Third Quarter 2002 Newsletter

We got off the plane, went through customs and then there seemed to be a mad rush for the very narrow gate in a prison-like metal partition. On the one side, we were trying to get out, and on the other were about twenty to thirty men, all in yellow shirts, the uniform denoting the porters for the airport, trying to get at our luggage. All the gentle manners that we had shown each other on the plane and in all the airports we had been through were suddenly thrown off, and it was push and shove as best you could.

I immediately began worrying about my luggage. What if someone grabbed and made off with it? Luckily, a hand-made sign appeared above the heads, tossing and turning with the flow of human traffic. I heaved a sigh of relief. The person who was to help me through the airport procedures and onto the helicopter had received the message and was waiting.

He got me onto the helicopter, which was another mad rush. Although I was first to set off for boarding, I was actually last to get in. The luggage was loaded in the center, and along the two walls were benches on which as many people as the helicopter could take were loaded. A gentleman was asked to carry the child of a mother who had two children. It seems there was no weight limit. When the helicopter took about twenty minutes, with groaning and wheezing, before it got off the ground, I began to worry again about whether I should have taken the almost two-hour journey by road instead of the
seven-minute helicopter ride. We flew low across the water, from Lungi Airport to Freetown, the capital city of Sierra Leone.

Freetown to Kissy
This was nothing compared to the ride from Freetown to Kissy Mental Hospital. Freetown is a crowded city with pavement sellers on every street, selling everything, from potatoes to lettuce and cucumber to shoes and clothes, gum and sweets to buns loaded with baked beans. The streets were crowded with people going to and fro, others begging, and money changers offering the best price every time the car slowed down.

The journey out of the city was slow, the streets were narrow, the traffic heavy and the seven-day rain not letting up. We gradually made it out of the city limits and began to climb a very pot-holed road. When I thought it just could not get any steeper, we suddenly came to an almost vertical incline with a pile of gravel in the middle of the road. The road itself seemed to be made of huge boulders and the gravel was an attempt to fill in the gaps between them. I presumed the job was begun and never finished.

I suggested to the driver that I walk the rest of the way but he decided to give it one shot. The car slithered and slid up the incline, threatening to stall and slide back every minute. We finally made it to the top without any major mishap. I looked around and saw a dilapidated sign saying Kissy Mental Hospital propped against an ancient building made of stone blocks. The hospital was built in the mid 1800s and for the most part, has not been renovated since then.

I had a note that allowed me entrance and a tour. The staff member in charge happily agreed to take me round. He informed me that he was a nursing aide. There is only one psychiatrist and one psychiatric nurse in the whole country of 5 million people.
Non-specialist staff like medical officers and general nurses are not willing to work at Kissy Mental Hospital.

At the Hospital
As we walked to the very first ward, which he called the acute male admission ward, he suddenly said watch out where you step. I was about to step into what looked like human excrement. In the first ward, there was not a single bed or mattress. The patients were all chained to rings in the floor. Most patients were naked. The ward had no door or windows. It was in a very dismal state.

We made a tour of the whole hospital. The wards progressively got better but most patients were still chained to the beds. The reason given was the lack of adequate staff, no isolation rooms and inadequate medications. An attempt was made to provide some art materials as recreation but the drawing was carried out while the patients sat on the beds to which they were chained. The occupational therapy room was overgrown with weeds, and so was the mortuary.

Kissy Mental Hospital is the only psychiatric facility in Sierra Leone. There are no psychiatric services of any kind in any of the other hospitals. The only outpatient mental health service in the whole country is the private clinic of the only psychiatrist. Following ten years of civil conflict, some NGOs have attempted to introduce mental health and psychosocial services. These include Medicins Sans Frontieres, Cooperazione Internazionale, Handicap International, the Centre for Victims of Tortures community based mental health program, and the International Refugee Committees gender-based violence program. These programs are few and far between.

Mental health has been included as one of the priorities in the countrys revised health policy, and the World Health Organization has made a commitment to provide a consultant to carry out an epidemiological survey and provide support to the development of a mental health policy. The time is ripe for facilitation of the formation of a consumer and carer organization to compliment the initiatives of the Government and NGO sectors.