Gregoire Ahongbonon

Gregoire is offering a singular and adapted care to the African mentally ill to help them recover their dignity and humanity they lost because of misunderstanding and taboo surrounding their disease. His biggest fight is to stop in Africa the practice of keeping mentally ill people in chains.

Gregoire created community-based solutions that address long-held cultural prejudices against individuals suffering from mental illness and has mobilized medical support and validation for his work from leading medical institutions in Europe and North America. In doing so he has ended systemic resistance to investing in health care services for the vast majority of people suffering from mental illness in Francophone West Africa. He has successfully waged a communications campaign that has led to a growing number of governments in the West Africa Francophone to partner with his organization.

His next step is introducing his approach in the periphery of Lagos, Nigeria. Gregoire has set up with his team a circular system providing care, food, shelter, and rehabilitation. They look for homeless people, thrown out on to the street by their families, and travel across West Africa on alert for reports of mentally ill people shackled or mistreated in remote villages. Such people are taken in charge by a Center where they are diagnosed by a psychiatrist, treated, and surrounded by caregivers who ensure medical care, affection and who help reestablish the patient’s self-esteem. After a few months and based on the patient personal evolution, he/she is directed to a Training or Rehabilitation Centre in the community for skill building and his integration into social life. The patient is then ready to be reintegrated into his home community. Families are educated on the very natural character of the disease that is curable if treated. There are also relay centers, created to overcome barriers to drug accessibility, where patients can pick up medicines. Another great originality lies in the place that the institution reserves for cured or stabilized patients, since the majority of the speakers and caregivers (cooks, managers, nursing assistants, nurses, etc.) are former patients having themselves benefited from the care provided by the Saint-Camille association. In each of the countries covered, the Ministry of Health has recognized the Saint Camille association as a major partner in the treatment and support of the mentally ill and support in operational costs.

At the national and international level, Gregoire set up a continuous communication campaign on the results of the center and was able to mobilize a lot of support and interest from neighboring countries for the establishment of a similar system. Gregoire’s association has more than 20 centers across Ivory Coast, Benin, Togo, and Burkina Faso. More than 60,000 patients have been released, cured, and rehabilitated.

In general, mental illnesses are poorly treated in Africa, if at all, while the continent counts a not insignificant number of patients who need appropriate treatments. In 2014, the president of the African Society of Mental Health (SASM) estimated that 10% of the African population had a mental disorder. Per SASMS, only 23% of the populations go to first instance consultation; for 43% of cases, the relatives consider that the disease has a mystical origin.

Mentally ill are rejected because of misunderstanding and taboo surrounding these diseases, which leads to excessive consultation among healers who do not have skills in this area. Often, a mental patient’s delirium and unusual, strange behaviors is consider to be “possession by the devil.” Everyone stays away, nobody wants to touch the ill person for fear of being bewitched in return. In town, the ill person wanders, helpless, and is left alone; people move away, and abandon them. In some villages, they are chained to a tree at the boundary of the village and left there until they die. In one of their reports, Human Right Watch said that in some spiritual healing centers in Ghana, known as "prayer camps," the mentally handicapped are often chained to trees under a torrid sun and forced to fast for weeks as part of a "healing process," denied access to drug treatment. This is even worse in Benin, home of voodoo. This ignorance is at the origin of an unstoppable evolution of the disease which can be adequately cured in 1 out of 5 cases when treated by a psychiatrist as soon as the first symptoms appear.

