This week I spent my week in psychiatry. During nursing school, I really thought I would not enjoy my mental health rotation, but I loved it. I never thought I would ever become a mental health nurse, but I always enjoyed learning about mental health. Mental health is so important and it is something as a nurse I will have to deal with daily both with my patients and myself. As I will become a CVICU nurse, it is important for me to know and understand mental health and how I can better help my patients who might be struggling with anxiety, depression, drug withdrawal, etc.
Here in Nepal mental health is treated a little differently. There are no therapists or counselors. Many of the patients do not want to be admitted for a mental health illness so they leave the hospital and in most cases the ending is never good. With patients who are not admitted they come to OPD (psych outpatient department) for their “therapy” appointments. The doctor I am with this week spends half his week on the ward and the other half having interviews and conversations with OPD cases.
The first day on the ward: there are no limitations the patients could have whatever they wanted with them. There are no restrictions. There are no sitters. All the patients are in the same room, there are visitors every where, patient’s spouses, children, parents, and patients with suicidal ideation have no limitations, where most patients in America with psychological issues would have sitters and not be able to keep their belongings in the room, depressed suicidal ideation patients would have strict limitations like plastic utensils or nothing in the room that they could use to commit harm.
Some diagnosis include acute psychosis, bi-polar depression/mania, seizure disorder with psychosis, depression, schizophrenia, and anxiety. On the ward the patients really do not have therapy sessions. They have a “group” session of listening to music/dancing with all the patients in the morning but therapy really does not exist. The doctor will come in and have conversations with patients, especially new admissions about how they are feeling, what they think might have been a trigger, their mood, appearance, self care, etc.
On the second day we went to a psychiatry seminar and learned about sleep disturbances and disorders, which was quite fascinating for me as I have had difficulty sleeping the past few weeks, but it is slowly getting better. We also got to watch ECT which was quite different than my experience with ECT during my mental health rotation. We got to talk with one of the patients after ECT, which was his fourth treatment. ECT takes places in the operating room here, possible because sedatives are used. I am really not sure as to why ECT took place in the operating room. Today we went to an anatomy class/lecture at the University. We went to the cadaver lab and the doctor talked us through all the parts of the body, the pathways, and how the organ works, which was a lot fo review for me, but I still love going to the cadaver lab and seeing real organs and real parts of the body. How the university receives the bodies for their cadaver labs is quite interesting. They contact the local police department and if a body has not been claimed by the family with in six months then the university can receive it for cadaver use. Many of the lungs in the cadaver lab were smoker’s, I have never seen such black lungs. You do not see many people smoking here, as many people do it behind closed doors, as well as drinking. There is a saying here that when the sun goes down Nepal comes out. Alcoholism, drugs, and smoking are big problems here. Many patients we see in psych are psychotic from drug withdrawal, or many depressed patients turn to drugs or alcohol.
While in the psych department with another volunteer we have become to know the doctor very well. We have in depth discussions about mental illness, delusions, schizophrenia. The other volunteer and I even got to interview and discuss with one of the OPD patients about his OCD and anxiety. His spoke well enough English that we conducted the questions and then discussed with the doctor, and he would ask any questions we didn’t.
Mental illness can effect anyone, and it is often a shamed illness but some many things play a role into why someone might be struggling with mental illness. It has been a great week learning more about mental illness and differences in resources and treatments here in Nepal compared to America.
Updates:
- my friend Lilly left this week
- I got to hold a newborn baby when I visited labor and delivery
- We made aloo paratha ?
