Bonthe Supervision, Part 1
The trip to Mattru was long.
I had left Ian sweltering in Makeni, the sun and heat taking on a new intensity in the past few days. Every night there were hours of electric storms over head. Like a child throwing a tantrum it felt as if the sky was crying out to rain but just couldn’t do it – lots of noise and lights but the more it tried the less likely the rain seemed and the hotter we got.
I felt guilty but relieved when twenty minutes outside of Makeni it started to rain and did not stop for the entire journey. On a tarmacced road the heavy downpours were fun and welcomed however the good road ran out after 3 hours of driving and the rain became more prolonged and intense.
The change of road was marked by a left turn off the paved road towards Bonthe District and almost immediately you saw over the end of the tarmac to the dusty red road that has become all too familiar.
This time the task felt enormous. The road was dotted with large craters filled with rain water that meant we no longer drove but undulated through the roads.
As the car descended to the bottom of each deep crater I expected to meet strange subterranean creatures who had never seen the light of day before and at times it felt like we would need ropes and tackle to return to the surface.
The sky grew heavier – more rain wanted to come.
In Makeni Ian assured me there was still no sign of rain – I tried to explain to his disbelieving ears that outside of Makeni there is rain, plenty of it, and in fact in the rest of the country there is rain.
We undulated through the rain and craters for four hours before reaching Mattru Jong – where we were to stay.
My mind always pictures Sierra Leone as a light and bright country. I see large, far reaching blue African skies only every interrupted by an enormous sun, but Mattru Jong is the darkest place I have seen.
The actual district capital of Bonthe is not Mattru Jong but is over on Bonthe Island a further two hour boat ride from Mattru. However because of that extra two hours all the disctrict council and administration has edged away from Bonthe and based itself in Mattru.
Mattru is dark, the roads are not roads but spaces you drive along where rocks stick up to tear the bottom of any passing vehicles.
The health offices are also squat, dark and swarming in Mosquitoes. Despite our late arrival on a Sunday night the nurse I am with insists we go to greet the District health team before he will give us the address of the hostel.
Crossly I agree. I am politely introduced to the district health monitoring and evaluation team – and it becomes apparent very quickly that they have as little interest in meeting me as I them however “the protocols must be followed” says the nurse.
To appease me he mutters something about food and a cold drink. We get back in the car and snake through the town relying on our headlights to pick a way through the gloom.
There is no light in Mattru or Bonthe – they do not make the list of cities or districts deserving of national electric grid and the only power there is is through private generators.
Mattru, and Bonthe as a whole, feels very neglected. In Bo and Pujehun there is investment of sorts but Mattru looks forgotten. It would be easy to get despondent at this point, except that my two favourite – and potentially best – psychiatric nurses are based here.
What are you doing here?
We go to bed and the next morning set off at 8. I learn fast that this is going to be a much better supervision trip than the previous one. The nurses have already fought for and obtained their own office. They already have books to record cases in and are using a form of assertive outreach to find patients and offer services.
I am shown around the office and then taken over to the hospital. One of the nurses wants to introduce me to one of the patients he is seeing – Intrigued to assess his interactions with patients and intrigued to see what kind of cases he is seeing I quickly agree.
Expecting to leave the hospital grounds and go somewhere else I am surprised when he continues leading me through the hospital corridors. Greatful that we are not out in the rain but under the covered walkways I follow. We take a right and turn down a hill; soon the walkway becomes overrun with plants and grass, almost totally taken over by the forest, and we move quickly to shelter in the covered patio area of a one roomed “house”. When I say house I mean one room with a door. On the covered patio there are small neatly planted flower beds on three sides and writing in white chalk all over the walls.
I lean in trying to read the writing but can’t make it out at first until I see what appears to be a long sentence with “….go away” at the end, some extracts from the Bible and, in a different hand, a message stating that a crazy person lives here.
As we approach the door opens and a very thin, bespectacled and neat man appears. He is dressed in light blue cotton trousers that swing at his ankles, exposing short white socks and old distressed black leather shoes. His shirt is short sleeve white cotton and he is holding a black leather woman’s purse.
His shirt hangs off his thin frame.
He looks up and notices us, stops in his tracks and smiles “What are you doing here?”
The nurse explains and the man relaxes enough to stop and sit with us.
He is in his 50s and explains how, in the 1970s and 80s, he studied in a theological college in Freetown. He said that he had a diploma in theology and loved to read the scriptures.
In the 1980s or 1990s he was working in Freetown and one night someone broke into his house and stole everything he had including his diploma. He explains that losing that diploma seemed to set of a string of negative events including him losing his job, his apartment and his life.
A common way of explaining mental illness here is to say that someone “went off” and he “went off” for about 10 years. He has ended up in Mattru Jong. At first he was staying with a family member but the local children were taunting him and throwing rocks at him so he moved. He was given his house by the hospital administrator who, he told us, helps him if people around the hospital start to bother him. Every day he goes to town and takes anything he is given although he stresses clearly he is not begging.
He looks bizarre but dignified, composed but deeply sad, he embodies isolation.
His eyes start to fill with tears when he says that things would be okay if he could just find that diploma.
He shows us his flowerbeds, talks us through the writing and points to the added on bits of writing by local kids calling him crazy – it is strange to hear a 50 something year old man state that when the kids torment him he has to go to another older man to get them to stop.
After 20 minutes he says in a non aggressive manner “What do you want from me today?”
“Nothing,” I reply, “just to meet you”. He seems appeased by that and then says,
“I do need a copy of the old testament , do you have one?”
I think to myself “Not on me but I will get you one.”
He leaves us and walks off towards town – noticeable because of his trousers swinging at his ankles and his oversized woman’s purse looped over his shoulder – dignified and alone.
Although I am not working as a nurse while here I am coming into contact with the patients sometimes directly and sometimes through discussions with the nurses here; the common theme between all the patients here, despite having very different symptoms and illnesses, is this overwhelming sense of isolation and loneliness.
In a society where community and belonging to something are fundamental it is strange to see people who are so separate.
Back in Bo, the young patient I met under the Mango tree: We went back to see him another day and his parents were out of the house he was there with 7 of his siblings and while his siblings sat outside together – the girls braiding each others hair and the young boys playing games or just sitting – our young man was sat in the house, eating alone – something that rarely happens – just alone, staring at the wall. Even as his siblings passed through the house there was no interaction, no connection to each other. He was in a different world, a different reality either of his own making or the making of his illness. It was one of the most poignant moments I have seen.
Until seeing this man in Bonthe walk away. Once again he seemed so disconnected from everything around him but still functioning as best he could.
The nurse expresses a desire to work with this man and try and help him; he says that he has tried to trace a copy of his diploma but can’t find one.
We talk about letting that man tell his story if he wants to and ways that we can help him do that. I get silently envious of the nurse being able to spend time with the man, there was something intriguing about him.
Sierra Leonean culture values “belonging” – you have to be part of a family, tribe, secret society – or all of them – life is so hard here that belonging helps you survive but I feel it is more than that. It is where the power and strength lies.
The mentally ill are rejected from society every day – every second of every day here. No one greets them, few, if any, people offer them food, many sleep in the streets or outside, many spend their times walking long distances with little purpose. Their clothes are always ripped and many times they are naked.
By the time they come to the attention of our fledgling services they have been through so much on the road and with the traditional healers that they have escaped even further into a different reality that it feels too hard to reach them.
Maybe the nurses need to start by giving them a sense of belonging again.
We walk back to the main road and even though the rain has stopped Mattru is still dark.