A Different Life
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January, 2012; Chennai, India: I got an opportunity to attend
the psychiatric outpatient clinic in C.S.I. Rainy Multi Speciality
Hospital in Chennai (formerly ‘Madras’), India. This hospital has
an interesting history relating to its establishment. It was
founded in 1888 by the Church of Scotland as a Medical Dispensary
and due to the efforts of Miss. Christina Rainy the hospital
buildings came into being5. The medical work was
pioneered by Dr Alexandrina Mcphail, between 1888 and 1928, who
established an institution primarily to provide medical care to
women and children. Both these pioneers were Missionaries from the
Church of Scotland. Over the years, the institution has grown under
the leadership of Overseas and Indian Doctors. The department of
psychiatry has been growing over the years.
On the first day of my first visit, outside this psychiatric
clinic, there stood a large crowd of patients and their relatives
waiting their turn to meet the psychiatric team. Among them was a
young girl restrained by three or four people. She suddenly
screamed and rolled on the floor and squirmed and shouted ‘It’s
coming’ (later, I came to know that she was referring to the demons
coming into her body). Her hair was untied and her sari tied up
shabbily; poor self care was apparent. She was surrounded by a
group of onlookers. At this point, the nurse came out of the clinic
and called that particular patient and her five (!) carers followed
her inside the clinic room.
This was my first day at the C.S.I. Rainy
Hospital. It was very interesting to see a range of mental
disorders in a very different cultural context. In India the
families are closely- knit as we can see from the above
description, a patient comes in with 4- 5 cares or relatives. They
take care of the patient round the clock.
Mental illness in India is gradually escaping
from the clutches of stigma, but still it seems miles away before
it is completely free. The family members of the patient feel
embarrassed to talk about the illness explicitly.
In fact, they try to cover up the facts about
the illness for months or even years until either they could no
longer contain the patient’s symptoms or they are burnt out.
They also try alternative medicines and keep
visiting the religious gurus. Finally, they arrive at the
out-patient clinic when all their alternate avenues have closed
In this scenario, this patient presented with dissociative
disorders (trance and possession disorder). She was brought in with
the help of five carers. When she was asked to sit down, she sat
down calmly. Her screaming had gone. She pulled away the hair from
her face. She was quiet for a moment or two. When I asked her what
had happened to her, she said the devil was torturing her. She said
‘It’ sometimes comes into her body and then she wouldn’t remember
what was happening. At this time, she screamed again saying ‘It’s
coming again’… she made a loud noise and tried to get up and run
but was restrained by her relatives. She then started to
behave as if she were ‘controlled by the demons’. Her relatives
reported the appearance of these symptoms immediately following the
death of her father. They said that these attacks lasted for a few
minutes only and she got several of such attacks in a day. Such
presentations are very common at this clinic.
I will update this blog with few more
interesting cases shortly.
To sum up, it was a fascinating experience to
see how the team operates successfully under pressure (when large
number of patients turn up to be seen). One of the reasons could be
that the team is not burdened by tiresome notes and record-
keeping. This may well be due to the use of the patients' paper
notes and lack of IT systems to record things. These notes are used
for patients' reviews only. The litigation by a patient or their
carers is virtually non existent!
Also the team has a very flexible approach and
is able to cater to the patients' needs for longer hours. There are
no waiting lists for new appointments and anyone can register and
see the team on the same day.
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Dr Jeshoor Jebadurai is an ST6 in general
adult psychiatry in South Wales Specialty Training Programme and
currently working with community mental health team in Swansea. He
is interested in International Psychiatry.
Prior to his move to the UK, he was trained at
the Institute of Mental Health, Chennai, India. He has been
travelling to India over the last few years conducting health
screening camps in rural parts of South India and raising the
awareness about mental health.
This personal blog reflects Dr Jebadurai's own
views and does not represent any organisation he is working
with. Dr Jebadurai is thankful to Dr Shanthi Davidar, Consultant
Psychiatrist for her clinical supervision and her team at the CSI
Rainy Hospital, India.