakfast is meant to replenish your glucose supply to boost the energy levels.

Many researchers have alluded to breakfast being the most important meal of the day, well, here are some of the reasons why; because breakfast replenishes glucose levels, brain functionality is improved. Breakfast boosts your mental performance because you’re less likely to feel sluggish. By feeding your brain the energy to get going, you are more likely to focus, be attentive and concentrated, otherwise, without feeding your brain the needed energy, other tasks will feel harder to accomplish. By maintaining blood glucose levels in the morning after eating breakfast, you may have reduced risk of type 2 diabetes and heart disease in the long term, and with various essential nutrients obtained, one is assured of good health. Breakfast will also help you control your weight, and I know a number of weight watchers have cheated us into thinking that a good way to reduce weight is to reduce overall energy intake and skipping breakfast can help you reduce weight but, research shows that breakfast eaters tend to be more physically active in the morning and eating breakfast will prevent large fluctuations in your blood glucose levels helping you to control your appetite and keeps you filled up before you become really hungry. If this is not enough, you’ll agree with me that having breakfast will reduce the likeliness of you grabbing whatever food you find nearby when hunger really strikes, and believe you me, the foods that are readily available and convenient are high energy, high fat foods with added sugars and salt which are detrimental to our health.

breakfast option, but with the few resources within our reach we can make a healthy ideal breakfast. Malawi is so privileged to have various food in season, such as fruits in each season, thus some of the breakfast foods that we can have are fresh fruits with added natural yoghurt i.e. Mangoes, Papaya, bananas, Peaches and Avocados, fresh juice from different fruits, wholegrain cereals or whole meals such as M’gaiwa porridge or Soy bean flour porridge mixed with ground nut flour and whole grain bread, fresh milk, poached or boiled eggs, salmon and vegetables e.g. mushrooms, tomatoes, green beans etc. My personal favorite breakfast with my busy schedule is any oat porridge with fruit and a cup of coffee. But when it comes to traditional breakfast I’d eat rice porridge mixed with groundnut flour any other day. Foods that are high in energy, high in fat and added sugars are not good breakfast foods and not all food labels are legitimate, let’s make better food choices.

As a Nutritionist, I do not recommend skipping breakfast, though certain situations which are inevitable may result in us not taking this meal, and if you do skip breakfast, try a nutritious snack such as fresh fruit, yoghurt and veggie snacks.

Therefore, my professional advice would be’ “Good nutrition is not just about the number of meals you have each day or the quantity of each meal, it is the quality, so if you do not have breakfast, aim to make up for the nutritional content you missed at breakfast with your lunch and dinner, and remember, healthy snacks are better than any snacks”.

Unfortunately, skipping breakfast is very common, I admit, even I have done it a couple of times, and for a number of reasons, skipping breakfast seems ok, but this should not be a habit. A good number of us skip breakfast due to some of these reasons; lack of time, trying to lose weight, too tired to bother, bored of same breakfast foods, don’t feel hungry in the morning, no breakfast food readily available in the house, cost of buying breakfast and other cultural reasons.

Some Malawians have few breakfast options and lack diversity as well. A significant population relies on leftovers such as Nsima for breakfast which is not recommendable Vol.1 Issue 12

Nutrition for Mental Health

By Noelle DeSantis, MS, RDN, CDN

we increase the risk of nutrition-related diseases such as type two diabetes and hypertension. Some mental health conditions can cause changes in appetite. Skipping meals can lead to deficiencies of important nutrients, making matters worse.

Cravings are also associated with mental health conditions.

Carbohydrate cravings are correlated with low serotonin levels.

Promoting healthy levels of serotonin can be accomplished by a healthy, balanced diet, which would decrease cravings.

Our food choices also impact the health of our gastrointestinal (GI) tract, also known as the gut. What we eat can affect the types and the number of bacteria in our gut. Bacteria is very important for our health. While we all have some pathogenic, or “bad” bacteria in our gut, we also have symbiotic or “good” bacteria as well. The good bacteria help protect us from bad bacteria. They also support healthy immune function and healthy GI function overall.

You may be wondering what your gut has to do with mental health, and the answer is quite a bit! When we eat foods that are rich in fiber, the fibers are not digested and absorbed by us.

Nutrition plays a key role in promoting mental health. A diet that provides all essential nutrients will prevent any deficiencies, which may contribute to mental health conditions. Proper nutrition, including adequate fiber intake, promotes healthy gastrointestinal (GI) function. Food choices can impact our mood and even future food choices. Nutrition can impact mental health conditions such as, but not limited to: Depression Anxiety disorder Schizophrenia Obsessive-compulsive disorder Unfortunately, nutrition is often overlooked when treating mental health conditions. Without proper guidance and support from a qualified healthcare professional, it may be difficult to make diet changes and stick with them. With mental health disorders impacting an estimated 264 million people globally, and depression one of the main causes of disability worldwide, it is an important topic.

