People of AMPATH: Dr. Edith Kwobah, Psychiatrist

A humble background* inspired Edith Kwobah, MBChB, MMed, PhD, to pursue a career that allowed her to serve those with the greatest needs. In honor of Mental Health Awareness Month, Dr. Kwobah, head of the department of mental health at Moi Teaching and Referral Hospital (MTRH), shared her inspiration and passion for expanding mental health services throughout western Kenya.

How did you get interested in mental health?

For me the behavioral science lectures in first year of medical school were the most interesting teachings. I remember a professor telling us that there is a reason why people behave how they behave and I thought that was deep. The second lecture I remember vividly was on mob psychology and that too was very interesting to me.

Then we went for clinical years and the visits to Mathari Hospital, the largest mental health facility in Kenya, made me feel that these were "the least of these" as written in scripture, and I thought it would be great to serve them. I graduated in 2007 and proceeded to my internship, and of all the rotations we needed to do for the one-year period, I loved the psychiatry rotation the most. After internship I practiced medicine for two years before returning for a master’s degree to specialize, and during that period, the love for mental health was cemented. I loved to counsel patients who had psychological issues in general wards.

The only other two possibilities were OB/GYN and forensic pathology. I loved doing cesarean sections, but the adrenaline when things got complicated was too much, and it really hurt to lose a mother or a child, thus Ob/Gyn was off the list.  While I was thrilled by forensic issues, the more I practiced medicine the more I realized that I am a people person, so I won't do well with microscopes in the lab and off went the forensic pathology. By the end of the second year of general practice, I was sure I was going back to do psychiatry. For me it has been a very satisfying job as a clinician, teacher, researcher and advocate of mental health. Given another chance, I would still choose psychiatry.

How did you start working with AMPATH?

I graduated with a Master of Medicine degree in 2013 and worked in Kakamega County Hospital for a year before I relocated to Eldoret in 2014 to join my husband. Once I came to MTRH, I heard about Professor Joe Mamlin and his work. I was thrilled. I wrote a one-page concept about mental health services and walked to his office, not knowing what I wanted him to do with it.  He was so excited to hear what I wanted to do. He immediately introduced me to people like Adrian Gardner, then the executive field director for the AMPATH Consortium, who connected me to get a Fogarty Fellowship through Duke University. I received funds from Indiana University to pilot mental healthcare in Mosoriot and later in Nandi…and here we are. We haven't stopped moving! Since then I have been involved in several activities geared towards increasing access to mental healthcare in the primary care and community settings. I am also participating in various research being conducted within the AMPATH consortium.

What are the biggest challenges in Kenya related to mental health?

Limited resources for mental health, stigma and lack of knowledge about mental health in the general population are the biggest challenges. Mental health in Kenya has always taken a backseat. For the longest time the priorities, understandably so, have been HIV and other diseases that cause mortality. But unfortunately, we also know that many people struggle with mental illness. There are less than 150 psychiatrists and slightly more than 500 psychiatric nurses for more than 40 million Kenyans. The society we live in doesn’t understand that this is an illness. As long as you don’t have a fever or your pressure is not high, than it is assumed that you are well.

How are you (and your AMPATH colleagues) working to address these challenges?

We have been leveraging on the gains by AMPATH on the care that they have been giving for HIV and diabetes. What we have been trying to do is build capacity for the clinical officers and nurses who are in the primary care settings who are taking care of other illnesses. Our conviction is that if you can take care of a patient with diabetes, if you can deliver a mother (baby) as a nurse or as a clinical officer, then you are able to recognize depression and initiate care. We currently have about eight clinics in western Kenya with a nurse and clinical officer interested in training.

We have also improved our case finding through increased screening and linking those who are affected to care. We have developed alcohol support groups led by peers who encourage each other to stop using alcohol. Through qualitative interviews, we know that many lives have been impacted. We have recorded many stories of people who would not stop drinking or go to rehab, but their life is changed. We believe this has bridged the treatment gap.

We are also providing community education through workshops with various groups including churches, students, teachers, police and village elders. Support from Indiana University, AbbVie Foundation and currently Astellas Global Health Foundation (AGHF) have helped to make this all possible.

Finally, we are also participating in various research being conducted within the AMPATH settings in order to inform the practice and influence policy.

What impact has the pandemic had on the mental health of people in Kenya?

The job losses, loss of social support systems due to lock downs and social distance, etc. have affected many people negatively. Though no research has been carried out nationally, there is an increase in reported cases of suicides, homicides, substance use and injuries that may be attributed to COVID-19 related psychological distress. 

What makes the AMPATH partnership special?

The network that the consortium brings opens doors for new opportunities. Having the Research and Sponsored Projects Office (RSPO) able to manage grant funds is an asset. 

In addition to the upcoming opening of the mental health transition home, also supported by the AGHF, what other future activities or innovations are you working on?

We are working on scaling up community mental health activities to more sites and also including special groups like youth. I really hope to implement a school mental health program to facilitate early prevention of mental health conditions.

*Read more about Dr. Kwobah from Med Room Eyes blog.