Haji Gul Nazar is 30 years old born in Afghanistan and living as a Refugee in Tehkal Payan, Peshawar. He was working as a car mechanic on basis of daily wages and had sufficient earning. He got married on Watta Satta basis (Watta Satta is a tribal custom of exchanging brides between two families. At the time of marriage, both families trade brides. That is, both families must have a daughter and a son and be willing to betroth them to a daughter and son of the other family). Soon after his marriage, both families got into some minor dispute, which resulted in divorce of his sister by his in-law. Due to family pressure in return he also divorced his wife soon after six months of his marriage. He became depressed and become addicted to THC (Tetra-Hydro Cannabis). He developed delusions, hallucinations and some guilt feelings. Due to paranoid delusions he left his home and workplace and became isolated. His family members sent him to Saudi Arabia for pilgrimage in the hope that this spiritual experience will bring him back or help him overcome his mental health problem. But this made him over religious on return home and he continues to demonstrate the old behavior. In September 2009, his brother brought him to community-based mental health care center where he was diagnosed as Paranoid Schizophrenia. He was motivated for treatment. He got free medication and rehabilitation services inside the community. His family also participated in rehabilitation process. He responded well to the treatment and start recovering. In month of December 2009 he re-joined his previous work in a Car Garage near by his living place.
Bibi Hawa is 22 years old single woman living in Peshawar with her parents in a joint family system. In her adolescent age her behavior became irrational and aggressive. Once she fought with her aunt without any reason. His father became reactive and hit her head with a brick she felt unconscious. She was severely injured on her head. Her parents ignored her injuries and left her rescue less. Later, she developed weeping spells, auditory hallucinations and paranoid delusions, wandering aimlessly etc. Her parents initially took her to tertiary psychiatric care unit where she was diagnosed as Shizo-affective. She receiving medication from the unit where she was first diagnosed and responded well. But due to poor economic condition of her family, she couldn’t sustain her medication and relapsed again. One of her family member informed by a local community activist about FOM’s activities and interventions, she was brought to the community-based mental health care center for further consultation and treatment. She was assessed again and was member with FOM for receiving free medication and rehabilitation services inside the community. Her family was also educated towards her disease and long-term treatment. Within few months she improved her insight and domestic living. She was already having good skills of tailoring and handicrafts before her illness; with little motivation she is now improving her previous vocational skills on self-help basis.
Case Study 3:
Inam S/O Amir Khan 25 year young man living in Tehkal Payan Peshawar. He has 3 brothers and 5 sisters. He has strong family history of psychiatric illness. 12 year ago he fought with his colleague and brought to jail where he started disorderly behavior and had grandiose thoughts that I’m hero, singer. He’d become so aggressive, violent attacked people and beat them badly, self talk, auditory, visual Hallucination. He has diagnosed as a case of disorganized schizophrenia. He received treatment for several doctors respondent to treatment well about due to heavy use of THC (Tetra-hydro Cannibal) and because of poor compliance he relapse. He was identified by FOM inside the community where he was kept chained because of his violent mood. By process of mobilization he was un-chained and brought to the community based mental health care center of FOM where FOM team made proper assessment which helped the team for developing treatment plan which included psychiatric consultation, psychotherapeutic services (cognitive therapies, behavior therapies, client-centered therapies), family support therapies and rehabilitation and recovery services. The patient shows good response to medications and because of counseling and family support therapies he developed insight about his illness and agreed for medication and rehabilitation at FOM. His family members with psychotic illness also involved their selves in rehabilitation and recovery process to improve their own insight towards disease as well. He is much more stable that he by himself visit the center on need basis and participate and communicate actively in his social living. He is also motivated to participate in income generating activity so that he overcome dependency on his family and community. FOM is in process to involve him in such sort of activity so that he can earn for himself.
