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Yasser M. Ahmed Yemen Times Human being is an aggregate of contradicting sentiments and feelings. The thought of mental health is just as important for him as that of water, food and medicine. Recent studies show that some of mental diseases were known since 5000 B.C. Psychotherapy is a multifaceted field which was the result of the development of knowledge about mental health. Islamic scholars were the first to classify diseases and human behavior according to their source, kind and degree. Avecena was considered to be a pioneer sergeant and psychologist. He described depression, worry and tensions and their effects on the body. Averroes had made a distinction between severe diseases and permanent mental diseases. The first sanitarium was established during the reign of Imamin. It is reported that after a few centuries Kerblin applied Muslims theories to the treatment of mental sickness. Some of the outstanding scholars who contributed a lot to the science of psychotherapy are as follows: a) Paracelus (1493-1541) who discarded astrology and concluded that there were some concrete, analyzable reasons behind mental diseases. b) Charct and Askerol were some of the most famous psychiatrists. c) Pritchard, Sygan and others committed themselves to the study of psychology and excelled in it. In our country we are in urgent need of further study in this science. We have to plan out and draw up strategies to start from the point others stopped at. The spread of mental diseases in our country is quite discernible in the past few years. It is triggered by social and economic reasons such as family problems, migration, divorce, increase in the number of qat chewers, deplorable economic conditions, especially after the Gulf War, accentuated by the return of a large number of Yemenis. One of the incentives that prompted me to conduct this survey is the First Mental Health Activities Meeting during (27-29) 2000 in which there were illuminating lecturers about the victims of obsessive compulsive disorders and their negative impact on the society. Dr. Ahmad Maki, specialist in mental diseases, talked about the preliminary steps to develop the network of services in the area of mental health in our country since 1982 when a number of specialists graduated. The graduation ceremony was attended by an advisor from the International Mental Health Organization. It was held in the Southern governorates before the unification. Since then, mental health services began, though in a limited scale, in Taiz and Hodaidah. In the past the government used to send mental patients to be treated abroad which used to cost the exchanger huge sums of money. However, if mental health centers are available in the country, more patients will be better treated here, saving the precious foreign currency reserve of the country. Therefore, it is of prime importance to establish these centers, so as to treat these patients, the majority of whom are still occupying key posts in the country. This can make them valuable assets to the country rather than making them a burden on it. The government has started giving more attention to psychiatric patients and a number of important decisions have been taken by the Cabinet to help them. The Cabinet also earmarked the funds for establishing a sanitarium for mental diseases in Al-Thawrah Hospital Sana'a. A short-term plan for 1984-1985 was also drafted, the objective of which was to create a central administration in the ministry of Health that would be responsible for developing facilities for treatment of cases related to psychiatry in different governorates of the Republic. In December 1986 a seminar on obsessive compulsive disorders was organized in collaboration with the World Health Organization in Geneva and Alexandria. A Yemeni team with the members from the Ministry of Health and the university participated in it. In the seminar the participants discussed and outlined the agenda for treatment of the mental diseases. Yemen was the third country to present its action plan to the WHO. Eventually, the then southern part of Yemen was making slow progress in the field of psychiatry. Regular treatment of patients started at the beginning of the 1960s by the British demonstration for the first time. That was in the central Prison of Aden. Then, Al-Salam sanitarium was established by the British government in Sheikh Othman in 1966 to quarantine the sick people and treat them in a far off place. Then there was a trend to establish such projects for ensuing the mental health of the people. In pursuance of this in 1985 the Educational Psychiatry Hospital was inaugurated in Aden. However, There was a marked focus on the educational side. The psychiatry program which was funded by the WHO ran a training program inside the hospital. Meritorious students were sent abroad for further studies. After the unification efforts were further consolidated in the hospital. As Dr. Zaki Mubark Saeed, general manager of the hospital, said "The progress achieved so far in the psychiatry field is very important and essential for the society to protect it from different mental diseases." Aminah Rezk, chairperson of the educational and psychological guidance, Faculty of Education, Amran, said "Mental health is the overall outcome of all the psychological activities of the individual. It is a goal everyone seeks. However, the point is, do we have a qualified cadre of physicians who are able to render the necessary psychiatric services? We can take the Educational and Psychiatric Department in Amran as an example. The college was opened in 1995\96. The number of students who joined this department were 265. There was a continuous increase in the number of students joining this department. The department helps individuals of our society to overcome whatever mental problems they suffer from. These cadres help the Ministry of education, Ministry of Labor and technical training, Ministry of Interior and social affairs and Prisons' Authority, Ministry of Health, etc."Despite the sincere efforts of the government to train a