David O’Shea uncovers the terrible treatment of Bali’s mentally ill, who are often chained up for years on end by their families.
Airdate: 
Sunday, May 31, 2009 - 20:30
Channel: 
SBS One

Beyond the beauty of Bali's sand and surf lies an ugly and untreated problem.

This week on Dateline, reporter David O'Shea uncovers the terrible treatment of Bali's mentally ill, who are often chained up for years on end by their families.

David brings us the story of Komang, whose parents had forced him to live in a cage for 8 years. "œIn the cage they fed me three times a day. Then they washed me, and I went to sleep," he says. The family say it was a last resort as they didn't have the money for treatment.

The problem is made worse by Bali's severe lack of facilities. There is just one mental hospital on the island, and only 30 beds are reserved for the poor. Komang's father says the hospital advised him to restrain his son, but the hospital's staff firmly deny this.

David accompanies Bali's leading psychiatrist, Dr. Luh Ketut Suryani, as she goes from village to village visiting her patients and providing them with treatment. Her holistic approach combines modern psychiatry and anti-psychotic drugs with Balinese spiritualism.

David finds a heartwarming development in this tale of loss and desperation.

In October 2009, this report won a United Nations Association of Australia Media Peace Award, in the Television Current Affairs category.

David talks more about this story in a feature for Dateline's 30th anniversary.

Transcript

Dr Suryani is not a name many of you out there would be familiar with, George Negus certainly wasn't until Dateline video journalist David O'Shea embarked on his report. We may never have heard of her, but there are plenty of families in Bali who are deeply grateful for the work of this Good Samaritan and her small but dedicated team. What you're about to see - Balinese in chains and cages - seems unimaginable in one of the world's most sought-after tourist playgrounds, not to mention a destination that's become almost a rite of passage for young Australian tourists and holidaymakers. David spent some time with Dr Suryani as she headed out on yet another of her missions of mercy.

REPORTER: David O'Shea


This is the Bali millions of holidaymakers know and love. But not far from these tourist playgrounds, Balinese villages like this one hide disturbing secrets. This man has been sitting here, his foot held in these crude stocks, on and off for 30 years.

VILLAGE CHIEF (Translation): He's been restrained continuously since the '90s. Before that we often restrained him - then let him go. We felt really sorry for him. He hasn't left here at all since 1990.

When he was free, he instilled fear in his neighbours.

WOMAN VILLAGER (Translation): He goes looking for women. He grabs them.

REPORTER (Translation): So there's nothing else you can do with him? No?

WOMAN VILLAGER (Translation): No.

It seems incredible that he could be left here like this for so long, but these people say it's their only option.

VILLAGE CHIEF (Translation): Time and again we took him to traditional healers and doctors without much effect. We were forced to restrain him.

REPORTER: Is money the problem?

DR LUH KETUT SURYANI: They don't have money and also because they are hopeless - nobody can help the patient.

The woman who has brought me here is Dr Luh Ketut Suryani. So what do you think should be done?

DR LUH KETUT SURYANI: Now we try to make them understand that if we help them we can help the patient become recover.

Dr Suryani is Bali's leading psychiatrist and the only one regularly getting out into the villages. What her team has filmed on these rounds is shocking. Far too often, treatable mental illness is being left untreated and at least 50 people, but possibly hundreds, are held in makeshift shackles - this man left chained up next to his own excrement. This young girl out of sight, out of mind, and this woman kept in a room without lights, chained to the wall. Today, Dr Suryani is visiting Putu Antasa who she recently started treating.

REPORTER (Translation): Why do you have to be like this?

PUTU ANTASA (Translation): I forget - about this - I forget.

REPORTER (Translation): Have you been like this long?

PUTU ANTASA (Translation): Yes, I have.

On the last visit Suryani gave him an injection of antipsychotic medicine and he improved almost immediately. Now he wants to be set free.

REPORTER (Translation): You want to be in the house?

PUTU ANTASA (Translation): Yes.

REPORTER (Translation): But how will you...convince them?

PUTU ANTASA (Translation): The key. The key.

In fact, the family did free him after the last visit, but then he exploded, attacking his elderly aunt and knocking her unconscious. His relatives say they had no choice but to lock him up again.

PUTU ANTASA'S FATHER (Translation): I really love my child. I love my child. But he's destructive.

REPORTER (Translation): But they say if they let you go, you'll...

PUTU ANTASA: I'll go berserk? I won't. I won't go berserk. I did - once. I did, one time.

Dr Suryani hopes that another antipsychotic injection will do the trick.

DR LUH KETUT SURYANI (Translation): Once there's been some change, you can give him a mattress. If he doesn't burn it, try letting him go. OK?

