Mentally challanged patients at Asha Kiran Home in Rohini, New Delh. (Express photo by Abhinav Saha)
The blue iron gate is rarely, if ever, opened. The boundary wall along the six-acre campus is crowned with barbed wires. During the day, small groups of people huddle outside. Occasionally, a few are allowed inside through a small passage. The only giveaway to what’s inside is a fraying signboard that reads ‘home for mentally challenged persons’, or ‘Mandhbudhhi Bikas Griha’ in Hindi.
To an outsider, it evokes both curiosity and fear. “A courier person recently came with a package. Some inmates were playing cricket, using bricks as stumps. The sight of one of them arranging the bricks rattled him — he thought they’ll hurt him,” Rachna Bhardwaj, superintendent of Asha Kiran’s female wing since 2012, said. “People treat our children like untouchables, like they’ll contract a communicable disease by mixing with them.”
The ‘children’ — as Bhardwaj and nearly the entire staff of Asha Kiran call them — are male and female inmates of the shelter home for the ‘severely’ and ‘profoundly’ mentally challenged people, who have been abandoned by their families. The facility, run by the Delhi government’s Social Welfare Department, was established in 1989 in Rohini’s Sector 1, with a capacity to house 350 people.
At the time, it was the sole government-run residential facility for the mentally challenged in entire north India. Thirty years later, Asha Kiran still remains the sole such facility in the region, with few parallels in the country. Its capacity was marginally augmented in 2013, when four new dormitories were opened, taking the sanctioned strength to 510.
The Home has five cottages and 10 dormitories each for male and female wings. A few cottages are reserved for inmates requiring isolation, owing to contagious diseases such as hepatitis and tuberculosis.
Today, more than 1,000 mentally challenged persons call Asha Kiran their home. And with numbers swelling by the day, overcrowding is a perpetual worry, Pankaj Mishra, the administrator, said.
The Home had made headlines in February last year, when reports emerged that 11 inmates had died within two months, between December 2016 and January 2017. This prompted a “surprise” visit by a team of the Delhi Commission for Women (DCW).
The DCW submitted a report, replete with indictments such as “shocking lapses” and “gross human rights violations” inside the Home. The Arvind Kejriwal-led AAP government then rejigged the Home’s governing body, a supervisory authority of 14 members. In July 2017, it announced the creation of 243 new posts for the Home. Nearly a year later, not a single recruitment has been done.
(Express photo by Abhinav Saha)
At Asha Kiran, around 503 inmates have profound or severe mental impairments, while 482 inmates have mild to moderate disabilities. Two other homes, Asha Deep (for males) and Asha Jyoti (for females), which cater to only mild and moderate category patients, house around 240 inmates collectively. A person is considered to have mild mental retardation when his IQ is between 50-55, moderate between 35-40, severe between 20-25 and profound below 25.
Mishra explained that such impairments can develop in a person due to violence inflicted on the mother during pregnancy, use of forceps during delivery, malnutrition, meningitis and a host of other factors.
The crunch
All cottages and dormitories The Indian Express saw were bursting at the seams. Except for the severely challenged and those with physical deformities, who have beds, the rest sleep on mattresses placed one after another on the floor.
A few inmates saunter out occasionally, which is another challenge. Between 2011 and 2016, 24 inmates (22 males and two females) have escaped from Asha Kiran premises.
According to the staff requirement drawn up by authorities, the three Homes need over 600 ‘house aunties’ and ‘caregivers’ to cater to the inmates. However, only 483 posts have been sanctioned by the government, of which 241 have been filled.
Moreover, 112 posts, including that of welfare officers, kitchen helpers, staff nurses, medical specialists and clinical psychologists, are also vacant, official records show.
“Ideally there should be one caregiver per profoundly challenged individual, and one for around five to seven mild and moderate category inmates. It is a demanding task as even things like toilet training take months. They have to be taught to sit, clean themselves, flush and return,” Bhardwaj said.
As a result of the acute crunch, existing staff are forced to perform multiple roles. The situation is such that a ‘house aunty’ also gives powerlifting training to inmates preparing for the 2019 Special Olympics. In the past, many inmates from the Home have bagged medals at the Olympics, including at the 2015 event in Los Angeles.
Staff also have to reckon with inmates who are bedridden through the year. Take for instance, an inmate found abandoned at Baba Saheb Ambedkar Hospital. “When authorities tried contacting her parents, it turned out that the person who brought her to the hospital had faked his identity. Subsequently, she landed here. It’s been three years, and she has been bedridden. But you will not find any bedsore; there are many such inmates who are provided constant supervision,” Pankaj Kumar Verma, superintendent of the male wing, said.
While admission to Asha Kiran is permitted only as per orders of magistrate/judicial officers or child welfare committees, this has not stemmed the tide of new inmates. According to records, 981 admissions took place between 2010-11 and 2017-18 (till date).
Dr Achal Bhagat, a senior consultant psychiatrist and psychotherapist who was made chairperson of Asha Kiran’s general council last year, said the “greatest crunch” is of “trained human resource”, and that there is need for about 400 people to be hired. “The process is slow and sometimes like pushing a wall. Once people are hired, they should be trained and supervised. We need to have clear policy of not admitting more people to an institution which has no way of restoring people to the community. I do not think one person or one year can change the institutionalisation,” he said.