qualified cadre, there are lots of obstacles that stand on our way to establish centers for mental health or psychiatry. Regarding these obstacles, Dr. Faraj Ba Saleh, specialist and chairman of the mental diseases, Avecena, Al-Mukala, said "Obstacles standing at establishing a prosperous mental health in Yemen are a lot which include the social beliefs, misunderstanding of some religious concepts, lack of trust in the psychiatrists, limited qualified staff, ignorance of the importance of this science not to include it in the schools' curricula, attitude to the specialist in this field and the prevalence of conjurers. The problem was aggravated by the absence of laws to regulate application of relevant rules." Dr. Abdul Rahman Salam, assistant professor, faculty of Medicine Sana'a University, said "There is also the problem of lack of cooperation on the part of our people. For example, some Yemenis have mental diseases. However, they do not consult a psychiatrist because the patient feels shy to reveal it resulting in the disease being serious. Of course, big families, strong faith help a lot to decrease the incidence of this disease. Other obstacles are the abnormal behavior of some patients which are not properly understood by the people around. Thus, the people should be aware how to differentiate between normal and sick behavior."Dr. Mohammed Al-Tushi, faculty of Medicine, who is researching on some mental patients, said "I have made different studies on mental diseases. For example, the case of S.M.S who is 19 years. He is suffering from a mental problem due to which he commits adultery and thefts. After studying his case, I found that he has an anti-social personality. He was found to be suffering from some mental problems even before he was 15. The mentally sick people suffering from schizophrenia are prone to lie, escape from home, steal, be skilled to insinuate others to commit illegal acts like cheating. If medicine is not timely used, there will also be greater possibility of committing suicide. You can not trust them for they may do things unaware of their results. Whatever the results, such patients are always indifferent. Such cases should be carefully studied and be given the attention needed so as to give proper relief to their families and retrieve the situation before it is to late." Dr. Al-Tushi also recommended that specialists in psychiatry have to make researches about the mental disorders that youth may be exposed to due to the migration of youths. He appealed to all universities to invigorate intensify the researches on such phenomena as Qat chewing, carrying weapons and deteriorating family relations. Another study was made by teacher Somiah Al-Tamimi. She reported that the obsessive compulsive disorders are prevalent more among adolescents. It affects their mental health and the harmony with their surroundings. This disorder has three parts: 1- Compulsive thoughts. 2- Compulsive rituals. 3- Compulsive thoughts and rituals. Such thoughts and rituals are forcibly accepted by the patient despite his full realization of their inappropriateness. The study pointed to the conclusion that parental care with their children plays a vital role and that the parents' strictness to make their children obey their orders leads to mental sickness in children. This creates an inner conflict inside the child between what he himself wants and what his parents want. She added that treatment of such syndromes should be tempered with mercy and love. There are many researches which highlight mental diseases. These suggest a number of remedies to lessen such diseases in the society. Anwar Al-Dhabhany, MA mental health, Mental Health Institute of the armed forces suggested building mental health service centers in the military cantonments, teaching basic psychiatry courses in schools, conducting field surveys and familiarizing the society members with elementary principles of mental health. Dr. Faraj Basaleh thinks that remedies should arise from spreading the awareness about mental health among people through specific programs especially through, TV, seminars, mosques, etc. Amat Al-Rahman Hameed and Zohrah Al-Nihari suggested building mental health centers to take care of those who suffer from mental problems and organize qualifying cadres working in the same domain. They said that the government should have statistics about the number of psychiatric patients in order to find the suitable solutions to the problem in a planned manner. We hope that in days to come health psychology will be paid full attention to overcome all the difficulties specialists are faced with in their work. By: Abdulkadir M. Al-Ariqi Environment/Development Consultant In response to environmental and economic needs many developing countries in the Middle East and Latin America introduced since long time the development of re-use system for agricultural irrigation in order to decrease the pressure of population growth, increasing urbanization, industries and agricultural requirements, considering the wastewater reuse in the framework of water resources. In fact, there are many economic benefits resulting from re-using waste water safely such as: recovering arid lands for agricultural purposes, creation of employment opportunities; increasing food production and improving nutrition and above all finding an alternative to sewage disposal and their corresponding pollution and public health problem. In other words by re-using the treated sewage, the polluting effect of discharging it into the environment, will be avoided. However the following problem arose: many countries started reusing untreated domestic sewage for irrigation in response to the pressure of water shortages and protein shortfalls. Thus these have posed some health risks for the farm worker and for the general population consuming agricultural products from sewage re-use sites (CEPIS). AS an example, in Latin America in Chile, Mexico City and Peru, problems of health hazards appeared after re-using waste water containing heavy pathogens; in fact in Chile, 57% of the population have been infected with