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Oct-Dec2001-9(4)
LETTER FROM CHENNAI
Erwadi and other 'homes' for
the mentally ill
Thomas George
The horrific images of an airplane being flown into
the twin towers of the World Trade Centre and the subsequent collapse of the
towers has driven all other horrors away from the news media. But, at least in
Tamilnadu, we have not yet got rid of the images of another tragedy that
occurred in August - the pictures of mentally ill people burnt to death when the
thatched sheds in which they were chained caught fire. The place was Erwadi in
Ramanathapuram district. Many of us were unaware that such places existed,
but we were forced to acknowledge, once again, what an uncaring society we live
in. It appears that similar 'homes' for the mentally ill - flimsy shelters
within which inmates are chained - exist all over India. The owners say they
have no other option but to restrain patients in this manner as some of them are
violent. It appears that these owners make a comfortable living.
After the tragedy, the state government shifted the
patients in Erwadi to various psychiatric hospitals that it runs. The largest of
these is the Institute of Mental Health in Chennai. Unfortunately, the institute
has fallen on bad days. Once a pioneer in the care of the mentally ill, it has
now become more or less a prison for the less fortunate. Patients who have
nowhere to go, end up becoming permanent residents, along with those with
serious illnesses. Rehabilitation is more the exception than the rule.
This is just another example of what a cruel
society we live in. The state makes little provision for the disabled, and a
heavy burden falls on the family. A lot is made of the strength of the Indian
family system, but the cost, both emotional and financial, is huge. Even middle
class families find the effort burdensome. Often a caregiver is available only
because jobs are so difficult to come by in India, and the person is
unemployed. Along with the trauma of leaving a family member in a place
like Erwadi is the stress of social censure. One would expect the state to
provide more help, but we are far away from such a society in India. Meanwhile,
we continue our hypocritical posturing on 'family values'. It is sobering to
remember that in a country of over one billion people, with at least 30 per cent
below the poverty line, millions of ill people must be in terrible condition.
But because they are scattered, poor and voiceless, they are rarely in the
news.
Doctors face this reality early in their training.
The first visit to a ward in a government hospital is often a traumatic
experience for the young medical student. Some get so upset by patients'
situations that they give up medicine altogether. Others who cannot afford to do
this choose specialities where there is no direct patient care. A few
others develop a missionary zeal to do something for these unfortunate people.
But the vast majority become immune to the situation. It is surprising how often
you will hear from doctors that the poor are lazy and that is why they are poor.
Quite a few believe that even the pathetic facilities that the government
hospitals provide are a form of pandering to the socially unproductive.
One of the major causes for this blinkered view of
society is the total lack of exposure to social issues. Science students learn
little other than science from quite an early age. Few medical colleges in India
provide courses in humanities. This is a grave lacuna as it does not ensure a
well-rounded education. Every definition of an ideal doctor stresses the need
for a wide exposure to all facets of life, but our medical education system
makes no provision for it. Such exposure must be provided, if necessary by
increasing the length of the course. But this in itself will not be enough. We
need to change the focus of medical education. At present the caring aspect of
medicine is not given enough importance. Most young medical students model
themselves on the impatient, 'brilliant', surgeon or physician. Hardly anyone
wants to be a Father Damien looking after leprosy afflicted people.
Recently I visited a terminally ill relation in a
hospice. The place was clean, and as pleasant as a place could be that housed
the terminally ill. It was run by nuns with help from volunteer doctors. I
understand that there are very few such places in India. Many of these patients
need a lot of nursing which may be difficult for a family to provide. Most
doctors in government hospitals have seen the terminally ill brought to die in
hospital so that the death certificate is readily obtained. Many such patients
are covered with bedsores, filthy, sometimes having lain in their own urine and
faeces for days. It is easy to blame the family for being callous, but enquiry
sometimes reveals that the family must work long hours just to get enough to
eat. Also, some people are unable to withstand the emotional stress of nursing.
It is necessary for a civilised state to allow the
incurable to die with dignity. But in a country like ours, where the curable are
often left unattended, we may have to wait a long time still for
this.
Dr Thomas George, 114J,
Rostrevor Garden, Railway Colony, Chennai, 600 018. Email:george@medicalethicsindia.org.