As I walked around the hospital, it had the feel of an old asylum. I had been warned what to expect, but the wards were still quite difficult to take in. The level of overcrowding meant that sometimes patients had to sleep on mattresses on the ground, outdoors on terraces. The male “locked ward “in particular was full to the rafters (about 35 beds and 220 patients) - this seemed to be the equivalent of our forensic wards where patients were sent on “court orders”. However, as far as I could discern from the nursing staff, men arrived here regularly, but the outward traffic of discharge was much less frequent. Although there were lots of patients, there were no discernable outward signs of psychosis or aggression, just lots and lots of men, milling around looking bored.  There was also an addictions ward, where people were admitted with substance use problems, mostly “wee” (cannabis) and alcohol. However, apparently there weren’t any in-patient resources for psychological treatment of addiction (although there was an AA groups within the hospital) and it seemed as if the patients were just taken off the streets to live here instead, out of sight.

I had a chance to spend some time talking to some of the in-patient staff. As ever, I was impressed with their professionalism in the face of very difficult working conditions. They told me of the stigma that mental illness faces in Ghana, even from within its own medical profession at times. They said that often they had experienced reactions of abject horror from their friends and family when they said that they wanted to work in Mental Health, and that their still remained a great deal of superstition and fear around psychiatric illness, with even some educated Ghanaians attributing its aetiology to spirits and demons. They described the difficulties they often faced in accessing appropriate medical health care for their patients. One nurse tells me of an incident where her patient needed to be taken for a blood transfusion at a local physical healthcare facility. During the treatment, she heard a member of their staff say loudly, within earshot of the patient, that this kind of medical treatment shouldn’t be “wasted on animals”. Obviously this is not an opinion held by the majority of educated Ghanaians, but still, it is indicative of the level of prejudice that exists in some quarters.

Probably the most starkly difficult part of the hospital to take in was the Children’s ward. This comprised a large compound which housed about 30 patients with moderate to severe learning disabilities, aged between about 8 and 35. The staff told me that children with intellectual disabilities (often with concurrent physical problems) were abandoned at the gates of the hospital by their families, or sometimes found on the streets. Once here, most had no further contact with their families and remained on the ward until their lives ended. The nurses explained that having a disabled child, particularly a child with a learning disability, can be very shaming for a family, and that it is sometimes taken as a sign of some sort of malevolent influence at work.

There are 2 nurses on duty and a couple of Ghanaian volunteers who are  here three days a week to help care for the children and who also try and organise activities such as art or games. But it is very clear that relative to the individual needs of the children, the wards are critically understaffed. It is all the nurses can so to keep the children clean, fed and safe and there is precious little time left to think about their emotional or learning needs. I noticed some of the children sitting quietly rocking themselves. For the brief periods that I have been on the wards, individual children come up, grab on to you and don’t let go; I left with scratches on the back of my neck because one little girl was holding on so tightly. I try not to be the overwrought, overemotional visiting westerner, and fail. It feels like quite a lot to take in. Currently there is no available input from speech therapists, physiotherapists or child psychology.

I spoke to staff and volunteers to see if there is anything practical we could do, in conjunction with Challenges Worldwide, the charity that is supporting me in Ghana. I was thinking of trying to fundraise for some educational and art materials for the ward and I asked the staff for a list of things that  the children need: although the list did include toys and art materials, at the top were more basic requirements such as detergent, gloves, nappies and second hand clothing.  I need to have a think about how best to take this forward, and I leave feeling a bit numb.