Despite a desperate need for facilities for psychiatric patients, Fort Napier Hospital in Pietermaritzburg is operating way below capacity because it simply lacks the staff to admit more patients. Although the facility has 370 beds, serious staff shortages have forced management to reduce patient numbers to about 280, says the superintendent, Dr Sharma Jogessar. The hospital is operating with less than a third of the staff it needs. There are 143 vacancies, mostly for professional nurses, and a total staff complement of 62. Psychiatric nurses are highly prized in developed countries and many of Fort Napier’s experienced staff have left for Britain and Saudi Arabia.
”This is demoralising for those who remain behind, because they have to double up on the work,” says matron Tholakele Madlala, who heads the nursing staff.
At least 60% of Fort Napier’s patients are state patients, the majority of whom have been certified as mentally unfit to stand trial for murder or rape.
The most common illnesses the patients suffer from are schizophrenia and bi-polar disorder. As the vast majority of patients are male, there is a particular need for male nurses, especially in the closed forensic ward. This is where suspects are sent for 30 days’ observation before the courts rule on whether they are mentally fit to stand trial.
”Some of these patients are very volatile because they are unmedicated and not on treatment while under observation,” says Jogessar.
From 5.30pm to 7am, the men — dressed in orange pants and light blue tops — are confined in single rooms furnished with only a bed and a potty. Their days are spent in a courtyard surrounded by electric fencing.
Sipho Mbongwa, who heads the closed forensic ward, says that while patients are often aggressive, they are seldom violent. ”I have worked here for 34 years and I have never been attacked by a patient. The staff understand how to handle them.”
When patients fight, perhaps twice a month, it is usually over cigarettes.
”There are about 90 men on the waiting list and we are booked up for the next three months,” says Jogessar. Two dazed-looking boys suspected of rape were being admitted for observation when we visited the hospital.
”There is a big problem because we don’t have facilities for children and adolescents, even for the mentally retarded,” says Jogessar. They were admitted to a female ward.
After 30 days’ observation, the court rules whether the men are mentally fit to stand trial based on the recommendations of state doctors. If declared unfit they are returned to Fort Napier — this time to the forensic security wards. They usually spend about three months there and are treated and stabilised.
Zakhele Ngubane, head of 9B, the forensic security ward, says patients ”can be unpredictable because they think they can be discharged and get aggressive because they want to go home. We have to sit and explain the situation and their treatment to them.”
While no women nurses are allowed to work at night, staff shortages mean that some have to work in 9B during the day. Sister Thobile Njokweni is the lone female nurse on duty when I visit, and admits it can be tough being the only woman in the environment. ”The patients try to touch you and they say things like, ‘Won’t it be nice if I touch your breasts.’ Others want special attention,” she says. ”I have to be with a male nurse at all times.”
Njokweni says she has had an interest in psychiatric nursing, stemming from childhood when some of her relatives were mentally ill. ”They are human beings too,” she says.
From 9B, based on their behaviour and response to treatment, high-functioning patients can progress to semi-open wards and then to open wards, where they have the freedom to roam the grounds of the institution and attend occupational therapy sessions.
After 10 to 15 years, some state patients could be discharged by a judge, either unconditionally or into the care of their families. But, says Jogessar, this seldom happens as their families are often afraid of them. ”Rehabilitation is one of our biggest problems, because families often don’t want them back.”