Where Food Meets Mental Health Our food choices, mood and mental health are very interwoven.

Our mood often drives our food choices. Our food choices can drive our mood and future choices. This impacts not only our mental health; it can lead to other chronic diseases too. When the food choices are consistently snack foods with few nutrients, 24 | E s s e n t i a l G r a c e M a g a z i n e

craving certain foods. Eating sugary foods and refined carbohydrate foods will satisfy cravings in the short term, often leading to a spike and a drop in blood sugar which then leads to more cravings. This cycle can negatively affect your mental health.

Helpful Diet Patterns Some diet patterns have been found to reduce risk of mental disorders, depression, and cognitive health disorders. One of these is a Mediterranean-style diet pattern. The Mediterranean diet is associated with a 30% reduced risk of depression. This diet pattern has benefits for both adults and adolescents. The pattern is rich in: fruits, vegetables, whole grains, fish, lean proteins, nuts and seeds When compared with the western diet which is comprised of more processed foods and added sugar, the Mediterranean diet is richer in fiber, nutrient dense foods, and healthy fats. These nutrients are what are thought to be protective against mental health conditions.

They make their way to the large intestine where bacteria get to ferment them. Fiber can be thought of as the preferred source of food for the bacteria in the gut. Feeding good bacteria helps them grow. In turn, this increases the products the bacteria make which benefit us. These products include nutrients such as short chain fatty acids, vitamin K, biotin, and neurotransmitters.

Small changes are easier to maintain than trying to overhaul your whole diet pattern. Begin with a goal such as decreasing added sugar and processed foods, that is a great place to start when promoting mental health.

The short chain fatty acids are the primary source of fuel for the cells in our GI tract.

They help us effectively digest and absorb the nutrients we need to feel well. The bacteria can also produce a variety of neurotransmitters. These are messengers that allow communication between our neurons. One of the neurotransmitters produced is serotonin.

Studies show that people with mental health conditions are often lacking in certain dietary nutrients, essential vitamins, minerals, and omega-3 fatty acids. The most common nutritional deficiencies seen in people with mental health conditions are Omega-3 fatty acids, B vitamins, minerals and amino acids.

If you have not heard of serotonin, many people refer to it as the “mood” neurotransmitter. It is estimated that 90% of our serotonin is produced in the gut. In addition to regulating mood, serotonin is involved in regulating sleep, appetite and other body functions. These all can impact mental health. For example, our body needs enough serotonin to produce melatonin, the hormone that promotes sleep. Sleep is an important part of managing mental health. Low serotonin leads to increased carbohydrate cravings, can interfere with sleep quality, and can make depression worse.

Key Nutrients

Nutrient deficiencies can arise for various reasons. These include: Picky eating habits Lack of variety in the diet Poor absorption due to medications or bacterial overgrowth Avoidance of food groups due to allergies, intolerance or preference Physical limitations Poor appetite Food insecurity

There are a number of nutrients required to produce serotonin.

If your body isn’t getting the right nutrients, you may start Vol.1 Issue 12

It is important to make sure you meet your nutrient needs for all vitamins and minerals.

Other Considerations Genetics There are genes that may be associated with mental health issues. It is important to remember that just because you have a specific gene it does not mean that it is your destiny. Our lifestyle and environment also influence our gene expression. This is something that will vary person to person, and is another topic of its own. An example of how genes can affect nutrition and mental health is the connection between the MTHFR gene and depression. People with this gene may have reduced MTHFR enzyme activity, which can affect the level of the nutrient Folate in the body. This can increase the risk of depression.

Medications Many people managing mental health disorders will be prescribed medications. It is very important to consider the side effects of these medications. It’s also important to note any food/drug interactions. Certain medications may increase or decrease appetite. A decreased appetite will impact your overall intake of essential nutrients. On the other hand, increased appetite can lead to excess calorie intake and can lead to weight gain. Additional body weight can make physical activity more difficult and impact mental health further.

Take Home Points

Noelle DeSantis, MS, RDN, CDN is a registered dietitian nutritionist, specializing in integrative and functional nutrition.

Noelle received her Bachelor of Science in Nutrition from San Diego State University, and her Master’s Degree in Nutrition from University at Buffalo. She works for Buffalo Nutrition and Dietetics, PLLC, specializing in neurological disorders out of their office at DENT Neurologic Institute in Buffalo, NY. www.buffalonutritionand-dietetics.com

Find this article at the Foundation for Female Health Awareness at www.buffalo-nutritionanddietetics.com If you prefer to follow more African diet, why not get some inspiration from the Oldways Preservation and Exchange Trust illustration.

