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Keeping the Calm at Aceh's Only Mental Hospital

With Most Patients Unaccounted For, Psychiatrist Copes With Basic Problems of No Electricity, Little Food

By Ellen Nakashima
Washington Post Foreign Service
Wednesday, January 12, 2005; Page A14

BANDA ACEH, Indonesia -- When a massive tsunami crashed into Sumatra more than two weeks ago, nurses at the Banda Aceh Hospital for the Mentally Ill unlocked the doors and let the patients wander off.

At least 200 of the 312 residents have not been accounted for. Seventy patients are living at the hospital now. They sleep on waterlogged mattresses, bare cots or sopping wet sofas on the sidewalk. They have no electricity and little food.

Kris Wardoyo, the only psychiatrist at Banda Aceh's mental hospital, sits with a patient. On Dec. 27, Wardoyo returned to the hospital, where nurses had unlocked doors to set the patients free when the tsunami hit on Dec. 26. (Ellen Nakashima -- The Washington Post)

But they do have Kris Wardoyo, 53, the hospital's medical director and only psychiatrist. Wardoyo had been out of town when the tsunami hit, but returned to the hospital the next day. For two days, Dr. Kris, as he prefers to be known, was the only staff member on duty. The rest were either too shaken to come to work or tending to family members, he said. Many, including the hospital director, still have not returned.

As international attention focuses on the plight of tsunami survivors in remote villages and overcrowded relief camps, the only mental hospital in Aceh province seems forgotten. Fifteen days after the tsunami, wood benches block doorways; gates and doors are broken; clothes are heaped in muddy piles on the ground; dishes and pots are piled up outside in the rain.

When Wardoyo arrived, he found the patients, most of whom suffer from schizophrenia, frolicking in the mud and water. "There was no panic," he said. "They were just having fun."

Not all the patients left the building during the flood, Wardoyo said, even though the water was waist-high in some wards and had demolished a concrete wall.

He said he reacted calmly and got back to work. "I'm not someone who gets too sad or too happy," he said. "I have to be stable. I have to be normal."

His first problem was figuring out how to feed the patients, many of whom had not eaten since before the tsunami. The kitchen was useless, he said, so he pulled a big aluminum vat outside and cooked rice on a wood fire.

During his rounds Monday afternoon, torrents of rain pounded the tile sidewalk and flooded the muddy grounds. Some patients were in the wards, others outside.

Most of the patients' medicine was stored on high shelves and had escaped damage. But the tensimeter to measure blood pressure, stethoscopes, electroshock equipment and an oxygen concentrator (to aid people with respiratory difficulties) were destroyed, Wardoyo said.

In one ward, nine listless women lay on beds, with flies and stray cats as their companions. Outside, a man stood barefoot in the rain, eating rice with his hands.

A patient with mournful eyes named Muzakir sat on a pile of bed frames. His legs were covered with a black, scaly rash.

"Muzakir, did you eat today?" Wardoyo asked.

The man nodded, crossing his arms over his knees. "I feel hot," he mumbled.

Most of the patients' families have abandoned them, Wardoyo said, as a patient with a crew cut walked by barefoot, wearing blue cotton hospital pants. "They don't care," he said. "They see [the mentally ill] as useless."

In Indonesia, where mental illness is heavily stigmatized, he said, committing people to a psychiatric hospital is akin to disowning them. According to Wardoyo, there are fewer than 600 psychiatrists in Indonesia, a nation of more than 238 million people. Psychiatry is not prestigious, he said, and the medical profession disdains it.

But Wardoyo said psychiatry was his calling. He was the second of nine children from a poor family in central Java, the main Indonesian island, and as a child, he saw many homeless people with mental disorders who had no one to care for them. He vowed one day to become a doctor to help them.

Few people want to come to work in Aceh, he said. The region has had conflict since the 19th century, when it rebelled against the Dutch. The most recent period of violence began in 1976, when the government tried to quash an armed separatist movement. The conflict has claimed thousands of lives.

Wardoyo said he took the job because he wanted to help the mentally ill and because his wife is Acehnese.

"It's very fulfilling," he said, flashing a thumbs-up sign as the rain poured over office chairs and desks stranded on the sidewalk.

Just then, a man walked up and said he was looking for his wife's nephew. Wardoyo nodded and led him back to the covered sidewalk piled with bed frames.

"Saleh!" Wardoyo called to a young man, who had been walking on a bed frame. "Your family's here."

The uncle, Sabil, put a hand on the nephew's shoulder. They greeted each other in Acehnese.

"Why don't you take him home?" Wardoyo asked Sabil. "He's been here too long already."

One of Saleh's companions walked up. "Is Saleh going to go home?" he asked, plaintively.

Sabil said he was going to tell his wife he had found her nephew. They would discuss whether to bring him home.

Wardoyo said later that he doubted the man would take the nephew home. If that was the intention, Wardoyo said, Sabil would have taken Saleh away then and there.

As Wardoyo finished his rounds, he passed a patient bathing naked outdoors, ladling water from a trough over his body. Seeing visitors, the man covered himself with a blue shirt.

Once the hospital returns to normal, Wardoyo said, he expects to admit more patients, because people will be suffering distress triggered by the disaster.

According to Indonesian authorities, the government and the World Health Organization will send psychiatrists and psychologists to the hospital to help tsunami victims cope with such distress.

Wardoyo said some of the patients who left would probably be returned to the hospital, especially those who became violent after missing their medication. At least one patient made the news since the tsunami when he brandished a plastic toy gun and five Indonesian soldiers drew their rifles on him, according to the local newspaper, Serambi.

Wardoyo has asked the Health Ministry in Jakarta, the capital, for about $10,000 to clean and repair the hospital. He said he hoped to receive the money this week.

Staff members began trickling back a few days after the tsunami. On Friday, the first groups of volunteers from Islamic civic and political organizations arrived to mop up, help haul away debris and move furniture.

As the day drew to a close and the sky darkened, Wardoyo trudged 80 paces through a sloppy lane to his house, a small cottage near the hospital. He lit a candle for some light. He said he would return later to check on the patients.

Special correspondent Yayu Yuniar contributed to this report.

© 2005 The Washington Post Company