Features

50 years in mental asylum

JACK ZIMBA, Lusaka
FOR the past 50 years, Mabvuto’s life has revolved around a ward at Chainama Hills Hospital.
Now 81 years old, he spends most of his time lying on his bed, although he does move freely within the hospital complex and likes to make his own cup of tea.
Mabvuto is a mental patient. According to hospital records, the old man was admitted to the mental institution in 1968 after being diagnosed with schizophrenia.
The old man was working for the government as a commissioner of some sorts and he still usually talks about government business.
According to Dr Nita Besa, who is head of clinical care at the mental institution, schizophrenia is a chronic mental condition which is usually hereditary, degenerative if not treated.
“The actual cause of schizophrenia is not known but it seems to run in certain families,” she says.
There are other factors that have been blamed for the condition, including trauma at birth and viral infections.
According to Dr Besa, schizophrenia affects at least one percent of any given population worldwide.
The condition causes patients to lose touch with reality.
“A person begins to hear things, see things and hallucinating and having delusions,” says Dr Besa, who has been working at the mental hospital for 10 years.
Usually, patients also have false beliefs about themselves.
Mabvuto, for instance, thinks he is someone very important in society, sometimes he thinks he is the President of Zambia or someone close to the Queen of England.
When he first came to the mental hospital, Mabvuto was violent and difficult to handle.
“He was violent and I think that is the reason he was brought here,” she says.
But with a regime of medication and surgery on his brain a few years ago, Mabvuto is a much calmer man now.
“He is someone who can function in the community. He is not a danger to others anymore,” says Dr Besa.
But after spending 50 years in the hospital, Mabvuto has lost touch with the outside world, and Dr Besa thinks he is safer in the institution.
His relatives may also have given up on him. According to records, his nieces last came to visit him in 1997.
Dr Besa says stigma is still a huge problem affecting mental patients.
Many of them cannot be accepted back into society even after making good recovery like Mabvuto.
The doctor has a list of about 10 long-stay patients at the institution.
The main challenge in taking care of long-stay patients is the cost involved in terms of human resource, drugs and bed space.
The ideal situation is to have half-way homes where patients can undergo rehabilitation before being assimilated back into the mainstream society.
But, according to Dr Besa, only three half-way homes exist in the country, and they are run-down.
“We are trying to work on one of these three centres so that we can be sending patients there,” she says.
When we visit Mabvuto, he is lying calmly on his bed and sits up upon seeing the doctor.
But in this ward, Mabvuto is not Dr Besa’s major concern.
There is a young man writhing on a mattress on the floor. He looks disillusioned and is not uttering any words. He has fresh scars on his face and arms.
Three of his relatives are standing over him, holding him down whenever he tries to get to his feet.
They fear he might escape from the hospital.
The patient, a 24-year-old from Kalikiliki, is suffering from the effect of alcohol abuse, a condition Dr Besa describes as delirium tremens, which has to do with withdrawal.
The patient had been consuming a strong drink called junta.
“He has been drinking for a long time. He never ate much, all he wanted was to drink,” complains his uncle, Evaristo Malikani.
Dr Besa has seen so many of such cases – young men drinking themselves to the sanatorium – the past few months. She now worries the country may be sitting on a ticking time bomb.
More and more young people are ending up at this facility with mental conditions resulting from alcohol abuse.
Records since 2014 show an upward trend of mental cases.
In 2014, 527 males and 23 females were treated, and in 2015 the number of males attended to increased to 718 while that of females remained unchanged at 23.
In 2016 the number of males treated for alcohol-induced disorder was 810 and 40 females. In 2017, the number of males had increased to 1,082 and that of females had increased to 55.
And between November 2017 and August 2018, the hospital attended to 747 mental cases related to alcohol and drug abuse, of which 24 were females.
Majority of the patients were aged between 20 and 29 years.
“It is a tip of an iceberg,” she says.
Dr Besa says prevention is always better than treatment with alcohol-induced mental illness.
“The mistake we are making is that we are concentrating more on treatment rather than prevention,” says the doctor.
She says with early diagnosis and treatment, mental illnesses can be better managed.
But many people tend to first take patients to faith healers or traditional healers due to denial.
“That is unfortunate because the earlier a mental illness is treated, the better the long-term outcome,” says Dr Besa.
She says some patients have been brought with scared wrists because they were tied up by traditional healers.
“That is unfortunate because the earlier a mental illness is treated, the better the long-term outcome,” says Dr Besa.
What may be driving the rising number alcohol-related cases of mental illness is the availability of cheap alcohol which is accessible to many young people.
In 2012, Government banned the manufacturing and importation of strong liquor commonly known as tujilijili which were being abused by many people.
But Dr Besa thinks the move did not help much because other cheaper alcohol drinks came on the market.
“I don’t think it helped much,” she says.
She thinks a total ban on cheap alcohol is the solution.
“If I had my way, I think that would be a better way,” she says
Perhaps what is adding to Dr Besa’s worry is that the number of psychiatric doctors remains very low in the country.
There are currently only nine psychiatric doctors employed by Government countrywide.
Dr Besa says for a population of about 16 million, the ideal number is 1,600.
Back in the ward the following day, the 24-year-old patient from Kalikiliki is lying on his back, stone-faced but calmer.
“He will be fine,” assures Dr Besa.

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