It’s been a year since I made my way down these crowded streets and I am on full sensory alert. This small window in time, before the novelty wears away, lets me view my hometown through the eyes of a tourist.
The effortless rain slickens the grimy pavement, reminding me of the rainy season that never came to Zimbabwe this year, disappointing millions of subsistence farmers. I am on Canal Street in Chinatown, New York, holding on to memories of "Chikurubi Maximum" and trying to gauge its imprints left on me.
Twelve months ago I left to work as a psychiatrist in MSF’s unique prison project in Harare. It was established to address an oxymoronic chronic emergency rather than the acute type which is more the norm. In 2012, following intervention in a cholera outbreak at the prison, MSF established a team to support and strengthen the inadequate services that were in place in the psychiatric section of the prison.
Overcrowding, lice infestation, a limited array of medication choices, medication supply ruptures, and the lack of collateral history for patients’ stories are just some of the challenges to delivering optimal care in this setting. Difficulty distinguishing traditional cultural beliefs from psychiatric symptoms and the language barriers were challenges I, and presumably, my three MSF expat predecessors, grappled with. Despite these obstacles, many strides have been made and before long, MSF will hand this project back to the original staff.
An estimated one thousand patients have benefited from the presence and persistence of a skilled and dedicated MSF team comprised of, in addition to the expat psychiatrist, national staff occupational therapists, psychologists, mental health nurses, a social worker, and two indispensable drivers. The biggest challenge now is assuring that gains, especially the high standard of psychiatric care despite the constraints, are sustained long after the handover is done.
This most meaningful of years has given me the opportunity to confirm again that the relationship, rooted in trust, between doctor and patient is the foundation upon which healing takes place. Medications have an indispensable role in the therapeutic quiver, but it is the bond between doctor and patient that is the sine qua non, the without which not, of good psychiatric care. This is highlighted in resource poor environments where that intangible can abound regardless of supply shortages.
Now, sitting in a noodle shop on Mott Street, my mind is a split screen. On one side are the moving pictures of my patients in their worn and tattered uniforms, accused, but not convicted, of crimes both petty and heinous. On the other, the colorful rain soaked live theater outside the steamed up window here in Chinatown. Pieces of me are back there, in the dusty yard where the patients while away their days gabbing, performing chores such as gardening and tending to the fluffy rabbits in hutches, or just hanging out in the golden sun rays under a cartoon blue sky. They are here with me, in the memories of revealing encounters that underscore the commonalities we all share, by virtue of our human genome, that allow for invisible connections between a psychiatrist from New York and a psychiatric patient in Chikurubi Maximum, Harare, Zimbabwe.