Abstract
Introduction:
This article shows that patients
attending psychiatric department of CMC Teaching Hospital, Bharatpur, Nepal
are found new syndrome, those who worked or live
on Gulf Country named as “Gulf Country Syndrome”. The clinical features are
vague which includes abdominal pain ,tingling sensation, feel hot sensation on
body, problem on digestion, problem on breathing , palpitation, and feel
something on throat etc.
Method:
This is a retrospective study on
the data recorded in the psychiatric department of Chitwan School of Medical
Sciences. Demographic data and disease profile of 128 patients attending the
OPD were analyzed. The ratios and proportions were used for statistical
analysis.
Result:
Data shows highest number of cases were age
group 25-35 (N-49, 38.28%), most of cases were working as security guards (N-35, 27.34 %) and servants (N-26,20.31%) and highest number
of cases worked in Gulf Country 2 to
2.5year (N-28, 21.86 %).
Conclusion:
Nepali people who
worked or live on Gulf Country are found new vague syndrome, named as “Gulf
Country Syndrome”.
Key words: diagnosis profile,
socio-demographic characteristics
Introduction
Nepal is a developing country. It is estimated
that 29.1% people are living in foreign country. Nepali people going for jobs in gulf countries are very
high. Because of less job opportunities in Nepal, people are seeking migration
in other countries. Earnings in these countries, in the form of remittances
sent are sustaining economic activities in Nepal, from villages to Kathmandu, the
capital city1.
Nepalese population working in Gulf countries are getting less paid as compared to their compatriots and most of
the times they end up getting jobs that are dirty, dangerous and risky. This
amounts to more physical and psychological stresses already perpetuated by huge
amount of loan they have taken while coming from Nepal and other family members
left behind in difficult situations.2
Migration is the process of
social change whereby an
individual moves from one cultural setting to another for the purposes of settling down either permanently or for a prolonged period.
Such a shift can be for any
number of reasons, commonly economic,
political or educational betterment. The
process is inevitably stressful and stress can lead to mental illness. Cochrane & Bal observed that migrants had higher rates of schizophrenia
than the native population.3 Bhugra
et al found that Asian women aged 18–24
were 2.5 times more likely to attempt suicide associated with
culture conflict4.
Bhugra & Jones refer briefly to refugees as a group of
migrants especially vulnerable to mental health problems and they mention
post-traumatic stress disorder (PTSD) as an important disorder in this
particular population5.
Nazroo reported that in a community
survey, rates of anxiety were lower in Indian, Pakistani, Bangladeshi, Chinese
and Caribbean women when compared with White British or White Irish females6.
The current study shows that people working on Gulf Country
are suffering from different types of psychiatric morbidities among them. “New Syndrome” which appear like that as of
somatoform disorder, with different mode
of presentation Many people working on Gulf countries become sick and are returned
back to Nepal. They get different modalities of treatment from different places
but do not get better. Patients finally come to psychiatrists by their own or
through referrals. Symptoms are vague, multiple, not properly explained by
general medical practitioner. The clinical features are vague abdominal pain
,tingling sensation, headache, faintness, decreased sleep, feel hot sensation
on body, problem on digestion, nausea,
problem on breathing ,dry mouth, palpitation, painful urination, discomfort on
chest, pain on joints, diarrhea, sexual
problems and feel something on throat etc.
This article shows that patients attending Psychiatry
department of Chitwan Medical College Teaching Hospital (CMCTH) have cluster of
symptoms that resemble “Somatoform Disorders” but mode of presentation is different.
These are patients who worked and live on Gulf Countries so it has been named as
“Gulf Country Syndrome”. Working and living on foreign countries may be
stressful because of problem of adaptation on new place, new culture, and new
level of job, difficulty to understand language and for form home. Because of
lack of developmental work on developing country like Nepal, people are
migrated and join for job on developed country. Migration to another Country or
even unfamiliar part of same country is a life change is stressful .Prolonged
waiting period, exhaustion, social deprivation and isolation may cause different
stress related disorder. Difficulty in readjustment and social isolation at
newer places are important contributors of psychiatric problems in people who
migrate voluntaril7.The rates of common mental
disorders will be elevated among all migrant groups in Britain 8. Immigrant women having lower rates of
psychiatric disorders as compared with
US-born women9. Foreign-born Mexican
Americans were at significantly lower
risk of substance use and mood and
anxiety disorders10.
Material and Methods
This is retrospective study based
on the data recorded in the psychiatric department of Chitwan School of Medical
Sciences. Data profile of patients
attending in psychiatric OPD were
included for the study. The time period covered was from October1, 2008 to
September 30, 2010. Demographic data and diseases profile of 128 patients
attending the OPD were analyzed. The ratios and proportions were used for
statistical analysis. The rapport was established with the patients to obtain
enough information. The semi structured Proforma was filled with adequate
information The Proforma composed of name, age, sex, marital status, education
and occupation. Questions related with complaints of the patient was taken
which include chief complaints, history of present illness, past history,
family history and premorbid personality. The examination of the patient was
done in a detailed manner, which includes general examination, systemic
examination and mental state examination. ICD-10DCR diseases diagnosis code was
strictly followed 11.
