Silent Death in The Nursing Home

More than a hundred of mentally ill patients in government-run nursing home died in short period from 2008 to 2009. A state-run hospital for mentally ill patients and its psychiatrist have contributed to the deaths. 

A number of mentally ill patients live in a government-run nursing home that more look like a prison.

PART 1

Absence of doctors puts patients in danger

ROYATI, 27, smiled while I sit on the bench in front of her. Her mother, father, brother and sister sit close around her. The bald woman whose skin is white seldom to speak to anyone. Yet, she would suddenly smile when someone called her. She is one of the mentally ill patients in Panti Sosial Bina Harapan Sentosa I, a government-run nursing home located in Cengkareng, western Jakarta. It is operated under Social Agency of Jakarta.

“She married at 17,” Rogayah says. She is Royati’s sister.

Royati’s behavior were dramatically changed after she gave birth to a son three years after the marriage. Her husband then left her.

Royati suffers schizophrenia, a psychotic disorder that severely alters the way a person usually thinks and behaves. One who suffers this mental illness might have such hallucinations, delusions, confusion, withdrawal, agitation, or emotional numbness.

In the early stages, Royati often heard sort of whispers. As the whispers came more often, she was caught in her delusion that brought her mind far from reality. The delusion began to screw up her mind. She would even do whenever the whisperer asked for, including burning down the family’s house. Nobody in the family could control her except Risan, her father.

“We ran out of money to help and cure her from such a strange disease that we’ve never known before,” Risan says.

He eventually did not have any choice but to sold his only small rice field to cure his daughter sickness. Yet, the effort seemingly were in vain. The family was no longer able to take good care of her. They could not afford to buy medicine or take her to a special hospital for mental illness.

One night in 2005, Royati ran away from home. For four years the family desperately looked for her across Jakarta.

“We never know where she is though we tried so hard to find her,” Risan says.

One day, on June 2009, she was brought to the nursing home by Satuan Polisi Pamong Praja (civil servant police) after they took her off the street somewhere in eastern Jakarta.

The family now regularly visits her in the nursing home as part of therapy to help bring her mental health back. They very thankful since Royati was getting better in the nursing nursing home.

However, there were many of the mental illness patients who were not as lucky as Royati. They were ill-fated and neglected by their family, neighboring community, and even the government. More than a hundred of them died in the nursing home from August 2008 to April 2009.

In addition to the lack of drugs supply, the limitations of room for the poor mentally ill patients, and the closure of the intensive care unit at Duren Sawit Hospital, there was poor initiative for the psychiatrist and physicians to recommend the patients with psychotic disorders who are in critical condition to another hospital or health center. Conflict of interest within the management added to the problem.

Absence of doctors

The wave of death started in early August 2008. The number of patients who died at the nursing home doubled, from five to ten. From the death certificates in the nursing home archives, most of them died because of suffering ‘long illnesses” that developed while living on the streets. There were no further explanations about the ‘long illnesses’. Upon the nursing home archive, only a dozen of the death were die because of malnutrition, respiratory disease, or other infectious diseases.

The high death rate continued in the following months. Ihud Saputra, head of Cengkareng nursing home, worried about the condition of mentally ill patients. He categorized the alarming mortality of the patients in nursing at the time as an ‘outbreak’.

Psychiatrists at the government-run Duren Sawit Hospital that previously visited the nursing home regularly were absent.

For two months psychiatrists from Duren Sawit hospital did not come to this nursing home,” said Ihud, adding that the nursing home was regarded as one of the critical nursing nursing homes for poor mentally ill patients in Jakarta.

The Cengkareng nursing home had no residence psychiatrists due to the lack of psychiatrists across Jakarta. Yet it had two resident nurses.

Psychiatrist from Duren Sawit played a critical role in the patients’ recovery at the nursing home. Besides regular check-ups and prescribing medicine, the psychiatrist was responsible to give referral letters for the mental illness patients that need intensive and further treatment. As cited in Governor Decree No. 58 year 2003, the hospital was a major referral for abandoned and poor mentally ill patients in Jakarta. The hospital was obliged to give medical and mental health care to these abandoned patients.

