Monday, April 22, 2024
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Mohlomi Hospital’s reign of terror


…as patients narrate their horrors and scars in the hands of nurses

Lerato Matheka

A litany of human rights violations, coupled with physical, verbal, and emotional violence, clouds Mohlomi Mental Hospital as patients recount their traumatic experiences at the hands of nurses and staff.

Patients suffering from mental health illnesses and seeking help by checking into the hospital have shared their harrowing experiences with Newsday, but have requested anonymity for fear of victimisation.

Some even claim that their mental health conditions were worsened by the inhumane treatment they received at the hospital.

Established in 1965, Mohlomi Mental Hospital is a national referral hospital that provides care for patients transferred from the mental and treatment observation units within the ten (10) district hospitals.

But in the harrowing accounts shared by the patients who spoke to this publication, the ingredients of their ‘treatment’ were nothing short of a cruel concoction: a hearty dose of neglect, a sprinkle of abuse, and a dash of intimidation.

Far from receiving the compassionate care they desperately needed, they found themselves engulfed in a nightmare where the very place meant to heal them became their tormentor, leaving them battered and broken, with wounds that cut deeper than any physical affliction.

Reitumetse’s Encounter

“They threw me into that squalid seclusion room for five agonising days. My hunger was so unbearable that I resorted to eating the pages of my own passport.

“It became my only edible possession since, for the first two days, I was denied both food and a blanket.

“It was only on the third day that they reluctantly provided me with some food. When nature called and I pleaded to use the bathroom, my pleas fell on deaf ears. Forced to improvise, I used a plate for relief and the remaining slice of bread to clean myself.

“I did what I had to do, driven by desperation. In the previous days, I had no choice but to urinate on the floor, as access to a toilet was still denied,” recounts Reitumetse*, revealing the harrowing experiences that worsened her already fragile mental health.

A patient with Schizoaffective disorder, Reitumetse* despises her check-up appointments to collect her medication at Mohlomi Mental Hospital.

She was initially diagnosed with the condition when she was a fourth-year student at 21 years old and has been a regular patient at Mohlomi ever since. She describes her relationship with the hospital as consistent but “abusive”.

She recalls being placed in the seclusion room only during relapses resulting from her failure to adhere to her treatment.

She attributes these relapses to the side effects of her various prescribed treatments, which she claims are debilitating and leave her feeling lifeless and mentally foggy.

“I have no doubt that the room is used as a form of punishment, and my mother confirmed this for me in April 2022 when she was instructed not to visit me for a week after my admission. After spending five days in seclusion, I saw a doctor on the 6th day, and two days later, I was discharged.”

Now 37 years old, Reitumetse* explains that most of her episodes are vivid, so she usually recognises her surroundings during these episodes. She has never been described as violent, but she describes herself as manic.

“During my episodes, I am either excessively excited, energetic, or extremely irritable. Therefore, it is difficult to fully realise that I am having an episode because, at that moment, I feel excited and at my peak functionality. I can go for a day without sleep, but if people try to control me or make me feel violated, I will respond,” she explains.

She says that during her last episode in 2022, she left home thinking she was going to a wedding, all dressed up and ready to dance.

She notes that upon their arrival at the hospital, she was met with hostility and immediately responded.

“They approached me, grabbed me, and began dragging me towards the seclusion room. Although it was not my first time in seclusion, it was definitely the worst experience I have had.”

Reitumetse* describes waking up from an episode to find herself being harshly beaten by a nurse.

“The slaps were severe and left marks. I looked at the nurse, and she had so much anger in her eyes. Her power as she pushed and shoved me outside made it feel as though I was being punished for something huge. Yet, I am told that I climbed on top of a table and started saying I am Jesus and preaching.

“She certainly slapped me back to reality because the last thing I remembered was sitting and having a conversation with other patients, and suddenly I found myself ducking slaps and punches,” Reitumetse* recalls.

She emphasises that despite being aware of the abuse she was enduring, she was hauled to the seclusion room and left there for a few days.

“Spending time in that room has left me traumatic scars. I can’t sleep in a dark room, and shadows remind me of the scary moments when I was trapped in there,” she says, revealing previous episodes where she was admitted at private hospitals, she was merely sedated and was later released when she woke up.

