In 2017, as the United States of America and other advanced countries of the world grappled with the realities of sustaining efficacious mental healthcare programmes for their citizens amidst very limited resources, a researcher, Elisa Nabel, recommended a simple solution: adoption of the Aro Village Project model, as founded by Prof. Thomas Adeboye Lambo.
Explaining the rationale for the recommendation, Nabel wrote in the American Journal of Psychiatry Residents’ Journal, “Although developed over 50 years ago in colonial Nigeria, Dr Thomas Lambo’s Aro Village Project addressed head on healthcare dilemmas we face today to conciliate moralistic concerns about space, funding, and resources for mental health care with financial limitations…The Aro Village Project provides a historical example of how the enormous societal cost of psychiatric care can be mitigated by making intelligent and affordable investments in the way mental health care is delivered.”
Interestingly, that poignant allusion by Nabel, as well as several others from scholars, scientists and historians from within and outside the field of psychiatry, constitutes just a fraction of the revolutionary contributions of Lambo to the understanding and advancement of psychiatric care in Nigeria and beyond. Regarded as the first Western-trained African psychiatrist, Lambo developed an unprecedented community and indigenous approach to the treatment of mental disorders. He believed, from his research and observations, that there were peculiar socio-cultural factors contributing to the nature of mental disorder experienced in different communities. This led him to the conclusion that a one-size-fits-all or universal approach to psychiatric care was unfeasible. Rather, he adopted and advocated culturally sensitive models of diagnosis and treatment of patients, and the results were remarkable.
The Aro village system model
It is noteworthy that prior to Lambo’s qualification and appointment as chief psychiatrist at Aro Mental Hospital in Abeokuta, the predominant approach to handling cases of mental disorder in the country was to confine the patients to an asylum, as was being done in European countries. This was what led to the creation of such facilities as the Yaba Asylum (now Federal Neuro-Psychiatric Hospital, Yaba) in 1907.
Observing the limitations of the asylum approach and the western methods of treatment – which the government tried to continue at Aro – Lambo, on resumption in 1954, opted for the outpatient and community treatment approach. Using this approach, which eventually became known as the Aro village system model, Lambo made frantic efforts to persuade villagers to rent out rooms to the patients. The patients were boarded out to four villages around Aro, accommodating 200 to 300 patients from a wide geographic area. Within a short time, Aro had been turned into a therapeutic community which later became a World Health Organisation Centre for Excellence in Brain Health.
Lambo believed that placing patients in a village environment would help them to quickly adapt to their situation than being admitted to a hospital. Under the innovative arrangement, he insisted that a patient be accompanied by a family member who cooked for them, washed their clothes and provided other forms of support. He also sought the help of farmers near the facility to take some of the patients as labourers, while they simultaneously underwent medical treatment, and the patients also paid for any extra services required, such as housing. He also encouraged a combination of modern curative techniques combined with native medicines.
Lambo equally used the opportunity to observe the patients’ symptoms and responses to the specialised treatments they were getting. This inspired his early publications, which described, for the first time, psychiatric disorders as they presented in Africa and as observed by a native African psychiatrist. In his papers, Neuropsychiatric Observations in the Western Region (1956) and Further Neuropsychiatric Observations in Nigeria (1960), he described the pattern of psychiatric disorders peculiar to his practice environment.
While affirming that schizophrenia, affective psychoses and psychoneuroses were prevalent among his patients, Lambo also noted that he observed “comparatively quick recovery, lack of chronicity, and better therapeutic response generally of schizophrenic patients.” He attributed these positive outcomes to the favourable social and environmental factors inherent in the community to which the mentally ill are exposed in Africa.
Resounding success and acclaim
Lambo’s publications and remarkable success with Aro patients soon gained massive publicity, turning him to an intellectual hero within Nigeria and an influential figure in international psychiatric research and global health governance. His observations of the relatively good prognosis of schizophrenia were later confirmed by the World Health Organisation’s International Pilot Study on Schizophrenia.
Writing on the deeper implications of Lambo’s feats at Aro, Matthew M. Heaton said: “Lambo’s insistence on cultural sensitivity in treating Nigerian mental patients – focusing on understanding the cultural masking agents of mental illness in Nigerians and the importance of traditional medical practice in treating Nigerian patients – allowed for dramatic improvements in the recognition and diagnosis of mental illness in Nigerians and resulted in higher recovery rates for patients than had been obtainable in colonial asylums. Politically, Lambo’s success highlighted to Nigerians the inadequacies of colonial psychiatry and the inability of racist and alien colonial rule to bring ‘progress’ to disadvantaged Nigerians…”
Lambo’s Aro model was soon replicated in many other parts of Africa. Moreover, his study of traditional psychiatry yielded large volumes of information that became integrated into the practice of psychiatry worldwide. For instance, he was first to draw attention to the vast superiority of the psychotherapeutic sessions of African traditional healers, as well as their unquantifiable pharmacopoeia of herbal and psychotropic drugs. So comprehensive were his discoveries that he became a regular face in world psychiatric lecturing circuits.
Background and recognitions
Thomas Lambo was born on 29 March, 1923 in Abeokuta, Ogun State. He attended the famous Baptist Boys’ High School, Abeokuta from 1935 to 1940. He then proceeded to the University of Birmingham, where he studied Medicine. To further his studies and become specialised, in 1952, he enrolled at the Institute of Psychiatry, King’s College London.
In 1954, after studying and working as a surgeon in Britain, he returned to Nigeria where he was soon made the specialist in charge at the newly built Aro psychiatric hospital, Abeokuta. He was at Aro, until 1963 when he was appointed professor of Psychiatry at University College Hospital Ibadan. He was later dean of Medicine (1966-1968) and vice chancellor of the University of Ibadan (1968-1971).
Lambo joined the World Health Organisation in 1971 as Assistant Director General, with special responsibility for the Divisions of Mental Health, Non-communicable diseases, Therapeutics & Prophylactic Substances and Health Manpower Development. He later became Deputy Director of the World Health Organisation in 1973, and worked in that capacity until 1988. Altogether, he published over 250 academic publications
Lambo received numerous awards and recognitions for his immense achievements. He was Member, Royal College of Physicians, Edinburgh, 1961; Fellow, Royal College of Physicians, Edinburgh; and Fellow, Royal College of Psychiatrists, 1970. He was also a Pontifical Academician to the Vatican City. He was awarded Nigeria’s highest honour, the National Merit Award; as well as the Order of the British Empire (O.B.E), from the United Kingdom.
Professor Thomas Lambo died on 13 March, 2004 and was survived by his wife, Dinah, and three children.