The invisible ones

In June 2010 I first saw a young lady wandering the streets.  She would dance and sing, or tease passersby, or snatch at someone.  Often they would chase her away, kick at her or throw something at her.  I was told she was crazy, and no other explanation was given.  No one seemed to be concerned about getting her help.  I was told her name is Fana. 


She begged for her food and found someplace on the streets to sleep at night.  I started taking some food with me as I was walking and when I would see her I would give her some.  I worked with a friend to offer her a room in his compound that would provide shelter, toilet and shower.  She did not agree to go there. 


Trying to find help for her I was told she has a 6 year old daughter that had been given to an orphanage.  She said she was 14 and had gone through the 3rd grade, but she is probably somewhere between 18 and 29. I had to talk to her through an interpreter.  The interpreter says she is very confused.  I had been told she is retarded.  The symptoms I see are more like mental illness than retardation though.


I talked to the town administration about getting her help.  They tried to find a relative that would help her, but were not successful.  We subsequently were told her parents were dead and a sister lives in a rural area but is too poor to help. The town administration said that we could take her to the only mental hospital in the country in Addis Ababa, even if she didn't agree to go.  She indicated she does not trust doctors and only wanted to use holy water, wanting to go to a "religious spa" that will cure her.


While working on paper work to get her into the mental hospital, we settled into a routine of getting her food and getting her off the streets at night.  The only person she seemed to trust was Ismail, who has a bike repair shop on the main street.  Fana typically spent much of her days sitting somewhere around Ismail’s bike repair shop, or walking around the town.  He had been the only friend she’d had until I started helping.  She obeyed him.


At about 8:30 in the evening Ismail biked around town until he found her.  He brought her to a room where we had her stay for the night.  We helped her wash her head and put anti-fungal ointment on her head, we shaved her head to help with this.  We then gave her the anti-depressant medicine the hospital had given us and some food.   Ismail then lay in the room with her until she fell asleep.  We locked the door.  She woke up around 5:30 in the morning knocked on the door to be let out, or climbed out a window, or forced the door open,  and started walking the streets.  About 8 AM I usually found her at Ismail’s, he would have just gotten to work, where she might have something to eat.  I took her back to the room, helped wash her hair, put ointment on her head again (she had to do this for 4 weeks!), and gave her the anti-depressant pill.  She then went back to wandering the streets


At noon I went to Ismail’s when Fana was there and bought her some lunch from a restaurant next door.  She called me her father and mother. Some days she would be very active and it was difficult to get her to settle down.  She would look at me and said "Father is worried!"  Most of the time she did not make a lot of sense.  The medication significantly reduced her aggressiveness toward others. For several days I had not seen her throw things or make nasty comments or try to hit anyone.  She still talked (nonsense) to herself most of the time.


When we had the papers we thought were necessary to get her admitted to the mental hospital, I contracted a minibus to take her, Ismail and a policeman friend to Addis Ababa.  We did not know how she would react to being taken to Addis so we did not want to risk fighting with her on a public bus. 


Our first effort to get her into the hospital was not successful, probably because it was a weekend, but we were told that there was no bed available.  We tried to find a room in Addis to stay the night but Fana became very agitated when she saw several men in the room we were trying to get her to stay in. (We thought she had been raped in the past, which was later confirmed by the hospital, and that fear of being raped was what agitated her.)  We decided to take her back home that night and try again when we knew a bed was available.  The hospital was to call me when a bed was available.


After a week of waiting for a hospital call, I worked with some friends in Addis Ababa who had contacts at the hospital and was told there were beds available. In spite of not hearing from the hospital, we took Fana to Addis again, this time in a public mini bus since she seemed to travel okay the last time.  This time I was finally able to get Fana into the only mental hospital in Ethiopia and reportedly the best mental hospital in East Africa.  In spite of that, I felt like I was leaving her at the hospital in "One Flew Over the Cuckoo’s Nest".


Her ward had twenty beds for women, mostly all occupied.  She was at the far end away from the door and under a window which was nice.  Two ladies started talking to us as soon as we got to the ward.  They both spoke decent English and one didn't have any obvious reason to be in the hospital, (but she was still there when Fana was realeased).  The other one sang songs to us, in English, with saliva dripping from her lower lip the entire time and when she found some leaves she stuck them in her nostrils and had them "growing" out of her nose!   A third women would march up and down the walk way like a Sherman tank, (a characterization based on her physique and mannerisms), chanting something to a military march beat and every few steps would spurt some water out of her mouth.  She would make a couple passes, and then go get some more water!  These were three of the more "entertaining" cohabitants.


Fana seemed somewhat amused/bemused by all this on that first day.  The next day she gave me a huge hug when I arrived and held my hand all the time I was there.  She begged me to take her back to Finote Selam.  After having previously said she wanted to go to Addis to get well.  She had difficulty adjusting to the change and other days was sleeping heavily when I arrived, due to medication they had given her to settle her down.


