- The Washington Times - Saturday, August 25, 2001

ERWADY, India The rusted iron chains that once shackled the woman are gone, but she is still bound by the horror of the fire that killed 28 other mental patients chained to stone pillars.
The woman rocks slowly as she sits inside a thatched hut, wrapped in a dirty cotton sari. No one knows her name or where she came from, so she must remain in the asylum where she saw other patients die.
The tragedy in this southern Indian village has drawn attention to the woeful plight of this country's mentally ill. No one is certain how many of India's 1 billion people suffer from mental illness; it is clear many don't receive adequate care.
Only a few scorched pillars remain of the row of huts that once housed 46 patients in the Badshah asylum. All the survivors, except the nameless, unclaimed woman who was unshackled before the fire reached her have been sent home.
Until the Aug. 6 fire, Erwady was known only as the site of a 400-year-old Muslim shrine that some believed could heal mental disorders. It was also a village with about 16 small asylums for the mentally ill.
The town of 10,000 is a mix of concrete houses and woven coconut thatched huts. Along its narrow alleys, goats dig through stinking piles of garbage.
At another asylum, the Bismi Home for Women Mental Patients, a 30-year-old woman said what the nameless woman could not.
"Please take me to a hospital," she pleaded through tears. "I promise to be good," said Bathmavathy, who like many people in Tamil Nadu state uses one name.
Pakir, the man who runs the Bismi Home, said the only treatment for patients is to "take them for prayers at the nearby mosque twice a day and one day they will be cured."
The seven women he oversees bear the scars of shackles on their ankles. Pakir, who also uses one name, seems not to notice their emaciated frames and skin lesions.
"If I don't beat them, I can't control them," he said.
Berham Beebi, 50, sits on the asylum's dusty floor. She is bloated and her joints are elephantine. She says she eats soil.
"Please, please, take us away. They are beating us. My genitals are injured," she said.
Although the fire cast a harsh light on the treatment of the mentally ill, it was not the first sign of trouble: At least two reports detailing the desperate conditions of mental patients have been forwarded to state and federal health authorities in India since 1998.
"This a crime against humanity," said I. Nazneen, principal of the Government Arts College for Women, not far from Erwady. She has been lobbying the state for two years to address exploitation and cruelty toward mental patients appeals that have been waved off.
S. Swamylal, chief of the state psychiatric hospital in Madurai, the main city near Erwady, said government officials make periodic visits to the thatched hut asylums to advise owners on hygiene and patient welfare.
He said many Hindus and Muslims believe in the healing powers of places of worship instead of taking advantage of what medical care is available.
"Enforcing the law takes time, especially because it involves religion. This incident may hasten the process," Mr. Swamylal said.
Tamil Nadu's health secretary, Syed Munir Hoda, said many people prefer to stay in private asylums because of their religious beliefs. He said a psychiatrist was posted at a government clinic near Erwady last year, but few sought his advice.
"This has been a bad experience. We must now move forward," Mr. Hoda said of the fire.
For Erwady's mental patients, moving forward will not be easy. Many of their relatives and their caretakers believe the soil and even the chains are part of a mystical cure.
Nurjehan, 52, has been chained to a tree at the Erwady shrine for five years. She growls softly as Muslim prayers come through loudspeakers. Her husband and their two daughters sleep beside her.
"The chains will spring open when she is cured," her husband said.
The state government, facing increasing criticism since the fire, has ordered the asylums in Erwady to close this month. It plans to transport remaining patients to government institutions, said C. Semmalai, Tamil Nadu's health minister.
"It is the previous government's inaction that has led to this situation," he said, trying to shift the blame.
India's federal government has worked on developing community-based approaches to mental health care. But the $62 million program, which began in 1997, hasn't reached enough people.
Nongovernmental rehabilitation centers have better conditions. In Madurai, 55 persons are housed at Shristi, a clean, pleasant facility where patients make greeting cards and other items for sale in nearby towns. The profits help run the home.
The fire in Erwady also reignited debate on conditions in government-run institutions.
Water drips from the pipes at the Institute of Mental Health in Chennai, the state capital. Sanitation facilities for its 1,600 inmates are abysmal. Some improvements to the old buildings have been made with private donations.
Dozens of women, some filthy with mucus and dirt, sit around or plead for attention while children and adolescents, some naked, crouch or crawl nearby.
It is Erwady, only without the chains or even the prayers.


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