Few African states have mental health legislation and rights for those affected suffering from mental illness. It is a medical sector neglected by the public authorities; social protection systems are poorly managed by governments. The World Health Organization (WHO) noted that while in Europe there is 1 psychiatrist per 1 000 inhabitants, in Africa the ratio is 1 psychiatrist per 5 million inhabitants. Thus, there are few adequate structures to accommodate people, treatment is long and costly, and many families can’t afford it even in public hospitals. The lack of adequate structures is based on the denigration of the mentally ill which has long dominated African societies. Medical support is not forthcoming because no government is willing to commit to top-down solution because of the sense of creating another system they cannot afford given the huge challenge of physical ailments. There are millions who are epileptic, schizophrenic, bipolar or depressive, and their unpredictable crises frighten their families who prefer to forget them. Rejected, mentally ill wander the streets when they are not chained to their homes and undergo bad treatments. Gregoire Ahongbonon realized the mental frailty of the human being and how, without proper support, downfall could happen easily. Understanding the need to shift public attitude, he developed a transformative solution, demonstrating the person is not “possessed by spirits” and can live and contribute to society. His solution shows low cost, bottom-up structures, and a way for the government to get involved and not be overwhelmed.

In 1990, Gregoire met the Director of Bouaké Hospital, who agreed to give him a small, abandoned space to gather the first patients and treat them worthily with the necessary medicines. Quickly many of these patients began to get better. In 1992 the Director of the Hospital, impressed by the actions of Gregoire, took advantage of a visit by the Minister of Health to the hospital of Bouake to share the experience. Indeed, for the first time in Côte d'Ivoire, a general hospital also received mental patients who were usually treated in hospitals exclusively dedicated for mental health. The ministry decided to offer Gregoire a space to build his first care center in Ivory Coast. Words around his work spread quickly in Ivory Coast and he was called from everywhere to collect the sick and help them.

In 1994, he was faced with a case that led him to expand the scope of his work. A woman asked Gregoire to help her sick brother, in a remote village. He discovers a young man stuck on the ground with his feet in the wood, his hands chained with wire, and the body covered with maggots. After several negotiations, he finally succeeded in bringing him to the care center with the father's permission. Despite all his efforts, the young boy died and Gregoire decided to take care of all the case of such patients chained in the villages. He conducted several campaigns of denunciations of these inhuman practices with administrative authorities, police, but without any positive result.

He then said that it was necessary to create more centers to welcome all those people whose families did not want them and offer them a more humane treatment. By negotiating with the families and the village council, and with the support of religious communities, he was able to help the majority of these men and women recover, by getting them to consult with a psychiatrist and providing them with a more adequate living environment as they recovered. He became aware of the need to think and organize psychiatric care and to go beyond medication. Moved by his intuition, he reflected on the founding principles of psychiatric care: (1) de-stigmatization of madness, (2) accessibility to care, and (3) opening need of care institution.

The Saint Camille association center in Bouaké as well as in Benin is led by a professor (Associate of Psychiatry). As an experienced psychiatrist, each of them is mentoring and training local staff as well as accepting part-time psychiatrists from other West African countries as well as Europe and Canada. These psychiatrists are recruited through a network of national associations commonly called "Friends of Grégoire" or "Friends of Saint Camille." The associations are based in France, Switzerland, Germany, Italy, and Quebec. They train Saint Camille staff and nursing sisters working in religious communities and provide ongoing diagnostic, professional treatment, and provide the medicines and expertise needed to analyze new or challenging cases. In addition, Saint Camille has the support of Dr. William Alarcon, who has been working as a full-time volunteer within the NGO since 2012. After meeting Gregoire, Dr. William a psychiatrist based in France, decided to create “Santé Mental Health in West Africa” (Smao) to support his work. With his team, Dr. Alarcon has also put in place a guide to standardize the medical management of patients and to simplify the diagnosis.

Gregoire has also set up relay centers (mental health care clinics) to promote long-term treatment adherence which is led by nuns. As mental patients are rejected by public systems, Saint Camille has built general hospitals to deal with the physical pathological cases of its own patients while serving the local population free of charge or for a paltry sum on a voluntary basis. For example, Saint Camille General Hospital in Bouake Côte d'Ivoire was set up in 1998. Initially reserved for the mentally ill, it has extended its services to all sections of the population. It receives on average 30 patients per day, 10,000 patients per year. In addition to general medicine, the hospital has an ophthalmology department with operating room for ophthalmic surgeries, an optical department, a dental office, a dental prosthesis laboratory, an analysis laboratory, a dental medical imaging, and a pharmacy. As reference structure, the Saint Camille hospital collaborates with the local authorities of the Ministry of Health and the University Hospital Center of the city of Bouaké. To give the patients their place in society, Gregoire created a dozen rehabilitation centers to offer them work or trainings that allow them to achieve certain autonomy.

