A tale of family issues, sex at Butabika hospital

A journalist has been writing about his experience at Butabika National Referral Hospital. He received treatment from there for three months, recovered and was discharged. He wrote to compare his experiences against the hospital claims to handle mental health care through a multidisciplinary approach, offering primary care, medical specialties, clinical services, and comprehensive personalised care. He has narrated tales of suffering, torture, substance abuse and stigma. Today, he continues with sex abuse and family issues.

Patients in the private ward see a doctor twice a week, depending on the group one has been assigned to. In addition to medical treatment, Butabika offers personal therapy, group therapy, and occupational therapy to help patients reintegrate into society.

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Twice a week, patients meet in the boardroom for group sessions moderated by two therapists. If it is your day to see the doctor, you then take your place in the long winding queue. Otherwise, patients loiter in the compound as they wait for the group sessions to start at 10:00am on alternating days.

The group is a rich resource of information for recovering patients; they share coping techniques, guided by experienced therapists. After the first session, I was appointed head of the patients, which gave me the unenviable task of rounding up the patients for these sessions.

Some caretakers fall in love with patients, and where the feelings are mutual, they take advantage of them.

It is akin to herding cats. Some patients are sulky, rowdy, or not interested in the sessions. Many patients open up during these sessions, while some drone on endlessly, their monologues making little sense, some doze off throughout the entire session while one or two are just so disruptive that they have to be escorted out.

During one session, a huge fight broke out after two patients hurled insults at each other. A girl of about four feet tall lunged across the long table at a six-foot giant man.

She accused him of, among other things, flashing his private parts at her. She threatened to go on a hunger strike, refuse to take medication, and directly engage the director of the hospital if the male patient was not isolated.

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Interestingly, the two patients subsequently made up several weeks later after he apologised. One of the tasks the therapist gave me was to take up suggestions from patients for activities that could enrich their stay here. I handed in a long list, including games such as basketball, badminton, tennis, pool, dodgeball, monopoly, chess, and cards, which he promised would be implemented.

In the afternoon, some lucky few get to go to the occupational therapy department for activities, such as baking, playing musical instruments and painting. In the occupational therapy department, it is sad to see the wasted opportunities.

Patients are supposed to learn tailoring, cooking, music, art and crafts, as well as gardening. But the machines patients are supposed to train on are often broken. The gardens where patients are supposed to learn modern farming methods are rundown, the pigsties are dilapidated and abandoned.

There are a lot of frustrated patients with a lot of free time on their hands, yet most of them are locked away from these facilities.

A typical day in Butabika starts at 6:00am with a trip to the nursing station for medication, and a general health check of vitals, such as temperature, pulse, blood pressure, and weight. Some patients do their exercise regimen before taking a bath.

Others go straight back to bed as a result of the strong medication. The first few days are made even more challenging by the side effects of the medication: Insomnia, heartburn, diarrhoea, drowsiness, general body weakness, et cetera.

Evenings are usually spent in the common room watching television. Patients who are up to it join the caretakers to play soccer matches on a makeshift pitch behind the ward.

Coping with life

Butabika is depressing - that is to be expected since it is a hospital. However, there is a side of Butabika no one talks about. Once in a while, when it gets the right mix of patients, it becomes an interesting place.

On Friday and Saturday nights, patients gather in the quadrangle with Bluetooth speakers, playing music loudly, dancing, playing games, and singing loudly, until the guards come to enforce a curfew.

Consequently, the next Monday and Tuesday, many of those patients are discharged and the hospital sinks back into the depressing place it was. Patients all have different ways of coping. I met a young woman who was brought there straight from jail after burning a neighbour's house.

She chose to frame her whole Butabika experience as a grand adventure and spent her time meditating, doing yoga, singing, dancing, and cheering up other patients.

She used her time constructively, reflecting and combating her anger management issues which had led her down the path to Butabika. However, most patients' perspectives of the place vary. I heard different patients describe it as a “camp”, a “resort”, a “place of healing”, a “dump”, a “prison”, and a “torture chamber”.

Spend enough time there and you become desensitised to nudity. Somehow, clothing just rubs some mentally ill persons the wrong way and when they are triggered, that is one of the first things to go.