A healthy balanced diet pattern with nutrient dense foods can help prevent and manage mental health disorders.

Healthy choices for mental health include: Avoid added sugar, highly processed foods, and sugary beverages.

Eat adequate fiber daily to promote a healthy gut microbiome.

Eat adequate protein to provide building blocks for neurotransmitters.

A balanced diet includes vegetables, fruits, whole grains, legumes, nuts, seeds, fish and other lean protein and healthy unsaturated fat.

Make sure to get plenty of restful sleep and regular physical activity.

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Nutrition program The program provides nutrition services such as nutrition supplementation to children with acute malnutrition, assessment and referral to other health providers for nutrition supplementation and training of caregivers/parents in nutrition.

Elvira institute of special needs education

St John of God Hospitaller Services The Child Development Centre (Mzuzu) Portage service It is a family focused home based programme delivered by parents in their natural environment. The program targets children with disabilities from the age of 0 to three years.

The key to its success for this program is partnership approach between staff and parents. The department’s emphasis is on empowering parents with necessary skills to guide their children through early development but also train volunteers as home visitors who facilitates awareness in the community about the portage service.

Sensory Motor Rehabilitation service This is a bio psychosocial service targeting children and adolescents with disabilities from the age range of 4-15 years. The program majorly enrolls children in portage who did not achieve milestones. Other clients are referred from other service providers. The services are provided through clinics in their communities twice a month.

Postural management The program focuses on provision of assistive devices to children and adolescents with physical disabilities. Some of the examples are prosthetics, orthotics, adaptive chairs, walkers, corners seats, toilet seat, standing frames, wheel chairs etc.

Child and adolescent psychiatry services The program focuses on children and adolescents with mental health issues. The department uses bio psychosocial approach in addressing the needs of clients identified.

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The institute provides special needs education to children with special needs from the age range of 3-15 years. The institute is in three sectors; preschool, primary school and pre-vocation center. The institute is transitory in nature.

This means that children do not write Government exams at the center instead they are referred to mainstream primary schools in order to learn together with their colleagues. Those with significant academic difficulties are oriented to the pre-vocation training programs for a maximum of 3 years in order to prepare them for vocation training program.

psychosocial interventions utilizing a multidimensional team approach. The services offered are done in collaboration with the guardians.

Early child intervention/Rehabilitation uses Portage model (home based family intervention program for children from 0 – 5 years) approach that includes: sensory motor group rehabilitative therapy at the community level; Postural Management; Nutrition assessments; Medical assessment and treatment for epilepsy and mental health problems and psychosocial support to mothers and their children.

The Director, Saint John of God Hospitaller Services Mzuzu P.O. Box 744 Mzuzu, Malawi Tel: + (265) 1 311690 / + (265) 1 311495 Email: sjog@sjog.mw The Program Manager, St John of God Hospitaller Services Lilongwe

Respite care program

P.O Box 31067, Lilongwe;

It is a program that mainly targets parents/guardians of children with severe and profound learning, intellectual and physical disabilities with an aim of providing them with a short relief. Thus when children are accessing the services at the department the parents/guardians are able to participate in socioeconomic activities hence improve their families.

Physical Address: Area 43, Off Ufulu Road (next to Emmanuel Teachers Training College); Tel.: +265 992 460 253/992 460 254; Email: sjoglilongwe@sjog.mw

Sports and recreation The program provides different kinds of recreation and sports such as Special Olympics, Paralympics, unified sports and music and dance.

Other services Other services provided to children and adolescents with disabilities and mental health conditions including their families include; pastoral care support, psychosocial support including positive parenting skills program, life skills and child rights.

Early Intervention Services for Children with Disabilities (Lilongwe) Early child intervention for children with disabilities services are offered to children with disability from birth to 5 years.

The services are community based and uses the bioVol.1 Issue 12

Looking for a therapist?

Check out the Therapy Route website for a therapist in your area or online.

Are you a qualified therapist?

Register to get your details online on one of the most accessible sites around the internet.

Find out more on www.therapyroute.com

Youth Net and Counselling (YONECO) Youth Leadership Development Center Complex Along Zomba-Lilongwe Road Next to Calvary Family Church P.O. Box 471 Zomba, Malawi.

Contact number: +265 1 526 199 Email: executive@yoneco.org www.yoneco.org 27 | E s s e n t i a l G r a c e M a g a z i n e

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Address

Area 47/2/50, Lilongwe.

Postal Address

P.O. Box 31105, Lilongwe 3

Phone Number

+265 880 91 70 90 | +265 888 89 65 20

Email

malawimac@gmail.com

Website

mwcounselling.org

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