It is 8am on a Thursday morning and the Kisumu County Hospital is already bustling with activity.
Medics make their way to the outpatient block as others conduct rounds in the wards.
But all is not well inside a secluded old ward tucked in a corner of the congested hospital compound.
Here, the patients are shouting at the top of their voices. Others are either fighting, singing or laughing loudly at their own jokes.
It is a madhouse, by all definitions of the word.
In the congested, stuffy ward, many of the patients sleep on thin mattresses spread out on the cold floor.
Welcome to Ward Eight — the oldest and biggest psychiatric unit in Western Kenya, where patients with mental illnesses are locked up.
Here, male and female patients share the same ward only partitioned into small cubicles.
Fights are common and nurses and medical interns spend most of their time separating scuffling patients, some of whom are extremely violent.
The weak and sedated ones are always at the mercy of their stronger, more aggressive colleagues.
Ward Eight, with a capacity of 30 patients, has a 15-bed section for male patients and another 15-bed section for females.
When The Standard visited the ward, the female section had five beds and six mattresses on the floor. Each bed is shared by up to three patients.
The male section had seven beds with mattresses scattered all over the floor. Here, some patients slept under the bed while others shared the few available ones.
The hospital has stopped more admissions into the ward because of over stretched facilities.
“We are now referring patients seeking admission here to other hospitals,” said a nurse at the facility who requested not to be named.
According to the nurse, the ward has in the past admitted patients from as far as Nairobi, Rift Valley and Western regions.
The poorly ventilated ward with broken windows lacks mosquito nets. Student nurses said many of the mentally ill patients had been diagnosed with malaria.
The hospital authorities said they discourage the use of mosquito nets in the ward out of fear that some of the patients could use them to strangle themselves or others.
They instead use mosquito repellents which have not been supplied for the past few months.
Nurses said the messy environment inside the ward made it difficult to take the patients through individual counselling.
“Sometimes when we are counselling them in an open place, other patients interfere with the sessions and start fights,” said a nurse.
Investigations by The Standard indicated that many of the patients at the ward have been abandoned by their families and have been there for many years.
“The oldest patient was admitted in 1995 with temporary lobe epilepsy, no family member has come to visit him since then,” said Maurice Odhiambo, the nurse in-charge of the ward.
The patient, Sylvester Onyango, 48, hails from Kendu Bay, in Homa Bay County, and has become a permanent fixture at the hospital. He knows all the doctors and nurses by name.
Sources and relatives of patients said the psychiatric ward was mainly ran by student nurses. Each is assigned six patients.
There have been reports of sexual assault on some patients. To remedy this, the hospital is constructing another ward for female patients.
Nurses who asked not to be named claimed there had been incidents of female patients falling pregnant while at the facility.
Mr Odhiambo, however, could not confirm or deny this claim. However, he revealed that patients in the ward were often given drugs that lower libido.
“This is the measure we have taken but we have not fully achieved our objective,” said Odhiambo.
He admitted that there was an urgent need to upgrade Ward Eight.
The ward, he said, was in dire need of a security room for violent patients and a rehabilitation centre to handle drug addiction patients.
According to the nurse, there have been cases of patients escaping from the ward. Two escape attempts have been recorded in the past two months. In both cases, security personnel at the ward managed to bring back the patients, though not without a struggle.
A social worker at the facility, who also sought anonymity, said shortage of staff was another challenge facing Ward Eight.
She said the institution has one social worker, two psychiatric nurses and one psychological clinical officer.
“This ward was built during the colonial times in the early 1960s. Today, it does not meet the standards of a psychiatric unit,” said the social worker.
Health Executive Rosemary Obara conceded that the ward urgently needed a face-lift.
She said the county had allocated Sh35 million to upgrade health facilities and that the psychiatric ward would be prioritised.