Butabika is a name that strikes terror into the hearts of many Ugandans. The largest mental hospital is regarded by some people as a mental asylum in the country.

Its website says it handles mental health care through a multi-disciplinary approach that includes primary care, a wide variety of medical specialties and clinical services.

This unique approach, the hospital claims, ensures that patients receive comprehensive and personalised care. However, behind the hospital walls, are tales of suffering, torture, sex and substance abuse. There are also fake patients, trauma, stigma and patients who seem to be above the law. A journalist was admitted there for three months and when he healed, offered to write his experience about what life is like for the pitiable patients locked away.

There is a large mango tree patients nicknamed the “open air theatre”. Under this tree, in the corner of a section that connects Butabika's private ward to the general wards, outpatient section, alcohol and drug unit, administration blocks and women's wards in the far horizon, became our focal point during my stay there.

We nicknamed it our movie theatre because it provided an endless source of entertainment that cheered up what would have been otherwise dull days in the hospital. There was always drama to witness whenever one sat there.

Patients are insanely creative in their methods of escape.

One particular evening we were sprawled on mats under the shade, playing board games, chatting as usual. Suddenly, we heard commotion behind us and jumped up to witness the drama.

A patient, who had been talking to us not long ago, grabbed his mother's handbag at a speed of lightening and scaled toward the private ward gate like a monkey on steroids.

He raced towards the parking lot while fishing in her purse for her car keys. Before the guards could stop him, he swung the door open and stuck the key into the ignition. Carrying the patient's baby in her arms, his mother stood in the path of the car to block him from getting away.

But he was not to be deterred; he was ready to draw blood if necessary. He quickly reversed the slick silver sedan, hooting loudly to get his mother and baby out of the way. His mother wailed loudly, banging onto the car and screaming for the guards to get him.

With the guards and several hospital staff in hot pursuit, the patient sped off, racing for the main gate like a bat out of hell. The hospital staff rushed after him, screaming for the gatemen to lock the gate.

They slammed the main gate. As the guards screamed in desperation and the patients cheered him on, he smashed the car right through the locked gate and sped off.

A Police patrol car usually stationed near the hospital rushed after him, accompanied by vehicles of other hospital staff in hot pursuit. But he left them in clouds of dust, taking them on a fast and furious ride through Luzira's panyas.

Escape attempts, broken dreams

No other type of hospital has as many escape attempts as a mental hospital. Not a day goes by without an escape or escape attempt at Butabika.

Some patients spend all day just staring at the gate, waiting for an opportune moment to escape. Patients are insanely creative in their methods of escape. Some patients simply steal their caretaker's uniforms and money and just attempt to confidently walk out the gate as if they are visitors.

Though one or two manage to get out this way, many are caught before they can smell the sweet scent of freedom. Patients watch the guards keenly and monitor their schedules.

For example, some patients plot their escape around highly anticipated football matches such as the Premiership where all the guards are distracted.

Many patients are at the facility against their will, desperate to flee the hospital before they lose something precious on the outside, like a job or family. The patient who crushed through the hospital gate had confided in us before his daring break that he was a truck driver who had just been promoted, but run the risk of losing his job if he remained at the hospital.

Like many other patients, his family had brought him to the hospital against his will. Patients have many reasons for wanting to leave the asylum, but one of the most common is fear of losing their livelihoods.

Unlike other hospitals, mental health institutions come with a heavy stigma and if an employer catches wind of the fact that you have received treatment in a mental hospital, chances of losing your job are high. I, myself, begged many evenings to leave the hospital in order to save my job, but to no avail.

“Your health is more important than your job,” is the phrase I was met with.

Turned into zombies?

I received a number of questions about Butabika, many of which I will answer in this series. One of the first questions the editor asked me is: “Is it true that patients are sedated at Butabika? Upon admission, some patients are knocked out cold with a strong dose of a dreaded drug referred to simply by its initials — CPZ, or even worse, locked into solitary confinement. But not every patient admitted to the hospital is sedated.

It all depends on how one is brought in. There are two modes of transport that feature prominently here: Police patrol trucks and ambulance. Patients who enter the hospital premises on the back of a Police patrol, a number of them handcuffed, usually arrive after being a menace to their families or to their community.

I saw one patient kick the door of the doctors' offices, screaming loudly that he was going to kill his mother who was cowering away inside. He threatened to finish off anyone who dared get close to him and it took a team of the strongest staff the hospital could conjure to subdue him.

Getting him was a struggle as he was large and muscular, but after a gang of staff managed to get him down, he was knocked out cold with two injections. A doctor, receiving treatment as a fellow inpatient in Butabika, explained to me that the first injection left him conscious, but unable to respond to anything happening to him.

“He can see them and feel what they are doing, but he is unable to move his arms, legs or any part of his body,” the doctor told me, as they laid the beefy bipolar patient onto a stretcher and carried him upstairs.

Some patients injected with the dreaded CPZ do not emerge from their rooms for two or three days. When they do crawl out, they appear dazed. However, not every patient gets this treatment.

