visiting Lentegeur psychiatric hospital

Don’t worry, they didn’t keep me in the psychiatric hospital, I just fell asleep last night during the movie, so I didn’t write anything.

Yesterday in the morning I finished the report of Day 2 of the PANUSP conference. I am very happy about that. The main part of my job here is finished now. I will just need to summarize Day 3 and 4, which is about drafting the PANUSP-constitution, the election of the new PANUSP-Board and making the Cape Town Declaration. Describing the processes and adding the finalized documents of our Constitution and so on is much easier than writing the presentations of all the speakers, and I will do that when I’m in the airplane, or at home. I will also summarize the PANUSP participation at the Global Summit as Day 5, and I already wrote about the Global Summit as well, so that won’t be hard either. These reports will have to wait when I get back in NL, because I don’t want to waste all my time here on writing reports.
Annie and I had a nice brunch at the Red Hawk again, a Spur burger. That is something I had to taste in South Africa, and it laid a good bottom for the day.

I had an appointment with Dr. Parker at 14.15 at Lentegeur psychiatric hospital. Lentegeur means The Perfume of Spring, and the concept of the psychiatric care at Lentegeur is explained in terms of the Essence of Spring, as a new beginning, growth and a source of life. They actively promote this view to reduce stigma.
Lentegeur is located in the Mitchells Plain, which is one of the biggest townships in South Africa, with an estimated 4 million people living there. Due to the forced removals the most of the population is coloured. Being coloured is still hard here, because they aren’t either black or white, and that makes them a bit lost in between. And poverty is also a big issue in the Mitchells Plain district.
At 14.15 Annie dropped me off at the Outpatient ward. I walked in, and I saw dr. Parker behind the glass of the reception desk. He said: I will be right with you, exactly in the way a doctor says that, and I sat down on the first row of the banks in the waiting room, in between some patients. The clock stood still, but there was another clock giving the actual time. I really felt like I had a doctor’s appointment when I was waiting there. Like I was a patient. I found that interesting.
Then dr. John Parker came to fetch me. He took me around in the hospital. First we saw the speaking rooms at the outpatient ward, where patients have a talk with the nurse or psychiatrist. It was a room with empty walls, and a table and 2 chairs, nothing special, except for the panic button that had just been installed. Dr. Parker hadn’t seen the buttons before, and he was happy that these were finally installed, because there had been some incidents with aggressive patients. The doors of the speaking rooms had no glass, there were only windows to the outside, so the room was quite isolated. I can imagine that when something happens, nobody notices that. I didn’t ask how many times it was used.
Then we got in dr. Parkers car, and drove to the Female Admission ward, which had 2 units: 16A and 16B. Unit 16A was the seclusion ward, but the ward was called High Care Ward. Dr. Parker told me he had put up that new name to raise awareness within the hospital, and change the views of the carers. But he also admitted that they still had a long way to go. Changing the name of the ward from Seclusion ward into High Care ward was a first step.
By the time we were there at 16A (Seclusion/High Care) everyone was locked in for the daily rest hours from 12 to 3 PM, this was an obliged rest that goes for all of the patients in the institution. Therefore we couldn’t look in the rooms/cells, but we would come back later, when the patients were out. There were about 12 patients or so, and 4 staff (2 nurses, 1 staff and 1 security). At nights there is only one nurse, which is leading to unsafe feelings, so basically the doors are locked at nights too, although they had the intention to leave the doors open at nights. This ward was the only ward with seclusion. We had a look at the camera screens, and the view switched from cell to cell. They looked like any other cell I had seen: quite small (maybe 2,5 or 3 metres, square), with a plasticized mattress on the floor, institutional blankets, and window to look outside.
We walked on to ward 16B, where 30 patients were, and again about 4 carers. The patients were obviously happy to see dr. Parker, and greeted him enthusiastic, telling him how they were now. The vibe was relaxed. The “living room” was basically a part of the ward, where plastic chairs were standing in a square. All patients were dressed in nightdresses, jerseys and gowns from the institution. They all went into the dining room, with plastic chairs and tables for four, and they all got a drink. That took them about 5 minutes, and then everyone was walking around again. I was allowed to talk with the service users. One lady showed us her sleeping room, and she actually appeared a naturally talented tour-guide. There were 2 wings on the ward. We went to one of these. There were 3 single rooms, and the rest was rooms for 4. They all had a closet and a pedestal, and a bed with 2 sheets, 2 blankets, a spree, a pillow, a towel, and an extra blanket for the afternoon’s sleep time. They had hardly any personal belongings, except for underwear and socks. Furthermore, there weren’t enough jerseys, they had a summer- nightdress and a winter-nightdress, and a gown. They also were allowed to keep a block of soap, and a toothbrush with toothpaste. Their own shower bag had to be returned to the staff after showering. In the sleeping rooms there was a heater, which was new, and the lady was very happy about it, because her underwear and socks now got dry in 15 minutes during wintertime. They all had a board above their bed, which was meant to pin pictures or whatever, but there were no pins available, because the women used to use them as ear pins, leading to arguments, so they had been taken away. Staples were no option, because some persons would carve themselves with it. But they had made some art using pritt and Velcro. Nobody had anything personal hanging in their room, and the lady said “someone should arrange that we can stick things on it”. She used to have a picture of her dog there. I’m sure dr. Parker caught this message.
The lady also explained the daily programme, starting with night checks from security, lock-out and showering from about 6, then some group exercises with the security in the yard. Then breakfast at around 8, and at 9 they were allowed to smoke a cigarette. 2 times in the week they had a climate-meeting, which was a group meeting at the ward where they are asked to tell how things are going and they can express any complaints or suggestions. One of the main complaints is the lock-in in the afternoons, but there is said to be not enough staff to change this.. (my suggestion would be to extend the visiting hours, which are daily from 3 to 4, family can be very supportive).

