“There is a belief in Zambia that if you are HIV positive and you sleep with a mad person, you will be cleansed of the infection, ” said Nurse Zulu. “That is why three quarters of the mad people are HIV positive.”
Living with severe enduring mental illness in developing countries is bad enough even without HIV infection. But suffering from both is a toxic mixture. You need to be fairly stable in order to comply with anti-HIV drug treatment and to attend clinic appointments at the correct time. Unfortunately, we have no anti-psychotic medication at the clinic. The patients who need it don’t have the means to travel two hours by bus to get drugs from Chipata Hospital. There is a national psychiatric hospital in Lusaka called Chainama, where hundreds of in-patients live inside a wire fence. According to Nurse Zulu, some live inside a cage. The patients are segregated according to how violent they are.
People with severe mental illness exist on scraps and leftovers, sleeping in doorways or wherever they can find shelter. Villagers provide community care when they can, tolerating bizarre, disruptive behaviour until a line is crossed and the police intervene. The police treat all lawbreakers equally and make no allowance for mitigating circumstances unless there is an official certificate from Chainama stating that the person is mentally ill and not responsible for their behaviour.
When I arrived at the clinic, our reception clerk informed me that a mentally ill pregnant patient had delivered a baby in among the empty market stalls overnight. “You should have sent her to Chipata, doctor,” said Daillies. “Everyone was watching the baby come out, even small children.” Perhaps I should have tried, but I have no legal powers to force her to go to hospital. The baby girl was tiny, just 1.8kg, born at least six weeks prematurely. Her mother did not seem interested at all, and paid the baby no attention.
Some local women rallied around and were offering to provide foster care, as clearly, the mother was in no fit state to look after the child. They were discussing how to feed the child. I asked about any woman whose baby might have recently died, a wet nurse, but there were none. Two of the women who were willing to help both flopped a breast out but could not express any milk. Daillies grabbed hold of the mother’s breasts and squeezed but unsurprisingly, there was no milk, just colostrum. “Baby will need formula milk,” she said.
I contacted a doctor at Kamoto about a referral to social services and he told me that both mother and baby should pass on to Chipata Hospital. I wrote out the referral, but another visiting doctor took a more practical approach, saying that it would take weeks for social services to respond. He suggested we make local arrangements to care for the baby here in Kakumbi. One of the women said that there was no baby milk formula in Chipata Hospital and the baby could starve. We did manage to obtain some prophylactic treatment against HIV for the baby. One matronly woman agreed to take on the role of foster mother to look after the child.
Two compassionate expatriate ladies offered to help with all the accoutrements needed for a new baby, feeding bottles, baby grows, nappies, blankets, formula, bucket for bathing, etc. One even provided some food for the mother, who has no visible means of support. We will wait until we are contacted by social services to decide what further action is needed.
“But the baby doesn’t have a name,” said one woman.
“What about calling her Marketina, because she was born in the market?” suggested another. This reminded me of a newspaper report in Swaziland of a baby born while the mother was in a supermarket. That baby was named “ShopRite”.
“And what about her second name? Doc Ian, what is your second name?”
I politely declined, saying that it should be an African name. There is already a woman, now aged 32, with the unfortunate name “Docta Cross”, who was born in the Gambian village of Galleh Manda when I was Regional Medical Officer. But that’s another story.
I think it would be better to give the child a traditional name meaning “Blessings” or “gift from God”.