Tajikistan: Problems of Mental Patient Treatment
"We took him to the mullah and exorcists"
The relatives of F.Dzh., a 25-year-old man of Kulyab, said that he became mentally ill after he served in the army, and has been a mental patient for five years now. His mother, on the condition of anonymity, said that her son was absolutely healthy and has never complained about his mental health before he went to do military service as a volunteer. Once he called her from the military unit and asked to take him home as he was feeling bad.
"We took him home from the military unit. He was behaving very strange, his mental health was poor – his hands and legs were trembling, he was always complaining that he could not sleep at night. We took him to a mullah and exorcists, and they read prayers. He seemed to feel better and he came back to army again. In 2-3 months, he returned again and his health was even worse than before. He served only for one year and could not continue to do military service because of his mental health," said the mother of F.Dzh.
She still does not know the causes of her son's disease.
"If we ask him what made him sick, he feels worse and he scolds with us. We still do not know if he got sick because of fear or he was battered. According to the officials in the military unit, they didn't report the cause of his disorder," the woman said.
According to the advice of the relatives, who said that the son's condition will get better if he gets married, she found a bride for him. But he kicked her out of the house in less than a month.
"At the wedding, he kept silent because he was frightened of his cousin. However, as soon as he went out, he started to behave strangely and sometimes attacked people. If he sees a person outside 50 times, he is saying hi to them 50 times," the young man's mother said.
However, his condition worsened, and mullahs and exorcists could not help him. He attacked the father and battered him. Thereafter, parents turned to the Rudaki Republican Clinical Psychiatric Hospital, known as "Kuktosh". He spent one month there and his condition got better. F.Dzh. was prescribed medications and was dismissed.
After taking psychotropic substances, his condition gets better for a while, but after the medication stops its action his condition gets worse. The young man's mother said that she could get medications in Dushanbe hospitals, but her son always refuses to eat them.
According to the woman, the public mistreats such patients. So, the society treats such patients severely every time, and when they see her son, they either laugh at him or avoid him.
"We took him home from the military unit. He was behaving very strange, his mental health was poor – his hands and legs were trembling, he was always complaining that he could not sleep at night. We took him to a mullah and exorcists, and they read prayers. He seemed to feel better and he came back to army again. In 2-3 months, he returned again and his health was even worse than before. He served only for one year and could not continue to do military service because of his mental health," said the mother of F.Dzh.
She still does not know the causes of her son's disease.
"If we ask him what made him sick, he feels worse and he scolds with us. We still do not know if he got sick because of fear or he was battered. According to the officials in the military unit, they didn't report the cause of his disorder," the woman said.
According to the advice of the relatives, who said that the son's condition will get better if he gets married, she found a bride for him. But he kicked her out of the house in less than a month.
"At the wedding, he kept silent because he was frightened of his cousin. However, as soon as he went out, he started to behave strangely and sometimes attacked people. If he sees a person outside 50 times, he is saying hi to them 50 times," the young man's mother said.
However, his condition worsened, and mullahs and exorcists could not help him. He attacked the father and battered him. Thereafter, parents turned to the Rudaki Republican Clinical Psychiatric Hospital, known as "Kuktosh". He spent one month there and his condition got better. F.Dzh. was prescribed medications and was dismissed.
After taking psychotropic substances, his condition gets better for a while, but after the medication stops its action his condition gets worse. The young man's mother said that she could get medications in Dushanbe hospitals, but her son always refuses to eat them.
According to the woman, the public mistreats such patients. So, the society treats such patients severely every time, and when they see her son, they either laugh at him or avoid him.
How does psychiatry work in Tajikistan?
According to official statistics of Tajikistan, 45,000 people are registered with medical centres and districts of the country, as mental patients.
The republican mental disease hospital in the Rudaki, 17 kilometres away from Dushanbe, is one of the largest specialised hospitals in the country that diagnoses and treats mentally ill people. The clinic was established for 50-60 patients. The hospital was designed for 640 beds, but due to the increase in seasonal diseases in spring and autumn, there are many patients at this time and there are enough places in the hospital.
The hospital is located inside a residential area. The building is not enclosed and is open for visits. During the talk with CABAR.asia, head doctor of the hospital Tovusbi Murodova called it as one of the main problems.
According to her, such hospitals are usually closed facilities, which makes them safe both for the neighbourhood and for the patients. In their case, local children often imitate the behaviour of the patients.
"Fortunately, there have been no cases of attacks on the people or injuries of residents from patients. But no one can guarantee such case won't take place in future," Murodova said.
According to her, the country's attitude to mental patients is not very good. Some people think that such patients are not needed to the society, but not all patients are dangerous and harmful, they also need kindness and care.
