PAKISTAN: Mental Illness among Women: Gender-Driven?
By Zofeen Ebrahim
IPS
KARACHI, Feb 1, 2010 (IPS) – No sooner does a visitor step into the facility than a surreal scene unfolds: The sound of laughter, the sight of ready smiles and vigorous, pumping handshakes mix with the acrid odor of an unwashed human body and the unbearable stench of neglect that in turn combines with the heavy smell of medicine.
A group of women gathers around the visitor, their eyes lighting up and faces breaking into a smile as they extend their hands to offer the latter a firm handshake, only to be shooed away by Waseem Fatema, a stocky nurse in her late 40s.
This is the Edhi Centre for the Mentally Ill Women in North Karachi – home to women suffering from various forms of mental or emotional disorder, some of which warrant long-term treatment, others do not, requiring at best compassion and understanding for otherwise fleeting states of mental or emotional impairment, brought about in part by these women’s inability to cope with what society expects of them.
Of the more than one thousand female wards confined at the centre, some are as young as five years old and others as old as 70, or even older. Children, who are either physically or mentally challenged, stay in an adjacent facility also run by Edhi. Some of them were brought to the centre by parents who invariably said they could no longer afford to look after them.
Edhi – which gets generous donations, including the ‘zakat’ or a portion of one’s possessions, from various sectors of Pakistani society – also runs a separate facility for men, located outside the city limits. It offers its facilities and services free of charge.
Built over 10 acres in 1986, the centre initially had 50 to 60 women with mental problems in its care. Today, the number of its wards has swelled to over 1,600. In 2009 alone, around 380 women were admitted to this mental institution. Of these, 212 were discharged, 80 of them above 60 years of age who died without ever having seen their families.
“When I joined five years ago, there were only 450 patients,” said Dr Naseem Attique, 55, the centre’s general physician. Only one psychiatrist comes once a week to the centre to check on the wards’ conditions.
According to Dr Murad Moosa Khan, head of the psychiatry department at the Aga Khan University Hospital in Karachi, the psychiatrist to patient ratio in Pakistan is an abysmal one to half a million to a million people.
“A vast majority (of the wards) are brought here by none other than their children,” said Fatema the nurse, who has been with the centre for over 10 years. “I see relief in their [sons and daughters’] eyes when they pass on their burden to us,” she said ruefully.
Fatema argued: “If they are given the same care that we provide here…, most will lead a fairly normal life. Unfortunately, their children do not have that much patience or the time.”
“Care is seen as a feminine activity in traditional societies,” said Haris Gazdar, a Karachi-based economist. “As economies develop and more people are sucked into the labour market, women’s time becomes limited too,” he said. The result is that there is no one to take care of the elderly and the mentally ill. This is increasingly happening in today’s society, Gazar added.
Anwar Kazmi, secretary to Abdul Sattar Edhi, a well-known philanthropist in Pakistan and founder of Edhi Foundation, which runs the mental facility, said most patients at the centre come from the lower-middle class. “The main reason why they are here and not with their loved ones is poverty,” he said.
For large families in congested living conditions, usually consisting of one- or two-room houses, “taking care of a mentally ill person over a long period can take a toll on the entire family, especially on the sole bread winner,” he said.
But Dr Khan dismisses poverty as the main reason why women are being brought to a mental institution such as Edhi. “Poverty only comes into play when the decision to discard them has been made,” she said.
“Do you think I’d be here if my parents were alive today?” asked Farida Noorani, 39, who has spent 10 years as a ward at Edhi. “It’s my sister-in-law who sent me here,” adding that her two brothers come and visit her every month.
“Her brothers are quite well-off,” said Fatema in a separate interview with IPS. “If they wanted to, they could very well have kept her.”
Dr Attique said very few leave or are discharged from Edhi. Of these, a majority return to the centre. For every 10 who are discharged from the centre, eight return on relapse, often in a far worse condition than before.
