‘Patients were chained to walls and beds’: Freetown’s psychiatric hospital released from the past

The Sierra Leone capital’s colonial-era asylum has modernised, offering psychotherapy, yoga and basketball as well as drugs – and has thrown away its shackles

His family had accused him of being a demon, Abubakarr Jallou tells a group of patients gathered in a room at Sierra Leone’s Psychiatric Teaching hospital in the capital, Freetown. When the black magic of a local witch-doctor didn’t help, he was beaten by his brother and cast out of the house, he says.

Jallou, 27, has since been diagnosed with bipolar disorder but he is not happy being here. “They sent me here, but I hate staying here. I’m not crazy.”

Group counselling is now part of treatment here at the oldest psychiatric institution in sub-Saharan Africa, which has seen a dramatic transformation in the last few years away from the days when patients would be kept chained.

Facilities are basic – Jallou is locked in a large room with bars on the windows with about 20 other men – but things have changed says Dr Abdul Jalloh, the hospital’s former director. “Until 2018, the hospital was like a prison. Conditions were awful. There was no running water, no electricity, no medicine and the patients were chained to the walls and beds.”

The human toll of non-communicable diseases (NCDs) is huge and rising. These illnesses end the lives of approximately 41 million of the 56 million people who die every year – and three quarters of them are in the developing world.

NCDs are simply that; unlike, say, a virus, you can’t catch them. Instead, they are caused by a combination of genetic, physiological, environmental and behavioural factors. The main types are cancers, chronic respiratory illnesses, diabetes and cardiovascular disease – heart attacks and stroke. Approximately 80% are preventable, and all are on the rise, spreading inexorably around the world as ageing populations and lifestyles pushed by economic growth and urbanisation make being unhealthy a global phenomenon.

NCDs, once seen as illnesses of the wealthy, now have a grip on the poor. Disease, disability and death are perfectly designed to create and widen inequality – and being poor makes it less likely you will be diagnosed accurately or treated.

Investment in tackling these common and chronic conditions that kill 71% of us is incredibly low, while the cost to families, economies and communities is staggeringly high.

In low-income countries NCDs – typically slow and debilitating illnesses – are seeing a fraction of the money needed being invested or donated. Attention remains focused on the threats from communicable diseases, yet cancer death rates have long sped past the death toll from malaria, TB and HIV/Aids combined.

'A common condition' is a Guardian series reporting on NCDs in the developing world: their prevalence, the solutions, the causes and consequences, telling the stories of people living with these illnesses.

Tracy McVeigh, editor

Neighbours lived with screaming coming from the imposing brick building, on a hill in the east of Freetown. The Kissy Lunatic Asylum, as it was known, was there to simply stop patients hurting themselves or others.

But, in a country which has historically paid little attention to mental health, the government has been raising awareness and attempting to counter stigma as part of President Julius Maada Bio’s “human capital” development agenda, which includes education reforms.

The hospital is operating at full capacity, with 150 patients receiving free treatment.

After patients’ chains were removed, the facility was also connected to water and power supplies. Now there is holistic care, which combines therapy and counselling with the latest medication. Yoga classes are offered and there is a basketball court.

Anneiruh Braimah, chief psychiatric nurse,started working at the hospital in 1998, and says the behaviour of patients has improved dramatically since the reforms.

“When people were chained they were very angry. They were throwing whole buckets of pee and poo at us. What we have noticed when we removed chains is that attacks have not increased in any way. In fact, they have decreased.”

One of the biggest issues is substance abuse. Many of the teenagers at the hospital are users of tramadol – an opioid found in cough medicine. Others arrive in a state of psychosis after snorting the black residue on exhaust pipes.

Ahmed Lahai, 21, was brought to the hospital in October by relatives.

“My mother called all the local youth to tie me up in our house; she thought I was smoking [drugs],” he says. “But I broke down the door, which is when they said I was crazy. After that, they brought me here, where I received an injection to calm me down.”

Lahai is being helped with his addiction. He doesn’t know how long he will stay at the hospital, first built by British colonialists in 1820. “The nurses are trying their best for us,” he says. “The only thing is the food – it could be more of a balanced diet than just beans and rice.”