Dr Lesmana is Dr Suryani's son. He has followed his mother's footsteps into psychiatry.

DR LESMANA (Translation): Stay here for now. When you get better, you can move inside. I have to go now, OK?

Dr Suryani and her son stumbled across Bali's hidden mentally ill while conducting research into the surprising increase in suicides after the Bali bombings. Since then, she's worked in her own special way to improve the island's mental health.

DR LUH KETUT SURYANI (Translation): Close your eyes. Concentrate your attention on your nose. I'm taking you back to the past when you were a child.

She holds public meditation sessions in the capital Denpasar as part of her preventative mental health program. Suryani believes meditation strengthens the mind and soothes the soul. And the rousing sing-alongs are designed to make everyone feel happiness. It's all part of her unique approach to psychiatry. Dr Suryani is about to treat this man, Komang, another one of her mentally ill patients.

DR LUH KETUT SURYANI (Translation): Concentrate on your cerebral processes.

As part of her treatment for Komang, Dr Suryani has called in a traditional spiritual healer. Many here believe the root of mental illness lies in the supernatural, which Western medicine is unable to treat. The healer carries out a purification ceremony designed to compliment the regimen of antipsychotic drugs.

DR LUH KETUT SURYANI: If I use only Western concepts, Balinese will not accept us. They will continue to go to healer. So if I can practice in Bali, I must use both Balinese concepts and Western concepts. Purification - the purpose is how to make the people, the patient, free from the burden and after that, they can be normal like other people.

At one stage my camera gets a little too close to the purification. It's been a remarkable recovery for Komang when you see where he has come from. For 8 years he lived in a cage his father built for him.

KOMANG'S FATHER (Translation): It was unbelievable! He hit me, he assaulted me. I'm lucky to be alive. I can't believe this illness. It's so destructive.

REPORTER (Translation): Did you ever get out?

KOMANG (Translation): During those eight years I never got out. I stayed in the cage. In the cage they fed me three times a day. Then they washed me, and I went to sleep.

REPORTER (Translation): Why do you think you had to be in the cage?

KOMANG (Translation): Because I kept wandering off.

Komang shared his cage with his younger brother, who is also mentally ill. He too has now been released.

KOMANG'S BROTHER (Translation): We were bad... We were bad.

REPORTER (Translation): In what way?

KOMANG'S BROTHER (Translation): We made trouble. We annoyed people.

The family say it was a last resort as they didn't have the money for treatment.

KOMANG'S FATHER (Translation): I still regret it. I wonder why I put him in a cage. I wouldn't put him in a cage again.

DR LESMANA: This is for the bed.

REPORTER: The bed in the cage?

DR LESMANA: Yes, it is.

Dr Lesmana says Komang's father was acting on advice from someone at Bali's mental hospital.

DR LESMANA: He got an idea from the mental institution that said "Maybe better you just lock your son up to make you feel safe and to make the community also feel safe."

 

This is Bangli, the island's only mental hospital. It has a capacity of 340 patients, but only limited places for poor people. Staff here know Komang's case and insist his father is mistaken and that they never advise people to restrain the mentally ill.

HOSPITAL STAFF (Translation): The parent might think that. He's drawn that conclusion. But we have never recommended that patients be confined. That has never happened. No, chaining people is forbidden. We rescue people who've been confined.

REPORTER (Translation): If there is help from the government... Why are people still chained?

HOSPITAL STAFF (Translation): There are many reasons why they're still chained. People may be reluctant to bring them here, to pay the cost of transporting them here. Then there is the belief among patients' families that treatment will not change the patient's condition.

REPORTER (Translation): Do you understand why your parents did it?

KOMANG (Translation): Yes.

REPORTER (Translation): You accept it?

KOMANG (Translation): Yes.

REPORTER (Translation): You're not angry or upset?

KOMANG (Translation): No.

Since being let out eight months ago, Komang has improved so much he has even got married - not that his wife was told of his condition, before the wedding.

REPORTER: Would you have married him if you knew he'd been living in a cage for eight years?

KOMANG'S WIFE (Translation): Maybe not.

Komang still has to take expensive medications.

DR LUH KETUT SURYANI (Translation): We can give him more Zeldox. What have we got?

DR LESMANA (Translation): We have 40 mg and 80 mg.

DR LUH KETUT SURYANI (Translation): Give him 40. Give him this first... And write it down.

Suryani pays for the medicine out of her own pocket with help from donations from Australia and Germany. Without that, there is little chance Komang could afford or get access to this medication. Suryani then drops in unannounced on Dr Made Pustaka, the head of the health department in north Bali.

DR LUH KETUT SURYANI (Translation): Is the doctor in?