To make matter worse, almost every weekend the nursing home was ‘flooded’ with new mentally ill patients that were brought by Satpol PP (civil servant police) who took them off the Jakarta streets. Ihud had no reason to reject these new mentally ill patients. Most of them were in poor condition and need emergency treatment, both physical and mental care.

 Number of patients in Cengkareng nursing home from August ’08 to April ’09

Month

Year

New patients (person)

Death rate (person)

July

2008

110

August

2008

45

11

September

2008

21

8

October

2008

66

11

November

2008

8

10

December

2008

2

14

January

2009

83

11

February

2009

69

10

March

2009

88

8

April

2009

71

6

May

2009

23

(Source: Cengkareng nursing home)

As time went by, the nursing home was overwhelmed. The patient needed help as soon as possible. Ihud could not stand to wait a visiting psychiatrist to come to the nursing home. He then decided to write a letter to the director of Duren Sawit Hospital.

The official letter was addressed to the Director of the Regional Special Hospital Duren Sawit. The official letterhead was “Panti Bina Laras Harapan Sentosa Social I”. It was dated October 27, 2008. Number: 651/-1.842.3. Ihud Saputra, the writer, firmly asked for the presence of a psychiatrist at the nursing home because of a “great need of immediate psychiatric examination”.

Ihud also emphasized the poor nursing home condition to support his reasoning. The number of mentally ill patients in the nursing home continued to grow over capacity. It reached 668 people, more than 1.5 times its normal capacity.

A few days after Ihud sent the letter, Joni Hendarwin Ismoyo, a psychiatrist and Head of Medical Service of Duren Sawit Hospital, visited the nursing home. Ismoyo was considered the right-hand of the hospital director, Gani Witono. Ismoyo was responsible for the whole medical service of the hospital.

“He (Ismoyo) only came two or three times to the nursing home. After that, he did not come again,” Ihud complained.

A regular visit of psychiatrist is needed to help recover number of poor mentally ill patients in government-run nursing home.

The absence of psychiatrists became a starting point that triggers the death of a number of mentally ill patients in Cengkareng nursing home. Due to the investigation, the ‘emergency’ letter signed by Ihud showed the negligence of mental treatment and medical care which are the responsibility of doctors of Duren Sawit hospital.

Citing Article 7d of Indonesian Medical Ethics Code, in any medical practice, every doctor is supposed to protect the lives of patients. Meanwhile, in article 7a, they are required to provide competent medical care with practical capability along with moral freedom, with compassion and respect for human dignity.

Governor decree No. 58 year 2003 has provided the foundation for physicians to refer poor psychotic patients to several government-run hospitals in Jakarta. Unfortunately, the critical initiatives that are needed in order to anticipate the death of patients were disregarded.

Irmansyah, chairman of National Mental Health Task Force, condemned the mentally ill patients’ death in the nursing home. The psychiatrist and lecture at Psychiatry Department, University of Indonesia, argued that government of Jakarta did not have systematically plan in order to curb mental health problem. The patients’ death was paramount of the problem.

“Tragedy of the patient’s death is an omission of duty caused by reckless and in-coordination mental health service for them,” Irmansyah said.

Meanwhile, Ihud and his colleagues at the nursing home regretted inaction in the hospitals to help prevent the death of mentally ill patients in the nursing nursing home.

Through the letter of emergency, he and his staff in the nursing home endeavored to prevent the death wave of derelict psychotic patients. Unfortunately, the letter seemed to be ignored by the hospital officials.

Ihud put a copy of the letter in a filing cabinet in his office. He only let me photograph the letter instead of copying it.

“I kept it as an archive and proof. As a civil servant, I just do what I have to do. So they (high rank officials) cannot say that I never reported the critical situation at the time,” he said. ***

*) This serial report is funded by Mochtar Lubis Fellowship in 2009.

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