“A vast majority suffer from various degrees of psychiatric problems and are on medication. When they get well, some are taken back by their relatives. But in most cases, medication is discontinued despite our strict instructions to the contrary,” said Attique.
Dr Khan said the status accorded to women in “our staunchly patriarchal society” has brought a number of women to mental institutions like Edhi even when their mental state does not require confinement in such a facility.
“Women are treated as second-class citizens and lower beings. Hence when they develop any kind of mental illness, they are discarded, he said.
“Sometimes women are simply labeled as ‘mentally ill’ in order to avoid the threat to family honour,” said Dr Asha Bedar, a clinical psychologist.
This is particularly true for women who do not fit the “ideal image” imposed on them by society, including those who “rebel against oppressive customs and traditions” or who are seen as being “tarnished” in some way, said Bedar.
“These can be women of all ages, who deviate from what society expects … refusing to marry according to family wishes, remaining single, seeking a divorce, marrying by choice, standing up to domestic violence, not having children, etc.,” she explained.
Sadia Yasmeen, 39, has been at Edhi there for 12 years. “I’m here because of property feud (that arose) after my father died. My sisters, six of them and one brother, don’t want me to get married so they brought me here. But they have never once visited me. I don’t even know if my mother is alive,” she said. She teaches Quran to the younger wards at the centre.
Bedar said women in varying states of emotional or mental turmoil are not found at Edhi alone. “These women are found at psychiatric hospitals and wards where the women have either been abandoned my family members or sent there to be ‘cured’,” she said. “They are drugged or frightened into submission to the demands of family members.”
“Even in my clinical practice it is not uncommon for family members to bring young girls (aged 16 to late 20s) to me because they refuse to heed the family demands” such as in cases of forced or arranged marriages.
“The women who end up in facilities such as Edhi belong to a category where such ‘deviation’ cannot be tolerated,” said Bedar.
“At times these young women really do exhibit psychiatric symptoms (e.g., suicidal tendencies), requiring (professional help), but this is often a result of their specific situations and the demands placed on them. In other cases, the mental illness is very real but is a result of the circumstances in which these women live,” she explained further.
Others appear normal. Take for example, Rashida Anees, 55, who has been at the Edhi centre for 11 years now. “Once my brother comes back from South Africa, he will come and take us home,” she said matter-of-factly. The former teacher in one of Karachi’s most prestigious schools, Mama Parsi, has never once received a phone call from her brother.
Pakistan’s Constitution allows a woman aged 18 and above to marry of her own free will, but in practice women are often severely punished or even put to death for straying from tradition. Women who bring dishonour to their families can easily become the target of ‘honour killings’, a practice banned in 2004 and made punishable by the death penalty. Yet the culprits are rarely punished.
It is also not uncommon for a young girl to be married off before the age of 18 because the prospective husband promises to pay off her father’s debts. In such a situation, women can easily succumb to depression, anxiety, and psychosomatic disorders, which Bedar said are common among Pakistani women.
“When girls in our society are socialised to believe that they are inferior, that their worth is less than that of boys, that their potentials … are only valuable if they are in the ‘feminine domain’ – such as the domestic sphere – this has the potential to affect their mental and emotional health and well-being, she said.
“It is no wonder then that depressive symptoms, anxiety, and issues of relationship, self-image, self-confidence, suicidal attempts are more common in women and girls in our society.”
Across Pakistan, Khan said approximately 34 percent of the population suffer from depression and anxiety alone and about 1 to 2 percent from psychosis, brought about by a host of factors.
For women, those factors include cultural mores that force them into a situation that, in society’s views, require their confinement in a mental institution such as Edhi.
Not quite the International Bill of Rights for Women yet
GENDER: U.N. Women’s Treaty Weakened by Slew of Reservations
By Thalif Deen
UNITED NATIONS, Dec 8 (IPS) – A landmark U.N. treaty on women’s rights, which will be 30 years old next week, is in danger of being politically undermined by a slew of reservations by 22 countries seeking exemptions from some of the convention’s legal obligations.
