The history of Africa’s oldest psychiatric hospital is written on the walls of its isolation units, desperate messages chiselled into the woodwork like scars. “I came here for I don’t have any money,” reads one note in a corner of the room. “People want me to run from my father’s house,” reads another. “You go nowhere,” announces a third. “Stay out.”
Since the hospital opened in the early 19th century, most Sierra Leoneans have aspired to do exactly that, avoiding this imposing building perched high on a hill above the capital, Freetown.
Still the country’s only mental healthcare facility, the Sierra Leone psychiatric hospital is known in the local Krio language as the “crase yard” or “place for crazy people”. During the civil war in the 1990s, rebel fighters got as far as the staff quarters before turning back, too afraid of what they might find inside, witnesses say.
When the world’s worst Ebola outbreak began there two years ago, Sierra Leone had just 136 doctors working in the public sector, according to the World Health Organisation, a massive shortfall for a population of 6 million.
There was only one psychiatrist: Edward Nahim, a wry, Soviet-trained 70-year-old who spent his mornings scribbling prescriptions in the foyer of the hospital, where many patients were kept chained and treatment consisted of little more than a daily dose of expired antipsychotic drugs. Electricity flickered and rusting buckets served as makeshift toilets on the days the pipes ran dry, which was most of the time.
The mental health toll that Ebola exacted – depression, anxiety and post-traumatic stress disorder – was massive. But the hospital’s fearsome reputation meant few of those affected considered looking there for support. In the early days of the outbreak, many people considered hospitals to be dumping grounds for the dying or, worse, the places that had made them sick.
Those suffering from the virus’s psychological side-effects viewed the psychiatric facility in a similarly negative light.
“Because we have so few professional resources, people are used to understanding mental illness in their own way and most would never even think of coming to a hospital for psychiatric treatment,” says Stephen Sevalie, who this year became the country’s second psychiatrist, working for the Sierra Leone armed forces.