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Defaulting in taking drugs for any illness or health condition is risky at many levels. It can worsen the condition of the patient; it can cause resistance to the drugs even if the patient resumes taking them later and sometimes ends in loss of life of the patient.When it comes to psychiatric patients, the effect can be a dangerous combination of the above, and much more. Defaulting patients can be a danger to themselves, which is bad enough as there is a risk of a relapse or drug resistance.
Furthermore, psychotic patients who skip taking their drugs pose genuine danger to those around them. Many of them tend to be violent as a result, as the medication is meant to suppress certain undesirable behaviours.
We have a big, sobering challenge at Ingutsheni Central Hospital, one of the country’s largest health facilities for psychotic patients.
The Bulawayo infirmary is running short of anti-psychotic drugs for its inmates. As pointed out earlier, the primary problem in the most unfortunate situation at Ingutsheni is on the patients themselves since they suffer physically and emotionally.
In some cases however, given their conditions, many of them might, regrettably, lack the mental capacity to personally grasp their problem. Apart from the inmates themselves, nurses, doctors and other staff at the hospital must be concerned about the poor service that circumstances are forcing them to render.
It must be a natural concern for those who take the Hippocratic Oath, pledging to do their best for their patients. But at a more personal level for health workers at Ingutsheni, the concern deteriorates into fear. Many are unsettled attending to patients who have become more unpredictable due to lack of drugs.
The institution requires a constant supply of Fluphenazine Deconate (FD) injection, Benzhexol tablets and Chrorpromazine (CPZ) drugs, but they are reportedly in short supply.
“This problem has been there for sometime and it seems things are getting worse. The drugs are in short supply and as a result some patients are now hostile to staff members because of their condition. The problem is that the patients we deal with can be dangerous and can do anything if they are not treated.
They can even kill each other or attack staff members,” a staff member told Chronicle on Thursday. Recently there was report of an incident in which a mentally ill man admitted to the hospital was allegedly assaulted by staff members and lost two teeth in a brawl over food. The matter is in the courts.
Instead of giving medication to patients free of charge, the hospital is issuing prescriptions for patients to buy the critical drugs in pharmacies. But the pharmacies don’t seem to have them too. Making patients buy drugs on the open market is in itself, a problem because we know that many inmates at the hospital were dumped there by their relatives, some having been there since the 1980s. These do not have anyone to ask for money to buy them the drugs.
So they go without the much-needed medication. In the end they face the prospect of relapsing or turning violent. The situation we have could trigger a more complex problem with long-term ramifications.
Psychiatric patients, like those living with tuberculosis, or HIV and Aids must take their drugs for life and consistently. Defaulting medication for critical diseases or conditions is such a big issue in many countries that in Kenya for example, it invites arrest, an appearance in a court of law and a custodial sentence.
In May 2011, a court in Kirinyaga County, in Kenya sentenced a man to prison for defaulting his TB treatment. The man was also HIV positive.
HIV is different from psychotic conditions and Kenya is not Zimbabwe, but the moral is that erratic intake of drugs must not be allowed.
Whereas the Kenyan was jailed because of his own dereliction, here people at Ingutsheni are going without drugs because of factors beyond their control.
This tells us that the challenge at the hospital requires the most urgent attention, but we realise that Ingutsheni is not the only emergency we have. There might be a similar problem at Ngomahuru in Masvingo, for example a facility for psychiatric patients.
In fact, Ingutsheni is a microcosm of a wider challenge facing the health delivery system, the social services sub-sector and the country at large.
Our public health delivery system is, with respect, on its knees, a level that Zimbabwe does not want. Drugs are in short supply; equipment at many public hospitals and clinics needs replacement as it obsolete. Infrastructure is generally crumbling. The reason why this is so is that the sanctions-hit economy does not have the capacity to get its limited resources around.
Health and social services is an area that the Government has singled out for particular focus in the next five years under Zim Asset. We should see an improvement on that front so that Ingutsheni and the health services sector delivers the services it is meant to deliver.
Online Reporter