Daily, in addition to taking prescribed medications, residents benefit from socializing activities to facilitate their recovery. They participate in the maintenance of the site and other housework under the supervision of supervisors. The policy of the center today is to limit as far as possible the stays to a maximum of one month before the reintegration of patients with family. Through partnerships with other social structures, patients can continue their treatment from home. At the same time, Gregoire educates families about the non-demonization and contagiousness of the disease and encourages the formation of self-help groups. The former patients have become ambassadors of this fight against the rejection of people suffering from mental disorders. Furthermore, to facilitate their socio-economic reintegration, stabilized patients are referred to agropastoral training centers. The objective of these centers is not only to teach them a trade but also to provide food for the residents. Funding for the organization's activities is largely attributable to the costs paid by patients in hospitals and reception centers. Grégoire also conducts national and international conferences on mental health and a steady stream of popular articles and videos about mental illness available where people can understand before/after solutions. He has created a network of medical partners providing training, treatment, and other medical support from medical centers in Europe and North America, which has increased interest from medical research and training universities, foundations, and donor governments. These actions abroad have earned him the creation of very dynamic group of friends of Saint Camille composed of volunteers who are doing awareness campaigns and fundraising activities to provide human, material, and financial support. The association also undertakes fundraising campaigns for necessary capital investments such as the construction of new dormitories and reception centers for the mentally ill.

In 30 years, Gregoire has spread his model to Côte d'Ivoire, Benin, Burkina Faso, and Togo, with eight Reception and Care Centers, 28 Relay Centers and 13 Training Centers. As a result, the practice of chaining the mentally ill at home has been stamped out. More than 60,000 patients have returned to the family, many of them earn a living and have founded their own families. One of the patients became the director of one of the centers. Currently, Saint Camille and Gregoire have received invitations to set up their model in Congo, Chad, Cameroon, Senegal, Nigeria, etc.

Although he did not study medicine, Gregoire Ahongbonon became a figure of African psychiatry. He is a Beninese who emigrated to Ivory Coast in 1971 and settled down as tire repairer. His business quickly became prosperous before declining suddenly until he was experiencing bankruptcy. Debt-ridden, this father of six children sank into great depression, and found himself inhabited by suicidal ideas.

Thanks to the support of a priest, who helped him to perform a pilgrimage to the Holy Land in 1982, he recovered his Catholic faith and regained his equilibrium. He decided to devote his life to follow the religious teachings of his faith to heal people like him with similar problems. He thus began to visit patients in hospitals for assistance and medication, and prisons to talk with the prisoners and bring comfort.

In 1990 he began to worry about the fate of wandering mental patients abandoned to themselves. He decided to defeat his own fear and approach them. Every night he would walk to observe them and see where they were sleeping. With his wife, they bought a freezer to keep food and fresh water to distribute in the evening to the mentally ill and thus created a bond of friendship with them. He then told himself that they also needed a place to sleep soundly. With the unwavering support of his wife, he founded the association Saint-Camille, and made the promise to end the suffering of the mentally ill. Driven by his faith, and by an absolute will to restore dignity to these men and women, he traveled the streets and roads to untie and care for sick people.

For Gregoire, it is unacceptable, in the 21st century, to find people in chains and shackled to trees. Grégoire Ahongbonon has received several distinctions around the world such as the first world prize for psychiatry in Geneva in 2005, the prize for excellence in human rights in 1998, and the Van Thuân Solidarity prize, awarded by the Vatican, in 2010. He was also given the African of the Year Award in 2015 in Nigeria.