A good friend of mine who is familiar with the structure of psychiatric care in Bangladesh has offered to take on the piece of collecting information on psychiatric referrals. Along with crisis management, at KPR we want to be able to provide people with referrals if we have to. This is a pretty big piece of our research – there’s mental health and psychiatric referrals, there’s substance abuse stuff, there’s legal advice. Lots of different pieces to be thinking about, but I’m happy to say there’s just as much help coming in.
Anyway, my friend suggested that I come with him to DMCH (Dhaka Medical College Hospital), and meet one of the psychiatrists there before he got started on the work of compiling information. Just so I could see a piece of public health care in Bangladesh, and get a feel for how psychiatry works here, at least in the public system, as well as officially touch base with the psychiatrists that my friend will be working with for KPR.
I have not been to DMCH as an adult. I wouldn’t say it surprised me, necessarily. Put simply, I think it’s safe to say, this is where everyone goes. My friend laughingly pointed out later, if you didn’t know anything at all and just got dropped in here, you might think some sort of massive, massive natural disaster had happened, or we had just been bombed, or something. I’ve talked about Dhaka crowds before so I’ll leave that bit to your imagination. The hallways are lined up and down with patients and people waiting with patients. There’s multiple individuals in each bed. Mothers are casually carrying newborns through these hallways, tiny bodies wrapped in the end of mom’s sari. I keep thinking back to one particular young man lying on the floor, his head in a young woman’s lap, her holding his hand with a drip attached, the drip bag hanging from a doorknob.
It just makes you take a deep, deep breath.
Psychiatry is funky, too. Not in a bad way. My friend had explained to me, before, that patient-doctor confidentiality and such isn’t the way it is in the west. There’s no closed doors, no little white-noise making machines so other people can’t hear what you’re saying. Literally, what this meant was we sat in the doctor’s office, and he spoke with us in between speaking to the patients who were coming and going. We sat there and listened while the patients and their family members described their symptoms and responses to medication. The doctor and my friend have had a relationship for some time, and the doctor would casually wave his hand towards my friend and say to the patients, “He has bipolar.” We’d all sort of nod. The token bipolar kid.
This might sound very odd. But I actually liked it very much. All of the psychiatrists have open doors, and everyone’s coming and going, and anyone can listen to anyone’s business. In a place where stigma is a ridiculously huge brick wall, the casualness and openness is actually a decent system for making people feel okay about their condition. The doctor’s support staff were cheerful and friendly seeming – they actually reminded me of nurse practitioners that I was very fond of in the U.S. The doctor himself had a remarkable no-nonsense but very gentle manner with his patients that I liked right away.
He gave us some information to get started on. He had a couple helpful tips. He also reminded me that most of the people in Bangladesh are not like me, referring to the extreme privilege that I come from. Which is something that I do actually know, and when people bring this up with me I nod my head and say I know and that we’ll do out best. And there is no doubt in my mind that we will do out best. But oh, so often do I think I have no idea what I’m doing! I hope I learn.