Case Study 4:
Zarshad is 36 male, married having 5 children living Tehkal Payan of Peshawar. He has family history of psychiatric illness. He was first diagnosed as Schizophrenic Patient in Sarhad Hospital for Psychiatric Diseases, Peshawar formerly known as Mental Hospital seven years ago. Beside genetic factor as a basic cause of his illness, domestic problems and family disputes were among the other causes, which contributed towards his illness. He was regular patient of the mental hospital where he was putted down only on medication. For enhancing his psychosocial skills he was brought to community-based mental health care center by his family members. He was member with FOM for availing rehab and recovery services for improving his psychosocial skills. He actively participated to all rehabilitation process. His family also supported him in overall rehabilitation process. He was already having skill of carpentering which he was utilizing effectively before his illness. He has re-joined his previous work and started earning again.
Case Study 5:
Baghdad Shah is 25 year married man living in Tehkal Payan with his parents. He has 9 years history of psychiatric illness. He was diagnosed as Schizophrenia in tertiary hospital where he was only putted on medication but he did not respond well to medicines. As there was no proper awareness and education in his family regarding mental health his parents decided marriage is a best option for his recovery and he got married but it also didn’t work on his illness. His father came to know about community-based mental health care center and brought him for treatment where he received medication and rehabilitation services. He developed his insight and respond well to the treatment. Now he is working in car garage on irregular basis.
Akbar is 26 year married man living in Tehkal Payan Peshawar. 17 years ago, he had malaria during which he started talking disorderly had paranoid delusions that food is being poisoned, my family member wanted to kill me. He was taken to tertiary hospital for treatment where he was diagnosed as Paranoid Schizophrenia he was hospitalized for a month. He responded well to the treatment. Due to poor economic condition, he couldn’t continue his medication. A community activist has informed his family members regarding FOM activities. He visited a center and became a member. He received proper medication and facilitated with rehabilitation services. He is feeling much better and working on basis of daily wages.
Story of Jawad:
Jawad is 8 year old child living in Tehkal Payan with his parents. His family is migrated from Afghanistan since Soviet’s invasion on Afghanistan. Jawad was first seen by a community activist of FOM when he was wandering in local street of Tehkal Payan. Other children near by were teasing and making fun of him. His strange behavior confirmed him as mentally unstable child. His parents were contacted and they were informed about the community based mental health care center. They brought their child to the center where he was diagnosed as patient of mental retardation and epilepsy. For providing social protection and friendly environment to Jawad, his family was mobilized to send him willingly on daily basis to the center. Such children are vulnerable towards sexual abuse and harassment, drug trafficking and addiction and other abuses. He is regularly visiting a center where he spares all the day with FOM staff and patients. As FOM doesn’t has expertise in providing occupational and other specialized therapies to such people but still FOM is keep trying to enhance his living skills by providing a social environment inside a center. He has adopted the environment in a very good way and behaves friendly to all.
Story of Maryam and her family:
Maryam is married young woman having 5 children. She basically belongs to Parachinar (Kurram Agency). Kurram Agency is Federally Administered Tribal Area. It is bordered with Afghanistan. She was a housewife living with her husband and children happily there. Her husband was a tailor master and having his own tailoring shop, was earning enough to spend their livelihood. Their children were also getting qualitative education there. 2 years back her house was destroyed due to sectarian violence and terrorism. Her husband also lost his shop, which was burnt during the whole conflict. They were displaced and migrated empty hands to Peshawar where they got temporary shelter in their cousin’s house, which was located in Tehkal Payan. She and her husband started suffering from Post Traumatic Stress Disorder (PTSD). Her husband tried to cope with the situation and got a job on basis of daily wages. The income was insufficient for spending their normal livelihood. She became more depressed and anxious because of her husband’s attitude, which was aggressive towards her due to change of their socio-economic living and family psychodynamics. She came to know about the community-based mental health care center of FOM. She visited the center where she was diagnosed with stress related disorder. She was facilitated with anti-depressants, counseling services and stress management techniques. Her life skills were enhanced and she was motivated to cope with the situation on self-help basis. Within a month or two she showed very positive response, her psychosocial status was improved. She also motivated her husband to seek the services from the center. She became woman activist of FOM on voluntarily basis. She also mobilized other women living in her neighborhood suffering psychologically and emotionally and helped FOM in forming women groups for group counseling. Her family feels more empowered than the time of displacement. To encourage the family in best way, her husband was hired as a watchman in a center and she was provided with stitching machine to contribute economically for her family. Both husband and wife also re-admitted their children in Govt. School near by their residency.