“A reservation must not defeat the object and purpose of a treaty,” Ambassador Palitha Kohona, a former chief of the U.N. Treaty Section, told IPS.
If a state has intrinsic difficulties with a treaty, it has the right not to become a party, he said. “To become a party and then defeat the object and purpose of the treaty is unacceptable,” said Kohona, currently Sri Lanka’s Permanent Representative to the United Nations.
The Convention on the Elimination of All Forms of Discrimination Against Women (CEDAW), which will commemorate its 30th anniversary on Dec. 18, has been described as “an international bill of rights for women” and has been ratified by 186 member states.
But 22 member states, ranging from Algeria and Australia to the United Arab Emirates (UAE) and the United Kingdom, have exercised their right not to implement certain provisions of the treaty, even though they have signed and ratified CEDAW.
Algeria says it is prepared to apply the provisions of the treaty as long as they do not conflict with the provisions of the Algerian Family Code.
The government of Australia, on the other hand, says it does not accept the application of CEDAW in so far as it would require alteration of the country’s defence force policy – which excludes women from combat duties.
The UAE points out that it will not enforce one of the provisions of CEDAW because the provision violates the rules of inheritance established in accordance with the precepts of Shariah, the Islamic law.
Yasmeen Hassan, director of programmes at the New York-based Equality Now told IPS that lack of implementation of CEDAW is exacerbated by countries’ reservations to the treaty.
“Many countries, including most Muslim countries [with the exceptions of Afghanistan and Yemen], have significant and broad reservations to CEDAW that nullify their commitment to gender equality,” she added.
However, even in these cases, “the positive is that they are obligated to report on the situation of women which gives us a platform to advocate and push for change,” she explained.
Kohona said that human rights treaties tend to attract a noticeable number of reservations.
Some treaties, Kohona explained, may prohibit reservations. However, “states having the sovereign right to lodge reservations to treaties in the generality of cases when they become party, have exercised this right extensively,” he said.
Others, he pointed out, “have surreptitiously sought to achieve the same objective by crafting clever declarations of understanding.”
Consisting of a preamble and 30 articles, CEDAW defines what constitutes discrimination against women and sets up an agenda for national action to eliminate such discrimination.
According to the United Nations, the CEDAW treaty has triggered wide- ranging action in favour of women’s rights worldwide.
These include: new constitutional guarantees for women in Thailand; land- owning rights for women in Kyrgyzstan and Tajikistan; changes to the law of evidence benefiting women in the Solomon Islands; reproductive health rights in Colombia; and a new “Magna Carta” for women’s equality enacted in the Philippines.
But the United Nations complains that the Convention’s implementation is uneven, with seven countries still holding back ratifications: Iran, Nauru, Palau, Somalia, Sudan, Tonga and the United States.
However, 186 other states have ratified CEDAW – making it one of the most widely subscribed-to international treaties in existence.
Hassan of Equality Now said that although States’ implementation of CEDAW, and their commitment to rights enshrined therein, has been spotty, the convention has been an important tool for women’s rights activists all over the world.
“This instrument articulates the standards that we aspire to and can be used in holding governments accountable,” she noted.
Women’s rights groups have, with success, brought up State failures in complying with this treaty before the CEDAW Committee, and the Committee has issued recommendations that reflect such concerns, Hassan said. “Women’s groups can then use these concluding comments to push the government into action.”
Although CEDAW has not resulted in States automatically putting their houses in order with respect to women’s rights, it is an important advocacy tool to reach the ultimate goal of realisation of gender equality, she declared.
Asked about the status of women in his own country, Kohona told IPS that women’s rights have always been respected in Sri Lanka, given that it produced the world’s first elected woman prime minister – Sirimavo Bandaranaike, in 1960.
Sri Lanka has not expressed any reservations on the full implementation of CEDAW.
“Women have competed as equals in the job market in Sri Lanka and have overtaken men in the key professions like medicine, law, teaching, nursing, etc,” Kohona said, adding that Sri Lanka was ranked 12th in the world in the 2008 U.N. equal opportunity index.
