"But it's the truth, even if it didn't happen!" (Ken Kesey)

    Our 2 weeks in Addis were slowing coming to an end but there was still one more important place I wanted to visit: Emanuel Mental Hospital. When I asked about it, I was told just to “go ahead over there and see for yourself”. That was not how I envisioned a mental hospital to be run. I wanted to have a chance to speak with someone who could tell me more about it so I made an appointment with Dr. Samia.

    Upon arriving, the gateman readily let me in but warned me that pictures were not allowed. His assistant led me in search of Dr. Samia’s office, no easy feat, since the complex was a series of multiple low buildings, some attached, some semi-attached via parapet and others fully detached yet very close in; all at different angles from one another and in a hopeless jumbled maze . I followed my guide as we wandered from one area to another. I was struck by the vast throng of people everywhere, it was like the inside of a Wal-Mart on sale day only some folks wore orange clothing, others were in non-descript neutrals or black. I felt myself to be part of a “stream".  There was a mass of people moving with me but I fought for walkway with an equal sized stream flowing against me. I followed my guide thru narrow corridors, then outside on cracked sidewalks and then up and down stairways. He looked back from time to time to confirm I was still keeping pace and I gave him a scant nod thru the sea of blank faces. Suddenly a pair of hands emerged from nowhere and rose up, poised to encircle my throat in a choke hold. Mere inches from me was a wide eyed toothless woman laughing at me. As quickly as her hands momentarily started to tighten on my neck, they disappeared again and the woman faded behind me in the fleshy flow. It was disconcerting. I felt like I was on the set of Munch’s “Scream” and hastened to catch up.

    When I finally did connect with Dr. Samia, she told me about Emanuel Hospital, Ethiopia’s only public residential mental hospital. For the past 25 years it has housed 250 patients, with some wards having as many as 40 beds. They recently received a very fine donation of orange pajamas and now have enough clothing for the majority of the residents. The staff is pleased about this, as they find it quite difficult to distinguish the patients from the visitors, of whom there are always so many.
    Emanuel Hospital also allocates 14 beds as an outpatient facility but in truth, it seems to be more of a 10-day “holding” area, after which time the patient is either sent home with appropriate medicine, admitted if a bed is available or, if no bed is available at that time, told to return at a future date. During the 10-day outpatient (inpatient, actually) stay, the patients are involved in group therapy sessions and interviewed by case “teams” to assess their level of sanity. Dr. Samia said there is a great stigma in Ethiopia and patients are brought in at the last moment by family members, often in a flagrant state of profound mental illness.

   In terms of treatment, everyone is uniformly dosed with haloperidol 1.5mg  and chlorpromazine 25-50mg. daily. When I asked her about “talk therapy”, she said that each patient has a meeting 2x week with a health care team which includes either a psychiatrist or medical resident, nurse, social worker, OT and aides during which they discuss meds, progress and planning. I restated my question about talk therapy, defining it as a 50 min session, one-on-one with a psychiatrist, as a probative tool for understanding the basic pathology of the illness. No, she said, we don’t have that.

   Residents who have a “poor” card are admitted and receive their care free of charge. Those without this documentation pay a total of 200-500 birr ($11 - $27) for a 1-3 month stay. Recently a small private psychiatric hospital has opened in town, the only one of its kind in Ethiopia. It has 20 beds and the charge is 300 birr ($16) daily, which includes all treatment and meds.

   Dr. Samia showed me different wards around the hospital compound, most of them empty of any patients; easy to see why…they were all "on the move"! By now we had a small coterie of followers standing very, very close to us as we conversed; some in orange pajamas, some not. We seemed to all move together as a wave or a swirl. When we walked, they walked; when we stopped, they stopped. Dr. Samia must have been used to it; she paid them little attention, and shooed them away only when they touched us.This was not unfamiliar to me from my  nursing days on the psyche floor: vacant stares, word salad, self-stim, tremors; and those sitting cross-legged against the walls were trapped in hallucinations, incoherent babble or profound withdrawal. It was just a real busy sort of place.

    I asked how they managed patients in extreme mania and she matter-of-factly stated “we chain them to the bed”. She added that there was one patient chained up at this time. They had attempted to let him mingle among the general population but because of his bi-polar state and overt homosexual tendencies, he was found to “bother” the other patients and chaining was the best option.

   By now we had made a series of loops around the facility and we were finishing up at the Occupational Therapy dept. which had 5 sewing machines, a loom for weaving and a cupboard full of yarns. The staff members greeted me as they worked on their own sewing, weaving and knitting projects. Where are the patients? I asked. “they come and go”. At this time, they apparently had all gone.

   What is the biggest problem you face here? I asked Dr. Samia. I had expected her to comment about the tight quarters, the dilapidated state of the buildings or the lack of true psychiatric intervention. “Wander off”, she said, “our patients tend to wander off. At least now, with the orange pj’s they’re easier to spot in the Mercado (market).”

   I thanked Dr. Samira for the time she spent with me but in truth, she hadn’t seemed to be very busy. She is an internist who was assigned to Emanuel for a couple years as “pay-back” for her education. She only sees patients who are admitted with secondary medical concerns. She had been called to assess a hot abdomen the night before but that had resolved itself by morning. She said there are more psychiatrists than ever in Ethiopia, the count is now around 40.
  When I remarked about the hopeless/homeless “sleepers” I see on the sidewalks of the city at all times of the day or night, she said that “khat”, a chewable vegetation that provides a cheap euphoric state, is very popular among the street people. It is also flown out daily on 747’s from Ethiopia to Djibouti, the Netherlands and the UK where it is legal.

   Dr. Samia arranged my transport back to town with a nurse who was ending her shift. We headed out to the Mercado where we did a little shopping. I kept my eyes peeled in case I caught sight of a pair of orange pj’s wandering off. Then I caught a mini-shuttle for 1 birr (5 cents) that dropped me off at the gates to the Black Lion. It felt good to be back home.
                                         

Entrance to Emanuel Mental Hospital

My "shuttle-buddies". Mini-busses are privately owned but routes are given by the government.
They are always packed, noisy and have no schedule. The more often the bus owner comes around, the more
money he makes.Charge is 1 birr (5cents)

                                     

A busy street in the main market area


Below is a short street video I took at at the Mercado, the largest open-air market in Africa.
Click on the arrow in the middle of the picture.