Kittinan [i] was born in Thailand and is mentally handicapped. When he was 10 his father sold him to a film maker in the pornography industry. Said film maker de facto became his guardian and caretaker, and for almost 30 years, his abuser. When his guardian hit by dementia, was admitted in a specialized care institution, Kittinan was left alone. He could not care for himself and started roaming the streets of the city.
Kittinan is a nice guy, a rather happy person, whose joyful disposition endeared him to the inhabitants of the city, who over time had come to know and like him. And so they fed him, gave him clothes and cared for him as best they could, until one day somebody called social services, and the sordid reality was revealed. You may ask what the story of Kittinan has to do with us civilized countries of the west…
The answer is: everything. Because Kittinan was sold and imported right here, in the Netherlands, the goodest [ii] country on Earth.
Kittinan was smuggled into the country. Despite being a resident for 30 years, he has no papers, does not exist in any record, is not known from one single administration. Dealing with Kittinan triggered a ping-pong battle between different institutions. His situation did not fit anyone’s bill. He could have been taken in charge in a psychiatric institution, but his life story of sexual abuse meant that such a place may not have been 100% safe for him. A place specialised in brain damage patients could have worked from a care standpoint, but not administratively. Someone suggested that he be shipped back to Thailand, an option fortunately swiftly dismissed. It went on for another few months before a place was finally found for him.
Natasha Steenwijk is Dutch (Tall of course), has shoulder length blond hair, and smart blue eyes. Nothing in her demeanour suggests that she copes daily with people like Kittinan. Natasha’s passion is to create bonds between people to solve some of the most complex human puzzles that exist. This passion shines through in her conversation. She has a soft voice, but an assured way of telling the stories of her work-life. She does not hammer the harsh reality on you, for her stories are not stories you understand, they are stories you realise. It takes a few minutes to embrace the chasms in which people born or grown with some sort of weakness can fall, and how merciless modern society can look from there.
As Natasha goes on to explain how she leads her team of about 50 employees at Directzorg, I realise how challenging it is to face the radical alterity of people suffering from mental conditions, and how much competence it requires. I also remember from my meagre experience how being confronted to mental disorder can make me feel inadequate and helpless.
Natasha reports for example that 80% of police calls at night have to do with some form of mental disorder. It used to be the case that a person experiencing a bout of hysteria would be raided by 6 police agents loaded for bear, and physical restrain the only option. Directzorg employees nowadays regularly ride at night with the police. Where 6 agents were needed, only one remains, and together with a seasoned professional, they can in most cases handle the situation without violence, without escalation, with humanity.
In 2014, the Dutch government voted into law [iii], among other measures, the transfer to municipalities of the responsibility (And the costs) of organising healthcare services for the most fragile members of society (People who are handicapped, suffer from a psychic condition or psychosocial problems).
There is no doubt in Natasha’s view that this change is for the better, yet its application is a challenge. Municipalities need to learn how to organise and coordinate care. This is an essential part of healthcare, but not yet one that is perceived by all as a competence. Healthcare specialists and providers still often approach collaboration with the silo-mindset that prevailed until now.
Natasha contends that collaboration not only between health specialists, but also with the family and friends of patients, and with the patients themselves, is the essence of care. It’s not only for costs efficiency that this coordination should exist. Coordination facilitates the logistics of care, but above all, because it creates human contact in the healthcare chain, it makes it significantly more effective. As she puts it:
"Of all the known treatments, personal, direct and qualitative human contact remains the most effective medicine there is."
As a leader, Natasha keeps this in her mind always. More and better contact between all the links of the care chain is the life imperative, the compass that determines her days. It drives her sometimes to fearlessly ignore corporate calls for reports or meeting attendance, and occasionally ruffles some feathers. But that’s the real meaning of care. Care is entirely in the way the caretaker connects with patients and with the caretaking ecosystem around them.
"Care lies not in the activities around a person, that’s practice. It is entirely possible to practice medicine without ever caring for your patient. Care lies in the attention to the person while practicing."
Natasha is someone I call in my head a high congruence leader. She’s that type of person whose behaviour strongly supports what she says matters. Natasha says that contact is the essence of qualitative care, and she therefore indefatigably walks the streets of the city, hallways of partnering healthcare providers, and her own team spread over multiple locations, to create more qualitative bonds between people.
In some cases, all solutions are so imperfect that only the human touch can make them bearable.
She tells me the story of Helen. Helen is affected of a mental disorder like bipolarity. She is a courageous woman who after a long story of domestic violence separated from her husband and is the custodian of her children. One night, the ex-husband, against whom Helen never pressed charges, returned and beat her again. This violent episode triggered a relapse of epic proportions, and Directzorg were the first team responding to her call.
After assessing the situation, they turned to Safe at Home [iv] to come and make recommendations on the safety of Helen’s children. Due to her condition and instability, they were sent to a foster home, and Helen admitted in a specialized care establishment. The road to recovery is long for her because despite being the victim of a violent partner, and a victim of her own condition, she experienced her children being taken away as a failure and a punishment. But sending her kids away, tough as it was, was the lesser of two evils.
Working in healthcare means accepting to deal daily with stories that grab your heart and your soul, challenge your view of humanity, and drive you to make heart-breaking decisions. It requires courage, endurance and empathy to the highest level, and deep-rooted selflessness.
Bringing professional care for the weakest elements of society is not only humane, it is also a factor of societal health and stability at the best cost. Mentally unstable people in societies with insufficient care systems, frequently end up in prison [v], at a cost to society that is dramatically higher, and with little or no care to prevent relapses…
I profoundly believe that the work done by Natasha and her team is one of the most valuable services there is to our society both in economic and human terms. And I welcome as a good sign that we come progressively to embrace aiding people with mental conditions as a business as usual thing… The road is still long and full of obstacles. But with people like Natasha and her team at Directzorg to guide us, we can succeed.
Natasha Steenwijk
Natasha studied nursing and care management in the Netherlands and has spent her whole career in healthcare organisations. Over 30 years she has worked in a wide variety of environments and has more than 20 years of experience in management functions in this sector. She is the director of the Vlaardingen/Maassluis/Schiedam/Hoek van Holland units at Directzorg, a company specializing in tailormade care for physically and/or mentally handicapped people.
NOTES
[i] All names and places have been changed.
[ii] The Good Country is a very serious body of research and data, presented by Simon Anholt at Ted Salon Berlin 2014. It basically measures and ranks countries in the world according to how much they contribute to the world. The current Good Country index reports the Netherlands in first place. https://goodcountry.org/index/results
[iii] The "Law on social support", in Dutch: Wet maatschappelijke ondersteuning. See the Dutch government website for more information, and integral text of the law, in particular its article 2.1.1 and following. The new law on social support also enshrined the co-responsibility of care of healthcare professionals and the patient's own support system (Family and friends). Finally it elevated the principle of researching for each person the possibility to live in autonomy in the widest measure possible.
[iv] Safe at Home is the department of the Dutch ministry of health, in charge of assessing all situations of child abuse or mistreatment. Their recommendations are enforceable by law. https://www.vooreenveiligthuis.nl/veilig-thuis
[v] The link between mental disorder and prison population is abundantly documented. The World Health Organisation, Information sheet on this subject is edifying. Research work and articles abound and can be easily found all over the web.
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