A Transcendental Indian Adventure (2) Buzzing around Bangalore

NIMHANS has always occupied a place in my mind somewhere near the Maudsley and Institute of Psychiatry, and my own psychiatric training - with fantastically high institutional standards but also a punishing and paranoid culture for the poor juniors who work there. I remember this in Oxford as ‘the dark shadow of the University Department’ and how nobody walking its corridors ever smiled – and we all lived in fear of getting the dreaded ‘green memo’ from the heart of Mordor (the professor’s office).

NIMHANS - the gardens b etween the inpatient wards

But today that prejudice was really changed into something much more up-to-date and positive when we were invited to visit the Department of Family Psychiatry and Rehabilitation. As we walked in, there was a profound sense of it being a good space: a relaxed feel, colonnades of green walkways festooned with flowers, yoga happening in the spacious grounds, large airy and light-filled rooms, and people who rushed up to us and introduced themselves – as well as a few lazy and random dogs lying around.

NIMHANS - Family Psychiatry and Rehabilitation

We sat in a multidisciplinary teaching session where they used OSCE (Observed Structural Clinical Examination) methods as a teaching technique rather than an examination – with a role play of a mother from a rural area coming to ask for help about her psychotic son. The observing students then had to first comment on what went well, then what could have been improved – ‘Pendleton’s Rules’ as I remember from my own GP training. In the following discussion we explained how TCs have developed and changed in the UK. Although they were quite familiar with the underlying concepts, it is interesting that they still thought that all TCs were residential – but perhaps not that surprising as the same misunderstanding was present in several medical members of the UK group that developed the NICE guideline for Borderline PD. But we then had a lively and passionate discussion about how TCs can offer hope to people who have not received what they need from the mainstream mental health services, help those who are dependent on services to take responsibility for themselves, and hold out the possibility of authentic ‘recovery’ – whatever that may mean!

We went to a well-westernised coffee bar (multi-coloured LCD lights, not much Indian food on the menu and loud pop music) for our debriefing, with a burger and salad lunch. Unfortunately this coffee bar, unlike the ‘Café Coffee Day’ chain that seems to be spreading everywhere, had no coffee, and then the waiter told us that tea was off as well. So we went off to our next encounter: Athma Shakti Vidyalaya, ASV.

ASV is one of the first TCs which joined the Royal College of Psychiatrists’ ‘Community of Communities’ quality network - soon after it was set up in 2002. I was the external peer reviewer for its first review in October 2003, and remember being bowled over by how the culture and ‘smell’ of a TC was as easily recognised in such an utterly different culture as urban India as it was in London, rural Cumbria or the Home Counties. But this time we were a threesome, and we only had an hour and a half with them. The first difference I noticed was how a rural village on the outskirts of Bangalore – surrounded by big fields, wandering cows and children playing cricket - had become a dense urban development filled with apartment blocks, a new Hindu temple, tarmac roads and buildings everywhere. Such is the pace of Bangalore’s expansion, Anando explained to us.

We started off with a rather formal-looking session with the three of us behind a desk, and serried ranks of staff and interns arranged in rows filling the rest of the room. However, we soon got into an interested exchange about what we had in common, how we differed – and what had changed since I was last there. Then it was time for community tea – and we had milky tea (without sugar, by special request), biscuits and Indian sweets. We were enthusiastically welcomed by the members of the community: they wanted us to stay, or come back, or even work there!

With the staff at ASV

The members come from far and wide – and have a wide range of reasons for being there: some see it as their home for ever, some use it as a secure base from which they go out and try to get on with life and come back if they need to, and some seemed to want to get away from the place as soon as possible. It was clear how some members felt listened to in a way that made others therapies they had received seem superficial, and not able to fully understand their situation and problems. Most people there had their places funded by their families – who sometimes pay for them to stay indefinitely. Because there is now quite a number of long-stayers, ASV is considering whether to build a new block in the middle of their yard to house them. Of course, a treatment like ASV is inaccessible to most people as they don’t have any money.

 

The entrance to Christ's - a 'corporate university'...

...which still has a lot of students.

We knew the next day, Wednesday, was going to be hard work – but we didn’t realise quite how much Anando had packed in. We started with a three and a half hours lecture/seminar session at Christ University – which is what they call a ‘Corporate University’, meaning that the fees are much higher than a state university, for which the students receive pretty much the same education, but have much more comfortable and modern buildings and facilities.

The room in which we did our presentations was kitted out with a smart stage and all the usual digital projection – but the audience all seemed to be sitting in rows of bright red comfortably upholstered armchairs. There must have been about eighty of them, all full with standing room only – mostly with postgraduate students from the psychology department. We left just after 8am to get there for a 9am start, and Anando was surprised at how gentle the traffic was – but he spoke too soon. When we got to about a mile from the university, we hit the big-time Bangalore gridlock: probably similar to most huge cities in low and middle income countries – but with the trademark Indian addition of holy cows dotted amongst the vehicles, sometimes even lying down amid the noisy chaos. We arrived about 10 minutes late, and everybody on the red seats went quiet and stood up for us: we reassured them that we came from a tradition of flattened or fluid hierarchies and they didn’t need to do that – then we did three of our normal prezi presentations: the English national PD programme, the history of British TCs since World War 2, and why the philosophy of greencare is good for your mental health (click each title for link to presentation).

Talking to the Christ's University students

We left plenty of time for questions and discussion – and there seemed to be a good understanding of what we were on about, and us and Anando made several useful contacts.

After a quick rice and curry lunch in the students refectory – a vast space with an even more vast number of students in it (there certainly seems to be enough people around to pay the fees for their study at a corporate university) – we were heading off to our next assignment: a team meeting with all the HNI staff in Anando’s parents’ front room. Interesting facts we learned about HNI include the geographical spread of their activities, that some of their staff are volunteers, and that the non-volunteers are all paid exactly the same.

After this, just before the sun set, we were led up to the top of a nearby building where there was an airy terrace with views across the city, a bar, food service area and a circle of twenty-odd chairs: lovely evening views across the city, a gentle breeze and music of the city traffic just warming up for the rush hour. Beep beep beeeeep honk honk vrooooom vroom.

Sunset above the hurly-burly

This was the setting for the three-phase evening event to which all the HNI stakeholders were invited – the Social Evening.  The first part was a reception and general mingle as everybody arrived – Sandra braved the streets of Bengaluru for the two minute walk from Anando’s parents’ house with a couple of others HNI, got lost and arrived just in time for the next part. Which was a group discussion on ‘where to with HNI?’, in a conversational competition with the orchestra of traffic - which had now finished warming up, and was playing at full tilt. Which made the discussion a little difficult, a problem the group tackled by bringing all the chairs together into concentric circles so everybody was within a few feet of each other. Some good ideas were batted about, with plenty of energy and passion – particularly from the families of community members. Then it was time to eat, again. And beautiful food, again, with plenty of people and good conversations with people from all sorts of different backgrounds (the orchestra was quieter by now). And so to bed – in preparation for the biggest adventure of all: the Penukopnda LLE…


Links to talks:

PD talk prezi	http://prezi.com/oiawe-kxo6r0/?utm_campaign=share&utm_medium=copy&rc=ex0share	http://tinyurl.com/cupdinuk
TC talk prezi	http://prezi.com/xw10e7rt-5jy/?utm_campaign=share&utm_medium=copy&rc=ex0share	http://tinyurl.com/cutcsinuk
Greencare talk prezi	http://prezi.com/c_973vxnbw7i/?utm_campaign=share&utm_medium=copy&rc=ex0share	http://tinyurl.com/cugreencare