A journey towards mental health…

It was a Tuesday clinic at Kuniya in the month of July and the patients were pouring. The village, Kuniya is situated near Narmadapur, which is a headquarter on the plateau of Mainpat block in Surguja. Sangwari has been running a clinic here since last 1 year.  The patients attending the clinic are usually tribals from neighboring villages and hamlets. 

Rutu, our taskmaster-all-in-one lab assistant came to me to inform me about a man, around 30 years old, being tied up and kept aloof, away in the jungle for the last 4 to 5 years and asked if we could help him at all. We decided to visit this man after the clinic, with one of his family members to guide us along the path. This man stayed in Laleya village which is also in the  Mainpat block, approx 20 km away from Kuniya, our clinic, situated at the other end of the plateau, with the thicket of Saalai and Mahua trees. This village was well known in newspapers for the frequent attacks of wild elephants, bears and boars. As we were traveling to Laleya, our patient’s father Mr Jagan Kumar (name changed)boarded in a vehicle to accompany us to the place where our patient – Laxman (name Changed) was tied up. Jagan baba looked like a worn out old man even though his actual age was around early 60’s, bald and averagely built man, suffering from osteoarthritis walking with limp, needed support of the stick to walk.  He took us to the closest possible motorable place where vehicles could reach, following which we were supposed to walk till the patient’s place. 

As we started following Jagan baba on the narrow jungle walkways, he started sharing Laxman’s story.   He said “my boy Laxman was a very hard working boy till 5 years back, he looked after our farm, our cows, and cowshed very well. He started helping me out from a very young age and had always been my huge support for work. Our villagers used to envy my family as my boy would handle every family business, he had no tolerance to any addictive substance”.  As Jagan baba thought his son had come of age to get married off, his marriage ensued in the most fancy manner in the village itself. Around 6 months after Laxman’s  marriage,  his mother observed him muttering  to himself, when she asked what he was talking about, he got angry and pelted a stone at  her, which hit her head.  He ran away, people around chased him to stop but he ran into the jungle. He returned home on his own sometime later and talked very casually as if nothing had happened sometime back, even enquired about his mother on seeing the wound on her head. Similar incidents started  happening  again and again,  with one or other persons from the family or village. People started complaining about him but Jagan baba used to defend him with all his powers. 

Jagan baba took Laxman to consult many Baigas, Guniyas  and Maharaj, they suggested various  solutions but all  in vain. Someone from the village pointed out that this is all that  girl’s fault whom  he got married to recently;, She must  have done some ‘Tohny’, black magic kind thing (similar to Jadoo-Tona). This made Jagan baba take this new bride back to her maiden home.. 

One day, suddenly Laxman  started beating his mother, she was alone and could not defend herself. Till someone from around could reach her, she fell unconscious. Jagan baba  ran to the nearest hospital where she was admitted for almost a week, recuperating from this unexpected incident.  This particular incident shook Jagan baba  from deep inside. This time he didn’t have any courage to defend Laxman. So Jagan baba identified a lonely deep not-easily-accessible place near the edge jungle and built a small hut for him. He  somehow took Laxman to that place and tied him with metal chains inside the hut, free enough for him to move around for some distance  to get his food and do his daily needs. For the last 4 years his father or someone from the family, would visit the place  early in the morning with some  food for him to last for a day or two  then would leave for their daily chores. 

While we  listened  to  Jagan Baba’s story, I was  already  imagining how the place would be, how Laxman would be. We had almost walked 1.5-2 km for half an hour, had crossed a water stream mid way, climbed a small hill to reach a plateau just at the edge of the Jungle where we could see a small hut. The hut was open from all the sides but one, a central wooden pillar and 4 corner pillars along with the roof made up of plastic tarpaulin and  big Saal and Sagwaan leaves to cover it. Laxman was seated on the ground restrained with metal handcuffs and chains. He was indulged deep within himself. He  noticed us when we came and sat around him, but he didn’t heed. I tried to talk to him but he  would either ignore my questions or just keep smiling looking at me.. His mother had also joined us midway  to deliver food for  him. Jagan Baba & His mother tried to get him to talk, but Laxman’s reply did not change. We had to start our return as it was already dark and we were in the middle of the jungle. On our way back, I was thinking about our Laxman, this man was suffering from chronic psychosis, a severe mental illness.  I tried to  explain the nature of illnesses to his parents, offered admission in the hospital for him, But his parents denied, they said he is anyways very much isolated from all. Their only question was would our son Laxman be well enough to be back at home. I could not guarantee that but assured them he will improve with medication but slowly and will be in better condition than the  present. The jungle walkways got me thinking Why could Laxman not receive fair medical attention? Who is really responsible for his present condition- system, his parents or us? Why did anyone not inform us about him last year when we were in Kuniya? What must be the condition of all such patients suffering from severe mental illnesses living in rural tribal regions? The answers to these questions were as eerie as the silence of the jungle.

We  started him on antipsychotic medicines, with consultation from a psychiatrist as well. We had to ensure the medication compliance for him, his parents decided to show some faith in us as a last resort towards getting Laxman home. They would mix the medicine in his food and make Laxman have it. This particular  medicine was like any other tablet but was very effective in most of our  patients with severe mental illnesses like Chronic Psychosis. . We had planned to review Laxman next month as  he would probably regain his insight and awareness in a period of 1 month with regular compliance. 

Laxman did  not come to the clinic next month. Rutu and Barkha tried to call Jagan baba  but could not reach. So they decided to deliver the medicines to his relatives  for the next  2 to 3 months. 

After almost 3 months on one of the usual busy Tuesday Kuniya clinics, I saw Laxman sitting in the porch area of the clinic with Jagan baba, waiting for his turn in the clinic room. He was smiling happily with awareness, he had recognised me!! I asked Laxman if I could have his photograph, he smiled again, blushed and tidied his shirt to look at the camera. I got a beautiful photo of Laxman and Jagan baba standing straight, without his stick, both looking young and happy. 

In India the prevalence rate for Chronic psychosis, also called Schizophrenia, according to one of the articles published in 2010 was around 1%. This figure translates to  approximately 10 crore youths of India suffering from chronic psychosis. Like Laxman, there may be  lacs patients in rural, tribal villages of India suffering from  severe mental illnesses, well known in villages to be half-mind. Are we, our system, really reaching to them?  .

Laxman  has complied with his  treatment well and has shown a huge improvement.  He also has suffered from side effects of the medicines like weight gain but he  is complying. He and all of us have  a long way to go, to keep him and others away from the social and health wise sufferings of severe mental illness.

–Dr Dhiraj Deshmukh, Family Physician , Sangwari