The improvements are largely funded by a US charity, Partners in Health (PIH), which helps the government with running costs.

The charity has given $2.5m (£2m) towards refurbishment. There is now a full-time psychologist and a residency programme, established to train seven psychiatrists which will more than double the five that currently support Sierra Leone’s population of 8.1 million .

The government is preparing to roll out basic mental healthcare across Sierra Leone’s 16 district hospitals in the coming months, which should reduce pressure on the teaching hospital.

Earlier this year, Dr Carol Labor was appointed the first presidential adviser on mental health.

“Reforming mental health in Sierra Leone is a big undertaking, but we are up to the task,” says Labor. “Our aim is to train 10,000 mental healthcare workers in 10 years.”

A key challenge is reforming the 1902 Lunacy Ordinance – a colonial-era law that contains no mention of patients’ rights. Dr Labor says a “patient-centred bill” has been drafted, which includes protections for patient welfare. It should be passed in 2023 – giving dignity back to people with mental health problems.

Tom Collins in Freetown

The GuardianTramp

Related Content

Article image
‘Many patients are dying blind’: South Africa’s struggle to save eyesight
In a race to prevent blindness, a small team in the remote Northern Cape do their best to treat thousands of patients waiting in hope that their sight could be restored to them

Julie Bourdin in Upington

28, Aug, 2023 @5:00 AM

Article image
‘A lifeline’: mental health camps bring peace of mind to thousands in rural Assam
India’s severe shortage of mental health professionals and treatment funding leaves many patients without options. But a pioneering programme is working to get lives back on track

Anne Pinto-Rodrigues in Kuklung

13, Jan, 2023 @6:30 AM

Article image
At risk: 10 ways the changing climate is creating a health emergency
Diseases will spread faster and further, and kill more people, as the effects of record heat, floods, drought and storms escalates

Joan van Dyk

16, Nov, 2023 @6:00 AM

Article image
The door to door service that is changing the diagnosis for Malawians
In a country where many live far from clinics, a home-visit scheme has been a breakthrough in treating illnesses such as diabetes and spotting cancers

Kaamil Ahmed

23, Aug, 2023 @5:00 AM

Article image
Hospital and a home: Uganda shelters offer a lifeline to cancer patients
With no money for a hotel or to travel the long distance home between treatments, patients were sleeping outside clinics. A new project is tackling the problem

Dan Ayebare

23, Dec, 2022 @6:00 AM

Article image
‘It’s not just about dying’: Uganda’s pioneers of palliative care undaunted by huge challenges
Morphine was first introduced to the country 30 years ago, but as the burden of cancer increases, thousands of people still lack access to even basic treatment or pain relief

Isabel Choat in Kampala and Mbarara

06, Mar, 2023 @7:30 AM

Article image
‘A single cut brings excruciating pain’: haemophilia patients struggle to access care in Nigeria
People living with the blood disorder are often unable to obtain a diagnosis or vital treatment – a situation that is replicated across much of Africa

Promise Eze in Lagos

12, Jun, 2023 @5:00 AM

Article image
‘A place of healing’: comfort for young cancer patients amid Sri Lanka’s economic crisis
The families of sick children have been pushed into poverty to access the country’s severely limited care services. Now a refuge is about to open its doors

Weronika Strzyżyńska and Dilrukshi Handunnetti

20, Feb, 2023 @6:30 AM

Article image
Dying too young: focus on communicable diseases takes toll in South Africa’s slums
Diseases such as strokes and diabetes now cause most deaths in South Africa but the health system is still focused on tuberculosis and HIV

Sarah Johnson in Cape Town

11, Nov, 2022 @7:00 AM

Article image
In the blood: why diabetes is the scourge of entire families in Tanzania
Elisaria has had diabetes for decades. Her husband died of it and five relatives live with it. Yet millions in this fast-growing country cannot afford to get the treatment they need

Caroline Kimeu in Dar es Salaam

28, Dec, 2022 @7:30 AM