Butabika: Rules, religion, fake patients

This is the last in the series of an experience by a journalist who stayed on treatment in Butabika National Referral Mental Hospital for three months. When he recovered, he wrote about the hospital conditions that prevail against its claim of handling mental health care through a multidisciplinary approach and comprehensive personalised care. He has written about suffering, torture, stigma, sex and substance abuse. Today, he continues with the stories of religion, challenges and patients above the law.

Many Ugandans, including educated ones, believe spirits and witchcraft are the cause of mental illness. They try all sorts of spiritual remedies and the hospital is usually the last resort, by which time the condition has worsened. One of the challenges with combating mental illness is many people do not believe it even exists.

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“These are spiritual issues,” I heard many times. Many of the patients are devoutly religious and request one book during their stay there - the Bible. One of the patients paced the compound all day and night, praying loudly.

She had a small radio, one of the few items allowed, which was always tuned to prayers in Luganda.

Whenever she came to the Common room, she suggested, then demanded, that we change the channel to Pastor Senyonga's Top Television. Most of the other patients preferred to watch music and this would agitate her.

She would burst into prayer, binding the demons that were causing us to watch wicked secular music. Once, when she tried to escape, the guards pinned her down, and she rebuked them, calling them agents of Satan.

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Another patient, who was simply referred to as Hajjati, also paced up and down reciting prayers, repeating “Allah Akbar”. She went a step further and sprinkled herbs all over the hospital. She carried around the greenish herbs in a black polythene bag, sprinkling them in the cleaners' water when they came to scrub the wards.

This traditional medicine was supposed to ward off ‘bad luck.' She also put the herbs in other patients' food and juice, much to their consternation. Hajjati claimed her herbs cured every disease, even those science was yet to find a remedy for.

One patient, Laker, told me she could look through my eyes and see my soul. She told me I was born an angel, but I had allowed demons to take over. She added that through her union with a male patient whom she said was a reincarnation of Jesus, they would bring forth offspring who would save the world.

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And she was not the only one. There were a lot of cases of ‘reincarnations.' Naturinda, another young lady, also claimed she was pregnant with the ‘messiah.' She kept hearing voices of babies and asking me if I was hearing the same.

She asked me to check all the bags and make sure there were no babies hidden there. I heard a lot of fascinating things from patients here. Sadly, hardly a month after she was discharged, Laker returned bloodied and bruised after a fight with the Police.

She told me her father and brother, who had been ‘taken over by the devil' had called the Police on her in the dead of the night.

Sunday prayers

On Sunday, patients who obtain the necessary permissions are escorted to a church nearby and during the week, there are religious activities patients can engage in.

Two of the four weekly group sessions are religious in nature. The hospital believes these play a crucial role in recovery. The counsellors who conduct the religious sessions stress that they are non-denominational.

They say patients of all spiritual persuasions are welcome. But the sessions, naturally, lean heavily towards Christianity, perhaps since most patients are Christians.

They sing Christian hymns and read from the Bible. Patients are, however, free to openly share their views, regardless of religion.

Caretaker's challenge

Every patient in the private ward must have a caretaker who is responsible for their welfare and general wellbeing at the hospital.

A company contracted by the hospital provides these services at a fee. After spending considerable time with the caretakers, I got an insight into the inner workings and goings-on of the hospital.

It is a 24/7 job, throughout the duration of the patient's stay here. The caretaker wakes the patient up for medication, washes the patient's clothing, makes sure the beddings are clean and well laid, gets food for the patient, and feeds them where necessary (all the while ensuring the patient does not escape).

Some patients are violent and caretakers have to be able to resolve these conflicts without retaliating. Many patients are simply uncooperative and everything from getting them to eat to swallowing medicine is an uphill battle.

One patient threw her caretaker's phone into the toilet. Another caretaker woke up to find the patient had thrown all her belongings into the trash.

Relatives, too, can prove to be problematic. Some are unreasonable or unwilling to part with money after paying the hospital's hefty dues. This leaves the caretaker in the difficult position of looking after a patient with no food or toiletries like soap, toothpaste, basin, or bucket and one told me she had to dig into her own pockets to take care of the patient.

Caretakers are only paid when they have a patient, about sh45,000 per week, and are provided lunch and supper of posho and beans. While some caretakers are not up to the challenge, not understanding their role and mental illness in general, for others it is a calling.

