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Patient Support Group Case Study (Gorkha)

A 34years/F residing in a VDC of Gorkha got married 14 years back. Though married, she has been living in her maternal house with her parents, two daughters and one son. Her husband has been working in India as a migrant worker.

She started going to school at the age of 5 years and failed in class nine while her sister jumped in class ten and even passed out. She felt humiliated because her younger sister moved ahead of her. Her mother however suggested her not to be worried about the failure and  motivated to continue study. She continued her study whatsoever.

When she was in Grade 12, she started showing symptoms like staring vacantly, poor interest in interpersonal and social interaction, poor appetite and sleep disturbance. She paid less attention to self-care and her daily chores. She started muttering to self frequently and had suspiciousness towards people in the community that they were conspiring against her. These symptoms persisted for more than 2 months and thenshe was brought to Mental Hospital, Lagankhel and medication was started by Psychiatrist. She started showing improvement in her symptoms gradually and was almost pre-morbid over 3 months. She then got married in the same year and her husband was also aware of her illness. Her daily life was going well with positive support from her husband. However, in between, her husband went to India for earning and asked her to quit medication. She was then compelled to stop medication.

Hersymptoms started deteriorating thereafter. She began scolding and using abusive words to neighbors; stopped cooking food; experienced difficultieswith daily functioning; neglecting care of  her children,staring vacantly, self-mutttering, etc. Her condition was getting worse day by day and her mother brought her to maternal home. Her mother tried to continueher medication. However, it was difficult to convince her due to lack of insight.

Her mother kept her in rehabilitation center for two years in Kathmandu. After some improvement, she was taken to her maternal homeafter which her symptoms started deteriorating again. Her mother has been providing care and support to her. However, husband doesn’t provide any support.

One day HBCW visited her home and provided information about TPO Nepal and available psychosocial support services and treatment in the district. HBCW motivated her family to visit primary health center for treatment but was reluctant. Then, this case was reported to  psychosocial counselor who motivated the family members to take the patient to primary health care center in the VDC.  The prescriber diagnosed her as having Psychosis and started medication.

She has been taking Tab Chlorpromazine 300 mg daily from the health facility. During the home visit of counselor, her mother makes repeated comments about her daughter’s condition like- her daughter condition might be result of previous birth’s sin, she could not die nor she could do anything, it’s been a crime for her children because she never cares, always beats, does not feed her children, so she needs to take care and support of her grandchildren.  The counselor and HBCW are regularly following up the case and her family.

Four counselling sessions have been conducted with the family. The counselor highlighted on the need of proper family support for her improvement and meanwhile HBCW followed-up 15-16 times and again has made the plan to continue follow-up visits. Nowadays, her condition has improved significantly. Her mother is supporting in regular medication intake and follow up visits. She behaves well with her daughter and has been a part of patient support group. This group consists of eight members. The members participated in the meeting and training sessions and selected goat farming as an income generating activity. Seed money was released and the members have already started rearing goat commercially. TPO Nepal will try its best to monitor and supervise the group so that the farming is sustainable and helpful for generating income to provide economic support to the patient and the family.