Eloisa Pentecotisa was begging in the streets of Yaoundé, hearing voices and eating from trash cans, when a team of health workers came across her and suggested she join them. The 28-year-old had no idea how long she had been sleeping in the wild in Cameroon’s capital.
But because she had serious psychological problems and no immediate family to care for her, she faced threats, abuse and was at risk of contracting diseases such as cholera. Acutely mentally ill people like Pentecotisa are often rejected by their families, and their conditions are made worse by walking alone on the streets.
NCDs are simply that; Unlike a virus, for example, you cannot contract them. Instead, they are caused by a combination of genetic, physiological, environmental and behavioral factors. The main types are cancer, chronic respiratory diseases, diabetes and cardiovascular disease – heart attacks and strokes. About 80% are preventable, and all are increasing and spreading inexorably around the world as aging populations and lifestyles, pressured by economic growth and urbanization, make unhealthy living a global phenomenon.
NCDs, once seen as diseases of the rich, now grip the poor. Disease, disability, and death are perfectly designed to create and increase inequality—and if you’re poor, you’re less likely to receive an accurate diagnosis or treatment.
Investment in tackling these common and chronic conditions, which kill 71% of us, is incredibly low, while the costs to families, economies and communities are staggeringly high.
In low-income countries, NCDs – typically slow and debilitating diseases – see a fraction of the money needed being invested or donated. Attention remains focused on the threats of communicable diseases, but cancer death rates have long surpassed the death tolls from malaria, tuberculosis and HIV/AIDS combined.
‘A Common Condition’ is a Guardian series reporting on NCDs in the developing world: their prevalence, solutions, causes and consequences, and telling the stories of people living with these diseases.
Tracy McVeigh, editor
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Quick guide A common condition
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The human toll of non-communicable diseases (NCDs) is enormous and rising. These diseases end the lives of about 41 million of the 56 million people who die each year – and three-quarters of them are in the developing world.
NCDs are simply that; Unlike a virus, for example, you cannot contract them. Instead, they are caused by a combination of genetic, physiological, environmental and behavioral factors. The main types are cancer, chronic respiratory diseases, diabetes and cardiovascular disease – heart attacks and strokes. About 80% are preventable, and all are increasing and spreading inexorably around the world as aging populations and lifestyles, pressured by economic growth and urbanization, make unhealthy living a global phenomenon.
NCDs, once seen as diseases of the rich, now have a hold on the poor. Disease, disability, and death are perfectly designed to create and increase inequality—and if you’re poor, you’re less likely to receive an accurate diagnosis or treatment.
Investment in tackling these common and chronic conditions, which kill 71% of us, is incredibly low, while the costs to families, economies and communities are staggeringly high.
In low-income countries, NCDs – typically slow and debilitating diseases – see a fraction of the money needed being invested or donated. Attention remains focused on the threats of communicable diseases, but cancer death rates have long surpassed the death tolls from malaria, tuberculosis and HIV/AIDS combined.
‘A Common Condition’ is a Guardian series reporting on NCDs in the developing world: their prevalence, solutions, causes and consequences, and telling the stories of people living with these diseases.
Tracy McVeigh, editor
Eight months after the intervention of the health team, Pentecotisa lives in Le Village de L’amour – the village of love – where she receives therapy and free medication for schizophrenia.
Established in May 2021 and located on the grounds of Jamot Hospital in Yaoundé, the village is a joint project of the Ministry of Health and the Yaoundé Municipal Council.
“Our main goal here is to treat mentally ill people living homeless on the streets of Yaoundé,” said Dr. Justine Laure Menguene, a psychiatrist at Jamot Hospital and village chief. “It is the first and only free care center for homeless patients in Cameroon.”
The team – consisting of a group of more than a hundred volunteers, including nurses, psychologists, hygienists and doctors – regularly walks the streets of the city, under the supervision of the municipality, looking for homeless people in need of help. They are usually rough-edged individuals who have been discarded or rejected by families due to the stigma or fear surrounding mental health. When the team identifies someone who needs help, they first try to track down the family to ask if they will allow treatment at home. Patients whose families cannot be found or refuse to help them are brought to the village.
Not everyone is willing to do that. Menguene says that violence is sometimes used: “They are sick; some are naked and eat garbage; most are schizophrenic; it is a psychosis and they cannot understand what is happening.”
The center’s name reflects its ethos, says Audrey Pokam, a psychologist. “Love is our first medicine here. When patients arrive, we treat them with love. We show them that they are important. Many have been rejected by their families.”
Of the more than a hundred patients in the village, 95% have schizophrenia. Some also arrive with other conditions acquired from the brutality of life on the streets, including tuberculosis, wounds that may require amputations, cholera and other diseases linked to poor living conditions. For many, including Pentecotisa, it will be the first time they have been diagnosed. Once patients are medically stable, they receive therapy and learn life skills.
It took months of treatment and therapy before Pentecotisa’s story emerged. She says she always wanted to be loved. “I lost my mother when I was so young. Growing up with my uncle, I thought my father had abandoned me,” she says.
“When I finally met him, we spent a few times together and he also passed away. I went to live with my older sister and she later kicked me out. I wanted to die because no one loved me.
“People on the street called me crazy. Here they see me as a human being. I help with the housework, the laundry, the dishes. I talk to other patients,” she says.
After 10 months of treatment, Pentecotisa now has “a lot of dreams”. “I would like to become a teacher, get married and have children,” she says.
Caroline Martine Ibe Ngando is a mental health nurse and field coordinator in the village. She teaches patients how to dress, wash, eat with cutlery and drink water from a cup.
“Some have lived on the streets all their lives,” she says. “They have forgotten everything. We teach them everything like you do with a baby”
The center has treated more than 630 patients: 114 people are currently being cared for internally and another 350 on an outpatient basis.
Mental illness is often misunderstood and stigmatized in Cameroon, with witchcraft blamed if someone lives with a mental illness. There is little data on the extent of mental illness in the country, and a shortage of relevant health professionals has left many people undiagnosed and untreated. According to the World Health OrganisationIn 2020, there were only 12 psychiatrists, 300 psychologists and 150 mental health nurses in Cameroon, a country of 28 million people.
‘Most families go to the local medicine man. Sometimes he accuses the patient of being the cause of his illness,” says Ngando. “The families then reject the patient. That’s why we find most of them on the street.”
Parents may have difficulty understanding their children’s behavior when they are ill. Flore, 45, who came to visit her son Jordan Armel Tchoumtchoua, 24, calls him “a manipulator”.
“He became addicted to drugs. He was walking down the street and acting strange,” she said. Evelyne Essiane, a mental health nurse, mediates the conversation between mother and son.
“There is a lot of anger,” says Essiane. “Here we don’t just treat our patients. We do several therapy sessions with families who agree to reintegration. Above all, we advocate patience and love – 80% of patients are reintegrated (into their families).”
Menguene’s vision is a future where the village is no longer necessary. “The center exists because society rejects these patients. There is no village full of love for cancer patients or people with kidney or heart failure. Our goal is for families to support people as they do when they are ill with other illnesses. Society does not abandon these patients – and we actually want to achieve the same with patients suffering from schizophrenia in Africa.”