Abn Rashid Psychiatric Hospital

***Dr. BERTA H. JOUBERT

I was able to visit at least for a very short time, the Abn Rashid Psychiatric Hospital which serves 1,300 patients in the Baghdad area. There I met with several psychiatrists, Dr. Natiq Kamal Khalil, the Direct Manager of the Hospital who gave a brief overview, and Drs. R. H. Alkhaiat and N. J. Alhemyary. Also present were 2 other doctors and the Chief Nurse, a very friendly young woman dressed with the classic white uniform and cap. When I arrived, they were conducting an interview with a patient and his relative and asked me to join them. Although the interview was in Arabic, it became clear that the patient was depressed. His wife was very attentive and obviously an integral part of the therapeutic process. They did not seem to be bothered by my presence.

This first contact with a patient underscored what the therapeutic team said afterwards. Because of the sanctions, there is hardly any psychiatric or anti-Parkinsonian medicines. (The latter is used to treat some neurological reactions to anti-psychotic medications.) They had always used the family support as a key ingredient of the therapy, but now because of the lack of drugs, they have sometimes to rely exclusively on the patient's support systems. Unfortunately, this added pressure to the family causes more destabilization both in the family group which is unable to cope with the patient's symptoms that have become more frequent and disruptive, and their own hardship due to sanctions, ( Lack of  food, electricity, general medicines, etc., etc.) It then becomes a circle, patients have no medications, they get worse, the family support is missing, patients is worst. In some cases, particularly when the patient is extremely agitated and violent they have to resort to ECT (Electroconvulsive Therapy) which they have to administer in a very primitive way, without necessary drugs to counter the violent convulsions. Sometimes the relatives see their loved ones undergoing this treatment and take them home. It is difficult to imagine the psychological pain these patients and their relatives go through.

They took me to a tour around the hospital. The conditions mirrored those in the other general hospitals. Bare rooms, lack of disinfectants, etc. We visited the Hospital Pharmacy, a pharmacist and her aide were working in a room with 4-5 cabinets. Some of them were completely empty. One had a pyramid of Mellaril tablet boxes in the upper shelf. That's all the medicines they had to treat the 73 patients that were admitted at that time, not counting the outpatients. There must have been around 50 small boxes. Certainly not enough. Mellaril is a very mild antipsychotic and for that reason it is generally given to elderly patients. There, it was the only available. Every month the medicines they receive might be different, so there is no consistency in the treatment. Usually psychiatric medications need 3-4 weeks in order to reach maximum effect, in Iraq they cannot monitor the effectiveness, if they are lucky enough to have a medication, the following month they might not have any or will have to switch to another, starting the treatment all over again.

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