sierra leone -- kissy, situated here in Freetown, is the only mental health facility in the country, and its director the country's only psychiatrist. From the outside, the hospital complex of large lemon-yellow cement buildings with lots of windows doesn't look so bad. The windows have bars on them, but then, they all do here. It's only when you get beyond the walls that a horrifying picture emerges.
Mental illness is not looked upon favourably in Sierra Leone, the worst place in the world to live according to the UN's development index. It is a stigma to be carried like an albatross, not only by the people who are sick, but also by their entire families. One of two things usually happens -- the ill are either hidden in the home or driven out and left without any support. Kissy is for the few who receive any professional help.
I'm here with Doctors Without Borders. Our medical team operates a mobile clinic every Tuesday, and I do rounds, checking on patients who can't make their way to the administrative building where we're set up.
Upstairs, we find three large rooms, open, without doors, each with several beds. A few of these are empty, but men are shackled to most of them by chains of varying sizes that run from an ankle to the metal bed frame.
We check on all of them. All ask us for books, magazines, cigarettes, money, something to break the monotony, a way to connect with reality. We explain that we can only give them medicine. For the most part, they are like Lionel Sesay: quiet, well-spoken, very friendly and calm.
Lionel has a problem with heroin. His mother sent him here for treatment. Seems a lot of patients here are drug addicts. He tells us how hard it was going through withdrawal when he first arrived. Now that he's off drugs that suppressed his appetite, he's hungry all the time but there's never enough food.
Patients get two meals a day, both consisting of bread and pap, a corn-soya blend. Often breakfast isn't provided until midday. All the food is donated by the World Food Program. If patients don't have family or friends coming to see them, this is the sum total of their daily food.
In the ward for people without relatives to care for them, patients are attached not to a bed but to a metal ring welded to the floor. Without beds, chairs or any furniture at all, these patients lie on the floor 24/7. It's awful.
The farthest ward mainly contains young men, one of whom is lying on his stomach sobbing incessantly. They have virtually nothing save a few plastic containers for water. It's amazing to see how they share these freely, their only possession, when it's time to take their medicines.
Bad as they are, these wards aren't the worst. That distinction is reserved for the cells where the most dangerous patients or those who have escaped before are held. There's nothing inside the small cement rooms with tall red metal doors, oversized padlocks and small peep-holes about 6 feet off the ground.
For those locked inside, their only human contact consists of what they yell through the walls and the food delivered through a small opening at the bottom of their door.
One young man, an epileptic, died in these cells just three days before. We are simply told that he was swollen.
But most troubling for me is Janet, a young patient, and the only one I've seen who exhibits signs of mental disturbance. She runs around screaming, sort of spastic, and seems absolutely terrified of everyone and everything. I'm so impressed when our nurse walks up to her and wraps her arms around her in a tight hug. She tells her everything is OK, that she doesn't have to be scared.
This calms her down. She holds the nurse's hand; she holds my hand and accompanies us for a while. She's quite young, and has apparently been gang-raped several times. She runs screaming any time one of our guys gets anywhere near her. I hold it together while I'm here, but a big part of me just wants to cry. Lia Copeland is an administrator in Third World development with Doctors Without Borders.