VZCZCXYZ0000
PP RUEHWEB

DE RUEHAC #0382/01 1632007
ZNR UUUUU ZZH
P 112007Z JUN 08
FM AMEMBASSY ASUNCION
TO RUEHC/SECSTATE WASHDC PRIORITY 6988
INFO RUCNMER/MERCOSUR COLLECTIVE
RUEHC/DEPT OF LABOR WASHDC
RUEAWJB/DEPT OF HHS WASHDC
RUEAWJB/DEPT OF JUSTICE WASHDC
RUEHPH/CDC ATLANTA GA

UNCLAS ASUNCION 000382 
 
SENSITIVE 
SIPDIS 
 
G/TIP, G, INL, DRL, PRM, WHA/PPC, WHA/BSC KBEAMER, STATE 
PLEASE PASS TO USAID 
 
E.O. 12958: N/A 
TAGS: KCRM PHUM KWMN SMIG KFRD PREF ELAB PGOV ASEC
PA 
SUBJECT: NEUROPSYCHIATRIC HOSPITAL IMPROVES HUMAN RIGHTS 
CONDITIONS 
 
 
¶1.  (SBU) SUMMARY:  Asuncion's Neuropsychiatric Hospital, 
Paraguay's only facility for mentally impaired patients, 
resolved or alleviated several deficiences cited by previous 
human rights reports, including overcrowding; inadequate 
patient care; rampant infections; malnourishment; underaged 
patients; insufficient staffing; and a lack of access to 
water and electricity.  Hospital Director Dr. Nora Gomez told 
PolOff Paraguayan government assistance increased 
significantly over the past three years.  The hospital 
physically separated patients by both gender and temperament 
and had ample consumables, electricity, and running water. 
Dr. Gomez told PolOff that the hospital was fully staffed and 
able to handle its patient load.  A representative from the 
NGO Mental Disability Rights International, which initially 
prompted the Paraguayan government to action, stated the 
hospital still urgently needs to improve security and 
accountability.  END SUMMARY. 
 
¶2.  (SBU) The 2006 Human Rights Report for Paraguay reported 
significant abuses at the Neuropsychiatric Hospital, 
including overcrowding; inadequate physical and mental health 
care; widespread parasitic and skin infections among 
patients; inadequate nourishment; underaged patients; and 
insufficient staffing.  The report also noted that some 
buildings lacked roofs and that patients lacked adequate 
access to water and electricity.  The NGOs Mental Disability 
Rights International (MDRI) and Paraguay's Center for Justice 
in International Law (CEJIL) filed a petition with the 
Inter-American Commission on Human Rights in 2002 asking it 
to intervene to protect hospital patients.  The Paraguayan 
government subsequently signed an agreement in March 2005 
with MDRI and CEJIL pledging to improve hospital conditions. 
 
¶3.  (SBU) Hospital Director Dr. Nora Gomez told PolOff that 
the Paraguayan government -- notably the Ministry of Health 
and Social Welfare, the Senate's Commission on Human Rights, 
and the Office of First Lady Gloria Penayo de Duarte -- 
improved hospital conditions over the past three years.  She 
stated that the hospital reduced the number of patients from 
460 in 2005 to 253 in 2008, allowing the hospital to close 
one dilapidated wing.  She explained that the hospital 
reduced its patient count by releasing rehabilitated patients 
or transferring others to other hospitals or public shelters. 
 She stated that some patients under 18 years of age were 
still interned at the hospital but that the hospital has 
attempted, whenever possible, to place them with their 
families or in foster homes.  Dr. Gomez explained that many 
family members abandon mentally impaired persons at the 
hospital's doorstep; others end up in the streets.  (NOTE: 
Paraguayan law mandates that extended family members care for 
mentally ill relatives, and family members can be prosecuted 
for negligence.  This law is rarely enforced.  END NOTE.) 
PolOff did not observe any children or adolescents on site 
during his visit. 
 