“With Mohlomi, it seems that seclusion is their admission protocol regardless of one’s condition, and it is definitely their punishment tool,” she alleges.

She claims that at Mohlomi, individuals with mental illness are unfairly judged and mistreated, while those experiencing depression and suicidal thoughts are placed in a private special ward near the offices.

Liteboho’s Days Without Food

Like Reitumetse*, Liteboho*, a mother of two and an HIV patient who is also battling with depression and psychosis, has gone days without food and has experienced various forms of abuse.

She asserts that the staff is aware of her health conditions and her need for antiretroviral therapy, yet she often goes without her medication for days.

While recognising the necessity of seclusion for patient safety, Liteboho is concerned that even well-behaved and peaceful patients are subjected to the seclusion room.

“In 2023, I checked into Mohlomi because I felt my condition was deteriorating. I was almost fine when I arrived until the next day when I woke up in the seclusion room. I don’t remember what happened, but other patients told me I was fine one minute and suddenly started undressing. They say I was walking around naked when I was thrown in there.

“If I was not violent towards myself and others, it doesn’t make sense why I was thrown in there.

“They treat that room as a naughty corner for patients who actually need medical attention or those they want to punish,” Liteboho says.

She recalls that on the second day in the seclusion room, a nurse threw her medication on the floor and instructed her to pick them up and take them.

“This is the floor that every secluded patient uses to urinate and defecate.”

“When she came back before her shift ended, she did the same thing and even threatened that they would lock me in there longer if I didn’t take my medication, the same medication she threw on the dirty floor.”

Liteboho* says her memories of Mohlomi hospital are worse than her mental health illness and the untimed episodes.

“One time, they left me in there for days without food and a blanket. When they eventually came to check up on me, I was motionless. I was so cold, shivering, and couldn’t stomach food or even liquids.

“Instead of helping me, they started beating me, saying I am intentionally acting and refusing to eat. They beat me so much that I had wounds.”

“I hate that place. I hate getting to a point where I have to go back to that place.”
Liteboho* narrates that her strong character turns her into public enemy number one, saying she refuses to take on extra cleaning chores assigned to recovering patients.

“They ask recovering patients to clean up after ailing patients. I always, and will always, refuse to wash another patient’s faeces or even change diapers. That stance has subjected me to being given my medication on an empty stomach and being forced to go for days without food. Hear me, all recovering patients are asked to clean up after others.”

She recounts being admitted for three months, and during that time she would relapse as though she was not on her medication.

“I never relapse because I stopped my treatment, but when my mental health strikes, it cares not where I am or if I have taken my medication. It seems as if the medication doesn’t work and there is no one willing to explain why I keep failing on the same waggon despite being on treatment,” she says.

The Seclusion Room

The seclusion room at Mohlomi’s is approximately a 2×2 room with a cement bed and no mattress.

There are no toilet facilities available for patients’ natural needs.

The room has a partially broken rectangular window with barbed wire, which allows all weather conditions in, including the freezing winter cold.

The heavy steel door closes from the outside and has a small hole for delivering food.

The Damning Ombudsman’s Report

The Ombudsman’s Special Report on the Inspection of Mohlomi Mental Hospital in 2023 pointed out that Mohlomi is neglected and that the conditions under which patients live are worsened by a lack of resources. Additionally, the Ministry of Health does not seem to prioritise it.

The report emphasises that many human rights violations are a result of the long-standing and systematic neglect of mental health facilities during policy implementation.

“The living conditions at Mohlomi are inhumane and violate the fundamental human rights of the patients, as outlined in various domestic and international standards and agreements. The Ombudsman has found that these dire conditions hinder the improvement of their mental health due to the poor quality of care they receive,” the report states.

It further reveals that the facility is generally under-resourced, lacks professional expertise, and suffers from systemic failures that perpetuate human rights abuses.

“The hospital remains the only psychiatric hospital in the country; however, it currently operates without any resident psychiatrists. It has been determined that the sole psychiatrist who previously worked at the hospital left in 2016/2017 for similar reasons.”

According to the report, the hospital has been without a psychiatrist for the past seven (7) years. The facility currently relies on three (3) general medical officers, four (4) psychologists, and seven (7) social workers. The report also identified a need for occupational therapists, which the hospital currently lacks.

During the inspection visit, the Ombudsman was informed that the hospital now receives assistance from one (1) psychiatrist from Partners in Health (PIH), a partner of the Health Ministry.

