The trauma of finding yourself in Butabika

Butabika is the country's national referral mental hospital. A journalist was admitted there for three months and discovered the side of the coin that Ugandans do not see from the outside. When he got healed, he decided to share his experience behind the gates of the hospital.

He has written about suffering, torture, sex and substance. Yesterday, he wrote about what happens at Butabika; today, the story continues with the tale of different wards, the torture room and more substance abuse.

The Eagles 1976 hit album Hotel California pretty much sums up how most patients feel about Butabika.

“I heard them say Welcome to Hotel California Such a lovely place ...the last thing I remember was running for the door... ...‘relax', said the nightman You can check in anytime you like, But you can never leave.”

Getting into the hospital is easy, but leaving is hard. For a patient to get a discharge, a number of parties have to all agree and upend their signatures: the primary psychiatrist, the psychologist or therapists and the person or people who brought the patient to the mental institution.

If one or more of the three parties does not agree, you are stuck at the hospital. This can really be frustrating for the patient.

For example, my discharge was pegged to sessions with the psychologist, yet the psychologist I was seeing suddenly went on leave for several weeks. This meant I was stuck at the hospital just waiting for this psychologist to return.

Furthermore, I learnt he had several other duties; he is a lecturer and has to travel within and outside the country for other duties. This meant the number of patients he could see each week was limited.

Sometimes patients made fun of the misery in order to make it more bearable. We nicknamed one patient “World Cup” because each time he asked when he was likely to be released, the medical staff told him he would only be released when Uganda wins the World Cup.

RELATED STORY: Shocking expose’: Surviving three months at Butabika

Most admissions are painful. Patients are not told where they are being taken or are lied to until it is too late. I witnessed two patients escape from vehicles on two different occasions when they saw the Butabika signposts; one simply jumped out of the car when his people stopped to ask for directions to the hospital. Some patients are just told they are going for a simple health check, nothing more.

They, therefore, go wild later when they are told they are being retained. Some families even work with a private team from the hospital to come and pick up their patients from home if they suspect the patient will resist.

One patient told us he locked himself in his room and they had to break the door to get him out. Another patient, Kibuuka, made us laugh when he told us how he was tricked into coming to the hospital.

He had been asked to come to Kampala with his documents for a job. When he got to town, his uncle dragged him straight to Butabika.

Ivan, another patient, cried out to me that he did not even get time to close his shop; his father and mother simply bundled him to Butabika for a ‘quick' health check.

“What will I tell my customers, my suppliers, whom I had not yet paid,” he cried after realising he would be here for weeks. One defence that can never help you wiggle your way out of admission is: “I am not mad, I am normal.”

Many patients feel they are fine and do not have any issues at all. It is, therefore, with shock and horror when they realise they are being taken to a mental hospital and this probably adds to the trauma of admission.

Ironically, some see the other patients as mad and themselves as normal. Some patients are brought in unconscious (such as in cases of overdose), and by the time they gain consciousness later, they are in a hospital gown.

My caretaker told me his previous patient was brought in unconscious. He gained consciousness two days later, disoriented and wondering where he was.

As he tried to make out where he was, he read “Butabika” on the pillow and burst out screaming and kicking. One woman was brought into the hospital barefoot and in a manic state, wearing a fancy traditional dress. She showed us videos of her kukyala and told us the function was what triggered her mental health issues.

She said she had to organise and implement everything by herself and was under a lot of stress, which eventually pushed her over the edge. Some of the staff — from the guards to the nurses and doctors — do their best given the circumstances under which they work.

But patients often complained that some of the staff were not understanding or, in fact, despising the very patients they were supposed to treat.

Life in Butabika

Another common question asked is: What is life like in Butabika? Well, it depends, relative to where you are admitted. Mine is a subjective experience of someone who was fortunate enough to be hosted in the private ward. It gets considerably worse in the general ward.

One patient described it to me as “the worst experience of his life”. “It is a prison,” he told me.

Many patients were released from the private ward, not because they had improved, but because their families had run out of money for treatment.

For many families, the general ward is, honestly, not an option. Perhaps another thing that makes it hard to treat many patients is that they are in denial.

One patient who had been dragged here for alcoholism refused to admit he had a problem. This is despite the fact that he had got to the point of vomiting blood, his eyes were bloodshot and his lips ‘burnt' black. Not even the hospital laboratory results showing severe liver damage could convince him that he was an addict.

Many patients hate the place, but some are thankful for how the hospital has transformed their lives and continue to visit even after release.

In addition, an increasing number of people are learning to recognise when their symptoms are kicking in and drive themselves to the hospital for admission.

Some symptoms that may indicate you need to check yourself into Butabika include insomnia or the other extreme of sleeping too much; neglecting one's hygiene or self-care; and hearing voices.

The general ward

Butabika's wards are a tale of two worlds. The service patients receive in the private ward is worlds away from the experience in the general ward.

Though the private ward is not luxurious by any measure, it is a far cry from the destitution that characterises the general ward.

The pain and suffering that characterise the general ward are evident from the moment one walks in. The patients scale the chain-link fence like prisoners — some with ribs sticking out — begging passersby to throw in a morsel for them to eat. They fight over each crumb thrown over the fence. One woman even slammed another woman's head into a slab of concrete while fighting over a piece of cassava.

