Wednesday, 30 October 2013

Mental health training in Somaliland - Day 37

Tuesday 29th October

Business as usual. Today I go to the mental ward with the two mental health reps, Dr. Zainab and Dr. Abdirahman.  The students have the opportunity to meet with two patients and each rep gets the opportunity to lead a ward visit with the students. I am pleased that they have this opportunity as it is something we practiced during the TOT training that they were both part of. Again, I am thoroughly impressed by their leadership and ability to enthuse the students. I have been really impressed throughout the two week teaching at their hard work and commitment, along with their preparation for all their lectures/presentations and their knowledge.

We meet patients on the ward with diagnoses of schizophrenia and Bipolar Affective Disorder. I am always interested to find that the symptoms of schizophrenia present in just the same way and are described by people very similarly to how they are in the UK. It is also interesting for the students as sometimes believing that the theory learnt in psychiatry is true in real life is difficult.

This man presents with thought broadcasting and clear third person auditory hallucinations. It is a joy to see the patients face light up when he finally feels understood by the students asking him questions about his symptoms, and their faces light up when they are presented with the very symptoms that they have learnt about this week. One student comments that his view of mentally unwell people has been completely challenged and changed during this two week course. Before today, he had never been on a mental ward and neither had he wanted to go on one. He stated that now he is no longer scared of people with mental illness and views them just as he does any other person. It is an absolute joy to know that in only a two week teaching course this can be achieved.

On the way back from the ward, I reflect on how amazed I am at the students’ ability to study their entire medical degree in English. This is not any of their first language and I consider just how tricky it must be to not only learn  the new ‘language’ of psychiatry during this two weeks, but also to have to flit back and forth between Somali and English whilst seeing patients and then presenting their cases and doing exams. All the facilitators would agree that we have been very impressed with this group.

Good news upon our return. We find out that the mental ward has won a prize! They have been voted best ward in the hospital! Everyone is overjoyed. This is great news and is testament to just how hard working the team on the ward is. Dr. Gurguurte and Dr. Jibril grin widely, as does Faadumo and then we also find out that Suad, the chief nurse on the ward, has also won a prize, for best nurse! This is great and illustrates that the mental ward and their service are setting a precedent for standards that should be achieved on wards in the hospital. Their prize is $1500 and we all smile when we hear from both Dr. Jibril and Dr. Gurguurte what the money will be spent on. Without hesitation, both of them grin and say, ‘we can buy more medications for our patients!’


I am, again, thrilled by the enthusiasm, dedication and kindness shown by the team here who work with people with mental illness. They often work beyond their hours, and treat patients for free, as evidenced this week by Dr. Jibril consulting with numerous community patients we have seen after the students have taken their histories, for free. What a happy day! We end the evening by meeting again with all the co-facilitators and running though the plan for tomorrow OSCE examination. We have to examine 68 students, each doing two OSCE stations each and so we know we will have to run like clockwork to make it work. A big day tomorrow.