Psychiatric patients in Yemen: Victims of low social awareness and government neglect [Archives:2007/1030/Reportage]

March 5 2007

Fatima Al-Ajel
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Considered a shameful condition, psychiatric patients in Yemeni society still are looked down upon, even when, in many instances, such psychological and psychiatric cases are the result of a combination of various social conditions, genetic defects and/or physiological or mental imbalances. Going to a psychiatric hospital socially stigmatizes a Yemeni family's name, especially if the patient is a woman. However, regardless of this, some families are forced to admit a member after exhausting visits to local doctors and holistic centers.

Yemeni society still has limited knowledge of psychiatric disorders and conditions. Families will refuse to provide their last name when they go to psychiatric hospitals. “When we ask them for complete patient information for the file, they refuse in order to avoid the social windfall. We speak to them and try to convince them that this condition is like any other disease requiring complete and careful hospital treatment and check-ups. We tell them anyone can become a victim of such disorders,” Dr. Abdulwassa' Al-Wasa'i, manager of Al-Amel Psychiatric Hospital, commented.

In talking with psychiatrists and psychologists about the background of psychiatric patients, they say some are intelligent, politically-minded, educated men and women, mothers and fathers, etc. They often have endured extreme levels of stress, lacked social or familial support and suffered a myriad of events until they lose their hold on reality, their sanity and the ability to function normally.

One such example is a patient who was at the top of his secondary school in 1988 His scholarship was taken away, but he continued to study and entered the faculty of agriculture at the university. Again, he was at the top of his class and again, his scholarship was awarded to someone else. At that point, he no longer could bear it, so he lost his hold on his sanity and is now a patient at the hospital, according to Al-Wasa'i.

The Yemeni government plays a major role in the ongoing neglect of such patients and persistent lack of social awareness. Al-Amel Psychiatric Hospital is considered the Arab Board of Medical Specializations regional center in psychotherapy medicine and the only hospital in Yemen, aside from two small hospitals. While it was completely neglected prior to 1991, the Yemeni government now subsidizes approximately 30 percent of the hospital's annual costs.

“Most psych patients were sent to the central prison or lived on the streets. At some point, there was a psychiatric care center at Al-Jumhury Hospital that was able to care for these patients, but administrative mismanagement of the center obligated the administration to convert the needed space into a surgical center. So once again, psychiatric patients were back on the streets and their cause worsened,” Al-Wasa'i explained.

Just like males, female psychiatric patients also were sent to the central prison and faced the worst humiliations. For example, in 1991, Yemeni society was rocked by the scandal of two mentally retarded inmates who were impregnated while incarcerated.

This incident brought together philanthropists, executives, cooperating local councils and the Islah Party to jointly decide to build a Care Center for Mentally Retarded Women. By 2002, the center had expanded to become a psychiatric hospital for women with outpatient clinics for men. However, while it now beds some 200 patients, roughly 160 are for men and only 40 are for women.

As a charity-based facility, Al-Amel Psychiatric Hospital lacks sufficient funds to improve its performance. Seventy percent of support comes from philanthropists, while 30 percent is from the government. President Ali Abdullah Saleh attended the hospital's grand opening in 2002 and ordered 30 percent support for the hospital at the time, however, “In reality, we only receive 15 percent from official coffers,” Al-Wasa'i replied regarding how the hospital covers all of its needs.

Social awareness

Thankfully, awareness is spreading among some Yemeni families who do send their afflicted family member to the hospital regardless of their social peers' negative attitudes. Taiz University student Misk Ahmad Al-Magrami came from Taiz with her brother to treat their mother at the hospital. “Some of our neighbors will call her crazy, especially those who are uneducated. They laugh when they see us leaving, knowing that we're going to Sana'a for treatment. They think she's incurable, but we ignore them. Contrary to those, other neighbors are a good source of support and say that we should take her to the hospital even if there's only a 1 percent chance of a cure,” Al-Magrami explained.

