Friday, 4 October 2013

Mental health training in Somaliland - Day 14

Tuesday 1st October

I meet with the Clinical Lead, Dr. Mahdi, and another international doctor who has made Somaliland his home, to discuss psychiatry on the medical student curriculum. We are thinking about how psychiatry may be incorporated as a clinical attachment in the medical student final year. At present they only get 2 weeks of formal psychiatry teaching in their penultimate year and it would be valuable for them to have a further opportunity to meet patients and discuss cases as well as this. All agree that this is important, though fitting it in to their already very busy time schedule is another thing altogether. We think up a few different options for how this might work and I present some potential learning outcomes that might form the basis of a final year medical student log-book. We agree to maintain communication about this issue and all anticipate that this could become a reality perhaps in the next year.  Supervision is highlighted as an issue, as it always is, though we are excited that there will be two doctors returning from having completed Masters in mental health in Ethiopia in a few months’ time. They will no doubt be a fantastic resource for the medical students and also young doctors.  I am pleased that psychiatry is being taken seriously, that there is a real want to include more of it for the medical students.

I spend some time re-reviewing the medication of patients I saw yesterday and making management plans with them and their relatives. I then spend some time on the mental ward and talk through the current management of a female patient with the new doctor there. We come up with a treatment plan together and I agree to return tomorrow to review a few more cases with him, using them also as a learning experience for him.

The afternoon is spent with the 6th year students and they are excited today. They are happy and finally feel that they are really beginning to understand the art of OSCE’s for examinations. I am also pleased that they are remembering much of their psychiatric knowledge from when we taught them in May this year. They are a keen group and as always it is a pleasure to teach them and see them develop their skills. The message of our session today is ‘listen to your patient; he will give you the answers.’

I am visited in the evening by Dr. Gurgurte, who has worked very hard alongside his team to develop mental healthcare services in his part of the country. He is extremely positive about psychiatry and works tirelessly on both a mental health ward and also in the community to treat patients. He comments that he is happy to see patients, who he has treated, recover, and this propels him to continue his work. I am thrilled that he is happy working in psychiatry and, more and more here, we are seeing doctors who really do have an interest and a commitment to the specialty. Even those who do not go on to specialise in psychiatry, as very few in reality will, will be able to use their skills in mental illness wherever they are in medicine/ surgery, and so it is great to see people enthused and enjoying the subject. Unfortunately all too often there is stigma attached to psychiatry and mental illness, even amongst the profession and medical students, and it is part of our role here to also work at trying to lessen this stigma.