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Reports

Lusaka, Zambia, 11/12/2002

I have spent a great deal of time in the developing world engaged in health care work -- doing HIV education in Kenya and working at a street clinic for lepers in India. But never before have I attempted to practice psychiatry, my chosen field, outside of the United States. That is why my elective in Lusaka was such an extraordinary experience for me.

Working at Chainama, the only psychiatric hospital in the country, I was confronted with a situation completely unfamiliar to me. The small wards were locked and held up to 120 patients and as few as 3 nurses; patients were overmedicated as a matter of course, routinely on 30 mg of Haldol, to minimize disruptions; doctors or clinical officers spent no more than 10 minutes per week with a patient, but frequently patients were not seen for weeks at a time.

Needless to say, there was much for me to do. Due to understaffing, I took on my own roster of patients, and did full evaluations, treatments plans, any talk therapy that was possible, and discharge plans as appropriate. Not only did I take on the responsibilities of a full time staff member at Chainama, I also tried to address some of the problems I saw there. For example, patients were chronically sedated, even very young patients. New mothers were routinely sent home on high doses of Haldol and actively encouraged to breastfeed. I tried to educate colleagues and staff about the potential long (and short!) term dangers of such practices. When I saw things being done well and with compassion -- which occurred less frequently than we would hope -- I went out of my way to affirm these appropriate ways of treating patients with care and respect.

Overall, this was an invaluable part of my training, albeit a difficult one. As one committed to the developing world and equitable health care for all people, my eyes and heart were opened by my time in Lusaka in completely new ways. Understanding the bias toward the mentally ill throughout the world and the abysmal conditions in which they are forced to exist, I have deepened my commitment to psychiatry and to the equitable allocation of health care resources for the physically and mentally ill around the world.

Elizabeth Visceglia, Mount Sinai Medical School, New York, USA