Feb 11, 2007
Provided by: Canadian Press
Written by: ROBIN MCDOWELL
BANDA ACEH, Indonesia (AP) - Auzain, a 38-year-old who has suffered from schizophrenia for his entire adult life, was found locked in a cage in his mother's kitchen. Desperately poor and isolated by a brutal civil war in Aceh province, she saw it as the only way to protect her son.
A peace accord 18 months ago finally ended the decades-long conflict, bringing calm and the beginnings of normality to the region - but also the discovery of some 150 mentally ill people who were chained, shackled or locked up to keep them from hurting themselves or others.
More such people are expected to turn up as nurses fan out across Aceh to visit areas long isolated by war.
Medicine and counselling already have made a tremendous difference for some of the patients. But others, like Auzain, who has been ill for more than 15 years, are harder to help.
Glaring through the wooden bars of the kitchen cell, Auzain speaks bitterly about a man he accuses of wanting to kill his father. He jabs his finger in the air and bursts into laughter before launching into a new tirade.
"He's hallucinating," says Roslaini, a nurse who like many Indonesians has a single name.
She is one of more than 400 nurses in a mental health outreach program that became possible only after the tsunami crashed into the province two years ago, killing at least 131,000 people in devastation that stunned separatist rebels and the government into making peace.
Roslaini tries gently to coax Auzain into conversation, but his darting eyes look past her. "He barely knows I'm here," she says, promising to come back in a few days.
Indonesia estimates 400,000 of its 220 million people suffer from severe mental disorders, a figure the World Health Organization says is roughly in line with other developing countries.
The tsunami intensified high levels of depression and trauma in Aceh, a region already wracked by a 29-year war that killed 15,000 people, many of them civilians slain during army sweeps of remote villages.
While international aid poured in after the killer waves, the long-neglected health system remains underfunded. Aceh's only mental hospital does electric shock therapy without anesthesia, illegal in much of the West, and there is just one full-time psychiatrist for 300 patients.
So physicians are excited about the community outreach program, which initially was funded by WHO and later the Asian Development Bank. It's the first ever for Indonesia and is seen as a potential model for other parts of the sprawling archipelago.
By the end of December, nurses had reached half of Aceh's 21 districts since rebels signed a peace deal with the government Aug. 15, 2005.
Relying on word of mouth, they identified 4,000 people with severe mental disorders and more than 150 living in chains or cages, said Budi Ana Keliat of the University of Indonesia's nursing faculty, who heads the project.
She said once a sufferer is identified, nurses follow up with weekly visits to provide medicine and counselling to patients and their families.
Doctors say Aceh's prolonged conflict increased the prevalence of depression, anxiety disorders, brain injuries and acute psychoses in the worst-affected villages.
In three districts studied from December 2005 to February 2006, the population was found suffering from levels of trauma that rival Bosnia and Afghanistan, according to researchers from Harvard Medical School, the International Organization for Migration, and Indonesia's Syiah Kuala University
For example, among men aged 17 to 29 in Bireuen and Aceh Utara, 67 per cent reported having faced strangulation, suffocation, near drowning or severe head injuries from beatings. Forty-one per cent had a family member or friend killed and 38 per cent reported having to flee burning buildings.
"Simply hearing the history of what the villages went through is disturbing and shocking and providing numbers to this makes even the most seasoned Aceh-watchers grow quiet," said Dr. Byron Good, a Harvard professor of social medicine who wrote the report with his wife, professor Mary-Jo Good.
Mansur, 36, who lives in the former rebel stronghold of Pidie, said he had heard voices in his head for years, but after losing his wife and eight-year-old son to the waves the voices grew louder and angrier.
He started throwing rocks at strangers and threatening to burn down houses, so his family kept him chained to a tree, covering him with a plastic tarp when it rained.
"I felt myself go completely crazy," said Mansur, who managed to free himself one day, poured gasoline on his feet in a village market and set himself on fire. Vendors extinguished the flames, but he suffered severe burns to his feet.
"I have medication now and no longer hear the voices," he said. "I feel much better."
Nurses said that when they first started going to villages, people were too ashamed to identify themselves or others as mentally ill, but have since started opening up.
"I have no reason to feel ashamed. It's normal that I'm tied up because I'm sick," said Amiruddin, 26, who has been chained to the floor of his tiny room since he went on a rampage last June and almost broke his mother's leg.
Now getting medication, he no longer hears voices and talks quietly to visitors, but his family is not ready to release him.
Asked if he thinks he will get better, Amiruddin shakes his head "no." But he smiles when his nurse interrupts, telling him: "You will get better. You are better."
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