A Glimpse on Psychiatric Patients in Iraq
COVERING LETTER:
The article explains the different aspects of a psychiatric patient’s life in Iraq.
ABSTRACT:
Psychiatric patients in Iraq have many overwhelming conditions making their process of healing very slow and sometimes impossible. There are many faces of this issue financial, medical & social, each one has its own set of obstacles and these obstacles are victimizing the Iraqi patient in everyway you can imagine. This article is a frank discussion of this complex issue.
BODY:
Being a psychiatric patient in Iraq means only one thing “an endless misfortune”. Such patients are facing many challenges on multiple levels making their healing process almost impossible. There are social, medical & financial issues that are really influencing the outcome of such patients’ treatment & prognosis. Discussion of these factors really makes me feel sad because the final image of the whole process is a very gloomy one.
Medically, Psychiatry as a medical specialty is an unwanted one. Only doctors with bad records & low scores study such a specialty. As a matter of fact, Psychiatry is a qualification free medical specialty, you just need to apply for it and you have a 100% chance to be accepted. This situation of low standards regarding this field of study made the Iraqi Psychiatrists of low competitiveness and productivity because of lack of proper drive and sense of competition.
In the other hand we can not blame the physicians only; the patient has a key role in the process. The patient is a top ignorant one; never sticks to neither an instruction nor any set of medications. The patient can not understand that many psychiatric medications can not show any benefit only after 2 weeks of continuous treatment, so he gives it up and has a relapse and considers the medication a curse instead of blaming his ignorance ; then he switches to a new medication and so on. This vicious cycle makes any effort to alleviate patients` suffering a hard one; it makes psychiatrists feel unsatisfied all the time because all of their intensive study and thorough examination goes in vain. Looking in both directions, the patient in many times is never benefited from treatment and has no faith in his physician’s abilities and considers treatment as an experimental one or something like than; while the doctor thinks that treating such patients is a waste of time because they have neither compliance nor understanding for their own diseases.
Financially, the private sector is never willing to invest in mental health. In Iraq it is a cloudy area that no one is happy putting his money in it. To be honest, such an investment is a real waste of time and resources in the short run. People here consider a psychiatric illness like OCD a disease that entails prayer rather than treatment so that nobody is willing to pay a real sum of cash in exchange for treatment. This renders such investments deficient and incompatible with financial success.
The patient also has his own set of financial dilemmas. An ordinary Iraqi patient can barely afford 2$ as a single payment for cheap forged antibiotic course for treatment of a chest infection. No one can persuade a patient with chronic depression to buy Prozac (4$ per Packet) for life. This will be a heavy burden on the patient’s family. Eventually the same old story repast itself time after time as I witnessed with my own eyes ; the patient comes asking for help , he has depression, he is given Prozac for 6 months maximum , then he omit the maintenance dose by himself either because of lack of proper funding or because of ignorance , then the patient comes having a relapse and asks for treatment again and a again and this really makes people’s life here as a family a sad one especially if having a psychiatric patient as a family member.
Social discussion of this topic is so distressing to me in fact. It seems that nobody here wants to help psychiatric patients even themselves. The whole society is in denial state for the time being regarding such disease entities. A regular Iraqi family can easily consider their son drunk all the time or inhabited by an evil soul but they can not imagine even for a short while that he might simply be a schizophrenic one. Psychiatric illness in the middle east is considered a social stigma ; this make the patient’s family bear a double burden , the burden of treatment obstacles and the sense of shame that is hunting every family member. The entire society prefers to quarantine such patients instead of re-incorporating them again after treatment, they are all considered to be scary and aggressive and unpredictable even after they are cured, no one will value their abilities or their talents, no one can offer them a job or accept him/her as a future husband/wife. In other words, they are less human than others; they are more close to an alien or an animal than a human being.
As part of my investigation I visited Ibn Rushud Hospital (the grand mental health institute in Iraq). I heard very scary tales about patient’s abuse and neglect. ECT is done under simple sedation instead of GA. Female patients are raped very often simply because no one will believe them when they complain, the society considers them totally insane and can never regain their sanity, and also nobody cares for a psychiatric patient when she is raped because she became less human than others as I explained formerly. Patient was starved to death in many instances, especially during war times and during the embargo. As a final conclusion this happened because the Middle Eastern societies including the Iraqi society considers such patient less human and they can be abused, manipulated or neglected with no remorse.
Lastly I think that this issue is a complex one indeed and it has multiple factors. Ignorance, poverty & lack of adequate expertise are the main players in this sad game. The health system as a whole should be re-evaluated in order to achieve real steps forward. In my opinion, till now no serious action is made in this regard and the screams of such victimized patients will be heard over and over. I might seem to be pessimistic but this is the mere truth which I witnessed with my own eyes. Hope things will be better someday as time passes on.
Dr. Nabil Al-Khalisi,
MBChB,
Junior House Officer,
Medical City Complex,
Baghdad, Iraq.
