Mathari Hospital (Part 4)

My trip to Mathari Hospital was illuminating in a number of ways. The biggest one was the stark reminder of the stigma that accompanies mental health issues.

I bet there’s a reason we evolved to be afraid of people who were mentally unstable yet in this I am reminded of a dear friend who called me to remind me that if your ears are painful, you see an ENT doctor. So too, she reminded me, of mental health issues. A part of me wishes it were that simple.

At Mathari, you have to wait till 0800 to pay for services but you need a number from a clinic to do so. Getting a number means being there before 0800 and having to wait some more to see a GP once you pay. We wasted so much time waiting (to pay, to see a doctor, to be tested) that the 5 hours between 0800 and 1300 dragged on forever.

I wonder about someone who is a wage labourer and would essentially have lost a day’s work. Who would compensate them for the day? How can we make accessing such services the sort of endeavour that doesn’t take away your livelihood?

One of the reasons I went to Mathari was the cost of psychiatric care in private institutions. Like a lot of Kenyans, I found the charges prohibitive and needed an option. Even accounting for the tests, drugs and two sets of registration, I still spent less than KSh 1,000 during the trip. Is this accessible for everyone? It might not be, but it’s a fraction of what a private provider would charge you.

The Mental Health Act was last reviewed in 1989, from what I could gather. In the room in which I saw the psychiatrist, there was a poster with the ‘Mental Health Rights of an Individual’ on it. Yet I felt that between the law and best practice, the things we know fall through the cracks.

One of the romantic notions I had going in was that the staff at this institution would be able to deal with patients such as myself without the stigma that society attaches to mental illness. How ridiculous of me, I later realised. These people are you and I; one’s attitude doesn’t magically transform when they go through school. Hence the disbelief when I speak for myself (who would bring themselves here?), the doctor who doesn’t understand why someone would come to the institution she works at (the whole point of an education is to escape public services) and the nurse who won’t say the word psychiatry.

Because I don’t believe in private solutions to public problems (and yes, mental health issues are public matters), the question for me is how to make things more bearable. Here are my suggestions:

Let’s make mental health help available at the lowest level so that a person doesn’t have to go far from their home and workplace to access these services. This may take a while, but it would be great to work towards it.

Let’s make a place like Mathari more efficient. Put the masses of students and members of staff to work checking vitals, conducting tests, giving directions. Have more payment points so I don’t have a long wait every time I have to pay for something. Create a designated area for adult psychiatric patients so minors don’t have to interact with people having psychotic breaks.

Talk about mental health care. Let’s talk about it in the same way we talk about diabetes, or a toothache. Maybe then we can care for each other with empathy and something approximating normalcy instead of the treatment so easily accorded people in settings like these.

The one thing I’d like to highlight that gave me hope was the sight of friends and family accompanying people who were there for psychiatric services. My mother, the men and women there present. The morning I spent at Mathari she too spent and if it speaks to nothing other than her love for me, I am grateful.

Hopefully, we (patients, patients’ friends and family, everyone really) can move out of the shadows. Remember this: drugs, consultation, waits are things you can pay for and legislate. Empathy, kindness, even handedness, the knowledge that a college degree neither exempts you from these issues nor makes you rich enough to afford private care… These things we need to work towards.

This is my little thing.

Note: This post is part of #CuminWrites366, my year-long attempt to write a post a day. Find the rest over at readability.com/cuminwrites/

Questions, comments, suggestions or thoughts on mental health? Send them to cuminwrites@gmail.com 🙂

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Mathari Hospital (Part 3)

We got directions to the psychiatric clinic (same place as the lone cashier) and went to get signed up.
The guy who did my intake (a nurse, I presumed) asked who it was getting registered & I handed over my ID for him to take down my details. The process is basically copying down the things at the back of your national ID; the idea being that it’ll help them ‘find your people’ should the need arise. Strange moment: he asked me my level of education and I told him I have a university degree. He then promptly turned to my mom, “Anasema ukweli?”. It ground my gears; I was present, I had answered questions till that point, and I could speak. My mother redirected him, reminded him that the patient speaks her truth. Now I understood the urgent “Who are you with?” from the nurse. The assumption is that every patient is psychotic, delusional, and someone else has to speak for them. What would have happened, I wonder, if I had come alone and been sent that way? Who would have been there to answer his questions?

