No damage too severe to repair

WITH a refined vision and a dream to see people neurofunctionally rehabilitated, leading to functional citizens and quality of life, Aina-Nelago Iimbili established a Neuro Health Centre 2006.

Almost half a decade later, she has a different story to tell about the centre that specializes in neuro-functional disorders, impairments, dysfunctions and disabilities due to brain and spinal injuries, brain diseases, post brain surgery and traumas.

“While studying in Europe, I learnt that Europeans have neuro-injuries, surgeries and diseases just like we do here, but their post functional abilities are enhanced if not all functionally rehabilitated.

This is because their rehabilitation is done timely, through intensive neurorehabilitation, proper medication management, back to work and school and proper community re-integration. I also reckoned that not everything in their system can fit in Namibia, therefore I am Namibianising neurorehabilitation with sufficient insight of the field and culture,” she says.

Iimbili is currently practicing psychology, neuropsychology and neurotherapy. Neurotherapy is still a new specialised technique in Namibia. Psychology offers therapeutic intervention for psychosomatic illnesses like chest pains that has no organic cause, were doctors tell you all the examinations are fine. It is also there to help people cope with chronic diseases.

According to Iimbili, psychology highly depends on where you studied due to different schools of thoughts and focus.

She says, “The degree you do determine whether you take psychology primarily from an art point of view to scientific or from a scientific part of view to art, hence BA, MA’s (bachelor and Masters of Art) and BSc ,MSc (Bachelors and Masters of Science).”

Her work involves psychotherapy, neuropsychotherapy, evaluating the brain and its behavior that leads to specific dysfunctions, disorders, impairments, disabilities and rehabilitating brain functions. Iimbili helps those that cannot be rehabilitated to functional level with assistive technology and gives strategies and techniques for possible adaptation into society.

She integrates psychology, neurology and neuroscience to make sense of dysfunctions caused by injury, traumas, disease and surgeries and offers treatment strategies which she implements with the help of other multidisciplinary and interdisciplinary professionals.

“I call it a physical therapy of the brain which is the therapy part of the Neuropsychological Intervention but done independently after acquiring needed knowledge in Neurophysiology, Anatomy and Brain chemistry. This requires the understanding of chemical and electrical messages of the brain, how the whole process works from neurons, neurotransmitters and receptors. You get certified for this just like being certified as a charted accountant after all the accounting studies. Neurotherapy basically compliment Neuropsychology which focuses more on the assessment and offering of treatment strategies.”

She is concerned that some people get suspended and even expelled from work due to behavioural problems such as excessive drinking and not turning up for work which is accompanied by what the society refers to as ‘strange behaviour.’

“But during psychoanalysis it surfaces that even though there may be multiple factors, it is very common that the primary factor for former freedom fighters is post war trauma that needs psychological intervention,” she says.

Adding, “They dream of the battle front and it happens as fresh, a replay in the consiousness from unconsiousness. The most challenging part is that it really needs a well trained and experienced psychologist to get it out of these people and help them overcome.”

Some of these people suffering from post traumatic stress disorder tend to drink too much as an attempt to run away from thier own minds.

However, the noise in their mind remains after getting sober again. Some even help themselves with drugs to try and quieten the unquiet mind without success but more trouble.

From a Neuropsychological point of view, this is a big concern, as experience becomes biological which may interfere with brain functioning. Drinking and use of drugs makes it worse as this may lead to cerebral dysfunction if not immediate brain damage.

“I suggest that all Ministries come on board with psychology, as suspending people creates more suffering. We are fortunate to have psychotherapeutic centres in Namibia such as Okonguari and Alcohol Rehabilitation centres such as Etegameno, Novavita and others.”

According to Iimbili, alcohol, drugs and other recreational drugs and spirits kills brain cells, blocking of receptors and may cause misfiring of neurotransmitters. As soon as it is consumed it goes directly through the blood to the brain. The cells are needed by the brain as they are sending messages within the brain and between the brain, spinal cord and the body.

“Receptors need to be clear to be able to receive the correlating neurotransmissions for communication. Cells are specialised in different functions and killing them will lead to dysfunction of functions processed in those areas. We then end up saying, ‘I have a memory problem, my concentration is poor, thinking is twisted etc,’ if not causing mental breakdown whereby you see and hear things that are not there. The killing of the brain cells is also what happens during brain injury in car accidents, fallings and prolonged birth.”

Being a psychologist and neurotherapist, Iimbili has a post graduate qualification in Medical Neuropsychology and is the first Namibian to have such an advanced qualification in Medical Neuropsychology.

By studying and understanding the functions of the central nervous System (CNS) and Peripheral Nervous system (PNS), its physiology, the chemistry and anatomy, she aims to integrate the functional Neuroimaging, Neurophysiological testing, Neuropsychological testing, qualitative information from significant others with observation for a well informed diagnose and intervention.

The work involves determining the brain’s ability to function with respect to memory, reasoning, attention, concentration, executive functions, processing speed, central processing, speech processing, sensory motor skills and others.

She has years of experience working in neuro-rehabilitation and general rehabilitation in the UK and Czech Republic and as a consultant psychologist and neurotherapist in private practise in Namibia.

“My patients are not just those with mental challenges like neurasthesia as some people assume. I deal with clients who have been involved in motor vehicle accident, I deal with students with learning difficulties, people who have lost functions after stroke, brain surgeries, sleeping disorders, epilepsy, people with memory lapse and memory loss problems are some of the cases I deal with,” says the member of the International Neuropsychology Society (INS).

