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Complex Issues - Health, Culture, Life Turmoil,
Lack of Care - Poverty - "Deviant" Behaviors +
By Zofeen Ebrahim
KARACHI,
Feb 1, 2010 (IPS) - No sooner does a visitor step into the facility than a
surreal scene unfolds: The sound of laughter, the sight of ready smiles and
vigorous, pumping handshakes mix with the acrid odor of an unwashed human body
and the unbearable stench of neglect that in turn combines with the heavy smell
of medicine.
A group of
women gathers around the visitor, their eyes lighting up and faces breaking
into a smile as they extend their hands to offer the latter a firm handshake,
only to be shooed away by Waseem Fatema, a stocky nurse in her late 40s.
This is the
Edhi Centre for the Mentally Ill Women in North Karachi – home to women
suffering from various forms of mental or emotional disorder, some of which
warrant long-term treatment, others do not, requiring at best compassion and
understanding for otherwise fleeting states of mental or emotional impairment,
brought about in part by these women’s inability to cope with what society
expects of them.
Of the more
than one thousand female wards confined at the centre, some are as young as
five years old and others as old as 70, or even older. Children, who are either
physically or mentally challenged, stay in an adjacent facility also run by
Edhi. Some of them were brought to the centre by parents who invariably said
they could no longer afford to look after them.
Edhi – which
gets generous donations, including the ‘zakat’ or a portion of one’s
possessions, from various sectors of Pakistani society – also runs a separate
facility for men, located outside the city limits. It offers its facilities and
services free of charge.
Built over
10 acres in 1986, the centre initially had 50 to 60 women with mental problems
in its care. Today, the number of its wards has swelled to over 1,600. In 2009
alone, around 380 women were admitted to this mental institution. Of these, 212
were discharged, 80 of them above 60 years of age who died without ever having
seen their families.
"When I
joined five years ago, there were only 450 patients," said Dr Naseem
Attique, 55, the centre’s general physician. Only one psychiatrist comes once a
week to the centre to check on the wards’ conditions.
According to
Dr Murad Moosa Khan, head of the psychiatry department at the Aga Khan
University Hospital in Karachi, the psychiatrist to patient ratio in Pakistan
is an abysmal one to half a million to a million people.
"A vast
majority (of the wards) are brought here by none other than their
children," said Fatema the nurse, who has been with the centre for over 10
years. "I see relief in their [sons and daughters’] eyes when they pass on
their burden to us," she said ruefully.
Fatema
argued: "If they are given the same care that we provide here…, most will
lead a fairly normal life. Unfortunately, their children do not have that much
patience or the time."
"Care
is seen as a feminine activity in traditional societies," said Haris
Gazdar, a Karachi-based economist. "As economies develop and more people
are sucked into the labour market, women’s time becomes limited too," he
said. The result is that there is no one to take care of the elderly and the
mentally ill. This is increasingly happening in today’s society, Gazar added.
Anwar Kazmi,
secretary to Abdul Sattar Edhi, a well-known philanthropist in
For large
families in congested living conditions, usually consisting of one- or two-room
houses, "taking care of a mentally ill person over a long period can take
a toll on the entire family, especially on the sole bread winner," he
said.
But Dr Khan
dismisses poverty as the main reason why women are being brought to a mental
institution such as Edhi. "Poverty only comes into play when the decision
to discard them has been made," she said.
"Do you
think I’d be here if my parents were alive today?" asked Farida Noorani,
39, who has spent 10 years as a ward at Edhi. "It’s my sister-in-law who
sent me here," adding that her two brothers come and visit her every
month.
"Her
brothers are quite well-off," said Fatema in a separate interview with
IPS. "If they wanted to, they could very well have kept her."
Dr Attique
said very few leave or are discharged from Edhi. Of these, a majority return to
the centre. For every 10 who are discharged from the centre, eight return on
relapse, often in a far worse condition than before.
"A vast
majority suffer from various degrees of psychiatric problems and are on
medication. When they get well, some are taken back by their relatives. But in
most cases, medication is discontinued despite our strict instructions to the
contrary," said Attique.
Dr Khan said
the status accorded to women in "our staunchly patriarchal society"
has brought a number of women to mental institutions like Edhi even when their
mental state does not require confinement in such a facility.
"Women
are treated as second-class citizens and lower beings. Hence when they develop
any kind of mental illness, they are discarded, he said.
"Sometimes
women are simply labeled as ‘mentally ill' in order to avoid the threat to
family honour," said Dr Asha Bedar, a clinical psychologist.
This is
particularly true for women who do not fit the "ideal image" imposed
on them by society, including those who "rebel against oppressive customs
and traditions" or who are seen as being "tarnished" in some
way, said Bedar.
"These
can be women of all ages, who deviate from what society expects … refusing to
marry according to family wishes, remaining single, seeking a divorce, marrying
by choice, standing up to domestic violence, not having children, etc.,"
she explained.
Sadia
Yasmeen, 39, has been at Edhi there for 12 years. "I’m here because of
property feud (that arose) after my father died. My sisters, six of them and
one brother, don’t want me to get married so they brought me here. But they
have never once visited me. I don’t even know if my mother is alive," she
said. She teaches Quran to the younger wards at the centre.
Bedar said
women in varying states of emotional or mental turmoil are not found at Edhi
alone. "These women are found at psychiatric hospitals and wards where the
women have either been abandoned my family members or sent there to be
'cured'," she said. "They are drugged or frightened into submission
to the demands of family members."
"Even
in my clinical practice it is not uncommon for family members to bring young
girls (aged 16 to late 20s) to me because they refuse to heed the family
demands" such as in cases of forced or arranged marriages.
"The
women who end up in facilities such as Edhi belong to a category where such
'deviation' cannot be tolerated," said Bedar.
"At
times these young women really do exhibit psychiatric symptoms (e.g., suicidal
tendencies), requiring (professional help), but this is often a result of their
specific situations and the demands placed on them. In other cases, the mental
illness is very real but is a result of the circumstances in which these women
live," she explained further.
Others
appear normal. Take for example, Rashida Anees, 55, who has been at the Edhi
centre for 11 years now. "Once my brother comes back from
It is also
not uncommon for a young girl to be married off before the age of 18 because
the prospective husband promises to pay off her father’s debts. In such a
situation, women can easily succumb to depression, anxiety, and psychosomatic
disorders, which Bedar said are common among Pakistani women.
"When
girls in our society are socialised to believe that they are inferior, that
their worth is less than that of boys, that their potentials … are only
valuable if they are in the ‘feminine domain’ – such as the domestic sphere –
this has the potential to affect their mental and emotional health and
well-being, she said.
"It is
no wonder then that depressive symptoms, anxiety, and issues of relationship,
self-image, self-confidence, suicidal attempts are more common in women and
girls in our society."
Across
For women,
those factors include cultural mores that force them into a situation that, in
society’s views, require their confinement in a mental institution such as
Edhi.
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