"Dedicated Staff but Unsafe and Poorly Facilitated Conditions…. The Situation in Gaza’s Only Mental Health Hospital" While I was in Gaza myself and Hannah visited the only in-patient mental health hospital. We were shocked to find that in a country where there is such trauma and predisposing conditions for the development of serious mental health difficulties that there are only 10 admission beds for men and 10 beds for women. There are a total of twenty admission inpatient beds, spread equally between men and women. This services endeavours to cater to the needs of a population that is now exceeding 1.7 million. In a country where there is such exposure to stress on every level of life; social, economic, and political instability with constant threat of attack this is an extremely insufficient service. It has been shown that prolonged exposure to violence and especially unpredictable violence increases the risk of complex and prolonged traumatic disorders that affect every aspect of daily life from physical and psychological perspectives. In Gaza it has been seen in research and it certainly was our experiences from simply talking with people that there are greater rates of depression, anxiety and post-traumatic stress disorder amongst all age ranges though at times this is minimized by the people themselves as they have little choice to continue with life as best as is possible. I had heard about the hospital from someone who lived close by. She told us that she could often hear the activities, including crying and screaming, from her balcony which was at the rear of the hospital. She also told us that she felt very anxious at the thought of visiting the hospital as she did not want to “put a face to the cries and screams”. We pointed out that we were ok to walk around the hospital accompanied by the staff which left her, reluctantly, free to leave us in their care. We initially waited in the out-patient pharmacy, from where donated medication is dispensed, for the lead consultant to speak with us. The shelves appeared very empty with limited supplies of a very narrow range of medications and not at all like any pharmacies that we would see in Western hospitals. When we later visited the hospital pharmacy itself we noted that there was an even smaller range and as I work in the area of mental health it was clear that many of the very helpful medications were not in stock. We were informed while we were waiting in the dispensing area that there has not been any medication that treats potential and frequently experienced side effects of the common mental health medications such as anti-psychotics and anti-depressant available for over two years. This came as great shock to me as these medications are not of the expensive variety and it meant either that people could not be treated appropriately or that they had to endure side effects which might vary from uncomfortable, to unbearable to actually life threatening. The head pharmacist was very eager to speak with us and was very welcoming but appeared to us to be working under extreme stress. She later explained that on-going tension and depression and helplessness, is a condition that the staff of the mental health hospital experience all of the time in their daily working life. They were however very welcoming and eager to talk about the difficulties that they face every day. I was struck by how caring they were and how they spoke about their sense of hopelessness and frustration in facing seeing people recover and then relapse. While we were there the pharmacy staff had to turn three people away as they did not have the medication that had been prescribed for themselves for family members of conditions like severe depression, schizophrenia and bi-polar disorder. One lady left the pharmacy in tears. We spoke with the lead psychiatrist, Dr Hikmi, about the three year programme that they have in place for Children and Adolescents and the difficulties that they have in providing a service for them and their parents in the face of the on-going occupation and the lack of medication therapy when it is required. We spoke with a senior consultant who detailed how they feel paralysed by the lack of admission beds and the physical conditions in which they have to provide therapy. They told us that they endeavour to provide treatments for severe difficulties that are complicated by warfare, increased economic hardship and hopelessness. But they emphasised that this is becoming increasingly difficult given the increased need for such support and the lack of on-going training for staff. We were told that there is an increased rate of suicide and thoughts of suicide amongst the general population and that for the staff this is a relatively new challenge. As we had been previously told suicide appears to take very violent forms with self-immolation being on the increase. They told us that someone in the hospital that morning had tried to commit suicide by hanging but that this had been prevented. The man in question he said was now sedated. At this point we had walked accompanied around the hospital and there was no difficulty apparent in walking through the in-patient units. We were struck by the fact that not all of the beds, there were five to a room, were occupied. The reason for this was explained to us as being due to the fact that it was Ramadan and “families prefer to have the people they love at home”, and also “we don’t like people to go into hospital unless they really have to”. We were also informed that “with petrol shortages we cannot send ambulances to people’s homes and the families cannot drive to the hospital for appointments or to visit so they stay at home”. He explained that this had not been the situation however after the last attacks on Gaza in November 2012 when “so many people came here that they were sleeping on the floor”. He explained that they had all arrived in very distressed states and that though some, not all, had been known to the mental health services beforehand, that “the war just made everything worse. Most of them were hysterical, aggressive, terrified and actively hallucinating and traumatized”. He explained that often after times like this “when families see them at their worst” that it is very difficult to discharge people home and “we do not have the facilities as you see to take care of them. Often the patients and ourselves are not safe here and all we can do at these times is sedate people”. Both men and women, in separate rooms, lay on their beds with little comforts around them. Some had a family member by their side but beds were spartan, there were no bedside lockers and belongings were wrapped in plastic bags on the beds. The people that we saw there appeared to be under an amount of sedation, some appeared confused and disoriented and there was armed military at the entrance doors. We shook the hands of those who woke as we walked around. There was a very upsetting air of interminable suffering and pain. The corridors had open broken windows with shards of glass protruding and there was an observation room which we were shown to which could be observed through an opening in the office. This consisted of a mattress on the floor, a toilet and a wash hand basin. If someone was very distressed, physically violent toward themselves or others these conditions were not safe for anyone. There was however a very high level of respect apparent in the staff whom we met. We were struck by the mood of the staff and the open way in which they described how their work affects them. They appeared to be very low in mood, which is completely understandable, but in difference to the other people that we had met to date, they appeared to find it impossible to "wear" the smiles that we are commonly greeted with in the streets, in the homes, and in the other organizations. We were not sure why this was but they explained that this is due to the guilt and frustration that they feel when they are faced with a client for example who recovers well and then relapses due to their medication being unavailable and they feel that they get into conflict with the families who believe that there is medication but that the staff will not give it to them. They said that they do not see that things will ever improve. They said that they have no-one whom they can talk with about their feelings. They said that at times they have very little energy with which to support the clients who are suffering so much psychologically. We wondered how deeply they were suffering too and just how their own feelings of helplessness and hopelessness affected them and how they coped with it. Both Hannah and I on leaving felt that we had absorbed some of the understandable sense of helplessness in the face of a multi-layered complexity that we have only had a glimpse of and the depth of the needs of the people. The environment seemed to carry and hold in its walls all of the despair that the people must feel yet still, as we have experienced so much in Gaza, we were treated with utmost respect and a regard that I did not feel that I deserved. It is very important therefore that we speak of this situation, that we try to understand the needs and we seek to do what we can in order to support everyone who works and seeks support in this limited service. Eileen Carr Voices from Gaza voicesfromgaza/?p=45
Posted on: Mon, 12 Aug 2013 23:57:44 +0000
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