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Caring for the Mentally Distressed in Nepal

by Chhahari Nepal for Mental Health
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Caring for the Mentally Distressed in Nepal
Caring for the Mentally Distressed in Nepal
Caring for the Mentally Distressed in Nepal
Caring for the Mentally Distressed in Nepal
Caring for the Mentally Distressed in Nepal
Caring for the Mentally Distressed in Nepal
Caring for the Mentally Distressed in Nepal
Caring for the Mentally Distressed in Nepal
Caring for the Mentally Distressed in Nepal
Caring for the Mentally Distressed in Nepal
Caring for the Mentally Distressed in Nepal

Sita is a charming 37-year-old who is not afraid to speak her mind. She likes to wear makeup, beautiful clothes, jewellery and always makes an effort to look nice.  

When her family realized Sita was suffering from mental health problem, and were under the impression that marriage would cure her. While married and living away from the family home for one year her condition was somewhat stable. However, she contracted typhoid and after receiving medication for such her condition worsened and she became violent and started to roam undressed in the streets. Sita’s partner and his family were neither supportive or compassionate when her mental state declined, rather, they were ashamed. The marriage was broken off and Sita moved back into her family home.  

After few years her mental condition deteriorated as a result of stress over her brother’s disability. She has always been very close with her brother. Her brother was paralyzed after falling from a tree at his place of employment, rendering him immobile and incapable of independently caring for himself. At this time she became violent and her family, unaware of how to deal with her, tied her to a chain-link fence outside of the home.

Sita’s  family sought the help of traditional healers. The family, unaware of how to support Sita, and under the impression she was incapable of any level of recovery, contacted Chhahari with the request of ‘taking her away’. With the support and knowledge passed on by Chhahari the family was able to make an informed, and humane, decision regarding the care of Sita. 

For the past 4 years Chhahari has been supporting Sita and her family. With the support from Chhahari her treatment started and she has been diagnosed with bi-polar disorder . She now works as a part-time cleaner at a local school earning approximately 3000 rupees/month( 40 USD). Her medication costs are approximately 1500 rupees/month( 20 USD) , sometimes more. 

Last year on 1st of April her brother passed away and since then she is finding very difficult to cope. Now, due to lockdown she has not been able to continue her work as a result  her mental state deteriorated  and subsequently relapsed twice this month. She is now admitted in Patan Mental Hospital, Nepal’s only government Mental Hospital. Chhahari has been continuously supporting Sita and  providing service; arranging for warm food deliveries for both Sita and her mother. Also, continuously in contact with her doctor and providing support during this crisis time. Sita says  "During this difficult time Chhahari family remembered and cared and found ways to provide hot meals for me and my mother. I just wish Chhahari family can come and visit me frequently as I miss having conversation”. 

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Carers getting together at Chhahari
Carers getting together at Chhahari

About twenty years ago during a rainy day Sita’s house collapsed killing her husband. Few years after that her daughter died of cancer. She now has a son called Raju who is suffering from serious mental health problem. She says Raju was a smart boy, used to speak “good English” and “worked as tourist guide”. He used to “earn money and bought everything he needed during that time”. “He even missed classes to work as guide”. One day he left to visit pilgrimage in India. Sita was “not comfortable about sending his young son on a pilgrimage” but his “appeal and desperation” was such that she had to “relent to his demands”. It came as a great relief to her to know that her son was not travelling alone. He had 3 other friends who was going with him. 

However, while travelling to holy sites in India he was somehow disconnected from his friends and got lost. When his friends came back to their homes Sita was “devastated” to learn that her son was not with them. They told her that Raju was “lost in India”. Sita went to police station to report about him. Finally, one of the “senior police officer” “accidently found” Raju in a southern city near Nepal-India border and immediately contacted the family and helped to bring him back to his home. Since then he suffered from serious mental problem.”

Sita is his only carer. She cooks food and looks after him every day. One time when she was accidently hit by a school bus, she had to be hospitalized for 8 days. During this time Raju had to survive on instant noodles and water. Sita is already 76 years old and have been the only person taking care of her son since his mental condition deteriorated.

She complained:

“I used to be invited by my brothers and sisters during every festival. But now they invite me no more. I could not go to their parties because I don’t want to leave my son in this condition. Now I have nowhere to go. I have nowhere to turn to. All my relatives have abandoned me. Sometimes I feel as if my entire life is one big punishment. I have no rest and no holiday”

Sita with the support of Chhahari Social Worker took him to mental hospital where they were informed that he was suffering from serious mental health problems One of the “major problems” with Raju is that he himself is not able to remember which medicines to take regularly while his mother is “old and cannot remember it either”. Not taking medicines regularly have made his recovery progress slow. 