(END/2009)
Live dari Kota Bharu, Kelantan: Seminar Penggubalan Dasar Keluarga Mawaddah Kelantan
Wakil Timbalan Menteri Besar Kelantan, YB Dato’ Hj Ahmad bin Hj Yakob, tiba untuk ucapan perasmian.
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14. Elemen research perlu diungkapkan dalam dasar.
15. Elemen keluarga yang dysfuntional perlu juga dititikberatkan.
16. Penyakit-penyakit merbahaya yang disebut perlu dikhususkan apa jenis penyakitnya alam menjamin keselematan dan kesihatan keluarga.
17. Elemen rekreasi, mesra keluarga perlu difikirkan.
18. Konsep kesihatan, reproductive health perlu juga ditegaskan sebagai tanggungjawab suami juga.
19. Pembentukan modul-modul yg releven secara detail
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Diantara isu yang diutarakan ialah:
1. To what extent government can intervene personal matters, ie. familial matters
2. Dasar Negara: Mengutamakan kesejahteraan keluarga dalam pembangunan negara – berlandas nilai2 murni…
3. Semangat falsafah adalah penting – DKWK ialah faith-based
4. Dasar ke arah tindakan – perlu menggambar realiti keluarga di Kelantan. 46% tenaga buruh, wanita bekerja, isteri bekerja. Bagaimana masalah sosial lainnya? Masalah keluarga yang diterajui oleh ibu tunggal/bapa tunggal. Statistik perceraian trend meningkat – kedua terbanyak di seluruh negara. 70% bentuk keluarga nukleus – expanded family sudah berkurang. Jika demikian, bagaimana dengan sistem sokongan untuk keluarga? Umur reproduksi dalam masyarkat. Soal non-parental care. Apa implikasinya? Adakah taman-taman asuhan atau pengasuh memiliki nilai yang sama dengan yang dipegang ibubapa atau hasrat DKWK.
5. Tanggungjawab suami – tetapi kaum bapa sudah pincang melaksanakan tanggungjawab. Perlu ada penegasan terhadap ungkapan “Autonomi membuat keputusan yang sama utk memberatkan kerjasama”.
6. Suami sebagai pemberi nafkah utama. Skim pemberian upah negara tidak berasas keluarga, tetapi individu. Kemiskinan sekarang lebih nyata di bandar dari luar bandar, dengan segala tekanan-tekanan besertanya.
7. Sebuah keluarga yang berfungsi, berkesan, jika mempunyai effected negotiated roles. Contoh, suami beralah untuk menjaga anak kerana gajinya lebih rendah dari suami…
8. Parenting adalah dibentuk, boleh dibincang…Kita mempunyai peranan mengorak-ngorak peranan keibubapaan…
9. Apakah peranan-peranan yang dijangkakan…adakah sistem pendidikan boleh mendidik kerukunan kekeluargaan
10. Adakah kerajaan Kelantan sanggup membuat flexibility kepada ibu bekerja? Ada kosnya.
11. Keibubapaan profesional – tidak dianggap sesuai – ibubapa kompeten lebih sesuai
12. Adakdah indikator mengenai keluarga bahagia?
13. Sektor Ekonomi – menggalak suri rumah mencari pendapat dari rumah – tetapi terdahulu telah mengganggap bapa sebagai pencari nafkah utama.
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Seminar sedang berlangsung sejak jam 9.00 pagi tadi.
Ia adalah usaha Kerajaan Kelantan dalam memperkukuh institutsi keluarga sebagai unit-unit dalam masyarakat yang membentuk negara.
Sekali imbas, draf DasarKeluarga Mawaddah Kelantan (DKWK) merangkumi hampir keseluruhan aspek mengenai institusi keluarga dan merupakan suatu usaha yang bersungguh-sungguh dan teliti serta perlaksanaan visi terhadap pembangunan insan cemerlang yang komitted.
bersambung…
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