A Pakistani
patient’s brutal killing in Jaipur highlights the abysmal state
of mental healthcare
 |
Forgotten
and damned:
Patients in the Jaipur Psychiatric Centre
Photos Molina Khimani |
| |
‘Here we have
a bijliwala (electrician) pretending to be a therapist,’
says Dr Kumar |
On a quiet September
morning in the criminal ward of the Psychiatric Centre Jaipur, Ramesh
caught hold of 70-year-old Muhammad Janaad by his hair, yanked him out
of his bed and threw him on the floor. Then he dragged him under one
leg of the bed, climbed on to it and kept jumping till Janaad was killed.
Janaad’s screams
went unheard because the ward boy and police guard on duty were missing.
Ramesh, who suffers from epilepsy, committed the murder in a fit of
epileptic rage. The battered and bleeding naked body of the victim was
discovered with human excreta splattered all around him. The body was
later covered in hospital whites, “for media pictures”,
according to Dr Kumar (name changed on request), a senior doctor at
the Psychiatric Centre Jaipur, who spoke at length about the condition
of patients at the hospital.
Muhammad Janaad
was a Pakistani national. A resident of Moga village in Bhahbalpur district
of Pakistan, he had wandered into India across the border near Ganganagar.
Janaad was diagnosed as a schizophrenic and shifted from the Ganganagar
Jail to Jaipur for treatment just a week before he was killed. His body
is still in the mortuary. The Pakistani embassy was informed about his
death but there has been no response from it as yet.
The post mortem
report says that Janaad “died from a fall and brain haemorrhage”.
It describes the circular injuries on his chest but does not say what
caused them and states that the body is “being investigated for
electrocution”. According to the report, Janaad died at 6.00 am.
The ward is supposed to be manned round the clock but the body was discovered
only at 7.30 am.
Dipti Kachawa, the
Sub Divisional Magistrate in-charge of the case, refused to speak on
Janaad’s death. “There is the Pakistani angle to it and
for the sake of international relations, we cannot comment,” she
said.
According to Dr
Kumar, the first remark by the hospital forensic expert, Dr Punia, on
seeing the dead body was, “This is not a natural death”,
but there is no indication in the post mortem report that Janaad died
because of a violent attack. Dr Kumar says that Janaad was reduced to
a “clinical piece of medical examination,” with little concern
for his right to live with dignity.
Ramesh has epilepsy
but he is being administered medication meant for those who suffer
from psychotic illnesses |
No patient is supposed
to be treated like a prisoner at the Psychiatric Centre Jaipur but those
housed in the criminal ward might as well be in jail. Dr Kumar paints
a grim picture of the way they are treated. “They keep crying
out for water. Cleanliness and hygiene are non-existent in comparison
to the other wards in the hospital. There is no entertainment available
for them; they aren’t even let out for a stroll in the open. We
don’t have good paramedic support, no psychiatric social workers
visiting the inmates, no clinical psychologists or occupational therapists
on board to fulfil the requisite angles of the treatment being meted
out.”
Such is the state
of affairs that, according to Dr Kumar, electricians often double up
as therapists in the hospital. “We have a bijliwala masquerading
as a therapist,” he says. He points out that there is no lack
of funds. Hospital employees and doctors are too afraid to speak out.
“Custodial care is not understood in India. I don’t have
evidence or witnesses because everyone is scared of speaking up and
losing their jobs. The fear of the system saddens me.”
The rules specify
that there should be one guard for every two patients, but only two
guards are posted outside the criminal ward. The fact that Ramesh is
still housed in the same ward along with other patients is a stark example
of the criminally lackadaisical attitude of the hospital authorities.
According to Dr Kumar, Ramesh’s records had not been updated in
the last three months. “Now suddenly, all records have been updated.
These records, ideally speaking, should have been immediately impounded
before the management was given a chance to fill them up. Pages are
torn, making an accurate revision of medical treatment quite impossible.”
The resident doctor,
Dr Gupta, (name changed), sees patients thrice a week. “They do
respond to kindness, talk about their families but are in a constant
state of denial of the crime committed by them once they are clinically
treated. It’s a rather ambivalent situation since somewhere in
their subconscious, the guilt still gnaws at them. By the time they
leave the hospital, most of them are cases of anti-social personality
disorders,” says Dr Gupta.
Janaad’s death
is obviously not an isolated incident. In July 2003, Baba Khan, a paranoid
schizophrenic wrapped two other inmates, Kalu and Sovik, in cotton mattresses
and set them on fire, killing them. Neither the ward boys on duty were
present, nor the security guards supposed to be at the ward entrance.
When the guards at the hospital gate saw smoke coming out of the window,
they informed the hospital staff. It was too late by then.
There were seven
patients in Janaad’s ward when he was attacked — patients
with different types of mental illnesses bundled together till they
are certified as “treated” and sent back to prison to complete
their terms. Dr Kumar points out that schizophrenics, violent bi-polar
disorder patients, psychopathic disordered patients, epileptics should
not be kept in the same ward.
“There is
no drill of a thorough tabulated risk assessment of each patient in
terms of suicidal or homicidal risks, only general statements are made
in the records. Like Baba Khan, a paranoid schizophrenic lived with
delusion that people were out to kill him, while Kalu and Sovik were
mentally retarded — weak, aloof and withdrawn. The highly silent,
like Janaad, can’t live in the same ward as the highly violent
cases. His killer was an epileptic who had no business being in the
ward for the mentally ill,” Kumar says.
Dr Kumar points
out that the general state of confusion that prevails is clear from
the fact that after he killed Janaad, Ramesh is being administered medication
meant for those who suffer from psychotic illness like schizophrenia
or psychotic depression. This means that either the original diagnosis
in his case has been forgotten or the second diagnosis is wrong.
In a report submitted
in 2003, the Special Secretary, Medical and Health Department, Government
of Rajasthan, had pointed out many lacunae in the functioning of the
Psychiatric Centre Jaipur. These included, “Lack of regular watch
of inmates by the ward boy, failure of ensuring proper handing and taking
over at the end and start of a shift, failure to stay on duty till designated
time or reporting to duty at designated time, delay in reporting the
incident to senior officers, failure to assess and clinically evaluate
the aggressive and homicidal tendencies and meagre clinical reports
and ineffective dose scheduling.”
The report said
that such incidents can be prevented by “timely interventions,
i.e. — proper medications, isolation, ect use, counselling and
other psychological therapies.” Had these points been addressed
Janaad would have escaped his horrify end.
There are 36 state-run
mental hospitals in India and only 500 qualified psychiatrists manning
them. The judiciary can order hospitalisation of prisoners when it might
not be required and in these cases professional psychiatrist expertise
is essential. There is little hope for patients in a custodial environment
which breeds isolation and exclusion. They are deprived of any skills
for daily living and social interaction. There is no counselling to
prepare patients for adjustment problems, relapses, re-admission or
abandonment. Dr Kumar laments that the fear of social stigma has rendered
mental hospitals “waste baskets of the society for burnt out cases”.
