7(G). Denial of healthcare


The health of patients in psychiatric wards in Zambia is seriously compromised by poor hygiene facilities, inadequate diets and endemic violence and abuse. Even among healthcare professionals operating in psychiatric facilities, patients with mental health issues were stigmatised.

Mental health staff consistently referred to the lack of medical attention to their patients given by general medical staff. Monitors learned about a liaison process for patients in general hospital wards who showed signs of mental health issues to be seen by mental health staff and vice versa. This did not work in practice. Staff at mental health wards told monitors that consultation requests sent to general medical assistance went unanswered and healthcare needs of those on mental health wards also went unaddressed.

Deaths from denial of healthcare

On the wards at Kabwe and Chipata, staff told monitors about the death of two patients following denial of healthcare.

At Kabwe, a 30-year-old man reportedly died in August 2012 from a haemorrhage two weeks after being admitted to the hospital because doctors from the regular part of the hospital failed to attend to him, despite mental health staff requesting their assistance.

At Chipata, a 29-year-old man reportedly died from pneumonia four days after mental health staff requested a medical team to attend. They received no response from the medical team.

There was no investigation in either of these cases. Staff told monitors that deaths are only investigated when relatives request this.

Photo: A woman at Kabwe. Her burns were left unattended for three weeks, and then she was discharged, 24 October 2012. © MDAC.Photo: A woman at Kabwe. Her burns were left unattended for three weeks, and then she was discharged, 24 October 2012. © MDAC.

During a visit in October 2012, monitors saw a woman on the female ward at Kabwe who had suffered serious burns all over her neck and a large portion of her chest. The nurse said that she had been brought to the psychiatric unit the previous night by community volunteers who claimed to have found her in that state. She was taken to the psychiatric ward because she had a mental health consultation card. The day after, a consultation request was sent to the general hospital section to attend. Monitors called the psychiatric nurse a month later to find out what happened. She explained that no doctor had shown up to examine the woman, who was discharged after three weeks in the hospital. Monitors could not ascertain the state of the woman’s wounds upon discharge.

At Chainama Hills Hospital, monitors learned that the “F Ward” had a sick bay to treat patients who developed physical illnesses. The nurse told monitors, “our patients are being rejected from general hospital wards”. In the “B Ward”, a nurse informed monitors about a female patient who suffered from diarrhea and was sent to Levy Mwanawasa General Hospital for treatment. There, the healthcare staff asked Chainama staff to take her back to the psychiatric ward, “because she was touching things.”

Despite active cleaning regimes (especially at Chainama Hills Hospital), hygiene was observed to be very poor. Across the mental health units there were shared open showers and a lack of sinks and soap. Patients moved between beds and shared beds, matresses did not have sheets, toilets were broken and did not flush, and seclusion rooms lacked toilet facilities altogether.

A woman detained on the B ward at Chainama told monitors:

If the woman next to you has her period there’s blood on the ground in the shower, it’s not pleasant. I contacted TB on the ward. I’m HIV positive.

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