Transcending artificial barriers

First in Asia- Mother and Baby Unit at Mental Health Hospital at Angoda:

"It's not the large things that send a man to the madhouse... no, it's the continuing series of small tragedies... not the death of his love but the shoelace that snaps with no time left." - Charles Bukowski

by Rosanne Koelmyer Anderson and Ranga Chandrarathne

Once a condition with grim hope, shun by family and society ,discarded and unknown by the outside world, amidst trauma and their silent struggle for survival were the inmates of the Mental Hospital, Angoda but today incredibly mentally uplifted, no longer doomed for life; a totally changed scenario, an inconceivable experience, a change for the better by Consultant Psychiatrist, Dr. Jayan Mendis.

Another first in Asia, brainchild of Dr. Mendis is the Mother and Baby Care Unit at the Angoda Hospital to add to his credibility in the field of mental health in Sri Lanka.

The unit was set up four months ago as a prerequisite of child psychology to fulfill bonding between mother and baby as well as reuniting the disintegrated family, a 4.5 million project funded by a well-wisher, T.M. Soysa.

The eight bedded Unit is well equipped with eight separate units comprising two beds, a cot, cupboard and an attached bathroom, an immaculately hygienic and environmentally friendly unit which houses the infant, mother and the by stander for a year after childbirth.

Priority is given to mothers with metal illnesses after childbirth as psychiatric illnesses after childbirth is ten times higher than in other circumstances while pregnant mothers in such conditions are also accommodated Dr Mendis explained.

Incredibly mentally uplifting the status of the inmates the Unit has around eight visiting psychiatrists, interview rooms, a baby room and a specially trained nurses' station which tells the onlooker a story that "there is so much good in most of us", the commitment to serve the traumatised is well perceived.

Dr. Mendis explained that the initiative of setting up such a unit has proved a success as the recovery rate of patients has been tremendously commendable with the environmental factor playing a contributory role. We are able to discharge patients sooner as a result and they return to their normal lifestyles and are reunited with their families sooner or later.

However, there are more priorities to be ironed out subsequently such as the necessity to have a community team to visit and monitor the progress of the patient for at least a year after they return home.

It is interesting to note that over the past decade, there has been increasing attention towards the identification and management of mood and anxiety disorders related to childbearing with physicians, psychiatrists, primary care providers, obstetricians, gynecologists, and pediatricians, encountering women struggling with mental health issues during pregnancy, pregnancy loss and after childbirth.

In some cases, the reproductive event itself may precipitate a mental health crisis while in others, it may exacerbate an underlying mental health condition that, in turn, may need to be managed differently because of issues related to pregnancy or breast-feeding.

"The bottom line message is: 'Mothers who are depressed, go get treated for your depression. It will help not only you, but your child". The rate of depression is higher in women than in men, particularly in women of childbearing ages."

A mother's depression does affect her sibbling," A parent's depression not only has a strong impact on the family as a whole, but it often affects a child's functioning. This raises the need for parents to seek treatment for their depression."

Mental illnesses such as depression and anxiety are brain-based, biological illnesses. They can be triggered by traumatic experiences or tragedy and/or by genetic predisposition.

Since the brain is such a complex organ, there are a number of genes involved in its development and thus a number of generic causes of mental retardation while 60 per cent are of severe mental retardation. In order for a genetic condition to be inherited, the disease-causing gene must be present within one of the parent's genetic code.

Some types of mental illness are genetically transmitted which are associated with mental retardation, chronic health problems and developmental delay.

Mental retardation is attributable to any condition that impairs development of the brain before birth, during birth or in the childhood years. Two of the most common genetically transmitted forms of mental retardation include Down syndrome (a chromosomal disorder) and fragile X syndrome (a single-gene disorder).

When we are physically healthy, emotionally resilient and have positive family and social relationships, we are in the best position to be mentally healthy, says Dr Jayan Mendis.

Before the setting up of the Unit, the standard practice with regard to handling mother who have developed post-pregnancy psychiatric disorders was to separate the baby from the mother and to send the baby to the Lady Ridgeway Children's hospital, allowing the mother to visit the child from time to time.

The father was sent home, putting a full stop to the otherwise longstanding marriage, unfortunately, with the child birth.

The hapless situation led to the exploitation by people seeking babies for adoption. There were instances where sick mother's consent was obtained for such unscrupulous adoptions.

It was pathetic scene that sick mothers wetted their cloths with milk as they had no way of feeding their children who had been separated and were under the care of Lady Ridgeway hospital.

The idea of the Mother Baby Unit was not only set up to keep the mother and baby together but also to help unite the family. This was made possible by T.M. Soyza, a prospective philonthropist who donated 4.5 million for the eight- bedded construction of this fully-fledged Unit.

Another important aspect of the unite is that it will dramatically improve the care provided to the mother who are suffering from post-pregnancy psychiatric disorders as managing of these patients will be different from ordinary patients.

Unit has facilities for each family to stay in a homely environment which betrayed no sense of being admitted in a hospital. The process has speeded up recovery rate while cementing the natural bond between mother and child and also the unity of the family.

Currently the Unit boasts of a dedicated medical team including five nurses and a doctor in addition to visiting psychiatrists.

What is needed at the moment to improve the quality of care for mothers who have developed post-pregnancy disorder is a community team to look after these mothers up to a period of one year from the child birth before being handed them over to, for other psychiatric treatments. For after treatment care and progress evaluation, the hospital requires a vehicle.

The unit is not only a boost to the excellent care provided by the hospital but also adds another dimension to Sri Lankan system of hospitals and perhaps for the first time in Asia.

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