Care in the Community

When I was attending in the health centre earlier this week I heard a sudden commotion outside.  The health promoters informed me an injured patient was coming in off the local bus.  The young woman came in very shaken, blood covering her face and her blouse.

   

“Did the bus crash?”  I asked.

“No, a mad man threw a stone at the bus.”  The woman´s companion informed me.  “He was wandering around in the undergrowth at the side of the road talking to himself, and then suddenly threw the stone.  It hit the window of the bus, shattering it.  The glass cut my friend´s face.”  

As I stitched up the woman´s nose, I reflected that I knew exactly who had done this.  A young man from a nearby village has been schizophrenic for many years now.  He is currently sleeping in my parents-in-law´s shed most nights.  They and several other villagers give him regular meals.  He wanders up and down the road incessantly all day gesticulating and talking to himself.  

My next patient was from our village and immediately commented on the incident.  “I see David has been giving you work.”  She said, “But he must have done it without intending to hit anyone.  He is not violent.  He is harmless.”  

He has certainly never caused anyone any harm that I know of before.  I hope this incident was a one off.  But it is alarming none-the-less.  What if the glass had entered the woman´s eye instead of her nose?  Would she have simply walked away then?  What if he does it again?  I must admit I now drive very warily when I pass him on the road.  

David’s family used to take care of him.  But after a time it became too much and they gave up trying to keep him home.  Since then he has walked miles and miles every day up and down the main road.  He came to see me once, but has refused to ever come again because he thinks I tried to poison him with the medicines I gave him. 

 

Here it is very difficult to help someone like David because someone has to take responsibility for paying for and carrying out his treatment.  The state does not.  There are no community psychiatric nurses.  There is no way of giving him treatment by force if his family do not ask for it and pay for it.  He is abandoned.  He is at the mercy of the villagers.  

Thankfully so far the villagers have been remarkably caring of him.  He does not want for food to eat, water to drink and a floor to sleep on.  Maybe we need to be more creative in finding a way to help him with medication as well.