Patients who enter the hospital calmly and co-operatively and those rare ones who self-admit are not sedated or even restrained forcibly.

Another question I constantly received is, “Is Butabika any good? Does it help?”

This is perhaps the most complicated question to answer as there are a lot of factors and a lot of nuance. What I can say for sure is that it is the best Uganda has to offer in terms of mental health care.

It has the largest collection of experienced psychiatrists and well versed therapists under one roof in Uganda. Countless people have passed through its gates and gone on to thrive on the outside.

I personally witnessed enough transformations not to dismiss ‘mad' people. It is heartwarming to witness remarkable transformations. Some patients are brought kicking, screaming, hurling insults and stripping. About three days to two weeks later, they are a totally different person, calm, withdrawn and introspective.

When I asked them whether they remember the things they did on the day they were brought to the hospital, they have no recollection whatsoever. However, there are practices here that irk human rights activists. I saw a lot of what could be generally considered abuse in Butabika.

Patients beaten, neglected and there is bribery. After all it is a public institution, not free from the inefficiencies that plague other public institutions.

Place of geniuses

“Butabika is a place where genius is refined,” Camela, a fellow patient, told me, a few weeks into our admission at the hospital.

We had spent hours talking about what Butabika meant. Camela is a brilliant young lawyer, the sharpest legal mind I know — insightful, artistic, compassionate and articulate.

She had two large volumes on her fingertips: The Bible and The Constitution of Uganda.

“I do not read the Bible, I live the Bible,” she told me.

“I do not read the Constitution, I live it, it applies to every single facet of my life.”

She had an encyclopaedic grasp of the country's Constitution and would give you the context for the conditions under which each law was framed. Every single conversation was punctuated with citations from these two books, she did not go a minute without quoting a verse and chapter from scripture; without quoting section, subsection from the Constitution.

Butabika was full of brilliant geniuses and I learnt a lot from patients during my stay there. That does not mean every patient at Butabika displays extraordinary intellectual flair.

The three groups

From my layman observations, patients at Butabika generally fall under three groups. There is one that has totally lost all their marbles — naked, loud, totally unpredictable, does not respect others' boundaries and personal space, given to sudden outbursts and generally gets under everyone's skin.

Usually, this one's family offloaded him as their ‘problem' to the mental hospital and does not hope to see or hear from them. This is the stereotype most of the nation has about Butabika, but these are usually the minority of the patients.

The second group is the charming, charismatic one who draws everyone like a magnet, spreading sunshine and good cheer wherever she or he goes. It is usually hard to tell exactly why this person is admitted here, unless you spend time digging a lot deeper.

The third is the quiet, depressed, withdrawn one who talks to no one, abhors all form of social interaction and remains firmly ensconced in their shell throughout their time here. Inconsolable, he or she does not leave their room except for compulsory doctor's visits.

Stigma at Butabika

One of the first things that happens when you are admitted to the hospital is all your civilian clothes are taken away to decrease your chances of escape.

Your phone, money and all other personal effects are confiscated, leaving you alienated from the outside world.

Things one has always taken for granted become a big deal here. Unfortunately, the loose green uniform you are handed only makes it easier for staff, visitors and the outside world to stereotype you.

When people across the road see you at a distance in that uniform, they call, treat or fear you as a mad person. I witnessed patients strip and parade naked, refusing to touch the dreaded green uniform.

One patient refused to wear the uniform, instead spending all his time here draped in the hospital bedsheets until the day he escaped. But behind every hospital garb is a unique, often fascinating story on a journey of recovery. (I did notice though, that those from influential families were somewhat exempt from the uniform.)

One of Butabika's core roles is to sensitise communities and reduce stigma, but in practice, everything from the name Butabika, a Luganda word that loosely translated as “to run mad”, to other practices just further reinforce stigma associated with the place, making it hard for many to seek help there.

The patients

Butabika conjures images of ‘mad' people, lunatics locked away to keep society safe. But the cast of characters locked up in the hospital is as varied as people on the outside world — a reflection of our general society.

Butabika is proof that mental illness does not discriminate, patients are from all walks of life — from the cream of society to the most wretched of the land. Patients of every race, age, religion, social class and creed walk through its gates seeking healing.

I met a relative of the first family; a minister's son, whose family had a history of suicide and patients from other high profile families. Patients include doctors, lawyers, engineers, businesspeople, policemen and people from other prestigious careers.

Anyone can suffer from mental illness, the brain is a complex machine, a million things can go wrong and often do. Although there are people who are at higher risk of developing a mental health disorder, every person is prone to developing a mental disorder during their lifetime.

Uganda's well-publicised high statistics are a case in point. An estimated 14 million Ugandans suffer from one form of disorder or another, according to statistics from the health ministry.

Uganda is ranked among the top six countries in Africa with high rates of depressive disorder. World Health Organisation estimates that 90% of mentally ill people in Uganda do not receive treatment.

The story was adopted from the New Vision archives - library@newvision.co.ug. It was first published on Thursday, January 12, 2023.

Tomorrow: Butabika's torture chamber and more abuses