Nearly all low-income countries are either just themselves emerging from conflict or neighbour a country that has just emerged from one. According to the Office of the United Nations High Commissioner for Refugees (http://www.unhcr.org), of the 38 million uprooted people in 2003 worldwide, Africa played host to 13 million internally displaced persons and 3.5 million refugees.

Psychiatric patients access both indigenous healers and services rendered by psychiatric facilities in South Africa. The various groups of healers which are available are clearly not all acceptable to the whole population and variable experiences are reported with different categories of healer and the different treatments provided. An increasing collaboration between psychiatric services and indigenous healers is becoming evident, as in other health services. Reports indicate that many African psychiatric patients seek treatment from indigenous healers while attending psychiatric clinics, in both rural and urban regions. This has led to much discussion and differing viewpoints as to the possible benefits and disadvantages of collaboration and simultaneous use of different treatment modalities. Included in this is the question of the medical competence of traditional healers and the possible neglect of serious conditions.

The association between ethnicity and pharmacology has been reported in the medical literature for several decades. However, the relationship between ethnicity and psychopharmacology has become widely recognised only in the last two or three decades. The large-scale migration which started after the Second World War, at first to the USA and more recently to other higher-income countries, as a result of globalisation, has greatly contributed to the attention and focus given to these migrant groups. In this context, these migrant groups primarily comprise ethnic and racial minority groups. This article briefly reviews the relationship between ethnicity and psychopharmacological agents.

Bangladesh is a small, populous South Asian nation with poor literacy, limited resources and a lack of basic healthcare. Caring for people with psychiatric disorders in such a setting is challenging. The prevalence of psychiatric disorder in Bangladesh is similar to that in other countries, yet there is a severe shortage of well trained psychiatrists and a lack of even basic mental health services. To generate large numbers of well trained psychiatrists, Bangladesh must expand its high-quality psychiatric training and education at both the postgraduate and the undergraduate levels. To achieve these ambitious goals, Bangladesh needs help and assistance from regional and international institutions. The Royal College of Psychiatrists can play a role of critical psychiatric public health importance by helping Bangladesh locally train a new generation of psychiatrists who will care for the vast number of those with ailments of mind and soul.

Education in modern medicine in India began in 1835 with the establishment of the Madras Medical College, in what is now Chennai. Initially the growth of new medical schools was slow but it gathered pace after independence in 1947. In the past decade or so, the growth in terms of the creation of new medical schools has been phenomenal.

Asians represent more than half the world's population but themselves consist of very diverse genetic, ethnic, cultural and linguistic groups. Understanding the role of ethnicity in an individual's response to psychotropic medications is of importance in treating psychiatric disorders among Asians. Recent research has supported the notion that Asians carry distinct genetic profiles that can influence both the pharmacokinetics and the pharmacodynamics of a given medication (Lin & Smith, 2000; Pi & Simpson, 2005). In this brief review, we summarise the research findings in the field, focusing on pharmacogenetic variations between Asians and other ethnic groups.

Many patients in Nigeria consult traditional healers before, or in parallel with, modern psychiatric services. Part of the attraction of traditional medicine for the populace, apart from its lower cost and easier accessibility, may lie in its ‘cultural’ explanatory concepts of the nature and course of mental disorder.

Egypt and the Sudan have historically provided a continuum of social and cultural exchange. With the Nile valley providing the only route between the Mediterranean and sub-Saharan Africa, Egypt became the natural host for Sudanese refugees.

Some 7000 years ago Egyptians believed in one God, the after-world and that our worldly deeds would be balanced in the day of judgement. This led James Breasted to consider that the emergence of Egyptian culture marked the dawn of conscience (Breasted, 1934; Okasha & Okasha, 2000).

In psychiatric medicine, as in other fields, Europe offers a diversity of history and academic tradition that belies its limited geographical area. There are numerous centres of excellence — in psychiatric research, service innovation and practice — and many countries have internationally recognised and excellent training schemes in psychiatry. But uniformity of practice is seldom in evidence.

There was a large influx of Afghan refugees into Pakistan during the 1980s and in particular after the US invasion of Afghanistan in 2001. That refugees have high rates of mental health problems has been well established (e.g. De Jong et al, 2000) — causes include migration, often with painful transit experiences, difficult camp life and the experience of major trauma, including multiple losses of family members as well as the loss of property and traditional lifestyle. However, the Afghan refugees in Pakistan have been poorly studied. Although the mental health problems of Afghan refugees have been studied in the West, the numbers of participants in such research have been relatively small.

Since time immemorial, people from East Africa, and beyond, depended on traditional healers for treatment of all types of disorders, including those related to mental health. Even today, the use of traditional healers is common, despite the introduction of modern drugs. Alternative medicine is growing fast all over the world.