A Tale of Two Sisters (and Grief and Mental Health)

Two little sisters had an extended stay in the small rural hospital. They were the stars of the Paeds ward. The little one was absolutely shining and brightened up the whole ward. I spent ward rounds with her in my arms, on my hips, and eventually falling asleep on my back. She was loved. The older one was a regular little mother-figure. No nurse was allowed to clean or feed her sister: SHE did it.

They were no longer ill, but had lost their parents in quick succession, followed by neglect and abuse by the relatives who took over their care. So, as they lived in a region with a single over-worked social worker, they were staying at hospital until placement could be arranged.

And we loved them, and because the little one was so cute and happy and the older one never complained, nobody thought to counsel them after their trauma and loss.

But one day we realised the older sister’s silence was not just her being introverted, and that her motherly role of her sister was inappropriate, because she was ONLY EIGHT and needed some nurturing of her own. She was grieving, and nobody was role-modelling grief for her; and she was alone, and we began to suspect that she was depressed.

But because this was a rural little hospital in an under-resourced little province with far too few registered public psychiatrists and psychologists, we had to do without. So the mental health team for these little girls comprised of family physicians, occupational therapists and a speech-language-and-hearing therapist.

They did well, given the circumstances. But statistically, these girls are at risk for further mental health issues as they grow up. And who will look out for them then, in that province where schizophrenic patients go without help and suicide is under-reported and doctors are so busy scrambling to keep head above water with all the infection and malnourishment and red tape that they sometimes forget about what goes on inside their patients’ minds?

In this country – continent – that scoffs at psychiatry? That writes hallucinations off as evil spirits and depression as a sign of selfishness?

A Protest in Cape Town 2013, Via Times Live, Halden Krog

What will happen to the minds of our people, in this country where the mental healthcare budget is too small and the psychiatrist-patient ratio is unrealistically skewed? This country, where there are psychiatrists who WANT to work in rural areas, but find that the government has not created those jobs?

Doctors need to eat, and non-profits focus on disasters and infections, so what is going to happen to the state of mental wellness in our countries, and the repercussions on physical health, society and the economy?