Anyway, I paid the KSh 200 registration fee, was issued with a file and sat outside a room waiting to be called. When I was, I found a small crowd of student nurses and doctors yet there was only one person taking temperature and blood pressure readings. No wonder the queue was moving so slowly, I thought.

Back outside and a short wait later,  I was called in to see the psychiatrist. In the very same room so no points for privacy. My mother came in with me and as we settled into it, I noticed adverts for psychotropic drugs on the walls. I am still curious about the ethics of adverts in that setting but that’s just me.

I told her about the sleeping, the compulsive eating, the other things, and she asked my mother questions too. Had she noticed these changes? Yes. She asked me, with a sincerity I found startling, why I had come to Mathari if I have a university degree. Why not, I asked. I needed mental health services, they offer them.

She said she would put me on a mood stabiliser and I had my usual routine of asking for non-drug solutions. What would you like, I was asked. Therapy, I was quick to say. She explained to me that she’d send me for psychotherapy after I was done with the dose and it worked. The other option, she pointed out, was psychological care as a walk-in patient at Kenyatta National Hospital (KNH).

I agreed to be put on the drug for a fortnight and was issued with a prescription as well as a note to be given an appointment for review. I went to the ‘Appointments’ window and got a date and place as my mother filled my prescription. I went back to get the talk from the chemist about taking the drug at the same time every day and I could leave.

We were there almost 6 hours and in the next instalment, I’ll tell you about some of the thoughts and observations about mental health care that came to me during my visit.

Note: This post is part of #CuminWrites366, my year-long attempt to write a post a day. Find the rest over at readability.com/cuminwrites/

Questions, comments, suggestions or thoughts on mental health? Send them to cuminwrites@gmail.com 🙂

Mathari Hospital (Part 2)

Maximum. So named because it’s where people who are under some armed protection are admitted. (Now is probably a good time to say that there are security guards everywhere. I can’t quite tell if it’s a factor of the psychiatric services on site or if I’m just sensitive to it.) There were APs and prison guards; making for a strange environment.

The lab and x-ray services are in a basement area that looks pretty run-down. There’s an abandoned feel to it, haunted even. Probably apt in the days after Halloween.

The tests took a while to be done and there was a strange moment as the most senior person censured the lab technicians for not following procedure (ensure payment before conducting a test, in this case). Once they were done, though, I was able to carry them back to the doctor.

Some context: I’m generally good at reporting my symptoms and I had told the GP I may have anaemia (the fatigue I had been experiencing was a factor) or I may be clinically depressed (ditto). She sent me to the lab to rule out anaemia &, because I am a woman, pregnancy, before we moved to step two.

When I got back, I gave another GP my results & repeated the things I had said before then I was sent to the psychiatry clinic. The GP gave a nurse my file, the nurse sat me down and asked me in Kikuyu who I had come with. “A friend” I said in English, “my mother” I corrected myself.

She went outside, called my mother aside and told her she needed to speak to her. “She’s been told to go to the other side for this,” she said in Kikuyu, pointing at the word ‘psychiatry’ as she said ‘this’. My mum, being who she is, read the word out loudly to force it out of her. The nurse was mum; we were now firmly on the silence track, the valley of the shadow of the unspeakable thing.

Next up: the psychiatric clinic

Note: This post is part of #CuminWrites366, my year-long attempt to write a post a day. Find the rest over at readability.com/cuminwrites/

Questions, comments, suggestions or thoughts on mental health? Send them to cuminwrites@gmail.com 🙂

Mathari Hospital (Part 1)

As some of you may know, things have come to seed in my head in the recent past. As some other ones may know, I am not currently swimming in a pool of cash. So when I needed some mental health help, I went to the nation’s shorthand for such services. Mathari National Teaching and Referral Hospital.

Two things struck me when I got there. The vast grounds (it feels like a maze) and the high staff/student to patient ratio. It felt like everywhere one turned there was a doctor, nurse, security guard, student nurse or doctor. Usually in packs. Two buses full of student doctors arrived while I was there and if there is a group word for doctors, I’d say the most apt was swarm.

Yet, somehow, this didn’t speed up the service.

Like a lot of government health facilities, one has to pay for services before they are given (read: what cost-sharing looks like). Unlike a place like Kenyatta, though, there is only one payment point. That means queuing before every single procedure and it makes fairly fast processes take ages.

