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DOMINICAN REPUBLIC: Managing Mental Illness on a Few Pesos a Month

Elizabeth Roebling

SANTO DOMINGO, Mar 22 2011 (IPS) - Cristina, 41, was able to support the last two of her five children despite the fact that she could neither read nor write. Raised by a step-grandfather, she started working as a house cleaner when she was 14 and had the misfortune to have children by two alcoholic and abusive men.

Her third child, Juan, was diagnosed early on with a heart valve problem and mental retardation. At 15, he was only in first grade.

“The teacher just kept him in class as a favour to me, so that I could keep working. He was not learning anything. He cannot read or write,” Cristina told IPS, asking that her last name not be used.

On the advice of a neighbour, Cristina started selling avocados three years ago, buying 100 fruits a day where she lived and taking them, in a washtub, on the four buses for her 45-minute commute to and from the capital, Santo Domingo.

She found a sidewalk space in an upscale neighbourhood. Despite the fact that her avocados cost 10 to 15 pesos (30 to 45 cents) more than the ones on sale in the supermarket, she usually managed to sell the bulk of them as she could easily pick out ones that were ripe for eating the same day and the day after.

She just managed to pay for her transport, food and rent. She was enrolled in the government Solidarity programme, which gives about one million of the poorest people in this country of 10 million a 700- peso (20-dollar) a month stipend for rice and beans and oil, and one free tank of cooking gas every two months valued at about 15 dollars per month.

But eight months ago, Juan started getting aggressive with the other children and the teacher sent him home, saying she could not keep him in class. He fought with his mother as well and would hit and bite her and throw things.

Cristina took him to the local public hospital near her home. There, a psychiatrist diagnosed Juan as having had a psychotic break and put him on several psychiatric medications, including haloperidol and carbamazepine. Calmed by the medications, Juan stayed with a neighbour while Cristina went to work.

The Dominican Republic has a system of subsidised pharmacies where the generic forms of most common drugs are offered for sale at discount prices. But psychiatric medicines are only available at designated hospitals. The hospital where Cristina took her son never had them available.

According to a report by the World Health Organisation, less than 20 percent of the state medical facilities have psychiatric medications available.

The report also noted that only three percent of medical education here concerned mental health, with only 12 percent of graduating doctors receiving more than two days of such education. There are just two psychiatrists for each 100,000 Dominicans. Of these, 68 percent work in the private sector.

For two months, Cristina could afford the generics. But then her son became dizzy and nauseous, and the doctor insisted that she had to buy the brand names. Those cost over 35 dollars a month, a price beyond her reach.

Cristina sold her stove and gas tank in order to buy the medicines. She took to cutting down trees near the one-room house that she rents and cooking with that outside the house. It is strictly illegal to cut trees without a permit.

In December, she sold her Solidarity card to a neighbour who gave her 175 dollars for it with the stipulation that he would keep it and use it for a year. This too, she knew, was illegal.

Despite the fact that an estimated 10 percent of the population is affected by mental illness, there is only one psychiatric hospital in the country. It receives half of the annual government budget for mental health – which is less than one percent of the total health budget of the country.

The hospital has been the subject of many articles in the press over the years, deploring its physical deterioration and the fact the patients are sometimes forcibly restrained and left in the nude.

Of the 125 patients, 58 have been abandoned by their families and have been there for up to 25 years. Every week, two or three new patients arrive. The majority stay for 10 days.

Cristina finally received help from one of her customers who called the director of mental health on her behalf. After explaining the situation to Angelina Sosa, a psychologist, she was told to bring Cristina and all the papers on the diagnosis and medications to their office.

“We have programmes to help you,” said Dr. Jose Mieses, director of mental health, giving Cristina a month’s supply of the needed drugs. “We will make sure that you get the medications. And we will introduce you to other mothers who have children like yours. There is help available for you in your business.”

Asked why the local doctor had not told Cristina of these programmes, Sosa explained: “That doctor may have to see 25 patients a day. We are trying to empower the families of the mentally ill to band together. We have some local programmes for the care of the ill. But it is difficult for the local doctors to do everything.

“It is not our job here to see patients, we deal with policy and programmes,” she added. “We took this only because it was a special case.”

Sosa promised that she would investigate placing the boy in a care centre near his home, if a 15-year-old would be eligible for that centre.

The next day, Cristina returned alone to the office and was given a cheque for 2,000 pesos (54 dollars) for her business and assured that the medications would be available to her at no cost every month.

Compared to countless other poor and working families with a member suffering from mental illness, Cristina’s case had a relatively happy outcome.

But she never did get any information on the promised aid programmes – no day centre, no training, no introduction to other mothers.

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