Bhagat believes the need of the hour is to do away with such large set-ups. “Such people have a right to live in the community with dignity, either with families or independently, or in assisted living facilities that have a family-like environment. Improving Asha Kiran is an oxymoron. The facility needs to be gradually phased out, and new methods of care need to be brought in,” Bhagat said.
Multiple officials in the social welfare department said that while the outrage over the deaths was “understandable”, the government should expedite construction of new homes to decongest Asha Kiran.
Going by the monthly death rates at the Home between 2008-09 and 2017-18 (till February), the 11 deaths in two months were not unprecedented. In 2008-09, there were 16 deaths in November and December; 23 in December-January 2009-10; nine in August-September 2012-13; 13 in October-November 2013-14; 11 in April-May 2014-15; and 13 in November-December 2015-16. Even in 2017-18, there were seven deaths in November-December. Between 2011 and 2017, 123 male and 73 female inmates have died in Asha Kiran, records show. After each death, the local district magistrate has to send reports to the National Human Rights Commission.
“They are always at a higher risk and are vulnerable as they have associated risks such as epilepsy and other complications. Also, when you put 900 people together in a situation of resource crunch, the likelihood of morbidity increases despite the valiant efforts of the staff,” Bhagat said.
Inside the home, inmates keep busy with lessons on stitching, sewing, making wax candles, trinkets and clay pottery, and neatly separating petals from flowers collected from temples and banquet halls so they can be dried and processed into organic colours. A ‘Kaushal Kutir’ where these skills are imparted had come up in 2015. The tasks are not random, but carefully selected to stimulate their sensory organs, Urmila, one of the vocational training assistants, said. “These tasks help refine motor skills, strengthen grip, learn counting and recognise colours. Things like pottery bring them close to nature. Moreover, these activities help them channel their frustration or anger in a positive direction. They feel a sense of accomplishment,” she said.
Homecoming made difficult
Only a few inmates are restored with their families every year. For instance, 24 have been rehabilitated in 2017-18, while in 2016-17, the figure was 52. Between 2010-11 and 2015-16, an average of 35 inmates were restored, Asha Kiran records show. In fact, one of the inmates, Prince, who was brought to the Home in 2001, was employed as a caregiver in 2014 when he became fit for restoration.
But the restoration numbers hide a bitter reality — that of gender bias. “The separate restoration figures for each gender reveal the extent of discrimination even when it comes to the mentally challenged,” Bhardwaj said.
Between 2010-11 and 2017-18, 147 boys in the ‘profound’ category were restored with their families as compared to 31 girls. In 2017-18, 12 boys were restored in comparison to three girls; and in 2016-17, 28 boys and eight girls were restored.
Mishra narrated the story of 28-year-old Gudiya, who was recently restored, to underline the challenges. “She was rescued after an attempted suicide in July 2017. While interacting with welfare officers at the Home, she gave sketchy details, but told them she belongs to Rajasthan’s Banswara. We got in touch with local police and traced her family, but they were not willing to accept her. We had to counsel them through an NGO. Summons were also issued by the court to her father to explain his reluctance. Finally, after collective efforts, they took her back,” he said.
Currently, there is no mechanism to track the inmates after they are handed over to their families, Mishra said.
After a visit by former Lt Governor Najeeb Jung in May 2014, a few ambitious announcements were made — the most important being the promise to construct a new facility at Narela, with a capacity to house around 600 inmates, within three to four years. Jung had also announced that a high dependency unit (HDU), with a team of dedicated medical officers, would come up in Asha Kiran, along with a dental care unit and a rehabilitation and physiotherapy-cum-vocational therapy unit.
Four years later, the Narela Home proposal is still on the drawing board. Only recently has there been file movement, with officials in the Social Welfare Department claiming that the project proposal would soon be sent to Chief Minister Arvind Kejriwal and the Cabinet for approval, as per directions of the department secretary. But as things were beginning to look up, the secretary was transferred. “This is the biggest hurdle in bureaucracy. Each secretary comes with his own style of working and the next one would be no different. He may want to have a relook at the entire project as it involves around Rs 350 crore. That will lead to more delay,” an official said.
Back at Asha Kiran, the rooms for the HDU and the two other units have been built. According to official documents, the approximate price of equipment for the HDU has been pegged at around Rs 46 lakh, and Rs 30 lakh for the dental unit. The annual Budget of the Home (excluding salaries) was Rs 4.16 crore in 2017-18 and Rs 4.75 crore in 2016-17.
“The HDU is being set up for residents who need specialised emergency care. At present, such cases are referred to the nearest hospitals. But the in-house facility will help save lives in cases of respiratory difficulties and choking, which are among the most common ailments. Also, most inmates don’t brush, so the dental unit will go a long way in ensuring oral health,” Mishra said.
Japanese national Joji Murakami (32), a special educator, has been attached with Asha Kiran for the last eight months as part of an exchange programme. Asked to reflect on his time here, Murakami doesn’t mince words. “The Home desperately needs more funds for beds, tables and human resources. The helper-inmate ratio is abysmally low. It’s a burdensome work for the existing staff. It’s really, really challenging,” Murakami, who will be here till July 2019, said.