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The Royal College of Psychiatrists Improving the lives of people with mental illness

The visit to Pabna

The major focus of this week was a visit to Pabna hospital, only 200km from Dhaka, but a hair-raising 8 hour journey on the bus.  Pabna is the largest mental health hospital in Bangladesh and has been open since the 1950s.  I had heard numerous rumours about Pabna, mainly circulated by persons that hadn’t been, so I did not know quite what to expect.  The Chairperson of the BSMMU, Professor Mullick, had worked there previously and recommended that I visit. 
 
Pabna Hospital
The hospital is centred in around 120 acres of land, just outside the town of Pabna, and the initial approach, I guess is not too dissimilar to some of the older larger mental health hospitals in the UK, reminding me a little of Middlewood in Sheffield. The staff had arranged for me to give a presentation on both psychiatry in the United Kingdom and transcultural psychiatry (delayed a little by a power cut!) which started the day.
 
I guess I was pleasantly surprised by the setting. Lots of green space, a theatre hall, a mosque, a garden area – much more tranquil than the hospitals in Dhaka. The staff were keen to point out the positives of the unit in terms of being an ideal environment for recovery. I understand several weeks before I arrived, the unit had been portrayed in a negative light on national television, with a documentary piece talking about locked wards and old-fashioned treatments – the staff were clearly unhappy with what they considered to be an unfair representation.
I understand that there are 18 wards, around 2/3 male with one substance misuse wards – I was able to see 6 of the wards – with a total of around 490 patients.  The majority of patients’ care is funded by the government, with a smaller separate paying unit.  Yes, the wards that I saw were locked – the staff informed me that the wards are generally locked in the mornings, with activities and more freedom in the afternoon.  The staff said that the wards were locked for the safety of the patients – there were clearly a large number of very ill individuals with a variety of illnesses, and a variety of ages.  The average stay is around six weeks, although some patients have been here for much longer.  Often the difficulty is finding suitable onwards care if families have disowned individuals. 
The staff informed me that they utilise the government formulary (that I had previously seen in the National Institute in Dhaka) which has a reasonable selection of psycho-tropics from different groups.  The staff I spoke to seemed very enthusiastic, but were a little upset that more doctors are not interested in working there – there are only 4 psychiatrists and a few other non-specialist doctors covering both the hospital, with a huge outpatient clinic, also.  Few of the senior psychiatrists wish to leave Dhaka (I understand mainly due to family and private work commitments).  On a positive note, I met my first mental health social worker since coming to Bangladesh, and I understand that there are three individuals who use an Occupational Therapy model, as well as one psychologist.  Interestingly, I was informed that sometimes the patients take part in psychodrama in the theatre.

 Pabna Hospital
This part of the Royal College Link was more for my own experience. There were clearly a lot of positives about the environment, the setting, the enthusiasm, knowledge and skill of the staff. The wards are locked, and I did see several patients who had bindings on. (admittedly these patients did appear very agitated). Visiting the unit, I could understand this in the context of not enough staff to effectively manage and treat the patients in a more open ward environment. There may be potential for future doctors under the Royal College volunteer programme to do some more work at Pabna hospital - the team informed me that I was the first British psychiatrist to visit the unit in many years and were supportive of the idea of a possible future link. 
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About this blog

Dr Adrian Phillipson

 

 

 

 

 

 

Dr Adrian Phillipson is an ST5 in general adult psychiatry, based in South Yorkshire.  He is currently part way through a year out from his training rotation, utilising the time to pursue research and travel interests.  Adrian is the first psychiatrist to take part in a new Royal College of Psychiatrists Volunteer Scheme Link with the Bangabandhu Sheikh Mujib Medical University in Dhaka, Bangladesh.  He hopes that this blog will provide good insight into the link, and will encourage others thinking of taking part in the volunteer scheme.

Adrian’s attraction to transcultural psychiatry stemmed from a chance encounter with a local practitioner in Malawi in 2003, where he witnessed a traditional healing ceremony for psychosis.  He has further developed his interest through completing a masters degree in Transcultural Mental Health Care at Queen Mary, University of London, as well as through further overseas exposure.   In 2010 Adrian made an initial scoping visit to Bangladesh to look at mental health services and help establish a sustainable link.  A report from this project can be found here.