The hospital expected someone, from the family or a friend, to stay with the patient, particularly the first few days to help the patient adjust and make sure the patient is taking their medication and get anything necessary for the patient.  The hospital is not staffed with aides to be able to provide much individual service outside their treatments.    A lady was available that provides the individual support, (to several patients) at a fee, (which is more than the cost of the hospital stay, but still inexpensive by American standards), so I hired her for the first month. 


I still did not have the correct papers to get free treatment for Fana, but the hospital administration talked to the Finote Salem town administration and the correct papers were prepared, however the papers required three signatures and those wouldn’t be available until the next week.  I stayed in Addis Ababa until the papers were faxed to me and I made sure the hospital had everything they needed.  If they had been mailed to the hospital I doubt they would have gotten to the correct people.


Until the "free" papers were delivered, the hospital required payment for laboratory work.  I "deposited" some money with the lady that is being paid to watch Fana and she made sure the hospital continued with the lab work.  I also gave money to the care provider for tea and coffee for which the patients must pay.   If Fana needed more than 30 to 40 days treatment, the hospital would require more money to continue the treatment, if she does not get the "free" papers.


During the next six weeks, I visited Fana in the hospital twice before I got the call that she could be released. It was difficult to see her there, she clung to me each time I visited and begged to be taken home.  I looked for other alternatives, but there were none.  There is no "safety net" in this country for people that have serious problems but no resources.  It is a very poor country with many needy people.  I am ever thankful I was born in the USA.


The bits and pieces we have been able to discover about her past is that she was probably an “indentured” servant to a family here in Finote Selam, probably at a very early age. She did not appear to be able to go to school during this period.  She later went to work for a family in Debrae Zeyit.  She did start school while there, but the son of the family got her pregnant before she finished the third grade and she was kicked out of the home.  She never went back to school and apparently started a life of living on the street at that time.


After getting the call that Fana could be released, I struggled through late busses and delays in getting Fana released from the mental hospital but finally arrived back in Finote Selam mid morning with Fana.  Leaving at 1:30 in the morning and arriving at 10 AM.


Ismail, the man that had been about the only person that helped her in the past had a celebration waiting for us when we arrived.   The town's news media came and interviewed us.  Most people were amazed she could be made "normal".  It is the first time for this town.  I'm hoping it will lead to the town taking actions to help other mentally disturbed street people. I think Fana was a bit overwhelmed by the attention.  When she was last there she was being chased away by people, now they were interviewing her and asking how she was.  We were also both tired from the early morning drive. Probably the nicest thing I heard that day was "Keith taught us how to love!"


I won't feel we have succeeded until Fana is a productive part of the community.  While looking for a job or a way for her to earn income, I am paying her to cook my meals.  But that is only temporary; she must have something sustainable for when I leave.


Fana has been recovering very well emotionally.  However, she was diagnosed as HIV positive, probably from being raped while on the streets, but maybe from the man who impregnated her. Her treatment for HIV/AIDS has been hard on her.  The first couple of months are hard on the body because the immune system is challenged by the medications.  After that the body seems to adjust to the medication and the patient improves.


She developed a very bad infection on her head that needed serious antibiotics to heal.  She didn’t complain even though, when asked, she admits that she had a headache.  I can't image that she felt very well with the size of the sore and her face being very swollen.  She slept a lot and did not ask for anything so we had to keep monitoring her needs for food and support.  She is such a gentle, unassuming young lady.  She has a wonderful smile when I bring her food or help her.


When the head infection was finally under control, I took her for her two month follow up from her mental hospital stay. We went to the hospital in Bahir Dar, which is much closer than Addis Ababa, but only has a Psychiatric Nurse, not a large staff for mental patients. She is doing very well.  The sore on her head is now a large scab.  The nurse asked if she had seen a dermatologist and indicated she would have us see one when we come back in two months!!!  Two months???  She is seeing medical staff in Finote Selam for this so I didn't worry about it!


There is a large lake, (Tana) near Bahir Dar, supposedly the head of the Blue Nile River.  Fana had never been on it so I treated her to a boat ride!  We went to a monastery and saw pelicans and hippos.


She is a joy!!!  The town/community continues to be amazed that this "crazy" person is normal. The community has supported us and we have succeeded in getting another mentally ill woman into the hospital.  I'm hoping that Zodi, the other "crazy" lady currently in the mental hospital in Addis does as well as Fana has.  I also hope the community will continue to help “crazy” people obtain treatment.


We are working on getting Fana some “Life Skills training” that will include building self esteem and assertiveness.  We also are working on getting her job skills training, as well as determining if she can continue her school education.

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“Sunset at the Railroad” by PCV Nicholas Baylor Hall. Namibia, 2011.