Kopano N. Mokale has just completed his fourth year of medical school at a South African university. He did his fourth year elective in Rural Psychiatry, something I thought was very brave and super interesting. I trust you will enjoy his story. As always, let me know if you’d like to share your Elective story.
Stark white straitjackets, padded-cells and distant indistinguishable shouts and yelps… murmurs and mumbles from deranged minds, far detached from space-time as we understand it…. men in white coats and unrealistically beautiful nurses with little “kappies” on their heads… sorry my friends, only in Hollywood.
My previous exposure to psychiatry (I prefer the term mental health), was limited to my mother’s textbooks – I used to read tons of them as a young lad – and a blue prescribed textbook we studied in my third year of medical school. I never had any true clinical exposure or experience, but I had passion I guess. Psychiatry was my reason for choosing Medical School over Engineering and after four years of all the other disciplines; I just wanted my piece of Psychiatry.
An elective in psychiatry is crazy enough I know, but an elective in rural psychiatry – hold me down and give me a shot of Promethazine – it’s unheard of!
My elective is a tale of two cities, Kimberley, South Africa and Lobatse, Botswana. I have always had an interest in how black people engage with Psychiatry. Growing up in the ghetto I can tell you stories of the mentally ill being locked up in the house to hide them from society or to hide society from them (if you know which is which, I will gladly listen) or how schizophrenia is demonic possession or bipolar a calling from the ancestors (I do not mock or dispute ‘spiritual inclinations’ but mental illness and The Calling should not be confused).
But I digress. Both cities have a Tswana population, Tswana language, Tswana culture, Tswana beliefs and both have a tertiary psychiatric facility. West End Specialised Hospital, in Kimberley, is the main psychiatric facility for the Northern Cape Province and S’brana Psychiatric Hospital, in Lobatse, is the main facility for Botswana as a whole. However, both Kimberley and Lobatse are small places, with small populations, all-round poverty and lack of resources.
Setting up my elective was quiet interesting. The facility in Kimberley had never had a medical student before and the facility in Botswana, even though having 4th and 5th year medical students from University of Botswana rotating through it, has not had an elective student since 2008, six years ago. I could have not pulled it off, if it was not for Dr. B. Chiliza, a psychiatrist at the University of Stellenbosch. He connected me to the right people and with a couple of phone calls and filling out forms asking about my criminal record, it was fairly simple to set up.
West End Specialised Hospital, Kimberley, South Africa:
After years of neglect from provincial government the once legendary facility has decayed. The walls are peeling from water damage, some corridors stand dark from light bulbs that fused but were never replaced and beds are always in short supply. The term “floor-bed”, a term not taught in med-school, was introduced to me there. Wanting to help as many people as possible, the nurses devised the “floor-bed” (a pillow and blankets on the floor) as a temporary solution, while a patient waits for a proper bed.
The facility has only one psychiatrist, so one-on-one sessions with patients are done by the general practitioners. One psychiatrist to service a province the size of Germany; it’s unfair to him and all the patients, but he handles it quite well.
It was not all sombre though, not at all. Patients escaping now and then, and patients greeting you every morning with a smile and a conversation that is hard to follow, it was great. “Wait did he just say something about me being Moses? That has nothing to do with our current conversation about mechanical birds that are spying on us.” The staff is really great, passionate and helpful and very peculiar themselves. We had a presentation on porn addiction on a Thursday morning, very stimulating… intellectually.
S’brana Psychiatric Hospital, Lobatse, Botswana:
This facility is a gem, built for the post-modern era. With an art room, music room, sewing room, class rooms for basic literacy, knitting and shoe repairs, welding, woodwork… just wonderful! Its own soccer field, staff gym and uncapped WiFi… a mental healthcare heaven. However, without an art teacher, music therapist and other allied health works, some of the facility stands unused. The Adolescent Ward is deserted and boarded up like a scene from a post-apocalyptic movie. But there are enough nurses to go around, three psychiatrists each with a firm of six general practitioners strong and the patients present with a diversity of pathologies. It’s a pretty sweet set-up.
“This is the end of this session.” said by a bald man in a cardigan –just another myth about psychiatry, a Hollywood thing.
In my opinion, the best way to understand a country and a society is to visit their psychiatric facilities; you’ll be surprised at what you learn. As recommendations go, I say; if you like psychiatry… go for it, do an elective in psychiatry. I feel that a general practitioner needs sound knowledge of psychiatry because just as all humans have blood and bones, all humans have a psyche. If plastic surgeons are the sculptors, cardiologists the plumbers and radiologists the photographers, then I would like to think of a psychiatrists as the programmers.
Barefoot’s Note: Check out Robin Hammond’s photo project CONDEMNED, about mental health in Africa.