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?