In Matagalpa, a city with 200,000 inhabitants in the central highlands of Nicaragua, the search for a remedy for a family member with a psychotic disorder often requires visiting a long list of ‘aid workers’. Families give their savings to natural and religious healers as well as wizards, to try to cure the mysterious condition of their loved ones. A small percentage of the people find their way to the psychiatrist in Matagalpa. This psychiatrist works half an hour a day in a public policlinic to give consultants to people who cannot afford private clinics. The psychiatrist merely notes down the sex and age of the patient, asks what kind of medication he or she is taking, and writes a prescription. He does not work with files nor does he work with increase/decrease schedules.
The Ministry of Health provides the policlinic with classical antipsychotics which are free of charge for the people visiting the psychiatrist. The medication is usually prescribed in old-fashioned high doses. Sometimes there are no more medicines available; as a result, the people have to buy them at the pharmacy. For extremely psychotic patients, the psychiatrist sends the patient to the only psychiatric hospital in the capital city Managua. The transportation to the hospital is to be paid by the family members themselves.
Since July of 2007, a second psychiatrist was employed in Matagalpa. This psychiatrist has morning shifts at the hospital in the city and contrary to the other doctor, she works with files. An appointment needs to be made for a consultation. On that day, the visitors are assisted on a first come, first serve base. Thus, a waiting period of four hours is no exception. There is no collaboration between the two psychiatrists.
Not a great deal changes for the families after a visit to one of the two psychiatrists. They still do not know what is wrong with their loved one and continue to try and hide the strange disease from the outside world. In many occasions, the family member in question refuses to take the prescribed medication or the ingestion of the medication is suspended because of developing side effects. In addition, often enough it is not understood that the treatment needs to be continued after the psychotic symptoms disappear, or families make an end to the treatment because they cannot afford the prescribed medication. Finally, there are people who do not follow the treatment because of religious motives. It is God who cures, and giving medication is sinful because it is an act against the will of God.
In October 2005, a project was launched in the city of Matagalpa for family members of people with a psychotic disorder. The philosophy behind it was simple: when people in the direct surroundings of a psychotic person are more stable, then he or she will be also. A Dutch psychiatric nurse, who came to Matagalpa in 2004 to conduct an anthropological research on poor families with a psychotic family member, started this group. The ‘Stedenband Tilburg-Matagalpa’ sought for funds for this project and the Matagalpese sister organization the Comité Mano Vuelta (CMV), supported the logistics of the initiative locally.
It was soon obvious what the function of the group was: family members visited the organized meetings in large numbers. For the first time in their lives, they were able to share their experiences with other family members and they learned to approach their ill family member in a different way.
At this moment, the family members have taken on the responsibility to continue the group. A mother, who has a schizophrenic son, coordinates with other volunteers the busy schedule of the organization, a psychologist makes home visits together with students from the local University, and there is a local administration. Everything is going well but there still remains a need for (practical) knowledge about psychotic disorders en how to deal with a psychotic person.
