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‘Patients were chained to walls and beds’: Freetown’s psychiatric hospital released from the past | Global development

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His family had accused him of being a demon, Abubakarr Jallou tells a group of patients gathered in a room at Sierra Leone’s Psychiatric Teaching hospital in the capital, Freetown. When the black magic of a local witch-doctor didn’t help, he was beaten by his brother and cast out of the house, he says.

Jallou, 27, has since been diagnosed with bipolar disorder but he is not happy being here. “They sent me here, but I hate staying here. I’m not crazy.”

Group counselling is now part of treatment here at the oldest psychiatric institution in sub-Saharan Africa, which has seen a dramatic transformation in the last few years away from the days when patients would be kept chained.

Facilities are basic – Jallou is locked in a large room with bars on the windows with about 20 other men – but things have changed says Dr Abdul Jalloh, the hospital’s former director. “Until 2018, the hospital was like a prison. Conditions were awful. There was no running water, no electricity, no medicine and the patients were chained to the walls and beds.”

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The human toll of non-communicable diseases (NCDs) is huge and rising. These illnesses end the lives of approximately 41 million of the 56 million people who die every year – and three quarters of them are in the developing world.

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Neighbours lived with screaming coming from the imposing brick building, on a hill in the east of Freetown. The Kissy Lunatic Asylum, as it was known, was there to simply stop patients hurting themselves or others.

But, in a country which has historically paid little attention to mental health, the government has been raising awareness and attempting to counter stigma as part of President Julius Maada Bio’s “human capital” development agenda, which includes education reforms.

Sierra Leone Psychiatric Teaching Hospital in Freetown is the only dedicated mental health facility in the country and the oldest psychiatric hospital in sub-Saharan Africa.
Sierra Leone Psychiatric Teaching hospital in Freetown is the only dedicated mental health facility in the country and the oldest psychiatric hospital in sub-Saharan Africa. Photograph: PIH

The hospital is operating at full capacity, with 150 patients receiving free treatment.

After patients’ chains were removed, the facility was also connected to water and power supplies. Now there is holistic care, which combines therapy and counselling with the latest medication. Yoga classes are offered and there is a basketball court.

Anneiruh Braimah, chief psychiatric nurse,started working at the hospital in 1998, and says the behaviour of patients has improved dramatically since the reforms.

“When people were chained they were very angry. They were throwing whole buckets of pee and poo at us. What we have noticed when we removed chains is that attacks have not increased in any way. In fact, they have decreased.”

One of the biggest issues is substance abuse. Many of the teenagers at the hospital are users of tramadol – an opioid found in cough medicine. Others arrive in a state of psychosis after snorting the black residue on exhaust pipes.

Ahmed Lahai, 21, was brought to the hospital in October by relatives.

“My mother called all the local youth to tie me up in our house; she thought I was smoking [drugs],” he says. “But I broke down the door, which is when they said I was crazy. After that, they brought me here, where I received an injection to calm me down.”

Lahai is being helped with his addiction. He doesn’t know how long he will stay at the hospital, first built by British colonialists in 1820. “The nurses are trying their best for us,” he says. “The only thing is the food – it could be more of a balanced diet than just beans and rice.”

The improvements are largely funded by a US charity, Partners in Health (PIH), which helps the government with running costs.

The hospital’s front desk, where a sign hangs reading ‘Chain-free since 2018’.
Staff at the hospital’s front desk, where a sign hangs reading ‘Chain-free since 2018’. Photograph: Finbarr O’Reilly/The New York Times/eyevine

The charity has given $2.5m (£2m) towards refurbishment. There is now a full-time psychologist and a residency programme, established to train seven psychiatrists which will more than double the five that currently support Sierra Leone’s population of 8.1 million .

The government is preparing to roll out basic mental healthcare across Sierra Leone’s 16 district hospitals in the coming months, which should reduce pressure on the teaching hospital.

Earlier this year, Dr Carol Labor was appointed the first presidential adviser on mental health.

“Reforming mental health in Sierra Leone is a big undertaking, but we are up to the task,” says Labor. “Our aim is to train 10,000 mental healthcare workers in 10 years.”

A key challenge is reforming the 1902 Lunacy Ordinance – a colonial-era law that contains no mention of patients’ rights. Dr Labor says a “patient-centred bill” has been drafted, which includes protections for patient welfare. It should be passed in 2023 – giving dignity back to people with mental health problems.

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Uganda condemned for ‘shameful’ decision to close UN human rights office | Global development

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Rights activists and campaigners have condemned the Ugandan government’s decision to shut down the country’s UN human rights office, describing it as “shameful”.

