By Dr.Abdirahman Jiciir
Somalilandsun – Dr. Ali staggers out of Room No. 5, his breathing shallow as he tries to maintain an emotionless stance, a subtle task that nonetheless proves too difficult for the genial doctor.
He turns back and blurts out, ‘Where will they go to?’ to his students, a gaAng of eight under observation, as they in turn observe the patients cooped up in the mental ward.
Abdi, one of the students keeping his answer to himself, is all too aware of what the doctor is pondering. The Mental Ward has always been a problem, but the case of Room No. 5 has been a problem within a problem for close to 7 years now.
Hargeisa, the capital city of Somaliland with a population of two million people, has only one mental health ward with a total number of twelve rooms, six for male patients and six for females.
It is located in Hargeisa Group Hospital, a place distinguished by colonial-era buildings built before the 1950’s during the British occupation of the city. The hospital has neither been upgraded nor rebuilt since but the structures still stand and has lasted surprisingly well through the midst of the devastating war of independence in the late 1980’s.
It is said in Somaliland, ‘What the British built, Barre destroyed’, a reference to the Somali dictator, Siyad Barre who orchestrated a devastating three year bombing campaign on Hargeisa leading international human rights observers to soon give Hargeisa its new nickname, “The Dresden of Africa”, but hospital staff working in the Hargeisa Group Hospital are quick to admit that the only portion of the Hospital dedicated for psychiatric and mental treatment was, in fact, commissioned personally by President Siyad Barre.
The newly constructed ward came in handy soon enough after it’s initiation, as a large influx of traumatized patients started to stream into the newly built psychiatric center, unable to cope with the bombings and the loss of lives, limbs or property that marked every single Somalilander until the end of the war in 1991 when Somaliland successfully declared independence from Somalia.
Since those years, the psychiatric center gradually shifted away from treating short-term, PTSD cases, and has become converted into a mental health ward where difficult and long-term cases are taken on.
Such cases can range from psychotic individuals that are deemed to be so highly schizophrenic and violent, Bipolar ,Drug misuse and Qat induced psychosis , suicidal idealition, to mentally-ill patients that are said to be affected by Djinn (spirits) and for whom the only recognizable treatment outside of the hospital, is a reading of the Holy Quran on top of their prone bodies by a local sheikh or imam.
Seeking his way to the mental ward, Dr. Ali passes the tall, lanky sentry who bars the front gate of the hospital, staring down visitors, allowing in family members carrying reed-notched satchels brimming with tins filled with rice, meat and bananas, the staple food of Somalis, and the only recourse for nutritious meals in the hospital.
Patients without relatives, on the other hand, suffice with gruel made from oats and maize.
The guard waves through Dr.Ali and greets him warmly with the traditional Islamic greeting, ‘Assalaam Alaykum” and adds enthusiastically, “Your students seem to be lost without you, Doctor”.
Dr. Ali understands, as he spies his students huddling not far from the sentry house.
He notices the dusty pavements all over the hospital grounds with no signage to help differentiate the divisions of wards into clusters that the visitors presume are joined to another thematically.
Nevertheless, that presumption proves to be false, as the mental health ward forms a three-pronged cluster with the pediatric and maternity ward. Pregnant women, sick children and mentally ill patients all staying in their respective wards a stone’s throw away from each another.
Dr. Ali gathers the students and moves them along, directing their steps to follow him as he chooses to check up on his favorite patient, the young occupant of Room No. 5, a girl by the name of Yurub Abdi.
Yurub Abdi is a 15 year old girl who has a shy demeanor except when she is with Dr. Ali, who is instantly recognized the moment he steps through the door, as Yurub calls out to him, ‘Ali, please come and listen to my song’. She turns joyful, shooting a bright smile at him, and for a moment there, it would appear that Yurub is a normal child who is not at all intellectually disabled.
Yurub’s mother is called Koos. She is also an occupant of the mental health ward and has been diagnosed with traumatic stress. Koos, for a lack of a better term, became mentally disturbed after she was told of the death of son, Yonis, Yurub’s younger brother, who drank poison and took his own life while he was just a child.
The two of them are being taken care of a third sibling, Muna?, who is divorced and has made it her full-time job to care for her mother and sister while they recuperate at the hospital. They have all been living together for over 7 years now in the same room, except for a brief period four years back, when the administrative head of the ward, Julia Currie, an Australian working for an Italian NGO called GRT that subsides the salaries of the hospital staff, had decided to evict the whole family on the grounds that the hospital needs the room for patients in greater need.
The family, with no other place to go, was then taken up by the head nurse, Maryam, who personally paid for a room at a private hospital in downtown Hargeisa. When asked about the accommodations prior to their admittance at the hospital, Dr.Ali states that, ‘Koos and her daughters used to live in a small hut in the middle of an IDP [Internally Displaced People] camp before it was burned down in a large fire’. ‘Now they have nothing… no place to go to… if it was not for Maryam, they would have been thrown to the streets, and with the state of mind they are in, I doubt they would have lasted any longer’, he added.
