Humanisation of the Berbera Mental Hospital 1996
This place, shaped as a caravanserai, existed in Berbera since before World War I. At that time, Berbera was an expanding city, as its port was used to ship herd of sheep and camels to Saudi Arabia. The Mental Hospital has been through different phases but at that time, everything seemed to be moving very quickly and the willing for change was there and evident.
The Mental Hospital was a very old structure built at the times of the British occupation of Somaliland and used as a prison until the end of the civil war. After the independence, the building started to be used as a Mental Hospital with the aim to separate mentally ill people from criminals, but the conditions GRT found when it first got there in 1996 were inhumane and appalling.
All the cells faced a big garden and men inside were naked, chained and cover in their own faeces. One thing was particularly evident, all these men had an incredible strength in their eyes and their anger was strongest than the stone, gates and chains that surrounded them. Stories of murders, violence and escape were at the order of the day. In the first cell there was the “President of the whole Somalia” an ex-teacher that, after having blamed GRT’s staff to be white and disloyal, let them all through “his” place. In a different cell there was the “traveller” that was wondering with his mind about places such as Rome, Madrid, Stockholm, Istanbul and Moscow. Then there was the man who has been left alone by the wife, the one that has killed the wife and many others patients, especially young people whose minds were shocked by something that nobody could understand. Families and relatives sporadically visited them at the hospital, many times they kept the keys of their chains and decided when to unchain them, usually when the youth were needed for pastoralism purposes.
In the other garden there were women chained because they bare themselves in public, blaspheming the Islamic religion, women left behind by their husbands and children, old women loved by everyone, especially from the male patients.
There was not any doctor in the “mental hospital”, sometimes some doctors came from the general hospital across the road, when they were called. Medicines were generally not available, apart from some rare exceptions.
The only presence were a group of guardians, with a big bunch of keys for the locks, but when these keys were needed, nobody ever could find the right ones, so it was necessary to saw locks and chains. Nobody cleaned the place or did anything else, sometimes families brought some food to patients. An old male nurse came to greet GRT’s staff, telling us about the history of that place, the war and the resistance. He was extremely tired and weak, especially if compared to the strength of the patients and their yells.
The central garden looked like a market, with plenty of women, kids, relatives, Khat sellers, camels and goats. In between these people, there was this group of young volunteers that was trying to do something for the patients: washing them, cover them, bringing them some cigarettes and sometime even unchain some and take them to the market. These people were part of GAVO, a volunteer organisation that was growing at the time.
GRT identified GAVO’s volunteers as a precious resource. They were young, deeply rooted in the different clans of Berbera, profoundly committed to the Islamic religion and with an insatiable curiosity, full of hope and enthusiasm. These volunteers knew perfectly that place, its traditions and which kind of change proposals could have been accepted, they also knew how to persuade patients’ relatives to accept a change in the mental hospital.
Psychiatric intervention? Training of local staff? Humanisation of the hospital?
GRT’s work was initially based on three issues: the humanisation of the hospital, the reduction of chain containment and the construction of social places, where patients could interact and listen.
The hospital’s humanisation and the reduction of containment have been carried out through symbolic actions. In particular, when chains have been abolished, patients had the opportunity to throw them all in a big truck that would have carried them away and patients would have had their freedom back. As well as this, some ways of pharmacological containment have been introduced so that patients did not need to be chained in order to be moved from one place to another and some awareness raising activities have been done with the community in order to sensitize it to Mental Health issues.
Concerning the introduction of social and recreational places, GRT has worked on it through introducing computers, books and board games that allowed patients to spend more time together, interact and listen to each other. Some street children were involved in some activities with the patients too and the “Hard Rock Café’ Berbera”was built, an interaction place where normality and abnormality did not exist.
The methodology used by GRT during this mental health intervention mostly aimed at social rehabilitation and patients’ reintegration into the society and their families. Families have been particularly important in order to treat and support the patients, they have always been consulted and informed about the benefits of a hospital without chains and containment and the relationship between the patients and their families have always been encouraged.
Moreover, GRT promoted some socialisation and rehabilitation activities such as football, volleyball, photography and board games and, when possible, some day trips.
The Mental Hospital gave the chance to be treated also to outpatients, coming from different regions. In particular, outpatients were given the opportunity to spend some time in the hospital and talk to the staff, so then, together with their families, a therapeutic treatment could be identified.
GRT’s intervention in Somaliland was extremely successful: chains were abolished, GAVO organisation was promoted and the collaboration between the hospital and the other institutions was strengthened. As well as this, Mental Health treatment was combined with the traditional medicine in a way that was suitable for the Somali community.