One of the days during my rotation I was given an opportunity by my mentor to visit the oldest mental health institute in Peru. This facility is called Hospital Victor Larco Herrera (HVLH). This has been named after Victor Larco Herrera who was a prominent Peruvian politician, farmer and philanthropist. Physically (alas not emotionally) it is situated in the heart of Lima in the Magdalena district. of Lima. As I took the taxi from my accommodation to HVLH I saw stigma galore. Even with my limited Spanish skills I heard the word “loco” about 4 times within the first 30 seconds of embarking. Later the cab-driver asked be of I was “ok”. I told him that I was, and that I was just going to visit HVLH, he gave me a long glare with a perceptible question-mark in it. Later during our conversations he explained to me that this was the street for the locos, and that most people would avoid this street as much as possible. I was excited to meet with my assigned mentor for this day: A child and adolescent psychiatrist Dr. Vargas. I reached the hospital a few minutes before 8. After a thorough check of my bag and belongings I was finally let inside the big iron door. My camera was withheld at the entry as I was not allowed to take pictures as a visitor. Dr. Vargas was kind enough to share some pictures which she sent me in an email later that week (All the pictures that you see here in this post are courtesy of Dr. Gisella Vargas). As I crossed the iron door I saw Dr. Vargas walking towards her car. She was surrounded by about half a dozen medical reps, who were trying to get 10 seconds of her attention, like you see sometimes the reporters running after somebody to ask “just one more” question.
I greeted her and introduced myself. Dr. V was very fluent in English, which was a big respite for me. For once at this moment I thanked my parents for sending me to the Sacred Heart convent where I was forcibly taught English. Dr. V explained to me that this hospital also has an inpatient and an outpatient component to it. Towards the outpatient side there are adult as well as child psychiatry services. Therapy including OT, PT and speech was given a respectable share of the space within the outpatient premises, and so was Psychology. The patients have to get a ticket for 12 sols at every visit, and then you wait for your turn till the doctor calls you.
The inpatient section is the big component of HVLH, and that was primarily the purpose for which it was created in the initial part of the 20th century. HVLH is divided into various sections. It was like a grand old majestic building. Since coming to the US I have been told stories about the institutions from the past. As I walked through the facility I saw that history was almost unfolding itself, though in another geographic and temporal context, and though I had never witnessed it before. I could relate to a lot of the books about the history of psychiatry that I have read in the past. HVLH is divided into sections or as an inpatient unit is referred to “Pavilion” in Peru. This hospital has many big pavilions with each accommodating from a few dozen upto a few hundred patients. The hospital is also under the ministry of mental health, and a major chunk of the funding comes from the government. The other sources could be foundations, charities and then there are patients who get employed within the hospital & contribute to the work force, and generate income within.
Pic 3: The road to the pavilions
The first Pavilion was an interesting Pavilion. It now had people who are in there 50’s, 60’s or even 80’s and 90’s. It was not a geriatric unit though. It is a unit where parents might have abandoned their children if they felt they were “not normal”. Normalcy as a concept has constantly defied me, so many times even since I have gained consciousness. What is outrageous today might be “perfectly alright” tomorrow. But as they say in Lima: “Asi es la vida” meaning “so is life”. In the yesteryears these not-normal kids were left to the mercy of HVLH by their parents who were embarrassed to have these children within their family. These are the patients who took their first step in the pavilion, grew the first wisp of that mustache there, got their first job in HVLH, and their friends and family and even the first crush was within this Pavilion. Most if not all, will eventually die there too…. I hear things have changed in the last 2-3 decades and that this kind of abandonment is almost non-existent these days. The other Pavilions were divided in male and female, short term and long term. There is a pavilion each for substance abuse, geriatrics, and an Emergency pavilion which is akin to a psychiatric ER. An interesting thing I learnt was the length of stay. The ER can hold people upto 3 days. Short term means anywhere between 30 days to 6 months. And Long term is 6 months to well ….forever in some cases. I visited each of the pavilions from outside. A very different experience for me, but as I expected very eye opening one. I had a lot to learn. As I was about to say my goodbye to Dr. V I saw a yellow building on the other side of HVLH, which was very similar in physical infrastructure. Other than that it had a vibrancy and an unexplained positive energy about it. I just could not resist asking her what it was. She told me that it was the biggest orphanage in Peru: Puericultorio Aranibar Perez. Having read about the East European orphanages, and having met with parents who had a story or two to tell me about an orphanage, my heart said Voilà. I have never visited an orphanage before in my life. I asked Dr. V if visitors are allowed in the orphanage. Having heard her answer, I departed from the big iron door of HVLH smiling.
Signing off on this Spring Tuesday morning till I talk about my next experience
Pallav
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