Storm season
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 December has arrived, and the island has been
assaulted by a tropical storm for the last few days – rain of
biblical proportions in the streets of Kolonia, grey mist hiding
the mountains, the coconut trees battered by gales from the
Pacific.
I made it out snorkelling, before the
storms, and saw an eight-foot shark lurking in the depths, and
hundreds of fish – neon pinks and yellows, striped and spotted and
tiger-print, and bright blue starfish on the coral
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Local healer I am now getting to know
many of the regular clients of the mental health team. We have been
spending time with a lady with a diagnosis of Schizophrenia, who, a
month ago, asked to stop her antipsychotic injection and visit a
local healer instead. She had never asked to do this before, and
when we went to see her, she told us that she has started being
visited by ghosts who talk to her and tell her to throw herself
into the river.
The mental health coordinator tells me about
some of the local beliefs here – angry ancestral spirits are often
held responsible for misfortune, including sickness, and the
solution is to visit the gravesite of the ancestor involved, to
tidy it up, or to “trap” the spirit inside it by making a hole in
the tomb and filling it with herbs and plants recommended by a
healer.
It’s hard to elicit a trigger for our lady’s
recurrence of psychotic symptoms, but she isn’t sleeping at night
and has lost a lot of weight recently, and reports suicidal
thoughts – not long ago, her daughter found her taking a knife into
her bedroom. I start her on Amitryptiline, the only antidepressant
available here, but we also arrange to meet with the patient and
her family, to talk through what they believe is wrong and further
explain my diagnosis. The mental health team do not discourage
patients from seeking help from local healers, although they try to
encourage them to continue taking medication and engaging with
mental health services at the same time.
As keen as I am to visit a local healer and
see what they do, I don’t think it’s going to be easy: the mental
health team say they don’t really have much to do with them, and
I’m told local healers guard their secrets and methods very
closely, particularly from outsiders like me. It’s really
interesting to see how traditional beliefs in the supernatural
exist alongside western concepts of illness.
Spirit level
Another patient is taken to jail – the only
facility for acutely disturbed patients here who cannot be safely
cared for at home – by her husband because she has started being
aggressive at home, talking to herself and not sleeping at night.
She also has a diagnosis of schizophrenia and tells me she is
seeing ghosts at night which frighten her. Her husband says the
house in which they live is cursed, and that local children have
reported sightings of the ghost that haunts it. The ghost has come
from Nan Madol, the ancient ruins on the island which are a very
sacred place, and which many locals will not visit due to fear of
offending the spirits there.
The husband tells us that he is happy for us
to increase her medication and that he would like us to help her as
much as we can, that he is aware she has a mental illness which he
feels the medication is helpful for, but that he also believes in
these ghosts and suspects she has been cursed. The other solution
is prayer, and lots of it, but her relatives, he tells us, who
lived in the house before them, also “went mad” and eventually
moved out to escape the spirits.
Mangrove sickness
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 The mental health team coordinator is Aieleen,
a lady from one of the outer islands called Pingelap, who studied
nursing in Australia before returning to Pohnpei to work in mental
health.
Aieleen is fantastic, and I’m regretful that
she isn’t able to attend more of our training because she is too
busy managing the clinic and looking after her four month old baby.
I try to spend time with her as much as I can as I am learning so
much from her about how mental health is conceptualised here in
Pohnpei and the FSM, and also about the many difficulties and
obstacles the mental health service faces.
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Aieleen tells me about Mangrove Sickness,
another local explanation for illness. Mangrove sickness seems to
be a “catch all” term for all manner of ills, including aches and
pains all over the body, chronic tiredness, despair, emotional
turmoil, hearing voices, seeing things.. It’s caused by the
Mangrove Demon, who possesses people who spend too much time in the
mangroves or who go there after dark. Aieleen explains to me that
although people here in Pohnpei are willing to accept Western
remedies for illness, they will often say that if you want to get
to the root cause of the problem, Mangrove Sickness is where it’s
at.
Mangrove sickness is cured by Mangrove
Medicine, but what Mangrove Medicine consists of is, again, a
closely guarded secret of the traditional healers. I am fascinated
by the mangrove swamps, and have spent many happy hours snapping
photos of the dark, creepy, tangled roots which fringe the island.
Pohnpei has no beaches, but the mangrove, in my opinion, is far
more interesting. However, when I am struck down by food poisoning
for the second time in a month, both times the day I am due to go
out in the jeep to administer my “western medicine” and spread my
western ideas, I do start to wonder if I have stirred up some
ancient spectre and need some mangrove medicine of my own......
Stigma
The next week, we manage to get together with
our first patient’s family – her mother and aunt, sister and
daughter. We can’t seem to track down her husband. We ask
about the ghosts and the local healer, but the family say they
don’t want to see a local healer anymore and are happy for her to
take our medication, even though they don’t seem to think it’ll do
much good. It’s hard to get information from them about what they
think is wrong. They have a private conversation with one of the
Pohnpei trainees in the local language. Back in the jeep he tells
me that they asked him not to translate for me, but he does, anyway
– apparently, they believe the problem is she is too lazy and the
best thing would be “to beat the evil out of her”. Oh boy!
Back at base, I switch my training session
plan to a session on tackling stigma and psycho-education, and try
to book another visit with the family as soon as we can. Time is
going very swiftly, and we’re now moving on to “training the
trainers” work, in order to try to capacity build.
Lock up
The trainees have some great ideas: the
trainee from Chuuk is keen to teach her colleagues in maternal
health about post-natal mental illness which they say is relatively
unheard of here. It’s handy that everyone on island is related to
everyone else – one of the Pohnpei trainees is the brother of the
chief of police, so we should be able to organise a training
session for the local force fairly easily. The police are depended
on here for assistance when someone is very disturbed and needs a
place of safety, and they seem to do a pretty good job with the
limited resources and expertise they have. The policemen I have met
seem empathic and concerned about the inappropriateness of jail for
mentally ill clients.
In other parts of the FSM I am told it isn’t
so good – in Chuuk, for example, the mentally ill are held in cells
with criminals, who beat them and abuse them. There is very little
legislation here for the mentally ill – if they are deemed unsafe
to stay at home, jail is the only other option; the mental health
team need to file a request with the court for a “commitment order”
within 24 hours of incarceration, and the court then commit the
patient to jail for a maximum of thirty days.
If the patient stabilises before then, the
mental health team request release. If the patient is felt to need
longer, the mental health team request longer detention. But
families play a pivotal role in whether patients are allowed to go
home – if the families insist they remain in jail, in jail they
remain, because there is nowhere else for them to go other than
home. Patients don’t have rights to lawyers or appeals or
tribunals, and although the mental health team try hard to ensure
nobody remains in jail for longer than necessary, they are
dependent on families working with them and not obstructing
release. There are no community facilities at all here, no hostels
or supported living. It’s either with family, or on your own, and
not many people at all can afford to live on their own or the
severity of their illness means it wouldn’t be safe. The mentally
ill are not entitled to benefits and there are no social services
as exist back home in the UK.
Tomorrow is our Christmas party, storms
permitting. We’re having it at the marine park, where the giant
turtles live. More news to follow soon.
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