Fifty people, mostly women, queued up outside a yellow-colored building, at the district hospital Pulwama, waiting under the scorching heat, to meet the only psychiatrist between the twin districts of Pulwama and Shopian.
After waiting for two hours, 34-year-old Khateeja, who had come from Turkwangam village, got her turn at 2 pm to meet Majid Shafi, sitting inside a room that he shared with another doctor.
The clerk let her inside the room.
“This is just like any other day for us. We try to see as many as possible,” Majid told The Kashmir Walla. “But there are so many patients that at times it becomes difficult to treat everyone.”
At the District Mental Health Centre, Majid has been seeing patients since 2015. In the past five and a half years, however, he largely fought a lonely battle amid the worsening mental health crisis in Kashmir following a near two-year long lockdown.
A single psychiatrist
Majid finished his masters in medicine (MD) in psychiatry in 2012 from Government Medical College, in Srinagar. Later he finished his senior residency in 2015. He was then posted in Pulwama in January 2016 replacing another psychiatrist, who was being transferred to Budgam district.
In Kashmir, three decades of conflict has created a drastic surge in the mental health diseases among the people. After back to back lockdowns — from the August 2019 clampdown to the Covid-19 lockdown — the mental health experts sound an alarm regarding the emerging crisis.
A survey conducted by an international medical humanitarian organisation Médecins Sans Frontières (MSF) from October to December 2015 found that 45 percent of Kashmir’s adult population — 1.8 million people — was suffering from some form of mental distress. There is a high prevalence of depression (41 percent), anxiety (26 percent), post-traumatic stress disorder (19 percent), and 47 percent had experienced some sort of trauma.
Majid has three duties in OutPatient Department: on Monday, Wednesday, and Friday, where he tends to 150 patients per day from 9 am to 6 pm. On other days, he has other patient related assignments. Some days, the numbers can go up to 200. “I try to be there for a patient even at odd times. I leave at 6 [pm] for a reason,” he said. “They have just me. Where else will they go if I leave early?”
On the other side of Majid’s room sat Chandni Wani, a second-year MD scholar of psychiatry at Institute of Mental Health and Neurosciences (IMHANS), in Srinagar.
She is part of the District Residency Programme, where scholars are to undertake a mandatory rotational duty in the district hospitals for a period of three months as part of their curriculum.
After five years of exhausting work, Majid said that these new additions, however small, have helped in decreasing his workload. “But she will finish it in three months and then the burden will be more, again,” Majid said.
A patient walks in with the prescription by Dr. Mushtaq Magroob, the valley’s senior psychiatrist and Majid’s guide. He looks at the tickets and smirks: “You have been consulting a great doctor, why did you have to come to me?”
“It doesn’t feel good, honestly, to take in patients who have already been to your seniors,” Majid said, looking at the tickets. It also implies, he said, that it is going to be a difficult case. “I honestly feel what will I do to this patient,” he said. “But then you have to do your job.”
Usually, the cases that come to Majid are those of depression, anxiety, psychosomatic and trauma related illness.
Majid believes that mental illnesses have a stigma attached to them. “Illnesses like bipolar, schizophrenia, and OCD are severe illnesses. He said that due to the conflict, mental illnesses increase in greater numbers. However, he said, due to the stigma, many people don’t come forward to treat themselves.
Along with the psychiatrist, there is another counselor and a clinical psychologist. But eventually, the final call for each patient is taken by Majid himself. “There should be at least another psychiatrist here(Pulwama district hospital),” he said.
The trauma of the conflict does add to these symptoms. “The people of south Kashmir do get more affected,” he said, while looking at his patient. “We don’t need any rocket science to understand that.”
As Kashmir has witnessed multiple conflicts over the past two decades leading to increase in various psychiatric disorders and south Kashmir is no exception to it. During this period there have been violent and traumatic situations, resulting in deaths of thousands of people and its aftermath which leads to post-traumatic stress disorder (PTSD).
Majid said that many of his patients suffer from PTSD. But due to his professional boundaries, he said, he couldn’t share the miseries of his patients. He further said that there is so much anxiety and stress that it is not possible for him to remember all of his cases.
“At this time, case stories are totally out of my mind,” he said.
After five hours of continuous sessions, Majid was exhausted. He got up from the chair, stretched himself and took a five-minute tea break. Sometimes, he said, they don’t even have a lunch break because of the number of patients.
However, despite the toll that this job has taken on his own mental health, he is scared that his patients might die if he does not give his 100 percent. “There are suicidal patients, where will they go? I will feel guilty about it.”
He said that it gets difficult at times to listen to the stories of the patient and not get affected by them. The narration of their ordeal, how they are affected in their lives by various things happening around them. “We are humans after all. I try to take it as a job. I try to not take these stories to my home but it is not possible every time,” he said.