Wednesday, June 11, 2008

What Can You See In The Horizon




I spent the last 4 days at Al Rashad hospital where I work and train these days. The first 2 days we had no electricity at all. The second day the whether became so dusty that you cannot see farther than about 100 meters. You know what, I start liking those dusty days because the whether is colder during it. I’m hearing his sound again. There is a chronic schizophrenic patient in the nearby ward and he got a habit of screaming the same word again and again till his mother call him. He got no telephone and the hospital got not telephone too. So she calls the nurse's mobile phone number and talk to him once in a week. That made him better for some days, but soon he will start shouting again. If you go and ask him during shouting why he do that, he will tell you that he don't know. But he will thank you that you asked. If you ask him why, he will keep quite for a while. But he will start shouting again. I can hear him from my room in the house of doctors. During the first day he was shouting something that I cannot remember exactly. I think he was just making some sound that means he was in protest against something. He sometimes bang his head against the wall recurrently he is drowsy. He is on high dose of a tranquilizer and a mood stabilizer.

I saw him that day in the evening while I was doing my evening tour. He was squatting, with his back supported by the wall and his eyes fixed on the ground. I greeted him saying “Hi, how are you…..” the nurse standing near me whispered to me his name, I added his name at the end of the greeting, “…..M”, he just smiled. I stayed looking toward him while he downcast his gaze again to the floor. I thought about what I can do for him. It was sadly nothing. There are about 1200 patients here. Most of them are not wanted by their families. The government provides food, shelter and clothes for them. The staff tries to provide acceptance and respect for them. Some of them are enrolled in the rehabilitation program of the hospital which include training in: sewing, carpentering, blacksmith working, sport and art in form of drawing (mainly oil drawing), and drama. The rehabilitation is not that active. The psychodrama is the slowest one because it is a difficult work. It is done maybe once every 2 years, and the most beautiful thing about it is the time spent preparing for it. It took months of training and of hard work for the staff and the patients.

Not all the patients are enrolled in the rehabilitation program. The main cause is the prominent negative symptoms of some patients. All patients are seen once every 2 weeks. Some of them, actually the majority, seem not enjoy being seen and talked to. They have very poor if any eye contact. And they got marked poverty of speech. My senior sometimes asks some of them: do you like to go outside the hospital? The majority answer: no. But is it correct to let all these patients with the so called DEFICIT STATE to chose their islands of isolation? should we force them to join the rehabilitaion? Was it because of lack or rehabilitation that they are so "negative"? Is it irriversable?



Al Rashad hospital is a type of a TOTAL INSTITUTION, Goffman had talked about before decades. It is a type C hospital according to the classification of Wing and Brown in 1961, which is a hospital that patients spent most of their time unoccupied in the ward, and generally treated as “inmates”, and they got little liberty, and few personal possessions, things that lead to increased incidence of social withdrawal (underactivity, lack of conversation, neglect of hygiene and personal appearance) and socially embarrassing behaviour (incontinence, mannerisms, purposeless overactivity, threats of violence, talking to self).

I know all that but now, what can I do for M. is he in receiving the best care we can offer? He got all those socially embarrassing behaviour listed above (taken from companion to psychiatric studies). Can I help in enrolling him in carpenter working for example? Or sport? But what about the others? Can the rehabilitation building find place for them? Maybe each patient can have a day in the week. One day per week. And the trainers got to agree on this cause this means much work for them. How many staff we will need?

Will patients agree that they go to work there? Did somebody try before? I don’t know. Am not one of the permanent staff, I came here last February and I will leave soon. I didn’t come to change things here, I came just for watching and learn, didn’t I?

5 comments:

Laura said...

About 30 years ago I worked on the 'same' units you're training on now, Sami. Chronic cases, with odd behaviors, far too many unwanted by their families, many over medicated and lost-looking. And I too, thought about Goffman and also Jules Henry, and wondered if things could ever be better. You're very right, you are there to watch and learn, and that's a painful thing (not being able to help as much as you want to) and a good thing. There is SO much to soak up, just to experience, just to float in, at the beginning. I think one of the biggest things we get in this early time (if we're blessed) is a deepened compassion for our brothers and sisters. I can still remember the faces and the quirks of many of the people who taught my heart how to listen, so long ago, as your patients are teaching you now. I am still grateful to them. I didn't imagine then, that I was going there to receive this great gift--of more compassion, humility, and sense of limits--things we cannot find, or put, in text books.
In english, the root of patient is latin for one who suffers or endures. And patience, too, shares this root. Such a gift, learning to tolerate and bear pain, patiently....
You have a kind and caring spirit, Sami. It flows through your stories like a stream of sweet water.

saminkie said...

Thank you Laura for your nice words and encouragement. I'm always in a state of waiting to get older and wiser. It seems that the day I will reach that I will feel that I want to go back as I am now or maybe younger. I don't enjoy my life now much, but your comments, dear Laura, made me contemplate more and smile to myself, and to you....
With you, reading what I write, I found life more beautiful...
Thank you Laura...

3eeraqimedic said...

Another thought provoking post, it remnided me of one of the first patients I met in my psychiatry hospital stint during the fifth year at medical school.
She was tall with long dark hair drawn back in a very tight knot, extremely neat and tidy, and had a masters degree in french literature. For the first few minutes of our meeting I thought she was a member of staff, until the conversation suddenly veered and she started a very vicious verbal attack on a patient.
The experience shook me at the time, she had apparently been in hospital for many years even then, I wonder what happened to her?

Indigo-Daisy said...

Touching post dear Saminkie, how painful it must be...your kind and gentle spirit shines through in your writing.

Laura, what a beautiful response..we sometimes want to heal the world from all its pain an misery and all we can do is stand by and watch. To hear you say that you are grateful for the gift you received from your patients hit a cord with me and helps me in a way find my inner peace. If I continues to bear the pain of the world, How can I ever illuminate peace to others.

Thank you both

Mohammed, Sheffield said...

Thank you sami, very touching

Change is an accumulative process . Lets not underestimate the good that we could do even if it is so small, even if it for only one patient.