This psychiatrist visits the facility once a week, and this arrangement has been in place since December 2022. However, the Ombudsman discovered that the psychiatrist’s scope of work is limited to general patients.

Outpatient Treatment Still Poor

Lieketso*, an outpatient who has had an on-and-off relationship with the hospital, narrates that she relapsed twice due to a misdiagnosis.

Diagnosed in South Africa while still a student, she returned home with confidence that the country’s only mental health hospital would be a safe haven. Little did she know that her progress would be derailed multiple times over.

“That hospital should just shut down because it causes more harm than good.

“I am one of those patients who are aware of their conditions and know their treatment regimen, so when I was misdiagnosed, I tried to reason. But the last time I was there, I was chased out of the consultation because ‘I knew too much’,” Lieketso* recalls.

She says that the two times she agreed to take medication prescribed at Mohlomi, she experienced severe relapses and was admitted to a hospital in Bloemfontein.

“I was lucky, and I am still fortunate to be able to afford a psychiatrist and receive the correct medication. However, what happened to me is happening to a lot of people because patients are seen by healthcare providers who refuse to listen and learn. I mean, patients are referred to Mohlomi by general practitioners from different health facilities, only to be treated by other general practitioners. That is a recipe for disaster,” she says.

Concerns by the Mental Health Association

Mathabang Manamolela, a former nurse and current president of the country’s Mental Health Association, pointed out that the hospital building is very old and dilapidated.

She stressed the need for the health ministry to take intentional action to help improve the hospital.

When asked if she was aware of allegations of human rights violations at the hospital, Manomolela said that as a former employee of the hospital, she knows that the seclusion room is used to ensure the safety of patients and staff.

“What you have told me is terrible. We have a close relationship with the ministry and I promise you that we are going to take this up and demand that an investigation be lodged because the hospital is supposed to be helping mental health patients get better and not worse.”

She quickly pointed out that since leaving, the situation at the hospital has worsened.

“We continue to hear that the hospital is severely understaffed and lacks the specialists needed to adequately assist patients.

“What one can infer is that, given the poor working conditions, the workers may also be experiencing depression. There is much work to be done, and with the help of the stories you share as the media, our advocacy efforts will be strengthened.”

Manamolela emphasised that while they advocate for policy changes and improved services, they strongly disapprove of any abusive acts towards patients.

Management Shocked

When Maholi Rampeta, Senior Nursing Officer, was interviewed about the condition of the hospital, they explained that the procedures for seclusion are clear. Only highly disturbed patients who pose a danger to themselves, other patients, and staff are placed in these rooms.

“The rooms are specifically for certain types of patients, and it is protocol to check on them regularly and provide their medication while they are in the seclusion room.

“If a patient is highly disturbed, they receive attention from multiple staff members and are given sedatives to help them sleep. They are placed in the seclusion room to allow them to rest away from other talkative patients in the wards. Prior to being placed in the room, the patient is searched to ensure they do not have anything harmful on them.

Rampeta mentioned that once a patient has calmed down, it is expected that they will be taken out to bathe and be monitored.

“It is very rare for a patient to remain in a seclusion room for more than a week because they need regular medication to help calm them down. They are given injections, and if they complain of pain, they are encouraged to take tablets, which they usually do.”

She noted she would not refute the allegations labelled by patients. While she tries to regularly visit the wards, she finds herself buried in other work.

“There are a lot of departments here, and as much as I visit the wards, I can’t say whether what the patients have told you is true or not. I am very shocked at what is said to be happening.”

Rampeta said that while all her patients know her by her name and often tell her their grievances, most of the abuse that patients are subjected to, exposed by this paper, were all new.

She noted she tries to make her patients feel comfortable enough to open up.

“I guess I still have a lot to do so that they open up more and are free to tell me their problems.”
She confirmed that the hospital has one psychiatrist who sees patients once a week, citing that patients are seen by General Practitioner doctors.

She was quick to stress the need for improved infrastructure, citing that the state of the seclusion rooms is devastating and perpetuating inhuman treatment on their own. “The rooms are very old and in devastating condition. The beds don’t have mattresses, forcing us to always have a mattress ready for when a patient is sent to the seclusion rooms.”

Rampeta concluded that all allegations would be investigated.

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