Chhahari social workers have “drawn a colorful chart of various medicines and various times to take it” and have even stuck it in Raju’s room wall but he still forgets to take it.  Social workers have even tried by giving a cell phone for Raju so that they could phone him or Sita to remind them of taking medicine regularly but “they had difficulty in learning to use the phone”. Social workers are worried that his irregular consumption of important medicines could “worsen” his mental conditions and that is the main reason why they frequently organize home visits to his place. 

Chhahari Social workers have also played an active role in fixing appointments for him with doctors. They also frequently accompany Raju and his mother Sita to the hospitals to consult with doctors. Sita explained why she appreciates when social workers accompany her and her son to hospitals:

“The doctors are very intelligent, and they think we are like them. They speak very fast and use words that we do not understand. Whenever I stop them when they are speaking to ask what they have just said they will tell me “just give him this medicine and meet me next month”. After the appointments with the doctors are over the Chhahari social workers explains to me very slowly about what the doctors had said during the appointment”

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” It slowly became clear that I was the only person who had to take care of my son in our house. I felt very alone and depressed at times. I always asked why I was even born but again the condition of my son made me realize that I had to continue living to take care of him.”

“At first I was little irritated by the Social Worker's emphasis on building relationship with my son and hence I asked them why they needed to build a strong relationship with him. It would be more helpful if they could simply take care of him for the whole day. They replied that they could not force anyone to stay in their office. I was irritated by such arguments and I argued back telling them that my son had to be forced because he was mentally ill but social workers of Chhahari Nepal for Mental Health argued back to me stating that just because they were stronger than my son that does not mean they have rights to impose their will on him. Although I was still irritated but I was also impressed by their arguments because I felt that these social workers were willing to treat my son with respect when even his own family members never treated him with respect. Never.” 

“ One difficulty for me right now is that I have to remember if he has taken 5-6 different types of medicine every day. In this condition I feel very much helped when social workers from Chhahari regularly phone me or come to see me and my son and remind us."    

- Mother of Male CNMH client

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Harry is 31 years old, from Lalitpur. He lives with his parents and an elder brother. He suffers from depression and his wife left him along with their son after not knowing how to handle his mental condition. His older brother has a small vegetable business and is the sole breadwinner for the whole family making around Rs 5000 (£ 30) a month. Harry started his Bachelors in Humanities education but had to stop due to issues relating to his illness. But he is still eager to continue his studies. Upon constant follow up, we have been able to build a close relation with him and his family. With our support, he is continuing his medical treatment and he is now ready to go back to his studies.

Harry is interested in music and wants to learn to play the flute. He attends our weekly welcome centre and has shown vast improvements, interacting with the group and eagerly learning to play music.  We are continuing to monitor him throughout the time of course and beyond.We firmly believe that enrolling in college will further benefit him and his social growth. Therefore with our support he is enrolled for Bachelors in Humanities course in a Government college. Government college in Nepal cost much less then private college.

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In the Nepali context one of the first aspects of poverty is the lack of purchasing power. Indeed this lack of financial resources is readily expressed to us each time by our clients and their families.Almost 90% of Chhahar's clients earn on average Rs.5,500per month ($50) and most of the families own their house. Despite this, families continue to struggle every month to make means meet. In other words, ‘poverty’ for these families is closer to the idea of deprivation in the sense that they cannot make means meet, rather than absolute poverty. 

Sita at the Mental Hospital Lagankhel(MHL) on the day of her discharge: Some of her family were there to pick her up. Sita’s mother had stayed with her daughter in the hospital for the whole period of her treatment, as MHL requires a carer in order to admit someone into the hospital. Sita’s sister was in charge of picking up her sister and mother from the hospital and she mentioned to us that having to take care of her sister was very expensive. 

Shyam’s father, who is now too old to work, says he cannot afford his son’s medication and therefore is obliged to reduce his dosage. 

These financial difficulties were also among the first factors repetately mentioned by the psychiatrist with respect to hindrances to the continuation of medication and/or formal treatment.In sum, this ‘lack of financial resources’ aspect of poverty is widely acknowledged, although in fact, there are ways around paying the full price of the prescribed medication.

At MHL, clients who cannot afford treatment can, in theory, get help from a ‘poor people fund’. In order to be eligible for this help they are required to present their citizenship, a letter from their municipality and proof of diagnosis from the doctor. In practice however, a psychiatrist revealed to us that the people assessing for the ‘poor people fund’usually ‘rely on their gut feeling and do not investigate the financial situation of the family’. These flaws in the system makes the life of those in need very difficult. 

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Organization Information

Chhahari Nepal for Mental Health

Location: Kathmandu, Province 3 - Nepal
Website:
Facebook: Facebook Page
Twitter: @chhaharinepalmh
Project Leader:
Bidya Maharjan
Program Manager
Kathmandu Valley, Bagmati Nepal
$28,026 raised of $50,000 goal
 
340 donations
$21,974 to go
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