Salmonella, and 30% with typhoid and antibodies. According to the epidemiological data collected by the researchers in the area, (campus)1 for the populations in the district producing the sewage (at Sanjuan)1 and those consuming the produce from the re-use site, it appeared that the most prevalent infectious diseases in the area are: acute diarrhea diseases (principal agents are rotavirus, entro toxigenic and entropathogenic E coli, Salmonella, and shigella) typhoid and paratyphoid fever; viral hepatitis polio; and intestinal parasites such as Entameba histolyica and giard'a Lamblia. The mortality and morbidity associated with these diseases in line is shown in table I. The above mentioned example indicates that the greater public health risk contains in "NOT Anticipating re-using projects" and planning for it appropriately and accurately, but what so ever the need might be it should not be at the cost of harmful effects on human health that might be caused by exposing to pathogen and toxic substances contained in untreated wastewater. Thus the main objective in re-use project should be to minimize the exposure and reduce the potential health risk without unnecessary discouraging wastewater reclamations. Wastewater re-use for irrigation The practices for wastewater re-use for agricultural irrigation proved successfully in many parts of the world especially in developing countries with water resources scarcity such as: Jordan, Saudi Arabia, Peru. On the other hand agricultural use of sewage sludge (night soil) has been applied particularly in the Far East countries for many centuries. In fact, in many countries of Middle East with severe water scarcity such as: the Republic of Yemen the main source of water for agriculture is groundwater and due to the limitations and over exploitation of that source, many countries in the region looked or are looking for other alternatives to be used for agriculture irrigation. As a matter of fact re-use of wastewater became a fact and a means of water conservation and pollution control. Many private farmers by their own initiative, especially in Yemen, started using waste water for irrigating their farms. This is a clear indication of the high demand for agricultural re-use in respect to the extreme shortage of water resources and high pumping costs. In doing so equal quantities of fresh water can be made available for potable water supply. this practice of re-using might encourage to re-consider waste water as an essential part of a water resource plan or to include it in the national water policy. In addition to the sewage sludge, agriculturally there is an obvious benefit of waste water-reuse through conserving water resources, and using it as a fertilizer especially providing nitrogen to the soil. The recovery of the nutrients will help in reducing the direct cost to the farmer and his dependency upon inorganic fertilizer often imported from outside. If the irrigation operation is managed appropriately the water-resources (surface and ground water) could be protected from pollution such as high nitrate concentration due to the use of fertilizers on irrigated land. The treated waste water re-use in irrigation will contribute significantly in improving or controlling the ground water resources which are the main sources (especially in Yemen) for agricultural irrigation provided that irrigation management system would be based on:- - High frequency irrigation without increasing the applied treated effluent. - Application of the needed effluent in amount just sufficient for plant growth having almost no excess effluent to percolate into the ground water basin. - Application of the needed effluent with low pressure orifices or close as possible to plant roots. Understanding STRABISMUS What is Strabismus (Syn. Squint)? It is abnormal eye movements where the affected person uses his/her good eye to concentrate while the affected eye moves inward, outward, upward or downward. About four percent of children are affected of some sort of strabismus. What are the causes of Strabismus? There are different causes for strabismus (squint): - 1. Paralytic Squint Ð due to paralysis of one of the nerves supplying the muscles of the eye. 2. Non-paralytic Squint Ð due to long sightedness or it can be congenital (which appears within the first six months of life). What are the symptoms of Strabismus? The patient or the parents of the child notice that there is imbalance of ocular motility. How is Strabismus diagnosed? The eye doctor will determine if the child has "pseudo-strabismus" or "real strabismus". Pseudo-strabismus can be diagnosed easily by the eye doctor but he/she has to do all the eye examination required before saying that the child's eye are normal. If the strabismus is real the eye doctor will do the eye examination and investigations required detecting the type and cause of the squint. Knowing the type of squint helps the eye doctor to give the correct treatment. What is the treatment of Strabismus? ¥ The first step is to diagnose the type and cause of the squint ¥ Treatment of amblyopia (lazy eye) after checking the vision of the child. Remember that amblyopia can only be treated before the child is eight years old otherwise it becomes untreatable ¥ Examining the back of the eye (the retina and optic nerve) and checking the eyes for glasses. These tests are performed after putting drops or ointment to dilate the pupils. ¥ Certain types of strabismus need an operation to correct it. REMEMBER: ¥ If your child have strabismus, you need to take him/her to your eye doctor for an eye exam as soon as possible. ¥ Amblyopia (lazy eye) can be treated before the child is eight years old otherwise it becomes permanent. ¥ Certain types of strabismus are treated with glasses while others are treated with surgery. Routine eye exam by an eye specialist is very important. It is your sight and your eyes need every care they deserve. ------ Mahfouth A Bamashmus FRCSEd, FRCOphth Consultant Ophthalmic Surgeon Ibn-Al-Haitham Clinic University of Science & Technology, Sana'a |
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