Patients in psychiatric hospitals throughout Kyrgyzstan are poorly fed, live in dreadful conditions and are often forced to work either for hospital staff or the local community, IWPR revealed.
IWPR contributors visited three different psychiatric establishments. One lies in the northern Chuy region, in the village of Chymkorgon, while the second is in the village of Kyzyljar in the southern Jalal-Abad region. The third is the Osh Regional Psychiatric Hospital, also located in the south of the country. All told, they hold about 1,400 patients.
Hospital managers were reluctant to divulge information about their patients, especially to a media organization. But staff and patients related their experiences, often with indignation.
The Chymkorgon lies 85 kilometres from the capital, and the hospital serves all of Kyrgyzstan and the southern regions of Kazakstan as well. It currently has 500 patients, well below its capacity. It is something of a showcase because it is often visited by non-government organizations and journalists.
But it still has a pervasive atmosphere of poverty and deprivation, and is badly in need of complete renovation.
Patients at Chymkorgon are usually locked up in squalid rooms with barred windows and stone floors. The rooms are overcrowded, holding up to 15 in one room. A single nurse is routinely left to supervise 10 to 15 people. Staffing shortages mean that patients are deprived of the right to a daily walk and physical exercise.
Outside, the destroyed fences and open gates contribute to the air of neglect…
Kyzyljar, which houses 750 patients, is fairly remote and has poor connections to the outside world. That has clearly had an effect on conditions there. One woman, Jarkyn, recalled the 18 days she spent there in April 2002.
"Patients who did not obey attendants were tied to beds," she told IWPR. "They might lie there tied up for days on end. They could also be left without food and not allowed to go to the toilet during that time. The attendants don't care.
The hospital in the center of Osh is relatively well off, as it houses only 150 patients. However, lack of space still means that it resembles a jail. The effect is heightened by the bars placed on the windows. Patients are not allowed to walk around freely, and children and adults are placed in the same rooms.
Overall, though, patient conditions in Osh seemed better than at the two larger hospitals that the team visited…
Mental hospitals in Kyrgyzstan are officially termed "centers of psychiatric health". The unofficial names "durdom" (nut house) and "psikhushka" (loony bin) are sadly more reflective of public attitudes. According to Azimjan Askarov, a human rights activist from the Bazarkurgan district of Jalal-Abad region, popular stereotypes remain unchanged, "The average person has inherited the Soviet-era stereotypical idea that psychiatric illnesses are incurable and mental patients are hopelessly ill."
Such prejudices mean that patients are seen as outcasts and there is little public interest in how they are treated. Mental health is already low on the list of priorities for a government that is hard pushed to fund basic social and healthcare services.
"The state would love to increase the funding for psychiatric hospital - but it can't," said Bubusara Ryskulova, who runs the Sezim women's crisis center. "It's no secret that the country is going through an economic crisis. Of course the government selects the top-priority areas of social sector funding. Mental patients have never been a priority." Lack of funding also affects the quality of staff that the hospitals can recruit. Doctors, nurses and auxiliaries receive pitifully low wages - and these are often paid two or three months late…
The result is gross abuses of patients' rights. "The rights to adequate living standards, appropriate treatment and environment, and to obtain information are all violated in mental hospitals," said Nazgul Turdubekova of the Youth Human Rights Group, which has surveyed the state of mental healthcare in Kyrgyzstan.
Patients in mental hospitals are made to perform hard, manual labor on the private farms of hospital staff members. Staff even lend their patients out to local farmers.
Bakirjan, a patient at the Osh hospital, told IWPR that he and other patients had been taken several times to work at the homes or farms of doctors and nurses…
Another hospital patient … has been put in charge of cattle. Every morning he turns about 10 cows out to grass and drives them back in the evening.
A third patient we met confirmed he worked in a doctor's home. "I've just dismantled the motor of his washing machine," he said.
Interviewed by IWPR, Janybek Ajybekov, recently appointed head of Chymkorgon hospital, admitted that such "labor assignments" do take place, especially at the homes of doctors and medical personnel. But he insists the problem is being put right.
Patients at Kyzyljar also work regularly in doctors' households. We found one hospital patient working at the home of the head doctor, Abdujalil Begmatov. Local residents described him as the doctor's "malai", or "slave", performing all the menial tasks for the household, such as tending cattle, chopping firewood and so on…
The IWPR contributor also met three psychiatric hospital patients digging up a field belonging to Altynbek Ryskulov, who heads another department in the hospital. It was hot, and as the workers took a tea break they told IWPR that it was better to work in the fields than stay in hospital. "Here we can have some tea with sugar. Additionally, the master feeds us bread and curdled milk. If we stayed in hospital, we would go hungry," said one of them.
Abdykerim Temirberdiev, a psychiatrist from the southern city of Osh, who has been in practice for more than 20 years, told IWPR that patients have been exploited in mental hospitals for years.
This exploitation has nothing to do with legitimate work therapy, which he defends. "Labor therapy exists as a discipline," he told IWPR. "It should be used on particular patients for two to three hours a day to work out their reflexes.
"For labor therapy to make sense, the patient should understand that his work is needed by society. It does not make sense to assign them routine labor just to kill time. You cannot force patients to work, it is wrong."
In reality, though, that is not what happens. "The attitude towards patients at psychiatric hospitals is that if you live and eat there, you should also work," he said…
A 1999 law on mental healthcare stipulates that people with psychiatric disorders can work, but requires special workplaces and training to be provided for them. By law, doctors are supposed to use work therapy for rehabilitation purposes, to enable patients to re-adapt to society.
The law says such work should be remunerated, "All patients under medical treatment or examination at psychiatric hospitals have a right to receive compensation for work on an equal basis with other citizens, in accordance to the amount of work done and its quality, if the patient is engaged in production."
Those not involved in work assignments are fed poorly. The state budget allocates 13 soms (around 30 cents) per patient as a daily food allowance. When IWPR looked at the kitchen of the Osh psychiatric hospital, all that could be seen was boiling soup and bits of dough. A cook told us, "We do not add carrots, onions or spices - they are too expensive."
After a long search, the cook found a small bone, which was to be added for taste. Several rats were seen in the kitchen, though their presence did not alarm either staff or patients. "Rats run round my room as well, so that's no surprise," said Sultan, a patient.
The same IWPR contributor, on a tour of Chymkorgon hospital at lunchtime, said patients begged for bread and extras to eat. That day, patients were given a yellow-brown soup for lunch, in which small worms could be seen.
IWPR's survey of three hospitals has revealed a catalogue of abuses, many of which our team witnessed personally. While there is relatively little evidence of malicious treatment by staff, it is clear that patients are routinely used for unauthorized labor in hospital grounds and for domestic service. Patients are frequently complicit with these arrangements simply because the standard food is so poor that any alternative is preferable.
Patients have few means of redress, and complaining may prove counterproductive. "Until recently, if a patient in a psychiatric hospital complained about the bad food, the rudeness of the doctors, the disappearance of personal belongings, or the violation of hospital rules, it would be attached to his or her medical record," a staff member at the Center for Psychiatric Health said. In other words, complaints were used as additional evidence of anxious or aggressive behavior.
By Ulugbek Babakulov, Natalia Domagalskaya and Asel Sagynbaeva,
IWPR's Reporting Central Asia No. 212, June 28, 2003