Sir Cowasjee Jehangir Institute of Psychiatry: Only a mad man would want to be admitted into the asylum

The patients are provided certain facilities but are generally mistreated

HYDERABAD:

In a country hurtling towards madness, the province’s biggest mental asylum in terms of area covered, the Sir Cowasjee Jehangir Institute of Psychiatry in Hyderabad, is crumbling apart, brick by brick.

The hospital was built in 1865 and has continuously been ignored and mismanaged since partition, to the point that a few of its buildings have collapsed, bringing the total capacity down from 500 to 300. Save for one recently renovated building, which houses a TV and a carom board for the patients’ entertainment, the rest of the hospital also seems as if it may collapse any minute.

Mismanagement of funds

As with most government institutes, the hospital suffers mainly due to the mismanagement of financial resources. Additional medical superintendent Dr Darya Khan Leghari claimed that the hospital is underfunded but Liaquat University of Medical and Health Sciences (LUMHS) Department of Psychiatry chairman Dr Moin Ansari, who also delivers lectures at the hospital, claimed that the money is there but is not being used properly. “If even half of the money that the hospital receives is utilised properly, then the hospital can be changed drastically,” he said. “For example, the hospital does not have any psychologist on its payroll, despite receiving funds for one. The only psychologist in the entire hospital is a visiting psychologist on LUMHS’ payroll.”

Most of the equipment is in shabby condition. The electroconvulsive therapy machine is heavily duct-taped, despite being used in one of the more complicated and last-measure medical procedures. “The Sindh government provides funds for renovation and medicines, but it does not provide the hospital with the latest machinery,” said Dr Ansari.

Separate wards

The patients - currently 303 of them - are divided into separate wards, based on how unstable they are. The wards look like jail cells: heavy padlocks lock iron-grilled doors. Two male and two female nurses are to be present in each ward at all times, but this is seldom implemented. Those that are present stand guard like jail wardens, more concerned with keeping the patients in than trying to help them get out. However, before the patients can be given a white bed inside these grey walls, they must go through a rigorous screening process.

Admission into the hospital

All patients have to first go to the OPD where a couple of post-graduate students sift through the files and sort out the patients for the doctors. The large room is divided by a green curtain, segregated by gender.

The doctors then diagnose the patients and either prescribe medication for them or admit them into the hospital. “Some of the patients are given medicines for a week, others for a month,” explained Dr Leghari. “It depends mainly on their mental condition, but we also take into account how far away the patients live.”

If a patient is diagnosed with an illness like schizophrenia, he is admitted for further treatment. But first he will be tested for diseases such as hepatitis and Aids; diseases that may spread to other patients. If he passes the screening, his information is then added onto a digital database through an old computer. A hard copy is also kept on file and a ‘receipt’ is handed over to the patient’s family. A copy of that receipt is kept in an adjacent, much larger room, which is filled with stack after stack of dusty paper: confidential medical files.

No way out: Abandoned by their families

Most of the patients that arrive at the hospital do so never to leave again, left here by their families who refuse to take them back even if they show signs of progress.

“A lot of patients are just dumped here by their families,” said Dr Leghari. “They just leave them here and never return since taking care of these patients can be a hassle. Even if we are able to track their families down, some of them refuse to recognise the patient and claim they do not know who he is.”



In order to counter this, the hospital tries to discuss the mental condition of the patients with their families before admitting them. “We explain the patient’s condition to his family and tell them whether there are chances of improvement or not,” claimed Dr Ansari. “We inform them that the patient can only improve with their help and love, and that if he is discharged from the hospital and his situation worsens, then he can always be brought back.”

However, before discharging patients, the hospital needs to check for signs of improvement and whether they are fit to be released. This can be quite tricky. “There are over 200 different parameters and indicators, called psychological scales, that can be used to measure a patient’s mental health,” said Dr Leghari.

These psychological scales compare the patients to their record when they were admitted. “We check for indicators such as improvement in mood, improvement in appearance and self-grooming, and whether the patients are showing signs of mental degradation.”

Mad men: The thin line between madness and genius 

The history of the hospital is littered with tales of extraordinary patients. “There used to be a patient here that memorised an entire psychology book by heart,” claimed Leghari. “You could ask him to recite any page of that book and he would do so. Another had mastered all of Ghalib’s poetry. Unfortunately, both these patients died a few years ago.”



Such extraordinary patients may now be part of legend, but there is still no shortage of creative and productive minds inside the wards. Some of the patients paint and sketch in their free time and while most of these paintings are rudimentary and basic, a few show advanced artistic skill and creativity. A psychosis patient, Fida Hussain, particularly stood out, signing all of her works with a ‘Fida Art’ signature.

Others create decorative handicrafts, including miniature figurines. The patients stand proudly over their work as they display it, grinning widely and hopping from one foot to the other, too excited to stand still. “I made this all by myself,” Muhammad Mansoor said with pride, unable to contain himself, displaying a dress that he had sewn. “Look at how I stitched it here. It was my own idea to do so.”

Others are not as artistic but are still quite productive. They fix the hospital’s broken furniture and even paint a few walls if and when required.

The admitted patients

The buildings and equipment may be in a rundown state but a system for patient wellbeing is in place. There is a small 10-bed clinic for those who fall sick. However, the patients cannot always be taken on their word. “Doctor sahib, main buhat beemar hun [I am very sick],” Arshad Ali, a mental patient, bemoaned. “They don’t let me go to the clinic,” he added, raising his right hand and pointing towards the two male nurses standing in a corner.

“He has been insisting that he has fever every single day since he arrived here, more than six months ago,” one of the nurses explained.

The patients are given regular dental checks and a dental surgeon visits the hospital often, claimed Leghari. The dental room is large, the silver equipment inside gleams in the sunlight, so do the shiny teeth of the visiting dental surgeon, Dr Zahid Qurban Ali. The patients, however, are conspicuously absent.

The equipment in the dental room is shiny but overall general hygiene is questionable. Swarms of flies buzz around the entire hospital and murky puddles of water cover the main hallway as men with mops sloppily try to clean up the mess.

Most of the patients are inside their wards, drugged up in varying degrees. In one of the wards, 11A, the patients sit on the edge of their beds with blank stares. Others gather around a television set and smile, their eyes riveted on the screens; seeming more like mindless zombies than mental patients with a chance of a better tomorrow. However, their predicament is paled by that of others.

Chained up

A few of the patients, the especially aggressive and troublesome ones, are chained to their beds. The patients, heavily chained, are tied in awkward and uncomfortable positions and are completely unable to move. “I will be honest with you,” said Leghari. “This is not allowed. Attendants should not be doing this, but some of them get lazy as these patients require constant supervision. So if and when they pop out for a drink or to relieve themselves, they just tie these patients up. We try and stop them from doing it but it is not always possible.”

Dr Ansari claimed the patients are a danger to themselves and to others and are therefore chained up. “This is unethical and illegal,” he said. “No patient should be treated in this way but the hospital lacks the injections and medications required to control potentially dangerous patients. Hence, they are forced to do so.”

Thus these patients wait, chained up like wild animals, for the wardens to return; and the province’s largest mental asylum, once a crowning jewel, now stands in ruin. It functions but its existence is under threat, a lack of funds and blatant disregard of rules and medical procedures plague it. There is talk of an expansion that will increase capacity to a thousand, but such talk has been around for too long now to be taken without a pinch of salt. It would be madness to not do something soon.

Published in The Express Tribune, November 3^rd, 2014.