In a letter to the Office of the UN high commissioner for human rights (OHCHR) in Uganda dated 3 February, the foreign affairs ministry said it will not renew the host country agreement it signed with the OHCHR, which established its initial mandate in the country in 2005. The current mandate, signed on 9 February 2020, expires in August.

“The government of Uganda will now continue its cooperation with the OHCHR Headquarters either directly or through its Permanent Mission in Geneva,” reads the letter.

The development comes less than three months after the UN’s committee against torture adopted the concluding observations on Uganda, which raised concerns that torture and ill-treatment continued to be frequently practised, and called for investigation and prosecution of security officials accused of excessive use of force, violence and arbitrary detention.

“The closure of the @UNHumanRightsUG office proves that [the] government has lost all sense of shame. It no longer wants any close international scrutiny of its human rights record,” tweeted Adrian Jjuuko, executive director of the Human Rights Awareness and Promotion Forum.

“If the protectors are sent away, what then happens to those they were protecting? We are headed for tough times,” he added.

Adrian Jjuuko, (speaking, centre left) executive director of the Human Rights Awareness and Promotion Forum, has condemned the OHCHR closure.
Adrian Jjuuko, (speaking, centre left) executive director of the Human Rights Awareness and Promotion Forum, has condemned the OHCHR closure. Photograph: Alice McCool

Bobi Wine, the reggae singer turned Ugandan opposition leader, whose supporters remain in unauthorised places of detention or “safe houses”, said it was no surprise that Uganda’s president, Yoweri Museveni, who has been in power since 1986, has closed the OHCHR. He tweeted: “In the face of growing international condemnation and isolation, tyrant Museveni has responded by shutting down NGOs, Facebook, DGF [Democratic Governance Facility] & declaring several internationals Persona Non-Grata or deporting them! Now he shuts down @UNHumanRightsUG.”

Wine added: “You’ll recall in the aftermath of the 2021 election and the hundreds killed or abducted by the Museveni regime, we petitioned the UN Human Rights Office & the military brutalised journalists right there. This UN Office condemned these actions. Not surprising it’s being closed.”

Human right activists and advocacy groups have called the decision a “mockery” and accused the government of running from international scrutiny on abuse and protection of human rights.

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“This is unbelievable, and the reasons given by the government are a mockery of the real state of human rights in the country,” said Jjuuko. “To claim that Uganda no longer needs the office [OHCHR] because of its strong stand for human rights is ironic to say the least.

“A strong stand for human rights would imply opening up to the UN and other actors.”

David Livingstone Sewanyana, founder of the Foundation for Human Rights Initiative in the capital, Kampala, told the Guardian, “The decision not to renew the mandate deprives Uganda of a critical player in the field of human rights promotion and protection.”

At least 38 local and international staff at the head office in Kampala and two field offices in Gulu and Moroto stand to lose their jobs.

Jjuuko said: “Following closely on the closure of the DGF, this is a scary move which indicates that the government is no longer willing to have its human rights record scrutinised by international actors.

“This leaves local organisations at much more risk of being further silenced and their work curtailed without the government fearing close international security. It is a sad day indeed for the human rights movement in Uganda.”



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2023 State of the Union address, live | Biden will call for collaboration with Republicans | USA

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On the List: Biden’s guests at the State of the Union address

In the highly theatrical ritual of the State of the Union address, delivered each year by the President of the United States to a joint audience of congressmen and senators on Capitol Hill, the most eagerly awaited list in the hours leading up to the address is that of those invited by the President himself to attend his speech on the floor of the House of Representatives. They are carefully chosen to underscore with their presence the points the president wants to emphasize. This year they range from rock stars (Bono) to anonymous citizens unwittingly placed at the center of a whirlwind of tragedy and media attention, such as the parents of Memphis teen Tyre Nichols, the latest name to enter the history of police brutality infamy in the country.
 
What follows is a list of some of those illustrious guests at tonight’s speech in Washington: 

Bono. Singer of the Irish band U2 and activist for the most varied causes, for whose fight he deploys his worldwide fame.

Oksana Markarova, the Ukrainian ambassador to the United States. She was already invited last year, when Biden’s first speech came six days after the Russian invasion of Ukraine. Nearly a year later, the end of the war seems far off, but the U.S. commitment to Kiev’s cause remains unwavering.