They are patient, kind and considerate. I saw a caretaker endure endless insults and taunting from their patient, but they continued to attempt to cheer the patient up. I felt like it could be a dangerous job.

One of my caretaker friends was looking after a South Sudanese patient suffering from post-traumatic stress disorder. He behaved like he was still in a warzone, refusing to sleep all night as he patrolled the compound on the alert for the ‘enemy.'

He was prone to sudden outbursts and I asked the caretaker: “What if he strangles you at night?” The caretaker told me my concerns were not far-fetched as they have been cases of that happening. I woke up one morning to find this caretaker seated on the verandah, hands on his chin.

He told me he had been unable to sleep the whole night because his patient had eased himself all over the room and the stench was unbearable. The patient had also refused to open the windows for fresh air, claiming it would leave them vulnerable to attack from the ‘enemy.'

Whenever you see a caretaker waking up to look for disposable gloves, you know it is going to be a hell of a messy week for them. One patient simply refused to go to the toilet, opting to defecate on the bed, while one elderly man left a trail of poop all the way from his room to the washroom.

Patients above the law

The hospital is full of rules, but like elsewhere in our society, with the right amount of money, one can circumnavigate these rules. Patients with the right amount of money are unofficially exempt from these stringent rules.

A few weeks into my stay there, a celebrity patient arrived, causing a stir. He parked his car and casually walked in as if checking into a hotel. With the reception he received, it was obvious it was not his first time here.

My caretaker told me he was in high demand here because of his generosity. “Whoever becomes his caretaker does not eat posho and beans,” he said.

He tipped everyone, from the guards at the entrance to the nurses working on his file. Consequently, no one bothered to check his bags and he walked in with his phone, laptop, and other items that are strictly prohibited.

This patient told me he needed these items to continue working, even while admitted to the hospital. He also told me ‘tipping' helps speed up the process.

“I do not wait in line like everyone else,” he said gleefully, “I simply ask the nurse handling files whether she has had breakfast and hand her a 10k.”

The next weekend, this patient said he needed to attend to a client at his workplace. He drove out of the hospital without any hassle and returned two days later.

One patient, who told me he was the sole breadwinner for his family, had for weeks been requesting to be escorted to the ATM for a few hours so he could withdraw money to send his wife.

Fake Patients

I got to know two patients who were here to get away from the long arm of the law. Both were being sued by their former employees for misappropriation of resources and one came here after doing a stint in prison.

He was admitted two days before his next court date. Another patient was here for groping a waitress's breasts.

Family caretaker

Families who do not want to contract the hospital's caretakers are free to provide a family member to take care of the patient.

This is where you see the toll and cost of mental health on the family unit. Next door to me was a patient being taken care of by his mother. A university student studying law, he was more than a handful for the mother.

He would strip naked and storm out, if she approached him with clothes he would attack. She was at wit's end as he was much stronger than she was.

To the other side of my room was a patient being taken care of by his father. He often escaped from his room and wandered the compound naked, as his father was occupied trying to ‘befriend' female nursing staff.

The father did not seem to be helping much, causing us to speculate that he may have been the trigger for his son's mental health issues.

One day, this young man climbed the roof of the annex - the tallest block in the ward. Hospital staff surrounded the building, trying to prevent a suicide attempt, but his father did not seem much bothered. I often wondered when these family caretakers got time to work or do their private business.

Mental illness and stigma

Although there is generally a lot of stigma surrounding mental illness, patients struggling with substance abuse get no sympathy.

I overheard people say they feel bad for mental health patients, but not for those “alcohol and marijuana addicts.”

This espouses the general feeling in our society that, ‘they brought it upon themselves. Many sufferers of mental illness are not drug users, but many drug users also struggle with mental illness and use illicit drugs as a way to cope.

One psychiatrist referred to this as “self-medication,” a way to try to deal with the chemical imbalances in the brain by resorting to drugs. That is why there is a huge intersection between mental illness and substance abuse.

For example, in order to shut out the scary voices, hallucinations, anxiety, and depression, some patients resort to alcohol and narcotics. I met patients whose ‘demons' did not allow them to sleep at night, the bar was the place they spent every night for a little solace.

I made a lot of friendships at the hospital that continued even after we were all discharged. There is a lot of solidarity among patients and after we left the hospital, we formed a WhatsApp group to continue supporting each other.

The story was adopted fron the New Vision archives - library@newvision.co.ug. It was first published on Sunday, January 15, 2023.