WOMAN (Translation): Yes, he is.

DR LUH KETUT SURYANI (Translation): Right... I'm Professor Suryani.

She wants to get more government assistance for the region's mentally ill.

DR LUH KETUT SURYANI (Translation): We've seen the situation in the field. And while I'm here I'd like to ask if we can work together, our group and the Health Service.

Thanks to Suryani's lobbying, the government has recently pledged funds for her program in the east of the island but the money hasn't come through yet and getting officials onside is a struggle.

DR MADE PUSAKA, MINISTER OF HEALTH (Translation): We have a limited budget for drugs. If they're in the budget, okay. But any drugs not included... I'm sorry, we can't afford it. I don't know what to do. Those drugs are expensive. If we buy them, it will affect our basic services.

I find it astonishing in an island awash with tourist dollars that more money can't be set aside for mental health. This is Suryani's first visit to this man, Gusti. Although he is reciting stories from the epic Hindu tale, the Mahabharata, when he's free, he damages the local Hindu temples and steals from homes. So, for the past six years, he's been chained here.

DR LUH KETUT SURYANI (Translation): Do you often feel tired?

GUSTI PUTU UTARA (Translation): Yes I do. I sleep a lot.

I am surprised to discover that he speaks English.

GUSTI PUTU UTARA: My story to this house is... I help building my father when he lived here from the bottom until the roof.

REPORTER: So you helped build the house?

GUSTI PUTU UTARA Yes.

He asks Suryani for some basic necessities.

GUSTI PUTU UTARA (Translation): A toothbrush, a toothbrush. It's hard to communicate with the people around here. A toothbrush, toothpaste. and... soap.

Professor Suryani is convinced that Gusti will respond well to the medicine but she needs the approval of the family, and they're not keen.

DR LUH KETUT SURYANI (Translation): The drugs are expensive. And actually, it's expensive for us to come here. But for his sake... He's still a fine young man. He could be a useful citizen. Why don't you give your permission? Our service is free.

She then tries to convince Gusti's eldest brother.

DR LUH KETUT SURYANI (Translation): He's self-aware. Don't you feel sorry for your brother? You can talk to him normally. It's just that his mental processes are disturbed.

The family are still reluctant and Suryani decides to ramp up the pressure.

DR LUH KETUT SURYANI (Translation) If you leave him there, I'll report you to the police. Leaving a sick person untreated is an offence. We've come here to help. So if you leave him there, we'll go to the police, because you've left someone chained up. That violates human rights.

They finally relent and Gusti is readied for the injection.

MAN (Translation): He wants to be free, but please don't free him.

DR LUH KETUT SURYANI (Translation): Oh, we won't free him yet. I wouldn't dare. Thank you, sir.

Time and again Suryani struggles with families who are initially suspicious of her work. But at our next house call, I meet one of her successes, Nengah Sri. Until recently, she was chained up behind this house.

DR LUH KETUT SURYANI (Translation): How are you? You're looking great. You're better?

NENGAH SRI (Translation): I'm better. -Yes.

The first time Suryani's team visited her two years ago, they shot this footage. It shows just how much Nengah has improved since the medication. Now with all her faculties back she's embarrassed at the memory.

NENGAH SRI (Translation): I remember a bit, but not much.

Suryani is convinced her patient is better when she refuses to sing again.

REPORTER (Translation): You won't do it now? What songs do you know?

NENGAH SRI (Translation): No. I'm embarrassed.

REPORTER (Translation): You weren't embarrassed then?

NENGAH SRI (Translation): No. I was sick then.

There's no use any more for the chain and Suryani is over the moon with the progress. The whole team is delighted as the value of their work sinks in.

DR LUH KETUT SURYANI: This makes us have energy to help the other patients.

DR LESMANA: The change is so dramatic. It's like she had never been in that situation not having a disorder, maybe. So it's very surprising and incredible, really incredible.

REPORTER: It makes you feel pretty good?

DR LESMANA: Yes, really good, and really proud.

GEORGE NEGUS: And they say we don't do happy-ending stories. And Dr Suryani tells us that since David's visit to Gusti, the man who was singing those Hindu songs, he has apparently improved enough to be set free. And he's even decided to cut those fingernails of his.

Reporter/Camera

DAVID O'SHEA

Editors

NICK O'BRIEN

ROWAN TUCKER-EVANS

DAVID POTTS

WAYNE LOVE

Producer

AARON THOMAS

Translations / Subtitling

ROBYN FALLICK

GIYANTO MARTOREJO

Original Music composed by

VICKI HANSEN

Additional Footage - Dr. Cokorda Bagus Jaya Lesmana