Mental health crisis in Pakistan

Long Shadows
By Murad Moosa Khan

'When small men cast long shadows, the sun is going down.'
Venita Cravens

On the way to the Hawkes Bay and Sandspit beaches is the village of Grax. Many of us stop here to buy cold drinks and other eatables from the small cabins present on either side of the road. As part of the Community Mental Health programme of my university we used to hold a mental health clinic here every month.

Although by katchi abadi standards, Grax is better than many others, the village has many social, physical and civic deprivations. During one of our visits, the community health worker expressed concern about a girl who appeared 'mentally disturbed'. She lived about a mile from the centre. We went to visit her at her house.

A small cordoned-off area with two small rooms, a small area for the kitchen and a toilet with open drains constituted the 'house' of 75 square yards, perhaps a little more. The father of the girl was unemployed, the elder brother suffering from some sort of 'mental imbalance'. A number of semi-clad children were milling about — presumably brothers and sisters. Their only source of income was a buffalo.

The health worker was right. The girl did appear unwell, "for the past three years," her mother told us, "since the birth of her son". He died a month after being born. The girl talked to imaginary voices, was frightened of others, and laughed to herself. She had run out of the house many times. Unable to afford medicines or have her treated on a regular basis, the family kept her tied to a tree. The result: badly infected wounds with pus and blood oozing out from both ankles.

Long abandoned by her husband — older than her by many years — she now lay on straw matting in the corner of one of the two small rooms, oblivious to her surroundings. She appeared not to have had a wash in weeks. I tried to engage her in conversation but she looked past me, and I was unable to penetrate her secret world. I asked the mother the girl's age. "Fifteen..., " she said; the words echoed in my ears.

While we read about the fabulous growth rate of seven per cent and higher, the Karachi Stock Market making a record 14,000 points, a Porsche showroom opening in Lahore and of the economic 'miracle' that is today's Pakistan, the picture on the ground tells a different story. The story of the girl I related above is illustrative of the lives of millions of Pakistanis today.

Officially, a third of us live below the poverty line. Another quarter probably lives just above it. That makes more than half of 165 million living in poverty. That is a very large number of people. We have become a country of marginalised and disenfranchised people ruled by a small but powerful group of people who have concentrated wealth and power around themselves.

The contradictions in our country are simply astounding. We are a nuclear power but cannot pick the garbage off our streets. We have one of the largest standing military forces in the world, yet cannot provide security to our own people. A report in this newspaper a few weeks ago informed us that Rs65m were spent on the medical treatment of 18 government 'bigwigs'. Yet there are villages in Punjab where every other man is carrying a scar in the lumbar area, because he has had to sell his kidney to pay off his debts.

We have one of the highest rates of child mortality, hepatitis, rabies, depression and cardiovascular diseases. More than 30,000 women die in childbirth and more than 6,000 people commit suicide every year. Millions of our countrymen, women and children are deprived of basic necessities like clean drinking water, housing, education and healthcare. They have no recourse to justice. They have no rights.

This, sadly, is 21st century Pakistan. While many nations of the world move in an upward direction, for every step we take forward we take two back. Underlying all our problems is a serious crisis of governance. Today, corruption in Pakistan is not only institutionalised, it is, more worryingly, internalised as well.

We have no qualms about not paying our taxes or jumping the traffic signal, or asking for bribes. Lying, cheating, cutting corners, trampling on the rights of others, breaking the law and having no remorse afterwards, and corruption have now become part of our national and collective psyche and accepted norms.

This is not only obscene but unethical and immoral. It is immoral to let young mothers die in childbirth as it is not to provide clean drinking water to every household. It is unethical to force people to sell their body parts to pay off debts, as it is to not deal with social conditions that cause people to commit suicide. And it is obscene to buy yet another Lear jet or another tinted glass Mercedes for the use of ministers while hundreds and thousands live in abject poverty.

Is there a way out of this morass? Can the sinking ship of this country be saved? Can something be done to help the young girl in Grax and countless thousands who are suffering in silence like her? Yes, it can and must be. We need to declare an emergency in the education and health sector.

We need to do away with the corrupt feudal system. We need to have respect for the law. And all our processes must be strongly anchored in integrity. Nepotism, favouritism and cronyism should attract the heaviest punishment as should corruption in any form, shape or size. We have no time to lose.

This country was bequeathed by the Quaid to honest, hardworking, law-abiding and decent Pakistanis, and not to the crooked and corrupt who trample on our rights, who have no respect for the law and are a law unto themselves.

Pakistanis deserve better than this. All we want is to live a decent and peaceful life, where our life and property are safe, where our children can go to proper schools, and if they fall sick, receive good medical care. Surely, that is not asking for too much?

Let not the long shadows of small men be cast upon us. Let not the sun go down on this beautiful country that has immense natural and human resources. We have to reclaim it from the corrupt and the crooked. The time to stand on the sidelines for us has long past. We are paying the price of our own impassiveness. We have to raise our collective voice, whether we are doctors or engineers or teachers or lawyers or housewives or students or shopkeepers or businessmen. We have to follow the immortal words of Pablo Neruda who said, "Rise up with me — against the organisation of misery".

The writer is professor of psychiatry at Aga Khan University, Karachi.

muradmk@gmail. com