Basically, the patients say they just live from eating to sleeping, and there is nothing else, except for the smoking breaks. After lunch, in the afternoon they are supposed to sleep from 12 to 3, or do something else on your bed, like reading. There had been a new admission, and this lady had been screaming all afternoon, keeping everyone awake.. She is likely to be put in the seclusion/high care ward 16A, because of this screaming.
By the time we were at the female admission ward 16B, after the drinks, the TV was turned on, and most of the users were watching TV, some were reading or talking. Also many came to greet me and talk to me, asking where I came from and so on. The vibe wasn’t bad. There was also a door to go outside, leading to a small yard which had a fence around it. The users could choose to sit inside our outside on the grass. There wasn’t much to do.
We returned to the seclusion/high care ward, where they people just had been locked out. One lady was screaming and banging the door, she was still locked up. The rest was quite silent, just walking around or sitting in one of the plastic chairs. Most of them were wearing the same type of green jerseys with a sign from the institution on it.

At both wards you could see a bit of the medication in their eyes, but not really excessively (drugs are expensive). From the patients I have seen, most of them were walking around and talking to each other. And I was happy to see that it wasn’t like Tanzania, where users were scared and silent, and where violence was used against confused people who were just walking around.. But it was very poor to see that the ladies had absolutely nothing to be occupied with. Last week at the LSEN school I had seen that the children with disabilities were doing pottery, drawing, sewing. Why weren’t there any resources for the psychiatric wards???

I talked to John Parker about this, and he admitted that funding was a problem. They can’t ask for funding. It HAS to come from the government, and if they would ask for it, that would be implying that their needs aren’t met by the government. But the government doesn’t prioritize psychiatric hospitals, so they are lacking those things. It opened my eyes to hear that. (I never understood why hospitals could be so poor, while there are so many NGO’s spending money on care). Now I understand why..

