By Bibhav Acharya, Nyaya's Executive Vice President
Dr. Arunima Rajbhandry, a volunteer clinician working at Nyaya Health’s Bayalpata Hospital, recently recounted her experiences treating a mother suffering from mental illness on our blog:
Bayalpata Hospital outpatient department was crowded with patients, all lined up eagerly to be seen by a clinician. I was done seeing my first few and rang the bell to call for the next patient. A thin, nervous looking middle-aged woman walked in, along with her teenage daughter.
“I have a headache,” she said looking down, avoiding my eyes.
“Okay, tell me more about it,” I said as I lowered my head to get a good look at her face.
She paused for a few seconds, then, hesitantly uttered, “I see normal people as if they have long teeth and long bushy hair, like a demon.”
It took me a few seconds to comprehend what I had just heard. “Normal people walking down the street…they appear like demons. And I am afraid I might attack them like I did before. I am scared I might go crazy again like I did before,” she blurted out in a single breath.
“I don’t want to go crazy again because it hurts me a lot. Last time, when I went crazy, people tied both my hands. Then they hit me. They hit me so hard on my head that my head still hurts. Then they locked me up in a dark room for days. Please give me some medicines so that I don’t go crazy and I don’t get beaten up again,” she said.
This moving story of a mother dealing with stigmatizing condition reminds us how much clinical and advocacy work still needs to occur in Nepal around mental health.
Only 0.8% of the total healthcare budget of Nepal is allocated for mental health. There is only one public psychiatry hospital and it is located in Kathmandu, the capital. There is one psychiatrist for every 1 million people, and most of the psychiatrists practice in the capital city.
A government study funded by multilateral donors found that in 2008/2009, the number one cause of death among women aged 15-50 years old was suicide. The clinicians at Nyaya Health are constantly seeing patients that have received absolutely no treatment despite severe and persistent signs of mental illness. Patients and their families have narrated stories of neglect, shame and abandonment that range from verbal and physical abuse to murder attempts like the patient that we have featured in Dr. Arunima’s blog.
Nyaya Health has been working with a team of psychiatrists based in Nepal and abroad to provide support to our primary care clinicians at Bayalpata Hospital. The psychiatrists provide assistance in several ways. They have helped write protocols on management and they provide case-specific advice for clinicians at Bayalpata Hospital via email.
The treatment gap is large and in addition to availability of treatment, which we are providing as a part of primary care, significant steps need to be taken to address stigma so that we can not only provide treatment but also restore the dignity that our patients deserve.
Established in 2005, Nyaya Health works with the Nepali Ministry of Health and Population to develop health care services in the impoverished western regions of the country. Working to advance the solidarity model of Partners In Health, Nyaya aims to scale-up not only medical services, but also services targeting other population-level interventions.
Nyaya is one of PIH’s six supported projects, each dedicated to implementing the organization's philosophy on a global scale by working with local communities and governments to create change.