My patients make advances to me –Ndupu, psychiatrist

Dr. Ogonnaya Ndupu is a medical consultant passionate about mental and behavioural health with a focus on preventive, advocacy as well as treatment. She tells Ademola Olonilua about her career and family life

Out of all the branches in the medical field, why did you choose to specialise in mental health?

On several occasions, people have asked me this same question, I get this question from my relatives, patients and even their relatives as well as to why I chose this path. Many years ago when I was in the medical school, I noticed that I had this strange attraction to people that had mental health challenges. Initially, it started with a fear which the general population actually have towards people with mental health disturbances but it also made me more curious. Over time, I was privileged to be with doctors who managed these patients and I got to see a patient transform from being hostile to being loveable. For me, I realised that these people actually need love instead of being stigmatised. They needed people to understand them. Mental health is one of the most highly stigmatised conditions globally especially in this part of the world. Instead of us to stigmatise these people, they need to be understood and helped. The more I got involved the more I got to understand them and found out that I must have been called to help them because I have the passion for the job. I wanted to do more and nurse them to recovery and over the years, that is what has kept me in this part of mental health. I need to do more, to reach out to as many people as I can as regards their mental health and well-being.

How did you overcome the fear you had for people with mental health disturbance?

The more I spent time with these people, I understood how to relate with them better. It is no fault of theirs to be in that emotional state; it was based on their experience, suspecting people’s actions. For some people when you are suspicious of others, you begin to have this self-defence mechanism to protect yourself. Most times people would interpret that as hostility. It was not till I had fully delved into this field that I realised that it is just a function of their state of mind at that point in time. The more I understood it, the less the fear I had. I learnt of better ways to approach them instead of avoiding them like other people would. If you are calm enough to hear them out, then you are likely to gain their trust and you would get a lot out of them and this would assist you in helping them.

How do you handle hostile patients?

Most people with mental health issues are not hostile; I would probably say that one third of them are hostile and at the point where you get the history of a client being hostile or has exhibited any form of hostility, which may be from verbal aggression or physical aggression, everything you do in the presence of that client is important ranging from your posture to your look and the way you talk to the person. You may have your hands behind your back and he would feel there is something you are hiding. You would not want to respond to the person with a harsh tone if his voice is raised at you. You would have to be calm and hear him out. Most times, what they want to see is someone that understands their own point of view rather than taking sides with their relatives at that point. This would only make them get angry, so, it starts with a conversation. Be as civil as you can be. That is the first approach. After you must have done all this and it has failed, every method you know by the books to calm this person down has failed, depending on the circumstance; you may let him be for a while. Sometimes when he finds out that you are not listening to him anymore because he is too agitated, he cools off. If he fails to do that and you find out that verbal aggression is tilting toward physical aggression, then you may need some external help like physical or chemical restrains as the need may be, not forgetting that in the course of managing this client, it is important as a mental health professional you ensure that the person is safe. He is not a risk to himself or the people around him.

In the course of your career, have you had any terrible experience in the hands of hostile clients?

I am sure if you ask any psychiatrist out there or anyone working in the mental health sector, they would tell you that they have all had their bad days if they have been in the profession for a long while. The least of them has been verbal aggression, they use all kinds of abusive words on me but I know that I am there to help them and most time we do not listen to what they say at that point in time because we know that it is not the true person speaking, he just needs help to come out of that state.

Yes, I have had some form of aggression from some clients. I have had a client strike me on the face; I mean she gave me a ‘hot’ slap in the process of talking to her. Afterwards, she wrote me an apology letter when she was a lot calmer. She said that she was just agitated. I also had another client who once spat on my face but the family kept pleading on the client’s behalf. That is what we call occupational hazards. There are a lot of risks involved in what we do particularly when you are a female. It happens but as much as possible, we try to minimise them.

Is it right to say that the profession is more challenging for women?