Because I was a first-timer (and had not been referred by another facility), I went through the outpatient clinic to get face time with a psychiatrist. This meant queuing at 0800 to pay the KSh 50 consultation fee and then waiting my turn at the outpatient clinic (which doubles as the child and adolescent psych clinic).

There was only one GP at hand when I got back and a nurse issuing registration cards for newbies. Ergo, no one to check patients’ blood pressure, temperature, or weight. The GP was quite friendly and did a good job of talking me through the tests she wanted to run but she’d made it clear in conversation with the nurse that she wanted to leave soon. You could feel it in the air; this urgency around being elsewhere.

Lab tests ordered meant a trip back to the cashier, a queue, and payment (maximum KSh 150 for tests) and a trip to the main lab which is at the farthest reaches of the hospital (a place ominously called ‘Maximum’).

What happened next will be revealed in Part 2.

Note: This post is part of #CuminWrites366, my year-long attempt to write a post a day. Find the rest over at readability.com/cuminwrites/

Questions, comments, suggestions or thoughts on mental health? Send them to cuminwrites@gmail.com 🙂

/ʃeɪm/

Coming out………

No, I’m not gay, happy but not gay………..joke

Let me, as I usually say, wacha jokes……

The enry’s title is ‘Shame’….yes, it’s pretty obvious……..

I used to harm myself in high school. No, I was not a cutter…….I was constantly, compulsively, scratching myself to bleed. I bled my way through my final year of high school. No one knew. Not my parents………or the therapist they sent me to when I became suicidal. I was so ashamed of seeing a therapist it took me more than half a year to tell my best friends. I wasn’t psycho, I had to convince myself….even though I had had two sessions before going back to high school, didn’t think I could make it through to the end of high school.

I am ashamed of my crying. I wail when I am distraught………and hate to be reminded of those moments….moments I think of as those of weakness. I wailed in my school chapel once with my parents watching helplessly in my 18th year…..my most depressed, most helpless-feeling year. I refused to talk about it when my best friend, whose classmate had been present during the episode, asked me about it. I am supposed to be my parents’ perfect child….and yet…….. So I have cried alone since I was a child…..and my public displays of sadness are quite dramatic…..and they shame me…

I am ashamed to be a virgin at 20……not for lack of people’s efforts, but because I made a promise at 15 (same year I decided what my Masters would be, and where…..but I digress…) I feel odd when people talk about sex because, well, I have no idea…..really. And I was angered by my university GP’s questioning glance when I revealed that yes, vaginal infection notwithstanding, I am not sexually active. Angry at myself for not being gutsy………….And I hide my shame well. When I had another of those infections recently (yes, I am prone to those…….candidiasis……occurs as an STI, too….) and was instructed by the chemist to abstain from sex during the duration when I’d be taking the medication, I made a crack about sex being  a basic need which I would have to go a week without. Or my constant reference to the first time as ‘losing virginity’ eg ‘oh, I helped you break your rollercoaster virginity’ I figure if I say the word often enough, its power over me will diminish. This shame is strange because the most influential women in my life, not the Mary sort, encourage me in  my virginity pledge journey……I feel like I’m missing something….and I feel shamed………

I had a breast biopsy at 14. I was talking to my boyfriend (yes, I got round to referring to him as such finally…….I’m afraid he’ll break my heart into small, hard-to-fix pieces and yet…….) on the day of the arrest (my shock and shame about that should get an entry of its own….) about a famous Nairobi surgeon and when he asked me about how I knew him, I became obtuse. Same year, my cousin had one of those, too. I have body image issues (don’t we all? well, no….) My body falls short of my society’s standards…….Am I a dyke, I am asked?……I ‘look white’  I’ve been told. Yeah, great, thanks all…especially seeing as my white ears are turning red……………..not!! So I am ashamed that my grossly imperfect  body is more imperfect than you can see. Even though I have no shame about having a gynaecologist since 17…….there’s nothing shameful about taking care of my reproductive health. No logic, I know…….

I want someone to see this post. I am not ashamed of this blog….but I do not speak about it to my friends………

But I want him to know a little of what I am…….and to know that I love him, warts and all. And also that I wish he’d communicate more. Say what it is that is happening in his life so I get to understand him……call, text, message more often so I don’t feeel like I’m the one that has to go see a person that’s captive……..has no access to me. Say, when I ask how he is, that he’s had a crap day………that something amazing, beautiful happened today……..

I want him to take a chance on me……like I’ve taken a chance telling the world my truth….