Electroshock Sans Anesthesia: Inside an Iraqi Hospital

BAGHDAD, Iraq -- June 16, 2008— -- In this country, in this city, in this hospital, where the danger has driven the doctors away, Mohammad Rashid is as much patient as psychiatrist.

"It takes more than two hours daily to come from my place to the hospital. And the road, I see many scenes, I face many confrontations with the guards, with the American soldiers," says Rashid, one of four psychiatrists practicing at Baghdad's Ibn Rushid hospital. "I have the same worries about my children when they go to their school — I call my wife three or four times daily just to reassure that they came back safely. So it's not easy. We are fighting. We are fighting to live."

He didn't always have to fight like this. It wasn't always that Ibn Rushid had no psychologists. It wasn't always that the psychiatrists were so busy they couldn't spend more than five minutes with each patient. It wasn't always that doctors had only enough drugs to fill two weeks worth of a prescription.

And it wasn't always that electroconvulsive therapy, better known as shock therapy, was delivered without any anesthesia.

Years ago, before the wars and the sanctions, full teams of doctors trolled these halls, caring for the acutely depressed, the suicidal, the ones who couldn't cope with life. Patients would come from all over Iraq, and the pharmacy was relatively full.

But today, Ibn Rushid has little money or staff. It has a shortage of drugs. And it has zero anesthesiologists. Which means the worst patients — the ones who don't reply to medicine, the ones whose depression responds only to electric shocks — are forced to endure a treatment that, while ultimately helpful, is considered barbaric. The World Health Organization has called for a worldwide ban on shock treatment without anesthesia, but it is practiced multiple times every day here.

"The problem is with the human resources," Rashid says, standing over the anesthesia machine that hasn't been used in months. A few feet away, the electrodes that send electricity through patients bodies are used dozens of time per week. The problem is not, he says, with the equipment.

"It's fair enough. It can give anesthesia. But because of the shortage…" he trails off, shrugging his shoulders as he walks away.

Like so many of the learned parts of this city, this hospital suffers from a brain drain caused by fear. And it suffers from an economic shortage caused by a government unwilling or unable to make psychiatry a priority.

Today, fewer than 10 psychiatrists work in the capital of around 7 million people. A few years ago, the number was closer to 50.

"This," Rashid says, "is our destiny."

Ibn Rushid's courtyard garden is well maintained, and the doctors and the patients say they don't fear coming here, at least not now, although sometimes they can't reach work because of violence. Much of this city is safer than it was one year ago, thanks to U.S. counterinsurgency efforts and Iraqi government deals with the militants.

But ask the doctors, and they'll hint at an intimidation campaign that once stalked them like nightmares. Ask them what the hospital was once able to do, what it is incapable of doing today, and they'll sigh about the current state of Iraq.

"The effect of war is very dramatic here," says Rashid, who is also the chairman of the Iraqi Psychiatric Society. "Most of the patients, the depressed patients, the anxious patients, have stories of war or losing an important person."

Like Osama Hamid. He hasn't been the same since 2004, his family says. He lies on a gurney immediately after receiving electroshock treatment, unable to communicate but seemingly aware of his surroundings.

"He's furious all the time and never stays in the house," says his mother, Buthena Hussein, standing over him protectively. "Sometimes we buy him new clothes, and he exchanges them with old, bad clothes."

She didn't know what to do, so she brought him to the hospital. "Everything," she says, "is in the hands of God."

His doctors say the treatment they've prescribed — as many as three electroshock therapy sessions per week — has helped him.

That is the saving grace of this place. Despite the shortage of money, despite the shortage of drugs, despite the lack of doctors — this hospital, most of its doctors and patients say, helps people live.

"It's a magic treatment," Rashid says of ECT. "If you give it in a scientific way, for the scientific patients, for scientific purposes, it's very nice. It's free of complications because it's not medication. It's available most of the time, so no shortage, no drain of treatment."

When two women blew themselves up at pet markets in central Baghdad in February, American officials suggested the two had been mentally ill. Soldiers came to the hospital and showed pictures of the women they thought had killed more than 90 people.

A few weeks later the woman in one of the photographs walked into the hospital, intact and unaware people considered her a mass-murderer.

Since then, the Health Ministry has ruled patients must display a current photo and identification card before being seen.

Most of them don't need shock therapy. They suffer from milder depression, or any number of neuroses or addictions.

"I couldn't sleep. I was worried all the time," one patient told ABC News, refusing to give his name. "I didn't know if you take one of the roads, if you will even return back home. And I was anxious all the time. Anxiety was taking over my head."

He is now taking triptizol to fight depression and lexotan to help him sleep. "I feel the improvement," he said. "The people here are good. The doctor here is good."

If the hospital received more assistance from the government, its doctors say, it would be able to do more for its patients. "We're at the bottom of the list of priorities," Rashid says.

Still, it tries to create a stable environment. Patients will often relapse if they quickly return to their neighborhoods, where they may worry about militias, no electricity, and huge unemployment.

And so people like 42-year-old Majid Salim, whose mother begged Rashid to admit him, are allowed to stay for a few weeks.

He was injured four months ago during fighting in Sadr City between the U.S. military and the Mahdi Army, the Shiite militia loyal to Moqtada al-Sadr. To ease his pain, he began taking valium. He quickly increased his own doses and began taking as much as 100mg a day, more than double a traditional prescription.

"I agreed to admit him just to get him relief from this atmosphere," Rashid says.

Salim is one of the few to agree to an on-camera interview with a western reporter, perhaps because he is confident he can get better.

"I have eight kids. Who will win their bread if I am an addict?" he asks. He was admitted one week ago, and "Now, I feel I am good," he says.

Asked whether he will take valium in the future, he waves his hand away. "A person should try to learn from his mistakes. Once is enough."

Rashid asks Salim a few questions and sends him on his way after about five minutes.

Does Rashid ever consider leaving, giving up? Not if he can help it.

"I was threatened one year ago, and I left the country for three months, and I returned back. I feel that I'm not a normal person. I am an addict on my country."

All he hopes, he says, is that the hospital can improve.

"I don't blame anyone who left … But I wish my colleagues would return back to Iraq."

Ali Al-Mashakheel contributed to this report.