First published by Nepali Times

Yesterday I heard the news: Dana had died. She probably died the way we knew she would go, on a cold winter day, on the street, unwashed, staring at occasional passers-by with her unwavering dark eyes until they became uncomfortable and left her to die.

A train of memories. Her first appearance in my Patan neighbourhood. One day a well built, barely dressed person collapses in front of my two-storey house, face down in the mud. When the person is still there some hours later, in the same position, I start to worry. “Dai, please wake up!” I call and shake the foul smelling body.

Nothing moves. Some children in school uniforms join me and so does the chowkidar from a nearby house. “It’s not a man, it’s a woman and she is pagal”, he says. I don’t believe him. And a young Nepali woman doesn’t roam alone undressed on the streets, even when she is mentally ill.

Her name is Dana. She uses the barren land opposite the house to relieve herself. Sometimes she simply collapses in the weeds and stays there for the night or longer. One night I hear an eerie sound. I run to the balcony, expecting to see someone being raped or killed. Instead I see Dana, screaming while wringing her hands obsessively. It goes on for hours. That night, listening to Dana, I come close to understanding what it’s like to suffer from mental illness.

I start giving Dana some food. Often she sleeps, somewhere next to the road or in a pati, shelter, where she likes to stay, but the food is gone by the time I return. Sometimes I hear her screaming and walk over, just to find that she needs help in crossing the road. After some weeks Dana starts to speak: “Didi, titaura”. I guess our friendship gets baptised by sharing this sticky piece of titaura.

Some time later Dana developed a leg infection. The smell became repulsive. Some volunteers from a nearby children’s home came to see Dana occasionally. They suggested we make her see a doctor. Dana’s family, who live nearby but have more or less given up on her, agreed. She had to be taken to a hospital for deep tissue surgery, otherwise her leg might have to be amputated.

There was a frantic phone call from the hospital: “Dana is about to kill the doctor!” When I arrive on the ward Dana is about to attack a very angry young doctor with a massive fire extinguisher. “They want to lock me up. I’m going home,” she shouts, over and over again. The unfortunate doctor is the first in a long row of carers who have no clue how to deal with a mentally ill homeless patient.

We are saved by Lambu, a student from Dhapakhel, who volunteers to spend the first night at Dana’s bedside. As soon as Dana sees Lambu her attitude changes. Keeping an eye on her carers she agrees to come to the ward. Dana’s leg could be saved. She was diagnosed as schizophrenic by the visiting psychiatrist who not once looked or talked to her directly. He prescribed four pills a day and turned a deaf ear to our protests: how could he trust Dana with so many pills?

By now Dana seemed a different person. The nutritious food and 24-hour care had been good for her. She started talking about her life and family. She had been married once, but didn’t like it. One day she left her husband and started living in a nearby pati. Her mother had died and she loved her father.

Dana did not want to stay indoors. The pati smelled even worse than before. Street dogs liked staying with her, especially emaciated bitches with flea-infested puppies. We continued to change the dressing and to give antibiotics. Just when we thought the leg would never heal, Dana started walking normally.

Our lives did not entirely return to normal. Lambu seriously considered giving up business studies and become a social worker. He said he loved Dana more than his own sister and would never forget the days he spent in the hospital. He married a staff nurse. Some of the other volunteers continued to work as carers for sick children. They are quiet heroes who spend many restless nights in overcrowded hospitals.

Now she is no longer with us. I heard she was taken to Pashupatinath by relatives and neighbours. I hope that at the last moment she allowed a caring person to be at her side, watching him or her until she was ready to let go.

There are no care or rehabilitation services exclusively for homeless mentally ill people in Nepal. Chhahari Nepal was founded in 2005 to address their needs in close cooperation and collaboration with existing rehabilitation and medical services. The organization found in a study that the number of homeless mentally ill people of all ages in the valley is surprisingly much higher than expected.

Although community members usually provide food virtually none receive medical or social care.

Chhahari Nepal for Mental Health