It’s the ultimate walk of shame for any visitor to Mathari Hospital.
The main road is dilapidated, the paths overgrown with grass and serenaded by garbage, the staff quarters soiled by years of disrepair and the faces you meet downcast as if the people here are in a permanent state of mourning. The buildings are dilapidated. Condemned, just like the patients.
Recently when over 40 patients escaped from the hospital, most people blamed it on negligence. To some, it was just a case of lunatics seeking freedom. But it was a case of hunger, abuse, lack of basic services and a fight for survival.
Patients and staff told the Saturday Nation tales of hunger, abandonment and disease. Many sleep on cold, hard and dusty floors. Cases of abuse are so rampant that complaints of sexual harassment or abuse no longer jerk the management into action.
I walk into Ward 5, claiming to be an intern from Kenyatta University medical school. It’s stuffy like a public toilet. The patients look like they have been drugged into oblivion. One stares at me in a daze; his clothes torn, eyes blood red, hair uncombed and face dishevelled. If he had come across any water, it must have been when it last rained.
I turn around the room and count 32 saddened faces. I turn to the nurse by my side and quickly avoid her gaze. I am embarrassed at the appalling physical conditions in the room and the haplessness of the patients and the nurses.
There are beds all over me, but no mattresses. The blankets look like doormats at marikiti.
A gush of wind blows through the windows painted by grime and the whole ward is enveloped in a stench of urine and drugs. I flashback to my last visit to the Industrial Area Remand Prison in Nairobi. This is not a home for sick people in need of delicate care. It’s a dumpsite where mental patients are condemned to wallow in their solitude. I ask to see the hospital’s medical superintendent, Dr Kisivuli Atsenga, but he’s out in a meeting and promises to call back. I am still waiting for the call.
“How do you survive in such a dirty, depressing environment?” I ask the nurse. “It’s work. My job is to care for the patients and there’s only so much I can do,” she says, walking into another row of wards.
“Wards 8 and 9 are clean, having been recently renovated,” she says.
For the first time her face beams with a smile, but it’s not the smile of happiness. It seems to convey some sense of inevitability that everything that can go wrong here has gone wrong.
Eat in turns
The conversation returns to Ward 5 and 6. These wards were meant for 47 patients each, but they are holding double that.
“It is very unfortunate that the patients have to eat in turns because the wards do not have enough plastic plates for them. It is that bad and the administration is doing very little about it,” she says.
The diet is worse than that of prisoners with boiled cabbage and porridge being a constant on the menu.
The nurse, who cannot be named for fear of reprisals from the management, says the mattresses in ward 5 were withdrawn after the patients started using them as toilet paper.
“We had the standard mattresses provided by the government but they were phased out and replaced with ones bought by donors. It is these new ones that these patients turned into tissue papers.
When we ask for new mattresses, we are told the hospital is underfunded,” she says.
Cases of patients escaping are not strange here. On average, at least four patients escape every month.
“We are overstretched and patients escaping is the least of our worries. All we do is mark them as absconders, inform the police and move on,” she says.
The recent case only gained media prominence because of the number of patients who escaped. Interestingly, they were all in Ward 8, which is one of the cleanest.
The nurse says they work in shifts, but are rarely fully staffed. At times the patients turn violent, and the danger of sexual assault is always real.
It is claimed that the nurses work in full capacity only on Monday and Tuesday, because of the open day and cleanliness day. From Wednesday to Sunday, the story is different. A ward with 94 patients is manned by a single female nurse, especially on night duty.
In the 1990s, the annual budget for the hospital was Sh6 million, now it is Sh2 million annually. This saw the hospital revise its fees, making it more expensive for the poor. Admission fee has risen from Sh3,000 to Sh5,000, while the daily surcharge is Sh1,000, up from Sh500.
This has made a bad situation worse because some of the patients are stranded as they cannot clear the bills.
Power blackouts are frequent, as is the case in Nairobi today, but the hospital does not have a back-up generator.
This has hit the pharmacy hardest, with most drugs that must be refrigerated going to waste.
The hospital receives drugs that are almost expiring from donors and has to work with them due to lack of funds.
“Some of those drugs in the fridge are at the mercy of the blackouts,” says the nurse.
A former employee and psychiatrist Christopher Ouma who is now in private practice says in Mathari, patients pay for treatment when they can or when they have health insurance.
“From my own estimation, almost 50 per cent of the patients in the hospital are abandoned by their relatives because they are too poor to pay. Imagine a patient has been in the wards for six months.
His bill is almost Sh160,000. How will they bail themselves out?” he asks.
According to a Kenya National Commission on Human Rights report, The Silenced Minds: The Systemic Neglect of the Mental Health System in Kenya, out of the 10 million metal patients, only 1.5 million receive treatment with the remaining 8.5 million left out.
The government spends less than one per cent of its health budget on mental health.
Dr Lukoye Atwoli, the secretary of the Kenya Psychiatric Association, says that the government does not really fund the mental health department.
“Whatever they give is money to pay salaries for staff. With 0.01 per cent of the national budget translating to Sh100 million, that is not enough.”