Common illnesses are bipolar, depression and schizophrenia. Someone with bipolar disorder told me he had withdrawn and given out sh15m before realising he was having a manic episode and driving himself to the hospital.

Mental illness and family

During a conversation with a young woman taking care of her sister-in-law, I remarked how caring her patient's husband was since he always came to visit her at the hospital. The caretaker sniggered and said, “Hmmmm, yet he is the reason why she is here.”

Many women in the hospital said they were there because of their husbands, and issues in the marriages led to mental breakdowns. During one of the group sessions, one woman said her husband was sleeping with ‘anything and everything in a skirt' - all her sisters and the housemaids had not been spared.

She said the day she was brought there she had found him in the car with another woman. He dragged her there after she smashed his car in revenge.

Mental illnesses can be triggered by a variety of factors, including genetics and society. Among the societal factors, family is key. Most patients are brought by family members - parents, spouses, siblings, some are even brought by their children.

I saw one woman wailing and falling to her knees as she fought admission, saying her sons were admitting her because they were conniving to steal her property. This was a chilling accusation because if for a moment you allow the thought to cross your mind, who is to say she was not right?

It was, after all, her word against theirs. Sometimes these inter-family battles become so heated that the Police get involved. One woman was brought by her husband, but some of her relatives were against the decision, saying she should be taken to church, instead.

There were many accusations thrown about on both sides, with her brother saying her husband was trying to kill her, and accusations of witchcraft. Eventually, the Police were deployed to stop her relatives from accessing her.

Anything her relatives brought her was locked up in the office. Another woman who was brought one evening by an ambulance stripped naked, beat up her husband, broke the curtains, and attempted to break the windows to escape.

Her husband left with a huge gash on his forehead, but the very next morning, he was back to see her. She was as calm as a mouse. However, whenever she saw him, she would go wild.

After a while, the nurses asked her husband to stop visiting. Anything he brought her was received at the gate and passed on to her caretaker and he was sent away.

What happens in Butabika, stays in Butabika

There are things the hospital would prefer to remain under the covers. One battle the hospital is constantly fighting - and losing - is that of ‘coupling'.

While the other wards are segregated by sex, the private ward is mixed. Management is always warning caretakers, who do most of the nursing, not to get into relationships with patients.

This is futile because many of the caretakers are young women and men. They spend a lot of time with patients and, naturally, the proximity breeds intimacy.

The rules are clear: Patients are not even allowed to visit rooms of the opposite sex. But the caretakers are poorly paid and easy to compromise. Besides, some of them fall in love with patients, and where the feelings are mutual, they “take advantage” of them.

It is a case of asking the monkeys to guard the banana plantation. Sex is something no one at the hospital wants to talk about, but there was not a moment when there were no affairs going on inside. Patients and caretakers simply have too much time on their hands.

I saw many workers summoned and ordered to stop talking to a particular member of the opposite sex. They were even threatened with the loss of their jobs if they were seen near someone they were supposedly spending too much time with.

Several times, the management was forced to get involved when things got out of hand. For example, drama unfolded one night when one caretaker got into a physical fight with her patient over the affections of a male patient.

Recovery

One of the things that makes recovery hard, is that some patients are sent right back into the same setting that triggered their mental health issues in the first place.

No wonder, there are many cases of relapse. Some patients spend only a few weeks on the outside before being returned here.

While welcoming back a patient who was being readmitted for the third time last year, we joked that Butabika should start providing lifetime membership for repeat customers.

Stigma does not spare family, during one group session, the therapist told us that after a stint here, our families would not be able to fully trust and accept us again.

The hospital tries to do its part, inviting families to participate in sessions that give them a better understanding of mental health issues and their role in the care plan of the patient.

Patients who have been abandoned by their families usually end up becoming long-stay patients. I got a feeling that some of the mental health issues stemmed from childhood trauma.

One woman told me her father used to beat her mother to the point of unconsciousness. Because he was a surgeon, he would lock her up in the room and treat her himself, before administering more beatings as the children watched.

The story was adopted from the New Vision archives - library@newvision.co.ug. It was first published on Saturday, January 14, 2023.

 In the fourth part: Religion, caretakers, rules and fake patient