¶4.  (SBU) The hospital physically separated patients by 
gender and temperament.  "Highly aggressive" patients were 
sequestered in their living quarters.  Dr. Gomez stated that 
the hospital allowed "more benign" patients to roam in 
designated areas.  A wall physically separated the men's and 
women's common areas; however, gaps allowed patients easy 
access to most areas of the hospital grounds. 
 
¶5.  (SBU) The facility was generally tidy with ample 
foodstuffs, clothing and shelter.  It had functional 
lighting, running water, and buildings with roofs.  The 
kitchen, food storage areas, and laundry facility appeared 
adequate to meet patients' needs.  The hospital pharmacy 
stored large quantities of medicines and pharmaceutical 
products in a climate controlled, limited access environment. 
 Teaching and Investigations Director Liliana Bendon told 
PolOff that the pharmacy opened in November 2006 with 
Paraguayan government assistance.  Likewise, the hospital's 
health unit, psychology unit and laboratory were clean, 
orderly, and well-stocked.  Dr. Gomez said the hospital staff 
actively monitors patients to ensure that they receive 
adequate health care.  She noted that patients undergo 
psychiatric evaluations, and if necessary, receive lab work, 
but that neither the psychology unit nor laboratory had 
adequate staffing or equipment to offer patients 
comprehensive diagnoses and treatments. 
 
¶6.  (SBU) Patients' living quarters were relatively clean but 
austere with bare concrete walls and floors and twin-sized 
hospital beds; urine pooled under one patient's bed.  Rooms 
were lit by overhead lights and had open windows with bars to 
allow sunlight.  However, windows were paneless and rooms 
lacked heating or cooling systems, exposing patients to the 
elements.  Men and women were held in separate maximum 
security wings.  One vocal patient had several burns on his 
chest; Nurse Gustavo Lopez stated that the patient burned 
himself with a cigarette and that staff brought him to 
maximum security to isolate him.  Lopez confirmed that the 
hospital trained nurses to restrain patients and that the 
local unit of the National Police remained ready to respond 
to emergencies.  The hospital compound has one gated entrance 
and is surrounded by concrete walls with barbed wire. 
 
¶7.  (SBU) Dr. Gomez told PolOff that the hospital was fully 
staffed and able to handle its patient load.  She noted that 
the hospital would like to decrease its patient load to 
capacity (200 patients) but that it is the only Paraguayan 
hospital capable of handling chronically mentally ill 
patients.  She expressed gratitude to the Paraguayan 
government for improving the facility and providing 
much-needed resources.  However, she told PolOff that the 
hospital still needs a new ambulance to transport patients to 
other hospitals, and that it is still unable to provide 
sufficient psychological assistance to patients.  She 
expressed concern that the hospital does not adequately 
address all patients' needs. 
 
¶8.  (SBU) Although MDRI Legal Advisor Alison Hillman agreed 
that hospital conditions improved, she told PolOff May 21 
that the hospital still urgently needs to improve security 
and accountability.  She indicated that several patients were 
recently killed or abused, including a male and female 
patient found dead in December 2007 in the "Chacra" 
greenspace located behind the hospital.  Hillman stated that 
allegations of sexual abuse of patients by hospital staff 
abound, and that the hospital lacks a system of 
accountability that allows staff to detect risky situations 
and ensure abuse is investigated and prosecuted.  She said 
that the hospital staff pays inadequate attention to 
chronically mentally ill patients and frequently locked them 
away in isolated confinement.  Finally, she told PolOff that 
the hospital needs to change its policy to allow discharged 
patients to return to the pharmacy for medication, because 
the pharmacy is typically their only source for the 
medications they need. 
 
¶9.  (SBU) COMMENT:  The hospital improved since 2005 but 
still needs to enhance its security and accountability 
systems.  Although the hospital still does not appear to meet 
international public health standards, it has adequately 
addressed key deficiencies documented in previous human 
rights reports.  END COMMENT. 
 
Please visit us at     http://www.state.sgov.gov/p/wha/asuncion 
 
Cason