Hunger is a constant companion in the general ward. In the dead of the night, I witnessed some of the more daring patients scale the fence to enter the private ward and rummage through the garbage cans for leftovers.

Such is the irony: a lot of food is thrown away by patients in the private wards, yet those in general barely have enough to eat.

Patients in the general ward are entitled to free hospital meals, while those in the private ward buy all the food they need.

There are three restaurants in the hospital, one at the private ward. But visitors to the private ward usually come with an endless array of food — from Kentucky Fried Chicken to Cafe Javas, name it — to lift their patients' spirits, and the resident cats and stray dogs that roam around at night are well-fed.

When patients from the general ward get visitors, they are taken out of the ward so that the other hungry patients do not grab their food. They have a picnic on Butabika's manicured lawns, which have million-dollar views of Lake Victoria.

There are no such concerns in the private ward because patients are generally well-fed, and some are even forced to eat. While each patient in the private ward has a personal caretaker who caters to all their needs, the general wards are overcrowded and understaffed.

Most patients in the private ward get a room to themselves, but patients in the general wards share beds, with the unlucky ones even sleeping on the cold floor.

One caretaker told me a story about a time they brought mattresses to the general ward and patients tore them apart, each taking a small piece to sleep on.

The side room

The general ward has a punishment room — a torture chamber euphemistically referred to as a “side room”.

In this room, one can be punished for infractions ranging from minor misdemeanours such as attempting to escape, to more grave crimes like murdering a fellow inmate Regina, who got a taste of the side room when she attempted to escape, described it as a cold, grey bare room, with a concrete slab for a bed.

There was a tiny window at the top to let in a little light, and there was no toilet, so one relieved themselves like an animal. Regina told me she was stripped butt naked and thrown in — standard procedure for entering the side room.

The stench of urine and faeces stung her nose and she wailed and banged the heavy metallic door in desperation. To the consternation of human rights activists, the rooms look eerily similar to prison quarters, yet they house not convicts but patients.

More abuses

There are other heartbreaking abuses that one witnesses here, but that is a whole other story. I saw patients, including two children, thrown to the ground and beaten mercilessly, simply for trying to escape.

And it is not just the guards/ staff engaged in this abuse. Perhaps because of understaffing, some patients are tasked with ‘enforcing discipline' and in the morning you can see these ‘senior patients' battering those who resist medication or attempt to escape.

Some scenes will bring tears to even the coldest of hearts. I witnessed a thin, naked man being whipped on the ground, simply for not moving. Diet is vital to the recovery of mental health patients, yet no one can accuse the hospital of providing a balanced diet to its patients — posho and beans are the daily mantra for those in general ward.

Because they are hopelessly understaffed, many of the patients only get to spend a couple of minutes with the doctor and I fear these are misdiagnosed.

Earlier this year, Members of Parliament demanded improved mental health services in the country.

The chairperson of the Parliamentary Forum on Mental Health, Geoffrey Macho, urged the Government to increase funding for psychiatric treatment and mainstream mental health treatment in all hospitals. The Mental Health Act 2018, which came into force in 2021, introduces new referral admission procedures that should strengthen the protection of the rights of people with mental health conditions.

However, operationisation of the Mental Health Act continues to face challenges in implementation, including low recruitment of personnel and the lack of an advisory board to set standards, monitor the implementation of the Act and properly enforce it.

Alcohol and drug abuse

There is a unit in Butabika referred to as the Alcohol and Drug Abuse Unit, commonly referred to as ADU. It is located between the private and general wards.

Services there are subsidised, so patients do not pay as much as those in the private wards.

But they do pay a small fee, so services are not as bad as those in general ward. Patients in ADU sleep in dormitories, but are not as crowded as those in general wards.

Though they are also fed a steady diet of posho and beans, they have access to sports facilities and a library. However, because incidences of drug use are rife and on the increase, the demand for the alcohol and drug unit's services is overwhelming and patients can remain on waiting lists for months before they can get a bed in the unit.

The staff told me December is a particularly busy month for the alcohol and drug unit as Ugandans engage in festivity excesses. The alcohol and drug unit has a number of success stories. Some patients told me they were happy to be away from an environment of drugs — a safe space, so to speak.

But it is a double-edged sword — those determined to quit leave the hospital clean and move on to a life of sobriety.

Those who are not motivated to change their lifestyles, however, leave worse off than when they entered. This is because inside the hospital, they are exposed to a wide range of drug users and dealers.

One can be admitted for a marijuana problem and leave with contacts for heroin, cocaine, psychedelics and mushrooms, as well as addictive prescription medication.

Illicit drugs used to be common in the hospital, but, over the years, the hospital has fought back, tightening the noose on the rackets responsible for smuggling them in, from bodaboda riders to rogue staff.

In addition, the hospital is building a wall fence to replace the chain link, which makes it harder to sneak the drugs across.

Patients who consistently violate these rules and continue to consume and supply drugs to the hospital are also forcibly discharged. Workers caught smuggling drugs are dismissed. However, it is a constant arms race. No sooner has the hospital closed one loophole than addicts find a more creative way of smuggling in drugs to the institution.

The story was adopted from the New Vision archives - library@newvision.co.ug. It was first published on Friday, January 13, 2023.

Tomorrow: Sex, family matters among patients, caretakers