According to the chief doctor, relatives used to visit patients, take them home, when they felt better, but this is rare in recent years. The relatives do not want to take them home and see them as a burden. Some even acknowledge that they will not have any claims to the medical staff if something happens to their patients.
Now there are 400 people in the facility on an ongoing basis, who are treated at the state's expense. Disability benefits are paid to their relatives, not them.
20-25 people visit the hospital every day. Compared to the similar period in 2019, the number of patients has increased by 70 per cent. The experts link it to coronavirus and the people's fear of it. Doctors recommend to register the patient with a local policlinic if there is no need for hospitalisation, and to treat them at home.
"Every district or town must treat their patients locally. The reason for such a large number of patients in our facility is the inaction of psychiatric hospitals of other districts and the fact that patients from all the country come to us," Murodova said.
The hospital is located inside a residential area. The building is not enclosed and is open for visits. During the talk with CABAR.asia, head doctor of the hospital Tovusbi Murodova called it as one of the main problems.
According to her, such hospitals are usually closed facilities, which makes them safe both for the neighbourhood and for the patients. In their case, local children often imitate the behaviour of the patients.
"Fortunately, there have been no cases of attacks on the people or injuries of residents from patients. But no one can guarantee such case won't take place in future," Murodova said.
According to her, the country's attitude to mental patients is not very good. Some people think that such patients are not needed to the society, but not all patients are dangerous and harmful, they also need kindness and care.
According to the chief doctor, relatives used to visit patients, take them home, when they felt better, but this is rare in recent years. The relatives do not want to take them home and see them as a burden. Some even acknowledge that they will not have any claims to the medical staff if something happens to their patients.
Now there are 400 people in the facility on an ongoing basis, who are treated at the state's expense. Disability benefits are paid to their relatives, not them.
20-25 people visit the hospital every day. Compared to the similar period in 2019, the number of patients has increased by 70 per cent. The experts link it to coronavirus and the people's fear of it. Doctors recommend to register the patient with a local policlinic if there is no need for hospitalisation, and to treat them at home.
"Every district or town must treat their patients locally. The reason for such a large number of patients in our facility is the inaction of psychiatric hospitals of other districts and the fact that patients from all the country come to us," Murodova said.
Staff turnover
The salary of doctors in a clinical psychiatric hospital is 1,100-1,300 somoni (106-125 dollars). There are 13 psychiatrists, 25 medical specialists and hospital attendants in the hospital, but this number is not enough.
Murodova has written to officials, including the Ministry of Health and Social Protection of People, many times about the staff turnover, but the issue is not solved yet.
Murodova has written to officials, including the Ministry of Health and Social Protection of People, many times about the staff turnover, but the issue is not solved yet.
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"The majority of our staff leave Tajikistan for the Russian Federation. When we ask them about the reason for leaving, they say that conditions of work there are better. Four specialists of our hospital resigned in 2019-2020 and left abroad. Once the borders open, other specialists are going to leave. I don't know what will I do then. Now our facility falls short of four specialists."
The shortage of staff is the problem of psychiatric services of entire Tajikistan. The country has only 89 psychiatrists, which is very few. According to the main specialist of the Ministry of Health and Social Protection of Tajikistan, Khurshed Kungurotzoda, they need 192 psychiatrists according to modern requirements. But young people are not interested in this profession because it is not prestigious and provides little money. According to the expert, only one graduate of Tajikistan-based medical universities graduated in 2019 in the major of "psychiatry".
"GBAO falls short of 12 psychiatrists, Khatlon – 28, Sogd region – 30-35, towns and districts of republican subordination – 28, Dushanbe – 12," Kungurotzoda said.
According to him, presidential quotas for education and such motivations as land plots, housing and money for young specialists could solve the problem. However, no measures in this regard have been taken so far.
"GBAO falls short of 12 psychiatrists, Khatlon – 28, Sogd region – 30-35, towns and districts of republican subordination – 28, Dushanbe – 12," Kungurotzoda said.
According to him, presidential quotas for education and such motivations as land plots, housing and money for young specialists could solve the problem. However, no measures in this regard have been taken so far.
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"Psychiatry must be encouraged. For example, a phthisiologist gets 100 per cent more than other physicians because their work is full of risks. The work of doctors who treat mental patients is also risky. Therefore, the responsible agency must address the national government and ask them to increase the salaries of psychiatrists by 100 per cent. In this case, there will be no problem of staff shortage."
Diminishing money
Moreover, there are problems with food and medications. According to Tovusbi Murodova, each patient has 5 somoni (0.48 dollars) per day for food and 2.3 somoni (0.22 dollars) for medications, which is very few. The patients have hot meals and medications three times a day.
In addition to main medications, the hospital needs extra medications from diabetes, hypertension, hepatic and kidney disorders. Because of excessive sleep and use of psychotropic medications, patients develop other disorders that require additional treatment. But the health ministry does not allocate extra money for that.