Row Vaughn and Rodney Wells, mother and stepfather of Tyre Nichols. Five police officers beat him to death last month in Memphis. His case, and the poise of his parents, have reopened the debate about police brutality in the United States, an issue that seemed on the mend after the chokehold death of African-American George Floyd at the hands of a white Minneapolis police officer on May 25, 2020. 

Brandon Tsay, another anonymous man at the center of American political power. Tsay disarmed the killer of 11 people in one of the latest mass shootings to horrify the country. It happened in Monterey Park, California, and the tragedy ripped the Asian American community in half. 

Deanna Branch. Lead was found in her son’s blood because of water coming out of the home’s plumbing. The Biden Administration has set a goal of replacing all lead pipes in the country within the next decade.

Mitzi Colin Lopez. Immigrant rights activist, specializing in advocacy for dreamers.  

Doug Griffin of Newton, New Hampshire. Lost a daughter to a fentanyl overdose. Biden plans to stress the importance of the fight against opioids. The drugs have taken the lives of 100,000 Americans by 2022.

Amanda Zurawski, Texas neighbor. She almost died because of restrictive anti-abortion laws that came out of the Supreme Court ruling that eliminated a woman’s federal right to choose.

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High-profile lawsuit against Meta can be heard in Kenya, Nairobi court rules | Global development

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A Kenyan court has ruled that a case brought against Facebook by a former content moderator can go ahead.

Daniel Motaung, who was hired as a Facebook content moderator by the tech firm’s subcontractor Sama in 2019, filed a suit against the two companies last year, alleging that he had been exposed to graphic and traumatic content at work, without adequate prior knowledge or proper psychosocial support – which he says left him with post-traumatic stress disorder.

He also claimed he was unfairly dismissed after trying to unionise his co-workers to fight for better conditions.

Facebook’s parent company, Meta, contested its involvement in the case, saying that Sama was Motaung’s employer, and Meta could not be subjected to a hearing in Kenyan courts because it was not registered, and did not operate, in the country.

However, on Monday the judge found that the tech giant was a “proper party” to the case.

The Kenya employment and labour relations court is yet to release its full ruling on Motaung’s case, but the decision – the first of its kind in Africa – is already being hailed as a win for the accountability of big tech on the continent, and in the global south.

“If the attempt by [Meta] to avoid Kenyan justice had succeeded, it would have undermined the fundamental tenets of access to justice and equality under the law in favour of foreign privilege,” said Irũngũ Houghton, executive director of Amnesty International Kenya.

“We finally have an avenue for accountability,” said Odanga Madung, senior researcher for platform integrity at Mozilla. “It calls for tech giants to make serious changes within their companies that take into consideration their workers and users outside the US and Europe.”

Cori Crider, director of Foxglove, a UK tech justice non-profit, which supported the Motaung case, said social media platforms should not outsource critical online safety functions like content moderation. “It is the core function of the business. Without the work of these moderators, social media is unusable. When they are not able to do their jobs safely or well, social media’s safety brutally falters.”

Meta is facing a second court case in Kenya, which was due to be heard this week but has been postponed. It was filed by two Ethiopian petitioners and a Kenyan rights advocacy group, Katiba Institute, who claim that the company failed to take online safety measures to manage hate speech on the platform during northern Ethiopia’s civil war – which they say fanned the conflict, with serious offline consequences.

Mercy Mutemi, a lawyer for the plaintiffs in a second case against Meta due to be heard in Kenya, outside a Nairobi court in December.
Mercy Mutemi, a lawyer for the plaintiffs in a second case against Meta due to be heard in Kenya, outside a Nairobi court in December. Photograph: Anadolu Agency/Getty Images

The father of one of the petitioners was killed after a violent Facebook post that was reported, but not acted on in time. The petitioners claim that Facebook also failed to recruit enough moderation staff to its regional hub in Nairobi.

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“There are problems with Facebook’s woeful failure to value or to staff content moderation outside of the English-speaking United States,” said Crider, adding that Monday’s ruling could have global and regional implications on how tech firms think about and manage content moderation.

Leah Kimathi, a convenor for the Council for Responsible Social Media, agrees. “Big tech should not just look at Kenyans as a market, but should be accountable and alive to the nuances, needs and peculiarities of Kenya, especially when it comes to content moderation.”

Facebook has more than 13 million users in Kenya. It and Meta’s WhatsApp are the most commonly used social media platforms in the country.

A nationwide poll conducted in 2022 by the Council for Responsible Social Media showed that 68% of Kenyans who have internet access get their news from social media, and that a majority of these feel that social media platforms could do more to remove harmful content.

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