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The most disturbing part of my volunteer placement was seeing first hand the stigma that faces patients with mental illness. We are only just beginning to overcome this in Australia, so it is unreasonable to expect any difference in Nepal (their health care system, in my rudimentary assessment, is some 30 years behind ours).

A 30 year old woman who had suffered depression for fifteen years came in to see me. She was chronically suicidal, and the tragedy was that she was not even on antidepressants. I suspect she can’t afford to pay for them, but I never quite found out why. She lived at home and was constantly being abused verbally (and possibly physically) by her family. There was little I could do for her except for to prescribe her some B complex syrup, in the hope that this helped her mood. My interpreter seemed quite keen on getting her out of the room as quickly as possible. Later, she admitted that she was “afraid of mental patients” because once she had “seen a madman and he had a brick in his hand”. This is a well-educated young woman we are talking about as well. She didn’t even understand that being “mad” was quite different to being depressed, and told me quite authoritatively that “there are no medicines to treat depression here”.

Later, a young man came in with epilepsy. He had seizures twice a month, said my interpreter, and she was under the impression that these coincided with the full moon and the new moon. “It is often the way with epilepsy”, she said. She told me that he had gone to the “mental hospital” to receive treatment for his epilepsy, and when I asked why (I would have sent a patient to a neurologist) she told me “It’s because epilepsy is a mental problem”.

These patients have nothing. They have no family support, as they are shunned by society and their family is greatly ashamed of them. They have little or no access to counseling or psychological treatment. They don’t even have access to proper psychiatric care. They languish as pariahs and have no future. The suicide rate is high here. What I saw was tragic and I felt completely impotent in my inability to help.