Manual Serving the Insane : True Stories from the Diary of a Psychiatric Nurse

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Soon after the tsunami, the Indonesian military, with the help of foreign and local aid workers, cleared the bodies from the coastal areas. In one site in Banda Aceh alone, 45, bodies were placed in a mass grave site the size of a football field. This unceremonious burial disturbed many. To facilitate the mourning process, we landscaped the area together with the locals in the spirit of gotong royong working together for a common cause and built a large structure over it that would serve as a place of contemplation and to perform tahlil prayers.

Such small gestures meant a lot to the grieving survivors. Six months later, I was asked to return to my job as a psychiatrist in Hospital Kuala Lumpur. I pleaded for an extension of one more year to complete my work in Aceh. The then Director General of Health graciously agreed to the request but reminded me that I would have to return and serve my own country after the extension.

Six months became one year and the recovery process in Aceh had only just begun. People were slowly moving into new houses or their old homes which were repaired or rebuilt. The aftershocks continued to be a source of great worry. Every day, I slept in my work clothes with my passport and some US dollars in my pocket, fearing that I would have to run in case of another earthquake. True enough, in the early hours of an otherwise quiet and salubrious morning in the surroundings of a padi field, I felt my bed shake violently and heard window panes shattering.

I ran down from the first-floor bedroom when I heard concrete collapsing behind me. I turned back to see that the whole staircase had crumbled into a pile of bricks. I ran out of the house unscathed except for some minor bruises but soon after that traumatising incident, I was faced with a dilemma. Should I just quit and go back to the safety of Malaysia where such dramatic scenes are only seen in the movies?

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Or should I continue and just hope for the best? After three days of vacillating I decided to stay and fulfil my promise to the Aceh Provincial Health Office that I would help in the recovery process. Soon, my 18 months in Aceh passed. There was certainly a lot of improvement and the survivors went about their lives, demonstrating a resilience that surprised many, including the World Health Organisation which had predicted a longer recovery period. Yet there was still much to be done. Aceh had no mental health services except for the sole mental hospital in the capital of Banda Aceh, catering for a population of 4.

At any given time, the occupancy in the bed hospital was close to double its capacity. Mental health service was mainly custodial in nature but the tsunami opened up the minds of the otherwise rigid bureaucracy and political structure. I saw an opportunity to develop community mental health services.

This meant shifting from traditional institutional care to community-based care that would envisage more humane, less stigmatising and more accessible mental health care. Again, I had to make a choice. Should I leave my work in Aceh uncompleted or should I just pack my bags to go back to the comforts of government service in Malaysia? I took the bold step of resigning from the Health Ministry to continue my work in Aceh.

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There was no turning back and that was the real beginning in my long-term commitment to mental health development in Aceh. Training in mental health was given to nurses and doctors in primary health clinics; home visits were incorporated as routine outreach services. The main challenge was to convince the local governments of the sustainability of such a programme.

It was an uphill task to convince each district administration to make the necessary budgetary allocation, given the decentralisation of government and political structure in Indonesia with a high level of autonomy for the districts.

Fortunately, the idea caught on and the upscaling of services even went one step further — psychiatric in-patient care was established in several district hospitals. The greatest fulfilment for me in my years of developing mental health services in Aceh was in the removal of physical restraints from people with chronic mental illness. Aceh had very high numbers of such people who, for lack of proper mental health services, were chained or locked up by their family members.

Clinical rotations are a critical component of your nursing education. Your nursing clinical experience presents the opportunity to work with real patients, experience work environments you may want to pursue once you have earned your Bachelor of Science in Nursing , and learn how you will work with fellow nurses, physicians, and other members of the health care team. It may sound intimidating, and maybe even frightening, but your clinical experience offers you a learning opportunity to build the foundation of your nursing education.

I had a year of coursework before I began my clinical experiences. And I could. I was ready to go. The first few days at clinicals were, in my mind, fun.

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Taking blood pressures, charting on my paper care plan maps; it was great. However, a lot of my classmates did not share in my excitement.

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Was it 12 hours of mundane learning? Well, truthfully, yes. I enjoyed my time, but years later, this single experience has taught me how to treat my nursing students.

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I tried to go into each clinical experiences with an open mind, despite any reservations I had on the branch of nursing I was studying. The coolest, scariest, most exciting part was absolutely my psychiatric nursing clinicals. I went to a state psychiatric hospital, where I did clinicals on a floor where people were criminally declared insane, and most had been convicted of heinous crimes. However, this clinical experience, although scary please note, I was incredibly safe , I learned so much. I learned how you can have compassion for someone who has done some things you only read about because they were in a deep state of psychosis.

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I was able to interview patients who had different life factors that contributed to their mental health. Overall it was fascinating. I loved every minute of it. I was in my final clinical—critical care. It was in a busy ICU, very fast passed. The nurses were kind, thoughtful, and wanted us to be there so they can teach us. On my first day, a patient coded. Watching the staff come together in an effort to save the patient was truly a pivotal moment in my nursing career.

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On our lunch break that very afternoon, I went to human resources. I was interviewed for a student nursing position a few days later, and a week after that, I was offered a job on the critical care unit that I had witnessed the first code.