Tuesday, May 20, 2008

As war rages on, Iraq's psychiatric patients are plunged into an archaic past

The Ibn Rushid psychiatric hospital in central Baghdad was once, in a time before the war, a jewel in the crown of Iraq's healthcare system. Now, after five years of war, the staff struggles to deliver services under horrific conditions where they lack medications and equipment and are forced to compromise and make do, because the alternative to that is doing nothing, and that is anathema to most helping professionals.

They struggle on, doing the best they can, even though they are feeling the strain and exhibiting signs of PTSD themselves.
Nevertheless, he does his best to help his patients. Some he treats with the limited number of psychiatric drugs at his disposal. For others, patients who are suicidal or catatonic or do not respond to drugs, he prescribes electroconvulsive therapy, administered with a 25-year-old machine that, he says, has “technical problems.”

The patients are sometimes given Valium before the treatments. But because there is no anesthesiologist on staff, the shocks are delivered without anesthesia, as they were decades ago in the United States.

Dr. Hussain is acutely aware that what he has to offer is far from ideal — that the way the hospital gives electroshock therapy is “inhuman and dangerous,” that patients do not receive the panoply of special programs and therapies routinely available in other countries.

“I feel frustrated,” Dr. Hussain said. “I feel sad. I see the correct things but I cannot do them because there are barriers and limitations. We do not have the equipment, we do not have the treatable medication.”

Despite that, he says, patients often improve.

Only four psychiatrists, from a pre-war staff of eleven, remain on staff at Ibn Rushid, most have departed for the Kurdish areas in the north where the odds of being kidnapped or murdered is far lower than it is in Baghdad. Others have fled the country and never looked back.

The facility is so understaffed that patients admitted for treatment must be accompanied by a family member who stays with them at all times to help keep them calm.

And still, in spite of seemingly insurmountable odds, patients seem to get better.

Dr. Hussain envisioned things differently when he chose to become a psychiatrist in the 1980s, fascinated by the psychiatric symptoms of soldiers returning from the distant battlefields of the Iraq-Iran war.

But now a different war has settled over his country, and his patients, though not soldiers, are all, in a way, the casualties.

He could leave Iraq, but he has no intention of doing so, he said. He loves his work.

“Nobody forced me to be a psychiatrist,” Dr. Hussain said.

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