When asked about the chain of unfortunate events that have hit the family, Maryam bluntly mentions that Koos once had a brother who was mentally ill as well, as was at one time, admitted into the ward while his sister was living there at the same time. Her brother was however being supported by the family, whereas Koos and her daughters, for all intent and purposes, was left on their own.
She further added, ‘Leaving aside Yurub and Muna, there is a third daughter, the youngest of them all, who is currently being raised by a relative. She had been sent away by the relative and had to come and live here recently, and that was when the hospital realized that the family just cannot live here any longer’.
Dr.Ali recalls this moment quite well, as it was during a routine visit along with his fellow students, that word started to spread among the nurses that an official decision was to be soon passed down on the eviction of Koos’s family. They send someone up to the doctor, and without alarming the family, mention the news to him. The doctor staggers out of the room awaits a response from his students and not getting it, finally decides it must be time for someone to step forward and tell the story of the bright girl with the quick smile, Yurub Abdi of Room No. 5.
“Yurub is not always pleasant to be around”, Ali says, ‘She can get to be violent sometimes – either to her mother, her sister or to the nurses. But I have never even seen her upset when she is with Dr. Ali’. Abdi writes down the daily progress chart for the girl, and remarks on the improvement she has made over the past couple of years.
Yurub started to speak when she was the age of 10. She used to act out in frustration when she could not understand the people around her, but has now learnt to control her temper when her senses get overwhelmed, in large part to Dr.Ali. He spends an additional hour or two helping her gain the confidence to speak and gently correct her as she takes steps to engage in conversation with him.
Dr. Ali acknowledges that Yurub has not been given the treatment she needs yet, but all the hospital staff is in agreement that she would make great strides if only she was afforded the right environment to learn and overcome her mental disability. According to the American Association on Intellectual and Development Disabilities, there are three types of intellectual disability, which afflict patients – mild, moderate and severe. Yurub Abdi has been diagnosed with the mild version, and is not fit to live in the mental health ward which is only meant for patients with long-term, severe mental illness.
Nevertheless, she cannot afford to go to a special-needs school. Her sister does not earn any income, since she has to stay at home and take care of both her sisters. Their father, who used to support the family from a small village called Gadh iyo Gol, near the city of Hargeisa, has disappeared since Yurub was a small child and has not been seen since. The whole family is therefore dependent on the hospital for all their needs and through their stay at the mental ward, has at least managed to maintain a living semblance of normalcy in the midst of their abnormal surroundings.
Looking closely among the occupants of the other rooms in the ward, Maryam talks about the difficulties that is faced by normal individuals living among those that can be counted the most mentally ill people in Hargeisa. There is Hodan , who thinks of herself as ‘The President of Somaliland’ and bosses around the nurses until they acquiesce and take a subservient tone to her whenever they need her to take her medications.
There is also the patient Muna Adam*, diagnosed with psychosis, who accidently killed a fellow patient a few months back, after the two got into an argument. Muna in a violent fit, ran outside, grabbed a rock and threw it with such force that she fatally hit the victim’s head causing the brain to hemorrhage.
These are the patients that Maryam worries about when she talks about the risks involved in keeping Yurub within the mental ward. She nevertheless can also find no other solution but to keep the status quo until as such time that a solution can present itself.
Dr. Ali, however, seems to know what that solution might entail. Dr. Ali, the son of a strict and beloved headmaster of a famous public high school in downtown Hargeisa, has dedicated his time right after finishing his medical training at the University of Hargeisa (where he graduated top of his 2012-13 year class) to helping the mental ward develop into a well-functioning establishment that can turn its long-term medical cases into future successes.
With the help of King’s College, a UK-based medical college which supports the University of Hargeisa as well as the Mental Health Ward at Hargeisa Group Hospital, Dr. Ali aims to reach out to interested stakeholders and build support for the mental ward by either getting in financial or technical and skilled aid for the patients living in the ward as well for the desperate ward itself which is need of improved services and expanded capacity to cater to the large number of patients that are in need of psychological treatment.
Some support has already been successful in getting through to the ward, as can be seen from an exchange between Yurub and Dr. Ali. As Yurub sits next to Dr. Ali and cries out to him, ‘Do you have any new clothes for me?’, the doctor smiles and promises to take her down to the clothing collection box that has been set up exclusively for the ward, and let Yurub choose for herself among the regular donations of clothes that are brought by individuals and who have been contacted by the hospital staff.
However, the problems that face both Yurub and the ward, is a challenge that is beyond the staff and the kindly doctor that have worked tirelessly to build a suitable environment for treatment to take place. But hopefully, with some support, at least one of those problems, that of Yurub and her family, can be solved and Room No. 5 can finally be readied to welcome a new patient.
Dr AbdiRahman Ali Jiciir
Dr. Abdirahman Jiciir
Hargeisa Group Hospital