Address: Iraq, Baghdad,
Al-Risala Post Office,
P. O. Box 44008.
Email: nabeelraad@yahoo.com
COVERING LETTER:
The article explains the different aspects of a psychiatric patient’s life in Iraq.
ABSTRACT:
Psychiatric patients in Iraq have many overwhelming conditions making their process of healing very slow and sometimes impossible. There are many faces of this issue financial, medical & social, each one has its own set of obstacles and these obstacles are victimizing the Iraqi patient in everyway you can imagine. This article is a frank discussion of this complex issue.
BODY:
Being a psychiatric patient in Iraq means only one thing “an endless misfortune”. Such patients are facing many challenges on multiple levels making their healing process almost impossible. There are social, medical & financial issues that are really influencing the outcome of such patients’ treatment & prognosis. Discussion of these factors really makes me feel sad because the final image of the whole process is a very gloomy one.
Medically, Psychiatry as a medical specialty is an unwanted one. Only doctors with bad records & low scores study such a specialty. As a matter of fact, Psychiatry is a qualification free medical specialty, you just need to apply for it and you have a 100% chance to be accepted. This situation of low standards regarding this field of study made the Iraqi Psychiatrists of low competitiveness and productivity because of lack of proper drive and sense of competition.
In the other hand we can not blame the physicians only; the patient has a key role in the process. The patient is a top ignorant one; never sticks to neither an instruction nor any set of medications. The patient can not understand that many psychiatric medications can not show any benefit only after 2 weeks of continuous treatment, so he gives it up and has a relapse and considers the medication a curse instead of blaming his ignorance ; then he switches to a new medication and so on. This vicious cycle makes any effort to alleviate patients` suffering a hard one; it makes psychiatrists feel unsatisfied all the time because all of their intensive study and thorough examination goes in vain. Looking in both directions, the patient in many times is never benefited from treatment and has no faith in his physician’s abilities and considers treatment as an experimental one or something like than; while the doctor thinks that treating such patients is a waste of time because they have neither compliance nor understanding for their own diseases.
Financially, the private sector is never willing to invest in mental health. In Iraq it is a cloudy area that no one is happy putting his money in it. To be honest, such an investment is a real waste of time and resources in the short run. People here consider a psychiatric illness like OCD a disease that entails prayer rather than treatment so that nobody is willing to pay a real sum of cash in exchange for treatment. This renders such investments deficient and incompatible with financial success.
The patient also has his own set of financial dilemmas. An ordinary Iraqi patient can barely afford 2$ as a single payment for cheap forged antibiotic course for treatment of a chest infection. No one can persuade a patient with chronic depression to buy Prozac (4$ per Packet) for life. This will be a heavy burden on the patient’s family. Eventually the same old story repast itself time after time as I witnessed with my own eyes ; the patient comes asking for help , he has depression, he is given Prozac for 6 months maximum , then he omit the maintenance dose by himself either because of lack of proper funding or because of ignorance , then the patient comes having a relapse and asks for treatment again and a again and this really makes people’s life here as a family a sad one especially if having a psychiatric patient as a family member.
Social discussion of this topic is so distressing to me in fact. It seems that nobody here wants to help psychiatric patients even themselves. The whole society is in denial state for the time being regarding such disease entities. A regular Iraqi family can easily consider their son drunk all the time or inhabited by an evil soul but they can not imagine even for a short while that he might simply be a schizophrenic one. Psychiatric illness in the middle east is considered a social stigma ; this make the patient’s family bear a double burden , the burden of treatment obstacles and the sense of shame that is hunting every family member. The entire society prefers to quarantine such patients instead of re-incorporating them again after treatment, they are all considered to be scary and aggressive and unpredictable even after they are cured, no one will value their abilities or their talents, no one can offer them a job or accept him/her as a future husband/wife. In other words, they are less human than others; they are more close to an alien or an animal than a human being.
As part of my investigation I visited Ibn Rushud Hospital (the grand mental health institute in Iraq). I heard very scary tales about patient’s abuse and neglect. ECT is done under simple sedation instead of GA. Female patients are raped very often simply because no one will believe them when they complain, the society considers them totally insane and can never regain their sanity, and also nobody cares for a psychiatric patient when she is raped because she became less human than others as I explained formerly. Patient was starved to death in many instances, especially during war times and during the embargo. As a final conclusion this happened because the Middle Eastern societies including the Iraqi society considers such patient less human and they can be abused, manipulated or neglected with no remorse.
Lastly I think that this issue is a complex one indeed and it has multiple factors. Ignorance, poverty & lack of adequate expertise are the main players in this sad game. The health system as a whole should be re-evaluated in order to achieve real steps forward. In my opinion, till now no serious action is made in this regard and the screams of such victimized patients will be heard over and over. I might seem to be pessimistic but this is the mere truth which I witnessed with my own eyes. Hope things will be better someday as time passes on.
Dr. Nabil Al-Khalisi,
MBChB,
Junior House Officer,
Medical City Complex,
Baghdad, Iraq.
Address: Iraq, Baghdad,
Al-Risala Post Office,
P. O. Box 44008.
Email: nabeelraad@yahoo.com