Tuesday, 29 October 2013

Mental health training in Somaliland - Day 36

Saturday 26th October

Dr. Idiris, one of our intern doctor co-facilitators, begins the re-cap this morning. We are all impressed by how he manages to control the class and with the confidence he shows when teaching. Today we have nine community patients joining us and Dr. Jibril visits the mental ward with the students. The case mix is interesting and varied, with cases of psychosis, psychosis associated with khat use, depression, learning disability, epilepsy, possible ADHD or conduct disorder in a child and a child with epilepsy, whose mother believes she has been possessed from ‘djinn from the sky.’

The beliefs and stigma associated with epilepsy are akin to those for schizophrenia or psychosis. There is huge discrimination against people who suffer with epilepsy and Dr. Jibril’s talk on organic disorders today illustrates this with cases he has seen. Epilepsy is not considered a neurological disorder for many here and so comes under the remit of psychiatry. Dr Jibril describes a case where a young boy with epilepsy was forced out of school as he kept having seizures and these resulted in incontinence. His teachers allegedly spoke of him as ‘crazy’ and asked his parents to remove him from school. We hear of many other fascinating cases from Dr Jibril. He reminds the students that not all seizures are in fact epilepsy and uses the example of a case of a young girl who presented with seizures and was treated with benzodiazepines; however, it turned out that she was in fact pregnant and had eclampsia. She died as she did not get the treatment she required due to mis-diagnosis.

It is a real joy to have Dr. Jibril here with us this year and we are so grateful to him for having organised the whole set-up of the teaching this year. His teaching is excellent and is a great person to be able to present real life examples of cases to the students. I know that I will never forget the examples he has used in his lectures. He really managed to bring alive the topic in a way that few here could. I am genuinely impressed by his knowledge, teaching skills and commitment to his career as a doctor/future psychiatrist.