In Defense of our Psychiatric Wards

Venezuela es un manicomio. But, as I found out doing my rotation at Merida’s mental hospital, some of the manicomios are almost ok.

Ambulatorio Venezuela is a small building built in 1950, initially to treat tuberculosis patients. In 1973, it was retooled to house Merida’s Acute Psychiatric Unit (UPA, after its Spanish acronym), a place to treat patients in need of long-term psychiatric care under 24-hour watch.

I was apprehensive when I was told the next stop in my medical school rotation would be at UPA. Around town, people see it as some sort of creepy madhouse. Considering our current health crisis, I was dreading a Nick Caseyesque nightmarescape, with forgotten patients on the edge of starvation tied to their beds, crying and screaming.

My first impression was not positive. Like so much else in Venezuela, UPA has definitely seen better days. The paint, layer after layer, is peeling and cracking off the walls. As I entered, a nurse guided me through a  long, dark hallway barely lit by the last working fluorescent lamp on the ceiling. It reminded me of a found-footage horror movie.

It’s as creepy as everyone says, I thought to myself as I entered the library where doctors were meeting, checking the limited stock of drugs they still had on hand. They welcomed me and assigned me a woman to examine.

“You’ll find your patient on the last room on the left,” one of them said, as I headed back to the creepy hallway.

A nurse guided me through a  long, dark hallway barely lit by the last working fluorescent lamp on the ceiling.

I found my patient in a surprisingly bright room, illuminated by a single large window facing the gardens. Not creepy at all, except maybe for the rusted tube coming out of the bathroom wall that served as a shower.

There were five clean beds, each one occupied by a woman. The women were very quiet and relaxed: one was combing her hair, two were reading religious books and the rest were simply sleeping; none seemed to be hostile or angry.

My patient was the one combing her hair. A lady in her 70’s, she was admitted after her niece told the doctors that she was turning increasingly violent at home. She apparently experienced hallucinations concerning the Virgin Mary and her memory was  faltering. The twenty minutes I talked to her passed very quickly. She was cooperative and answered my questions clearly, if a bit slowly. She couldn’t understand why she was there, but didn’t really seem to care either. I made a quick, initial diagnosis: it looked like some sort of dementia. We’d need more tests to figure out which kind.

She had a rough road ahead of her, but she was receiving adequate care. The young man who saw Chávez every afternoon is getting help, too, as is the woman who tried to hang herself using a hammock after having to go two weeks without treatment because her pills are nowhere to be found in local pharmacies.

Nobody would call this place luxurious. As current coordinator, Dr. Ignacio Sandia explained to me, the crisis has hit UPA as hard as any other health institution in the country: obsolete equipment for which replacements never arrive and, more recently, lack of medicines, are the harsh reality.

The young man who saw Chávez every afternoon is getting help, too.

A year ago we treated patients here with the same drugs used in NYU or any other first world center,” he says. But today we’re forced to use 20th century medicine. The Health Ministry sends medicine regularly, but it’s not enough. Patients’ families also give us a hand when needed. If they have to go to Cúcuta to find the prescriptions, they do it,he says.

The food isn’t  what it used to be, either. Today’s breakfast was a María cookie and a glass of juice,” he tells me. “It wasn’t like that before.

And yet, you couldn’t say UPA has “collapsed” either. In broad terms, it works. There’s no sense that the patients here have been abandoned, much less forgotten. UPA does what it’s supposed to do: it takes in patients in enormous distress and gives them a refuge, and reasonable, scientifically-grounded treatment, free of charge.

People are the key, Juan,Dr. Sandia tells me.

The people here feel this place is theirs. As an institution, there’s an amazing work spirit here. UPA has always been different, and it always will be. A lot of people have tried to destroy our work here, but we haven’t let them do it, and we never will,” he says.

There’s no sense that the patients here have been abandoned, much less forgotten.

It’s easy to see the pride he takes in the work, and the sense of standing alone: a refuge for the mentally ill in a country that’s gone collectively insane.

“I think the worst aspect of our current crisis is not the economic, but the moral dimension. Everyone seems to have given up. This place proves that if you want something, you can do it, no matter how hard it might look.

As I walk back to the library to get my notes together, I notice that the patients are being taken to the gardens to get a little sunbath, so I join them for a while.

There aren’t many of them, maybe fifteen in all. A clear contrast with the perpetually overcrowded University Hospital. It was a beautiful day, the deep blue sky set off against the green mountains of the Sierra Nevada, the sun shining high, and that nice recent chill in the air.

On my way out, I could just imagine how beautiful the building must have looked 40 years ago. Even after years of underinvestment, there was something captivating about the way the light hit the walls and windows of the Ambulatorio designed by Carlos Raúl Villanueva over 60 years ago.

UPA’s courtyard was also oddly cozy: a tall, 50’s-era post on which a once glamorous lamp stands, is planted in the middle of a tiny concrete platform, completely surrounded by gardens of perfectly mowed grass with roses, mandarine and orange trees as well as some crops, all planted and cared for by the patients as part of their therapy. Scattered around the gardens are several benches and the ruins of a basketball court. The place feels like a school more than a hospital.

Most of the patients are just sitting on the concrete benches, letting the sun shine on them for a while. Some of them are playing a game I can’t understand on the derelict court: they lay down on the floor, roll over for a few seconds and then jump up to their feet again, repeating the cycle for several minutes. They’re having fun, or at least it looks like it.

These patients don’t know anything about inflation, about out-of-control violence, about the recently resupplied stock of the government’s political prisoners.

A twenty year-old girl who had to give up art school to battle schizophrenia draws the mountains in her notebook. She slowly shows me the flowers and birds she’d drawn earlier that day. She stays silent the whole time, her eyes lost in the horizon, trapped in her own mind. After she finishes, one of the doctors gently asks her to give her pencil back: they’re not allowed to keep them when not supervised.

These patients seem to be doing as well as could be expected given their situation.  They aren’t what you’d call “happy,” but today at least they seem pleased and relaxed. They’re living in their own heads, unaware of the harsh reality the country is facing. They don’t know anything about inflation, about out-of-control violence, about the recently resupplied stock of the government’s political prisoners. Some of them don’t even know how hard it is for us or their families to find the prescriptions they depend on on a daily basis. Their world is this courtyard and the gardens around it.

And it’s a nice one.

And then it strikes me: those psychiatric patients had more peace of mind than me and most Venezuelans I know right now.

Just when you think you understand the Venezuelan crisis, it surprises you. You read horror stories like Casey’s from the mental hospital in Barquisimeto, and assume they stand for the whole.

They don’t. Not yet.

Juan Carlos Gabaldón

Medical doctor from Merida, currently studying Medical Parasitology at the London School of Hygiene and Tropical Medicine