Results
Table-1
DISTRIBUTION ON THE BASIS OF AGE AND SEX
AGE GROUP
|
MALE
|
FEMALE
|
TOTAL
|
%
|
15-25
|
24
|
2
|
26
|
20.31
|
25-35
|
46
|
3
|
49
|
38.28
|
35-45
|
27
|
2
|
29
|
22.66
|
45-55
|
19
|
0
|
19
|
14.83
|
55 above
|
5
|
0
|
5
|
3.90
|
Total
|
121
|
7
|
128
|
100
|
Data
shows highest number of cases were age group 25-35 (N-49, 38.28%) followed by
35-45 (N-29, 22.66%).
Table -2
DISTRIBUTION ON THE BASIS OF MARIETAL
STATUS
MARIETAL STATUS
|
CASE
|
|
NO
|
%
|
|
MARRIED
|
87
|
67.97
|
UNMARRIED
|
36
|
28.12
|
WIDOW
|
5
|
3.90
|
TOTAL
|
128
|
100%
|
Data shows highest numbers of
cases were married (N-87, 67.97%).
Table
3
DISTRIBUTION ON THE BASIS OF EDUCATIONAL STATUS
EDUCATION
|
CASE
|
|
NO
|
%
|
|
PRIMARY
|
29
|
22.65%
|
MIDDLE
|
36
|
28.12%
|
SLC
|
39
|
30.47%
|
INTERMEDIATE
|
21
|
16.40%
|
GRADUATE
|
3
|
2.34%
|
TOTAL
|
128
|
100%
|
Data shows distribution of subject on the basis of
educational status. Highest were education up to SLC (N-39, 30.47%) followed by
education up to middle level were (N-36, 28.12%).
Table 4
DISTURIBUTION ON THE
BASIS OF OCCUPATION
OCCUPATION
|
CASE
|
|
NO
|
%
|
|
SERVANT
|
26
|
20.31
|
ELECTRICIAN
|
10
|
7.81
|
DRIVER
|
25
|
19.53
|
SECURITY GUARD
|
35
|
27.34
|
COOK
|
5
|
3.90
|
PAINTER
|
3
|
2.34%
|
STORE KEEPER
|
9
|
7.03%
|
BUTCHER
|
2
|
1.56%
|
SALEMAN
|
13
|
10.16%
|
TOTAL
|
128
|
100%
|
Data shows distribution on the basis of occupation, most
of cases were security guard (N-35, 27.34 %) followed by
servant (N-26, 20.31%).
TABLE -5
DISTURIBUTION ON THE
BASIS OF
DURATION OF WORKING
DURATION OF WORKING
|
CASE
|
|
NO
|
%
|
|
Up to 6 MONTH
|
4
|
3.13
|
6M-1Yr
|
15
|
11.72
|
1Y-1.5Yr
|
23
|
17.97
|
1.5Y-2Yr
|
21
|
14.41
|
2Y-2.5Yr
|
28
|
21.86
|
2.5Y-3Yr
|
2o
|
15.62
|
3Yr above
|
17
|
13.28
|
Total
|
128
|
100
|
Data shows distribution on the basis of duration of
working in Gulf countries ,data
shows highest number of cases worked 2 to
2.5year (N-28, 21.86 %) followed by 1 to 1.5 year (N-23,17.97%).
Discussion
This study shows that people working on Gulf Country are
suffering from different types of mental problem among them “New Syndrome”
which appear the symptom of somatoform disorder, however it is different in
mode of presentation. Many people working on Gulf Country become sick and are
returned back to Nepal 12. They go
to treat different places but not get better treatment and finally come to
Psychiatrist who found multiple vague compliant and pain symptoms 13. People working on foreign Country
can be stressful because of changes on culture, religion and being far away
from home might feel that they are less secure and probably that are psychologically
unstable 14.
The process of migration is itself very lengthy and complex
process, involving different waiting
periods, degrees of exhaustions and types of trauma. Migration leads to
various psychiatric morbidities among immigrants that are associated with
migration and settlement15. People
working on foreign countries can be stressful because of changes on culture,
religion. Being far away from home makes people less secure leading to
emotional and psychological instability 16.
Studies have shown that greater the differences between original and indigenous
cultures, higher the level of interpersonal stress and cultural shock17. Lifetime psychiatric disorder
prevalence estimates were 28.1% for men and 30.2% for women, rate
are increase with migrated people18.
In the current study shows
highest number of cases were age group 25-35 (N-49, 38.28%) followed by 35-45
(N-29, 22.66%).Data shows highest numbers of cases were married
(N-87, 67.97%). Data
shows distribution of subject on the basis of educational status. Highest were
education up to SLC (N-39, 30.47%) followed by education up to middle level
were (N-36, 28.12%). Data shows distribution on the basis of occupation most of
c, ashes were security guard (N-35, 27.34 %) followed by
servant (N-26,20.31%)Data
shows distribution on the basis of occupation, most of cases were security
guard (N-35, 27.34 %) followed by servant (N-26,20.31%).Data shows distribution on the basis
of duration of working in Gulf countries
,data shows highest number of
cases worked 2 to 2.5year (N-28, 21.86 %) followed by 1 to 1.5 year (N-23,17.97%).
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