Eloisa Pentecotisa was begging on the streets of Yaoundé, hearing voices and eating out of bins, when a team of health workers came across her and suggested she go with them. The 28-year-old had no idea how long she had been sleeping rough in Cameroon’s capital.
But with severe mental health problems and no immediate family to take her in, she received threats, abuse and risked contracting diseases such as cholera. Acutely mentally ill people like Pentecotisa are often rejected by their families, their conditions exacerbated by being left to roam the streets alone.
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.
NCDs are simply that; unlike, say, a virus, you can’t catch them. Instead, they are caused by a combination of genetic, physiological, environmental and behavioural factors. The main types are cancers, chronic respiratory illnesses, diabetes and cardiovascular disease – heart attacks and stroke. Approximately 80% are preventable, and all are on the rise, spreading inexorably around the world as ageing populations and lifestyles pushed by economic growth and urbanisation make being unhealthy a global phenomenon.
NCDs, once seen as illnesses of the wealthy, now have a grip on the poor. Disease, disability and death are perfectly designed to create and widen inequality – and being poor makes it less likely you will be diagnosed accurately or treated.
Investment in tackling these common and chronic conditions that kill 71% of us is incredibly low, while the cost to families, economies and communities is staggeringly high.
In low-income countries NCDs – typically slow and debilitating illnesses – are seeing a fraction of the money needed being invested or donated. Attention remains focused on the threats from communicable diseases, yet cancer death rates have long sped past the death toll from malaria, TB and HIV/Aids combined.
'A common condition' is a Guardian series reporting on NCDs in the developing world: their prevalence, the solutions, the causes and consequences, telling the stories of people living with these illnesses.
Tracy McVeigh, editor
Eight months on from the intervention by the health team, Pentecotisa is a resident at Le Village de L’amour – the Village of Love – where she receives therapy and free medication for schizophrenia.
Founded in May 2021 and located in the grounds of Jamot hospital in Yaoundé, the village is a joint project between the public health ministry and Yaoundé city council.
“Our main goal here is to treat mentally ill people living homeless on the streets in Yaoundé,” says Dr Justine Laure Menguene, a psychiatrist at Jamot hospital and the head of the village. “It is the first and only free care centre dedicated to homeless patients in Cameroon.”
The team – from a pool of more than 100 volunteers, among them nurses, psychologists, hygienists and doctors – regularly scours the streets of the city, with security provided by the council, looking for homeless people in need of help. They are usually individuals living rough who have been thrown out or rejected by families because of the stigma or fear around mental health. When the team identifies someone needing help they first try to track down the family to ask whether they will allow treatment at home. Patients whose families cannot be found or refuse to help them are taken to the village.
Not all are willing. Menguene says force is sometimes used: “They are sick; some are naked and eating garbage; most are schizophrenic; it’s a psychosis and they cannot understand what is happening.”
The name of the centre 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 100-plus patients at the village, 95% have schizophrenia. Some also arrive with other conditions that they have picked up through the brutality of living on the streets, including tuberculosis, wounds that can require amputations, cholera and other diseases related to poor living conditions. For many, including Pentecotisa, it will be the first time they have been diagnosed. Once patients are medically stable they are given therapy and taught life skills.
It took months of treatment and therapy before Pentecotisa’s story began to emerge. She says she has always wanted to be loved. “I lost my mum when I was so young. I grew up with my uncle, thinking that my dad had abandoned me,” she says.
“When I finally met him, we just spent a few times together and he died too. I went to live with my elder sister and she later kicked me out. I wanted to die because no one loved me.
“On the street, people called me crazy. Here they see me as a human being. I help with the housework, the laundry, the dishes. I chat with other patients,” she says.
After 10 months of treatment, Pentecotisa now has “a lot of dreams”. “I’d like to become a teacher, get married and have children,” she says.
Caroline Martine Ibe Ngando is a mental health nurse and field coordinator at the village. She teaches patients how to dress, wash, eat with cutlery and drink water from a cup.
“Some have lived on the street all their life,” she says. “They have forgotten everything. We teach them everything like you do with a baby”
The centre has treated more than 630 patients: it currently looks after 114 people in-house and a further 350 outpatients.
Mental illness in Cameroon is often misunderstood and stigmatised, with witchcraft blamed when someone lives with a mental health condition. There is little data on the scale of mental illness in the country, and a shortage of relevant health professionals leaves many people undiagnosed and without treatment. According to the World Health Organization, in 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 see the local witch-doctor. Sometimes, he accuses the patient of being the author of his illness,” says Ngando. “The families then reject the patient. That is why we find most of them on the street.”
Parents can struggle to understand children’s behaviour when they are sick. Flore, 45, who came to visit her son Jordan Armel Tchoumtchoua, 24, calls him “a manipulator”.
“He became addicted to drugs. He would walk down the street and act strangely,” she says. Evelyne Essiane, a mental health nurse, mediates the conversation between mother and son.
“There’s 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 the patients are reintegrated [into their families].”
Menguene’s vision is a future where the village is no longer needed. “The centre exists because society rejects these patients. There is no village of love for cancer patients or those with kidney or heart failure. Our objective is that families support people the way they do when they are sick with other illnesses. Society doesn’t abandon those patients – and we really want to have the same thing with patients suffering from schizophrenia in Africa.”