In addition to main medications, the hospital needs extra medications from diabetes, hypertension, hepatic and kidney disorders. Because of excessive sleep and use of psychotropic medications, patients develop other disorders that require additional treatment. But the health ministry does not allocate extra money for that.
"We must provide psychotropic and additional medications for just 2.30 somoni a day, which is of course not enough," Murodova said.
According to Khurshed Kungurotzoda, patients were treated with 10-12 types of medications before 2014-2015, and now the list of medications was cut to 3-4 types. The methods of treatment have not changed. It's just that new medications with higher potency appeared.
However, strong psychotropic medications are included into the list of narcotic substances and their import must be permitted by all law-enforcement bodies. Therefore, companies that import medications simply do not import them.
"We have such medications as Phenazepam, Sibazon, but they are not enough to treat patients. All medications used to treat mental disorders must be used correctly and according to prescriptions," Kungurotzoda said.
According to Khurshed Kungurotzoda, patients were treated with 10-12 types of medications before 2014-2015, and now the list of medications was cut to 3-4 types. The methods of treatment have not changed. It's just that new medications with higher potency appeared.
However, strong psychotropic medications are included into the list of narcotic substances and their import must be permitted by all law-enforcement bodies. Therefore, companies that import medications simply do not import them.
"We have such medications as Phenazepam, Sibazon, but they are not enough to treat patients. All medications used to treat mental disorders must be used correctly and according to prescriptions," Kungurotzoda said.
Disorder number one
According to the chief specialist of the Ministry of Health and Social Protection of Tajikistan, Khurshed Kungurotzoda, now the country has 1,525 psychiatric hospitals, and only 2.5 per cent of the national healthcare budget is allocated to this sphere.
According to him, the mental disorder number one in Tajikistan is schizophrenia, which is developed in about 47 per cent of patients.
According to him, the mental disorder number one in Tajikistan is schizophrenia, which is developed in about 47 per cent of patients.
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"Organic brain disorders are on the second place, dementia (primary or acquired feeble-mindedness – author's note) is on the third place, epilepsy is on the fourth place, and psychosis or mental deficiency is on the fifth place. Another type of mental disorders that are very common in the country is mental deficiency caused by alcohol consumption."
According to psychologist Makhmud Kabiri, the medical system in Tajikistan focuses on the human body only. However, emotional and mental health is equally important and one must see a psychiatrist or psychologist, when needed.
"To be able to live in a modern world, you must have a stable mind. Psychiatry and medications cannot meet all people's needs, so it needs to be updated. It means that new branches emerge – medical psychology and psychotherapy," Kabiri said.
However, according to him, there are very few specialists in the country. Often, people go to domulloh and tabib, exorcists, who just aggravate the diseases.
According to Khurshed Kungurotzoda, 97 per cent of mental disorders are being aggravated by folk healers as they prolong the moment of medical intervention. If a patient visits a specialist on time, they will likely to have a positive treatment outcome.
The average treatment duration in a hospital is up to 90 days. Afterwards, the disease becomes chronic and its treatment is much more difficult.
"The main method of diagnostics of mental disorders is a serious talk and taking of medications and pills. Every talk lasts for 45 minutes. We hear to what the patient says and then analyse what is real and what is nonsense," Kungurotzoda said.
According to him, about 1 per cent of the population in the country think they are mentally ill, but do not seek medical assistance.
"To be able to live in a modern world, you must have a stable mind. Psychiatry and medications cannot meet all people's needs, so it needs to be updated. It means that new branches emerge – medical psychology and psychotherapy," Kabiri said.
However, according to him, there are very few specialists in the country. Often, people go to domulloh and tabib, exorcists, who just aggravate the diseases.
According to Khurshed Kungurotzoda, 97 per cent of mental disorders are being aggravated by folk healers as they prolong the moment of medical intervention. If a patient visits a specialist on time, they will likely to have a positive treatment outcome.
The average treatment duration in a hospital is up to 90 days. Afterwards, the disease becomes chronic and its treatment is much more difficult.
"The main method of diagnostics of mental disorders is a serious talk and taking of medications and pills. Every talk lasts for 45 minutes. We hear to what the patient says and then analyse what is real and what is nonsense," Kungurotzoda said.
According to him, about 1 per cent of the population in the country think they are mentally ill, but do not seek medical assistance.
Authors:
- Zulfia Raissova,
- Daniil Lyapichev,
- Mazhab Jum'a
Editor:
Natalia Lee
Illustrations:
Nasiba Karimova
Layout:
- Zulfia Raissova
This publication was produced as part of the mentorship programme under the Development of New Media and Digital Journalism in Central Asia project delivered by the Institute for War and Peace Reporting (IWPR) with support from the UK Government. It does not necessarily reflect the official views of IWPR or the UK Government