One of the first things I mentioned to Dr Parker when I was inside, was to get rid of the enormous, hostile and visible, double fence that surrounded the institution, or to plant trees to make it more friendly and less stigmatizing, because that really looked like a prison and how will people understand that patients are not dangerous with such a fence. But trees planted on the outside will disappear, due to poverty and a lack of green all throughout the Mitchells Plain. One day they will plant trees in between the fences, but right now they can’t afford that.

Dr. Parker showed me the flowers at the entrance of the female ward, which he had planted there himself. It was his project to make the institution become “green”, stimulating a positive rehabilitation environment and minimized carbon footprint, because “if you live in a shithole, you will also feel like shit”, he said. He was building on his own concept of “environ-mental”. I liked that way of thinking. I am a Sustainability Engineer myself, so I could catch this drift. I suggested that they should arrange to keep some animals as well, because living nature is really healing. That was his dream too, but there was no money for doing that, and the risk of things being stolen is evident, in a poor neighbourhood as the Mitchells Plain.
Also there is a big piece of land (3 or 4 hectare) that will be used to grow crops. The ministry of Agriculture just agreed with a grant to develop this, which is great news.

Dr. Parker told me that one of the goals of the institution was to establish better relations with the neighbourhood, and spread smart, green knowledge, also to reduce stigma. One of the things they do is build wind-driven energy-suppliers from old plastic barrels, by cutting the barrels in two, and place them on a stick so that it turns in the wind, and with some old car parts they now produce electricity, which is used to drive the golf carts on the compounds. This is a smart solution, that can be used all over the Mitchells Plain. They want to show that “the insane” aren’t dumb, but that the hospital actually contributes to a better living. I liked that idea.

I also asked why there were plastic chairs all over, and that was mainly because they are cheap. John Parker was happy that I mentioned that those aren’t safe, because they are really sharp when you break them. He hadn’t thought of that yet, but he had been advocating for real chairs, so he liked this argument. It might help to bring change.

It is still a lot of information to digest, and my view on this hospital is a bit double. They have very good initiatives going on, but still a long way to go. The users of the admission ward are basically waiting till recovery happens, as if time is their healer.. But they weren’t massively unhappy, and looked quite at ease to me. But they seriously lacked freedom of movement (only movement within the ward), and lacked any occupational thing to do something. I saw nobody sewing or drawing or whatever active thing you could think of.. just reading, talking, sleeping.. They were just waiting for recovery to happen. The good thing is that users weren’t really dominated by fear.
I explained to John Parker that humane care is very important, and that I was happy to see the relatively “peaceful” wards. I have seen way worse. But also here the amount of peace depends on which nurse is on duty and so on..

John Parker used to be an activist during Apartheid, and he told me how he was once moved by seeing a poster about “freedom for all” or something. I told him how I also started my initiative by hanging posters, which is a great way to reach the public, and stigma might be reduced by just hanging the right posters. I think this can be a strong tool to fight stigma. We really had a nice talk. I liked John Parker. His office was a mess, very funny, he is a real human.

In my opinion Lentegeur hospital is really moving in the right direction, and they are lucky to have someone like John Parker in charge of the adult wards. But still there is a long way to go.

It was a very long, but very interesting day. I learned a lot again.
After visiting Lentegeur, John Parker drove me home to Annie’s place, and we stopped on the way to make a picture for his visa for the US. But we couldn’t find a photographer, so I took the picture, and we printed it at a printing service. And then I was brought home.
After a cup of coffee, Annie and I quickly drove to Hout Bay, to watch the sunset, but we were a little bit late, so we just saw the night falling. We still had a nice view, but the wind was firm and cold. Then we grabbed dinner in a restaurant, and fetched another DVD, and got one for free as well. I feel asleep during the movies, and just woke up.

Today at 12.00 I will visit Valkenberg psychiatric hospital. It is said to be worse than Lentegeur. I’m curious what it will be like. It is the last thing I will do for my work here in South Africa. After this visit I will be a full time tourist, and I’m really looking forward to that. After today, I will have 4 days to relax and see the nice sights of Cape Town and surroundings.