the psych ward

The week before I got sick, our clinical rotated through the neuro/psych ward.  They don't have enough rooms to separate the two, so they are all in one big room.  One one side of the room are older women who have had strokes.  They are pretty sad, most are poor, and one in particular touched my heart.  It was just she and her husband subsistence farming.  She was so worried about what was going to happen to her and her husband now that she couldn't work.  I worked extra hard with her teaching her some physical therapy exercises.  My heart broke for her, but it was all I could do.

On the other side of the room, there were four women who were as the Afghan doctor said "psychotically depressed".  That means they were so depressed that they were having breaks with reality.  I didn't really see that.  I think that the doctors were just tired of hearing them cry and they made up that diagnosis as an excuse to give them antipsychotic medication to put them to sleep.

The first girl was about 16-17 years old.  Her mother was with her and obviously cared deeply for her, as a mother should.  I sat on the bed with her, and accepted a warm, sweet cup of milk that her mother offered me and asked what was going on.  The mom told me most of the story.  She said that a year before, the girl had gone to a wedding and some men had come to the wedding and threatened to kidnap the girls.  Since then, this young woman had not stopped crying.  

Afghans are notoriously emotional, but this seemed way over the top, to be frightened, and then to cry for a whole year.  I had a sense that there was more to it.  In Afghanistan, if a woman is raped, it is considered her fault.  As I watched this young woman and her interactions with people, and the fact that we couldn't get her to tell her story, but just let her mom speak for her, I felt that she had probably been raped at that wedding, and perhaps even gang raped.  My heart burned for her.  I knew that if she told her parents, it may mean death for her.  I took the nursing student assigned to her (this is the same student that I took out to help me with Roqia [the little girl with abdominal TB]) out into the hall and told her my thoughts.  I asked her to just sit with the girl all day, hold her hand, and listen to her.  I told her to make sure that this girl knew that no matter what happened that day, it wasn't her fault.  I also sat with her off and on all day that day, and told her over and over that if anything else had happened to her, that it wasn't her fault, but it was shame on the men who did it.  

Another lady, near the end of the row was so depressed that she was starving herself.  She was literally just skin and bones, and she was completely catatonic from the antipsychotic medication that she had received.  She had several small children one of which would come and sit with her every day.  It broke my heart to watch these little children watching their mother starving herself to death.  I sat and held her hand as well, and cried with her (as I did with every patient that day).  I also snuck her a little money before I left that day to help her buy her medicines.

While I was sitting with her, another lady was brought in and put in the bed beside her.  She then began screaming a blood curdling scream and shouting that she will pour gasoline all over herself and light herself on fire.  

At the end of the row, in a bed beside the window, there was another young married woman.  I don't think she could have been more than 19, but already had several children.  She was also labeled "psychotically depressed".  As I was holding her hand, she looked at me with tears streaming down her face and said, "God has left me.  God has left Afghanistan."

That was one of the most difficult days for me in Afghanistan.  But my students learned a lot about caring for more than just a body part.  They learned to care for people.  The next day, when we walked through the door for clinicals, all of the patients that we had cared for the day before smiled.  Their problems are far from over, but a little kindness went a long way.

A few more notable things happened this day.  A man in the ward next to ours died.  He had a heart attack.  His family began wailing, which if you have never heard you are fortunate.  Then armed guards came running down the hall with their kalashnikovs at the ready.  When a patient dies, guards always come to make sure that the family members do not kill the doctors or nursing staff.

Did you ever see the movie "Blood Diamond?", They keep shrugging their shoulders and saying TIA (meaning "this is Africa").  The Afghans have the same phrase.  WHen you ask why something is the way it is, they shrug their shoulders and say, "Afghanistan as dega" (This is Afghanistan).