According to Iimbili, you do not need to get mentally confused for you to be helped. “In psychology we know that, it is not people who are sick who commit suicide. It is people who are healthy, like you and I now who feels hopeless and helpless.

Among others, suicide is seen as a way to run away from the temporary problem, with no fear of going to bigger problems that are permanent after the suicide. Distress makes people feel locked in, all they need is someone with the knowledge to assist them unlock and help them switch from the emotional brain to the logic brain.

It is not as easy as it sounds; there are strategies and techniques that need to be used by a psychologist that is why psychologists go to University for 6 to 7 years.”

Through neuropsychology and neurotherapy, she also gives therapy to those with Korsakof syndrome, a neurological disorder caused by alcohol and those with phantom pain after amputation, “when people have sensation of a limb that is no longer there, the sensory illusion,” she explains.

The difference between Neuropsychology and Neurology is that the former primarily focuses on functional abilities to structure, offers therapeutic strategies and do not medicate but can recommend brain nutrients, suggest medication as deemed necessary and advice on neurotoxin that can be cause by some medications while neurology focuses primarily on structure to function and treat the medical condition with medication.

Neurologist use MRI, EEG and Neuropsychologist and Neurotherapist use fMRI, PET, QEEG which is the same except that it is a functional measure and not a structural measure. QEEG is the measurement, using digital technology of electronically patterns at the surface of the scalp which primarily reflect cortical electrical activity called brainwaves, produced by firing of neurons. Brainwaves occur at various frequencies at various sites and setting, that is, some are quick some are quiet slow, desynchronized, synchronized which reflect mental state.

She explains: “My international senior colleagues use this to stimulate people from coma stage 2, those that can be aroused, not everyone in coma can be aroused and multiple factors need to be considered here. It is a non-invasive procedure but a very complicated process and needs really someone who is knowledgeable and experienced. I can only do it under supervision, not yet on my own. Once we have all the equipments needed and senior colleague in the field visiting us, we certainly will start doing it.”

Her job is to evaluate and stimulate the re-engineering of the damaged neurons in the brain and spinal cord and re-organisation of the functions (neuroplasticity, neuroregenaration).

Iimbili remarks: “I am very passionate about what I do and what it can do and fully aware of the limitations. Isn’t it fascinating and unbelievable? In fact the whole neuropsychophysiology field is too good to be true but scientifically possible. We must be neuroscientificaly oriented to appreciate this.”

Neuro Health Center Namibia currently operates two consulting rooms, in Windhoek and another in Ongwediva Medipark.

The Center offers Neuropsychological and neuropsychophysiological Assessment, Medico Legal and Clinico Legal reports, Psychological Assessments and intervention, Cognitive Rehabilitation Therapy, Neurotherapy, trauma debriefing post injuries or chronic health condition diagnose and Neuro-psycho-education.

It will soon start offering Neurorehabilitation assistant certificate and diploma to grade 12 learners who want to become support workers in Neurorehabilitation centers, hospitals or community.

The Center recently started publishing a bi-monthly briefing journal called Neurorehabilitation Namibia.

“This is the first type of journal in Namibia meant to educate society on brain behavior, spinal injuries, post neurosurgical procedures rehabilitation, effect of psychopharmacology and drugs on the brain and the actions one can take when rehabilitation becomes necessary.”

Iimbili says she landed in the neuro field rather by chance.

“My late mother always wanted me to be a teacher like her. Post matric I did a three year teaching certificate but teaching was just never my career, my dream career was physiotherapy inspired by the late Maureen Samaria.”

“I went into teaching at Pionier Boys School (PBS) after a year and few months of working as a clerk. At PBS, the school requested me to be a Leaner Support teacher, besides my Mathematics and Science classes. Being a Learner Support teacher my role involved counselling.This appointment was quite challenging as I had to deal with learners from different backgrounds with so many psychological factors and so forth. I then decided to enroll for a non- degree psychology course with University of South Africa (UNISA) a distance education institution.”

The non degree UNISA psychology studies, a car accident that gave her an opportunity to meet Neurologist Dr Amanda Duvenhagen brought her closer to what has become her dream career, shifting from her first dream career of becoming a physiotherapist.

Iimbili has graduate and post- graduate qualifications in Education, Psychology and medical neuropsychology starting with Btech Post Ed, (SA), Bsc Hons in Psychology from the University of Luton UK; MEd Psychology from the University of Manchester, UK; PGC Medical Neuropsychology from the University of Leicester, UK and is certified in EEG- Biofeedback by the Applied psychophysiology and Biofeedback, Czech Republic. She is currently completing Advance Neuropsychophysiology and is a PhD candidate in Neuropsychology focusing in Neuropsychiatry.

She encourages young Namibians eager to become psychologists to thoroughly study the field they would like to get into, know all sub-fields, specialties and which universities in the world are ranked top in their subfields for them to acquire firsthand knowledge which they can emulate back home.

“I am sure some may think, where will we get money from? I never had a sponsor myself, I had to work and study, it was challenging to be a fulltime student and juggling between different jobs but I am happy I faced the challenge. It is through these jobs that I learned more about the culture in Europe and gaining most of neurorehabilitation experiences. There are just many ways to get what you want, fast or delayed, but I must emphasize that it needs a positive attitude, focus, self-discipline, determination and perseverance. I mean, a flying eagle and not a chicken in a chicken yard .” PF