Yes, I think it is more challenging but overtime, women have been able to push that gender barrier and you would find out that more women are coming into the mental health field. The reason is because of the perception people have about the profession. I have had relatives sit with me and ask me what I am doing in this field because they think it should be a man’s job. They think of the risk of violence and they believe women are so fragile they may not be able to handle the stress of the job. Over time, the job has only made me stronger. Some years ago, I was in charge of a male drug rehabilitation centre. For about two years, I decided how these people were managed till recovery so you can imagine me in the midst of men. Also, if there is drug use, the risk of violence is higher and you would see all sorts of things. At the end of the day, we were best of friends and they came to respect me.

But don’t you also face stigmatisation being a psychiatrist?

Yes, we do even among colleagues. The stigma is in multiple stages; there is the stigma the clients face, there is the stigma the family faces and there is also the stigma the doctor faces among colleagues and members of the society and it is because people do not know a lot about mental health. There was a time I was at an event and we were asked to introduce ourselves; I stood up and introduced myself as a psychiatrist and people looked at me in a funny way. Some even asked if there were psychiatrists in Nigeria and I had to laugh but I replied in the affirmative.

I think that there is this lame perception that people have and they say that it only takes an unstable person to understand an unstable person. Some people also say that after treating people with mental health challenges for a long period of time, you would also begin to lose your mind but it is not true. I have not lost my mind in any way and unless I tell you that I am a psychiatrist, you would think that I am a regular doctor.

Do you get remarks like you look too fashionable or beautiful to be in this field?

I hear it a lot, sadly from relatives of my clients but I do not think that because I am a psychiatrist, I need to look shabby or unkempt, that is sending a wrong message. Do not forget that being in this field also helps me because I am more knowledgeable about how to manage my mental health. I do not need to break down like the clients I am managing. If people tell me that ‘what is a beautiful woman like you doing in this field?’ I tell them that it is to treat their relatives. Whatever you do, you should still be able to stick to your identity and look good at every point in time even when you work in the field. Regardless of the way I look, when there is work to be done, I do it.

Do you get love advances from your patients?

Yes, I do.

How do you handle that situation?

I have a polite way of telling them and letting them know that I am not interested and as much as possible it is important to let them know that the rejection has nothing to do with their mental state. It is so easy for that to be misunderstood. They may think it is because they have a psychiatric issue but you let them know that it has nothing to do with that. Also, in the professional ethics, there are lines you don’t cross. There is a professional ethic that states that as long as you remain my patient, there is no other relationship we can have. So if you understand what our ethics are, you would stick to that; but you have to communicate it nicely to the person.

When do you take time off work?

I try as much as possible to make out time for myself. When I want to relax, I spend time with my family; my husband and children. We go on family vacations, cinemas, other fun places. There is what we call the stress that comes with the job; it is a bit difficult for you to be a good mental health professional and not get involved emotionally with your clients. You begin to feel what your clients feel and you cannot help but worry about them. Even after you have discharged these patients, you are still concerned about them. You can imagine the number of clients I worry about. It takes a toll on you over time, so it is extremely important for you to maintain your well-being and you can only do this if you can stay off work for a while and have some rest. As much as possible, I try to make my weekend free unless I have emergencies. I use my weekend to relax and I would head to the spa for a massage treatment or hang out with my husband and kids.

Your job is 24hours; how has your husband been coping?

Sometimes we are home late at night and I receive a call about a patient and from the conversation, I know the case is bad so I have to leave home that late. He knows that I would need to see the patient that night. Because of the confidentiality of what we do, I do not discuss my patients with him but he has an idea and he is worried about me. He had been a very supportive husband as regards my career and he is always concerned about what I do but I know that in his mind, he still nurses the fear as regards my safety. Each time I tell him that I need to see a patient or I have an intervention because a patient has broken down, all he says most time is, ‘please be careful, just be careful.’ He worries about me a lot.

Did he meet you on the job?

Yes, he met me during the early years of my training.

How did he feel wooing a psychiatrist?

He had his reservations. He met me in this profession but I think the way he felt about me was a lot stronger than whatever his reservations were about the profession. By association and hanging out with me, over time, it helped to demystify his perception of mental health. I have made him see that there is no big deal in this profession. He knows a lot about it now. There are even times that he refers people to me.

How did you meet your husband?

We met through a friend. It is a long story but I don’t think I want to talk about it.

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