Wednesday, 6 November 2013

Mental health training in Somaliland - Day 45

Tuesday 5th November

Another early start, with the first stop being the beach! I have never seen the coastline in Somaliland, and it feels great to breathe the sea air. Then onwards to the mental ward once again. Today we spend time detailing what is available and what is happening on the ward, such as the numbers of patients locked in rooms, the numbers chained, trying to get some more sense of their diagnoses and the medications available on the ward. We speak to ward staff, who are mostly social workers with very little training in mental health. Many have only had three months training in mental health two years ago in Hargeisa and little since.

They all feel that they would benefit from further training. It is incredible really that they have all stayed on the ward for a number of years, despite not even receiving proper salaries. The ward administrator is very helpful and gives much of his time today to help answering questions about the general running of the ward.  It is interesting to find out how the ward runs, with so few staff. There are no trained nurses who work on the ward. Safety issues are striking. With so little staff and training, when patients become violent and wish to abscond, often they are left to go, as it is simply not safe to try and keep them there. Only two weeks ago, a watchman on the ward had boiling hot water thrown in his face as a patient tried to leave the ward. The watchmen have not had training in restraint techniques and so this clearly makes their job more challenging.

Though there is a doctor on the ward, we do not get the opportunity to meet with him today as he is away. He attends the ward from 7:30 am until lunch time each day. It is encouraging to see a system of clinical notes existing, though many are not written in any detail. I reflect on how challenging it must be to work here, without any senior supervision available.  The physical health of the patients remains a challenge, with very little input from doctors in the main hospital. They rarely come across to the mental ward whilst on-call, and so in emergencies patients are sent across to the main medical hospital. The patients only get their vital signs monitored on admission to the ward, and in an emergency. Their physical health is only assessed I am told, when the patients are noted to be unwell.  

We speak to a number of patients who report physical problems. It is clear that much could be done here to help both staff and patients. With better training, the staff would likely feel more able to manage the patients and also feel more empowered in their roles. I hope that we will be able to offer some input here in Berbera.


The journey back to Hargeisa from Berbera proves to be a challenging one. Rather than two and a half hours, we spend seven and a half on the road, and then end up back in Berbera! The road is flooded due to the rain running off the mountains and filling the rivers that the road crosses. We manage to cross two, though there is a real concern that if we try and cross any more, we may not make it across. We can see cars and trucks on the other side who have been impatient and ended up getting stuck in the sand. Many people are well aware of recent deaths when people have tried to cross, as often the waters rise and with such a strong current, cars get pulled downstream. We decide to turn back to Berbera to be safe, though then have to wait as the waters have risen in the rivers we have already crossed. We eventually get back and sleep soundly.