Farewell

Nurses Deepa and Darshana and their children on either side of me.

My six weeks at Shraddha are already over and I'm not ready to leave. I will miss my new friends here: Mansoor, Joma, Santanu, Dhruv, Poonam, Joseph, Suresh, Darshana, Vikram, Ghokale, Pushpa, Suresh, Vinay, Aziz and all the rest.... The Shraddha team threw me a going away party with speeches, songs, chai and bhel puri (a delicious Indian snack).

Another Reunion Trip

Social worker Suresh Lukose (right) assists patient to identify location of his home village.

On the road with social worker Vikram Shelar.

Led by social worker Vikram Shela, a Shraddha team again hit the road to reunite three patients with their families. This time the destination was Hyderabad in the state of Andhra Pradesh. The day before, social worker Suresh Lukose worked with the patients to determine the exact locations of the patient's families. We left Karjat at 5 A.M. and drove 600 grueling kilometers on National Highway 9 reaching Hyderabad at 11 P.M.
The next morning, thanks to Vikram's sleuthing, we located all three patients' families and witnessed emotional reunions. Most moving was Muhloo's reunion with his mother and sister. Muhloo (name and photo used with his permission) had been living on the roads of Maharashtra and Andhra Pradesh for eight years and his mother had given him up for dead. At first sight of Muhloo, she seemed frightened and Vikram translated that she thought she was seeing a ghost or a demon. Vikram's reassurance was enough to soften her from fear into tears of joy....

I say my farewell to Muhloo at his family's home in Hyderabad

Current Events

The staff at Shraddha have been talking about one thing today: the people of Mumbai are once again the victims of a brutal bomb attack. Three near-simultaneous explosions hit Mumbai at rush-hour on Wednesday and killed 21 people and injured 141. One blast hit the crowded neighborhood of Dadar in central Mumbai, another the Zaveri Bazaar, a famous jewelry market, and the third the Opera House, a busy business district. These blasts are the first major attack on Mumbai since November 26, 2008 violence, when 10 terrorists held the city hostage for 60 hours, targeting two luxury hotels, a Jewish center, a cafe and a busy train station.This attack killed 166 people.

Recovery

A decade-long study by the World Health Organization that followed 3,300 patients found that people with schizophrenia do far better in poorer nations such as India, Nigeria and Colombia than in Denmark, the U.K., and the U.S. Patients in poorer countries spent fewer days in hospitals, were more likely to be employed and were more socially connected. Between half and two-thirds became symptom-free compared to only about a third of patients from rich countries. This calls into question modern psychiatry's belief that schizophrenia is a organic brain disorder and best treated through medication and hospitalization. The researchers concluded that the stronger family ties in poorer countries have a major impact on recovery. In Dr. Vatwani's view, in addition to medication, an active family and village life contribute to recovery from schizophrenia. This is why he places such emphasis on reuniting patients with their families and communities.

Pushpa serves Shraddha by preparing food for patients and staff.

Pushpa  personifies how social context supports recovery. She suffered a psychotic break after the death of her mother ("my best friend") and wandered the streets of Borivli for six months. When she was found by Shraddha social workers, she was arguing with an internal voice as she lay in filth. Declining being reunited with an abusive family, she has remained at Shraddha for eight years. Pushpa (name and photo used with permission) has found her family here at Shraddha. She feels safe here and says, "They treat me with respect." 

Perceptions of Mental Illness in India

Understanding schizophrenia in the Indian context has been very eye-opening. Psychosis in the traditional Indian view is due to jada tona or black magic in which an individual is inhabited by a bhoot or spirit. What is interesting to me is that in India there seems to be so little fear of patients with schizophrenia compared the United States where the culture seems to believe that people experiencing delusions or hallucinations are dangerous. I haven't seen patients with schizophrenia at Shraddha that are agitated or out of control. On the contrary, they seem quiet, even timid. Perhaps because they aren't seen as a threat, people with mental illness seem more integrated into Indian society, especially in rural areas. Though it's difficult to generalize about a country as complex as India, there seems to be less stigma associated with serious mental illness here. Dr. Vatwani however, believes there is more stigma in urban areas than rural areas. Perhaps this is due to more easy access to Bollywood and Hollywood films that usually portray people with mental illness as psychotic killers.

Doc

Dr. Bharat Vatwani is the founder and guiding light of Shraddha. Starting in 1988 with a two-room tenement in Mumbai, Dr. Vatwani treated a few homeless mentally ill at a time. In 1997, the proceeds of an art exhibition of leading Indian artists and the contributions of several donors led to the opening of a 20 bed psychiatric facility in Mumbai. Unfortunately neighbors took Shraddha to court for housing "roadside, psychiatrically disturbing elements" that were perceived to be a threat to their community. In a landmark finding, the Mumbai High Court found that “mentally–ill, roadside destitutes are as much entitled to medical help as any physically indisposed person.”

In 2006, Dr. Vatwani was able to acquire 6.5 acres 90 kilometers southeast of Mumbai. The Karjat center provides a rehabilitation model that includes agriculture for up to 70 patients at a time. Over 1900 of the mentally ill homeless have been helped off the roads, treated, rehabilitated and reunited with their families throughout India.

In this clip Dr. Vatwani discusses how he was inspired to commit his life to serving homeless people with mental illness.

Reunion

Kamala returns home (photo used with permission).

Kamala's mother with grandchild.

The ultimate goal of Shraddha is reuniting patients recovered from schizophrenia with their families. Since 2006, over 1000 patients have been returned to their families. I've just returned from a road trip in Shraddha's ambulance through Maharashtra to northern Karnataka. I joined three social workers in reuniting three patients with their families. The last patient, Kamala, was a Banjara tribal woman who left her people seven years ago and was found psychotic on the streets of Mumbai three months ago by Shraddha social workers. In village after village around Aurad, the social workers asked Banjara people if they recognized Kamala or knew where to find her village. In the Banjara village of Bijalwadi Tanda, a woman called Kamala "Diwani" or Beloved, a common term in south India for those we call mentally ill. Deep in rural India down kilometers of brutal dirt track, we finally tracked down her home village of Nandi Bijalgau.

I was up front in the ambulance with social worker Vikram Shelar and driver Manaram Choudhary and had an excellent front row seat view of the extreme sport that is Indian driving. There were no seat belts. Glad we survived the road trip....