Hidden in earthquake debris, a Himalayan mental wreckage

KATHMANDU: A girl, perhaps in her early 20s, sits in front of Dr Ramnath Singh at the Vayodha hospital in Kathmandu's Balkhu area. Her eyes are red, the corners scraggy, belying her youth. She hasn't slept for about 160 hours ever since the day the quake struck Nepal on April 25, and has been fidgeting continuously.
"She's suffering from severe psychological trauma," Dr Singh, a surgeon who earlier headed the Nepal Police Hospital, told TOI on Saturday."She hasn't closed her eyes for a minute; it's been a week now.This is the other disaster Nepal will have to cope with." Across the country, thousands are exhibiting signs of acute psychosis, deep depression, grave adjustment disorders, panic attacks and what psychiatrists club under post-traumatic stress disorder (PTSD).
It's a growing emergency that doctors and psychiatrists in disaster-hit Nepal are putting their heads together to deal with, a problem many of them said the health infrastructure here is unprepared to tackle. All of Nepal has one dedicated government mental health hospital. In its 24 hospitals it has a unit each to treat psychological disorders. That's hardly enough for the hordes of patients who'd need help.
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Singh puts the number of people needing "immediate psychological intervention" at about 25,000. But this could be a conservative estimate.PTSD symptoms are more apparent after about six weeks of a calamity, and doctors are bracing for the worst.
At the Patan Academy of Health Sciences, Dr Rabi Shakya, vice-president, Psychiatrists' Association of Nepal, said about 30 new patients are streaming in for treatment every day. "Ten had to be admitted," added the AIIMS, New Delhi, alumnus. "What I've been seeing is shocking. We're in for the long haul."
Shakya said many complain that the tremor has "gone inside their bodies". He spoke of a woman who's been so distressed by the temblor that she can't bear to be near passing cars. "That small vibration sends her into spasms," he said.
Singh and Shakya said hal lucination is so common that it's everywhere — in refugee camps, among survivors and volunteers. Some volunteers returned from an affected area so shaken that a few had to be given anti-depressants.
"They'd seen so many severed bodies, such bereavement that they came back with their own problems," Shakya said."Existing mental illnesses have been aggravated. We're getting people with suicidal tendencies, people who've lost families and think they've no reason to live. Adjustment disorders where people have begun smoking or drinkng ex cessively have become fairly common. It's a nightmare."
Shrinks in Kathmandu said in a tragedy of this scale, about 30% of the affected need psychological help, a figure attested by Rangaswamy Srinivasa Murthy, professor of psychiatry at India's Nimhans, in a paper about the 2001 Gujarat quake. A UN report says the Nepal quake has left 8 million affected in various forms and degrees.
Doctors said Nepal is neither ready nor does it have expertise and infrastructure to handle a mental health crisis of this order. "We don't have the capacity," Singh said.
For now, they only want the girl from Hanuman Dhoka to sleep.