Jeannette (not her real name), a slender young woman with a squint, tries to shuffle out through the security gate behind us, but is roughly restrained by a stocky woman who puts a heavy forearm around Jeannette’s neck and pulls her back. When I remark that the security guard seems unnecessarily zealous, I am told that the stocky woman is an auxiliary nurse.
“They get like that after a while,” says Cynthia Isaacs, head of psychiatric services in the Northern Cape. “The ward is understaffed and some staff members have been threatened by patients here in the acute wards.”
Only one professional nurse and one auxiliary are in charge of the 13 women in the acute ward of West End Psychiatric and TB Hospital in Kimberley, the province’s only in-patient facility for psychiatric patients.
A short distance away, in the male acute ward, there are 19 patients. There, one professional nurse and two nursing assistants are in charge and the patients sleep together in dormitories. Yet the acute wards are where the most disturbed patients are kept, and where escape attempts and attacks on staff and other patients are fairly common.
The male patients stand or squat in the orange dust of a tiny courtyard. Most of them smoke — one of the major preoccupations of institutionalised psychiatric patients.
There is precious little else for the patients in the acute wards to do. The men can no longer watch television as there are not enough nurses to watch those in the TV room and those in the courtyard.
“We need three professional nurses in this ward alone. But no one wants to work in psychiatry. It’s a scarce skill, but this is not recognised,” says Evelyn Goieman, who manages the 107-bed hospital.
Patients’ food is sent over from Kimberley Hospital. But, says Goeiman, it is never enough. “The medication that our patients are on makes them hungry and our patients are also active. But they get the small helpings of ordinary sick patients.”
The hospital is an “out of sight, out of mind” kind of place — some of the psychiatric patients have been there for 40 years, long abandoned by their families. Even getting through by telephone is difficult as there is no switchboard operator.
Stable patients are transferred from the acute to the chronic wards where they have much more freedom. A handful of severely depressed and suicidal patients are in West End voluntarily and are kept together in open dormitories. They usually stay for two or three weeks and, although they are free to walk around, most choose to lie quietly on their beds. Those psychiatric nurses who work at West End are highly skilled, but because of the staff shortages they are only able to do “the critical things”, says one, who asks not to be named. There is no time to run group therapy sessions for the patients.
The province only has two psychiatrists but, says Isaacs with a twinkle in her eye, this is a 100% improvement as for years it had only one.
There are about 6Â 000 known psychiatric patients in the province, and the psychiatrists try to see every patient once a year, says Isaacs. Stable patients are treated at clinic level, where they get their medication. There is hope for the West End patients, however. A new psychiatric hospital is being built to replace the grim hospital, and the first patients are expected to be admitted in 2008.