Mental health service delivery is under spotlight following deaths of four patients at Zomba Mental Hospital this year alone. This has brought fears among guardians that their relatives are walking in the valley of the shadow of death.

Despite Nation on Sunday witnessing a seemingly dedicated workforce at the hospital, the bizarre deaths mirror challenges facing the facility.

Of the four deaths registered this year, the first three happened between April 25 and 27 with one allegedly due to strangulation.

One of the patients had his throat slit while another death that happened on August 5 was recorded as suicide.

The facility that has 301 patients against 67 nurses, one psychiatrist, seven psychiatric clinical officers, three medical officers and one clinical officer, is the country’s largest referral of mental health patients.

The front part of Zomba Mental Hospital

In an interview at the facility, Asiyatu Kuzaya from Pirimiti in Zomba and whose son is admitted to the facility, expressed worry at the recent turn of events.

“I used to be here once a month, but following the deaths of patients here in bizarre circumstances, I come here once a week. This is very costly, but I have no choice.

“One night you dream of receiving a message to come to collect the body of your son, the next night you dream of witnessing a serious scuffle among patients upon your visit here. It is that bad,” Kuzaya said.

Hemes Kondawala, who visited his nephew, appealed to authorities to investigate mysterious deaths.

But the fear is also extended to clinical officers and support staff who are now anxious as they discharge their duties.

The hospital’s spokesperson Harry Kawiya in an interview said rooms where the patients are attended to only have one door.

“In ideal situations, these rooms are supposed to have two doors with one at the back which our staff can use to escape if they come under attack. In absence of that, we advised our staff to be sitting closer to the door.

“Our clients become violent at times; we do have cases where they physically attack our officers. We had a plan to demolish this old block and come up with a purpose-built modern block that would have the designs befitting a mental facility,” he said.

Kawiya said they pushed to have the proposal accommodated in the 2022-23 national budget, something that did not happen.

He said the hospital was planting closed circuit television (CCTV) cameras to enable officers to keep an eye on wards.

Nation on Sunday was shown a ward where some deaths were registered.

The ward resembled a police cell complete with metal doors and burglar bars that separate the ward from a waiting lounge.

“You see; because we lock these burglar bar doors at night to protect our nurses, the aggressive patients climb the wall and go into the ceiling, they come this way and break the ceiling here and throw themselves down to the waiting lounge. They usually get injured in the process.

“It is here that one patient killed a fellow patient by slitting his throat using an aluminum plate which he broke into two pieces,” he said.

The spokesperson said on that fateful day, a security guard, heard a commotion around 2am and he saw two patients fighting.

“When our officers got there, they found this patient standing there, blood smeared in his hands as his friend lay breathless.

“For the one who committed suicide earlier, he had his lunch. Later he went into the ward and sometime later around 2 pm, he was discovered hanging in a bathroom to a window,” he explained.

The spokesperson took the journalist to a special male ward for “mentally retarded clients” whose conditions could not be reversed.

All were naked, except one who was partly dressed but in torn out clothes.

“Their condition is irreversible here. You give them clothes, they tear them. Some of them are dumb. They have no idea where they came from. If they had relatives, they needed to take them out, but their relatives are not willing to do that,” he explained.

Kawiya said in the 2022/23 national budget, Zomba Mental Hospital was allocated K2 067 200 000 including drug budget,

but minus salaries.

Charles Masulani Mwale, a director at St. John of God Hospitaller in Mzuzu, a psychiatric hospital, said hospital officials make constant visits to the wards to avoid cases where the patients may kill one another. He said Mzuzu keeps 28 patients and Lilongwe 40.

Spokesperson in the Ministry of Health Adrian Chikumbe said in a response to a questionnaire there have been some increases in budgetary allocation towards mental health services.

“But suffice to say that apart from funds for mental health programming at national level district and central hospitals have funds for services provision and drug procurement in general, including mental health, but these funds are not really specific for mental health; hence, not easy to quantify in that present form,” he said.

He said after closure of Bwaila Psychiatric Unit under KCH, which was providing tertiary mental health services, plans were made to build a new psychiatric unit at KCH.

Health and human rights advocate Maziko Matemba said in a response to a questionnaire the allocation to mental health is not enough, below five percent of the Ministry of Health annual budget, compared to other programmes.

“This is the case because of our funding structure which is donor dependent and most donors do support areas they are willing to support. What we need to do is to pursue one health approach and pool funding mechanisms where programmes with lower funding allocations are given a chance in terms of allocations,” he said.

In a December 2017 determination by former Ombudsman Martha Chizuma, which she conducted following an article in the Nation On Sunday of April 9 2017 that raised a number of human rights violations and acts of maladministration by Ministry of Health in the administration of mental health service delivery at the now closed Bwaila Psychiatric Unit, she directed that starting from 2018/19 financial year, the budget allocation to mental health from the national health budget should be increased from 1.1 percent to not less than five percent, but that budget still remains below five percent

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