However, many patients are confined to the hospital for years. Once they get better, they find they can't return to society because they either don't have any family or their families refuse to live with them. Victimized as patients, such individuals suffer due to society's lack of awareness and continue suffering even after they are well enough to integrate into society because both society and their families categorically reject them as “crazy.”

According to their condition, some patients require only a few days of continuous treatment and then are well enough to go home. Walking in the hospital garden, Fatima Al-Ryimi approached with a smile and greetings. She explained, “I became ill about four years ago after facing many social problems and stress. I suffered a crisis about a month ago, so my sons brought me here. Today, they're coming to take me back to my village.”

Since its grand opening, Al-Amel Psychiatric Hospital receives many patients. However the hospital has housed 11 inpatients who either are anonymously named, such as Ms. S., Ms. L. and Ms. X., or rejected by their family and society. Some patients come from the central prison, while others are taken off the streets. “As you know, women are the most exposed to rape and illegal treatment,” Al-Wasa'i noted.

Psychosis in Yemen

Psychiatrist Ibrahim Al-Sharifi summarizes the reasons for psychiatric disorders in Yemeni society, basically consisting of three elements: genetic, biological and environmental/psychological. Daily social conditions, their related problems, and the stress they can create are among the main reasons for psychiatric disorders in Yemen.

When it comes to improving a patient's health, those who have the support of spouses, children, parents and other relatives respond more readily to medical treatment than those who are single or have no family.

Mohammed Amar, a psychologist at the hospital, considers qat another reason Yemeni patients sink back into a crisis. “A patient returns to his family after treatment and is drawn back into chewing qat, neglecting the doctor's instructions regarding medication and diet. After awhile, he's back at the hospital and in a worse condition than before his original admission.” In many cases, this vicious circle of relapse-treatment-relapse worsens the patient as time goes on.

Most Yemeni patients in treatment are classified as suffering from psychosis. According to hospital statistic during 1991 – 2005, 46 percent of patients are brought to the hospital by force. Many patients suffer from delusional disorder, previously called paranoid disorder. “There is a patient here who always calls himself the president, continually repeating, 'I am Ali Abdullah Saleh,'” Al-Wasa'i declared, illustrating what goes on in patients' minds at times.

While 17 percent of patients are neurotic, will admit they are sick and are willing to go to the hospital for treatment and regular check-ups, “due to lack of awareness in society, many won't go to the hospital if they have depression or suffer from anxiety,” Al-Sharifi clarifies.

Treatment and rehabilitation center

Treatment and rehabilitation are essential elements of the hospital's activities. For example, treating delusional disorder mostly consists of medication and psychotherapy, which is a type of counseling. Delusional disorder is highly resistant to treatment by medication alone.

Many activities were held throughout 2006, with approximately 335 patients attending illiteracy eradication courses and other activities.

Huda Hamoud Mohammed, the hospital's rehabilitation center trainer, explained the center's role in developing patients' skills via handcraft activities. The center receives at least four patients per day. “Some patients have been here since the hospital opened and have become professional handcrafters, in a sense. They like to spend most of their time at the center. This helps them assimilate their environment and helps manage their illness as well.”

Fatima Al-Thaeri, one of many patients considered “crazy,” is one such patient who has been at Al-Amel Psychiatric Hospital since its opening. Her family brought her to the hospital nine years ago and never returned for a visit or to take her home. Because of this, Mohammed says Al-Thaeri now considers the hospital her home and spends most of her days at the center. When asked why she's in the hospital, she replies that she has a liver disease and will be back with her family in a few days.

Al-Thaeri's response to her condition is to escape from reality, especially after her family's rejection of her and the disorder with which they refuse to live. However, this belies such patients' usefulness, as they participate in hospital work such as cleaning their rooms, tending the garden and helping nurses with their duties. “They like to share in the hospital activities,” Mohammed notes.

Bringing about social awareness

Khalid Al-Abasi, the hospital's chief of general relations and media, explained that he prepared to launch a plan for a media strategy to raise social awareness; however, lack of facilities in Yemen defies its implementation at the moment. “We want to publish monthly magazines reflecting patients' activities at the hospital and spread social awareness, which would correct the negative concepts about psychiatric patients.”