Monday, 4 November 2013

Mental health training in Somaliland - Day 40

Thursday 31st October

Today is the final day of the course. We spend the morning giving out exam feedback to the students and also feedback from the OSCE. The students have all thankfully passed, and in fact, many have passed with very high marks. We are particularly pleased with the progress many of them seem to have made since the beginning of the course. Many have much higher marks on the post-tests than they had on the pre-tests, which is great for us to know as teachers. They are a competitive group and despite very high marks, some think they could have done even better!

Today is a day of Somaliland Psychiatry and we are lucky to be joined by Fatima, the Dean of Nursing, who has been a truly inspirational figure here in Borama in very many different ways, but particularly in mental health. She gives a talk about the development of mental health services in the region and Dr. Jibril then presents all the work he has tirelessly been doing over the last 4 years. It really is incredible what this team have achieved. They have started mental health services from scratch, and integrated the services into primary care, maternal health care and child health. This makes sense for such a community, where most people visit traditional healers or sheikhs before they ever come to the attention of a doctor. The team has mobilized the community, including sheikhs, schools, even the prisons and police, to raise awareness of mental health issues. The Somali diaspora population connected to the area have also been involved heavily, particularly in the development and continued running of the mental health ward at Borama Regional Hospital.

I am astounded by the work that has been done here, much of it on a voluntary basis by Dr. Jibril. We hear of stories of him and Faadumo, walking all day in communities, just to go and find people with mental illness and offer help. We hear of certain cases in the region which really make one realise how crucial it is for change to happen. Dr. Jibril tells us of a family in which there were a number of family members with mental illness. They were ostracized from the community and due to being so poor could not afford food. Due to their mental illness, they were unable to work. Unfortunately three family members starved to death. This represents the extreme end of the picture, and we also heard very positive stories of similar families being helped by the community to live and eat. It was clear that much change was happening in Borama and this was a joy to hear. Finally, we give out the certificates to all the students and all the co-facilitators. The day ends early as the students prepare for the evenings celebrations, and we cannot finish the morning without many many photographs!

The evening is wonderful. As is tradition in Borama, my female students dress me up in traditional Somali dress. This year is a beautiful pink and purple dira (dress), and Hayat. One of the students spends time fixing me up an elaborate head scarf with multiple colourful scarves weaved together. As I walk past people I know in the hotel to go to the party, I am not recognized!


The celebration is a fantastic event. We are all at the University faculty, with the stage set outside and trees in the background. The students have decorated the place beautifully and it looks ornate. The evening is led by one of our female students Nasra, and many people make speeches, though I am touched especially by the student contributions. I had stated that I love poetry and had requested that one of our students, Jama, prepare 20 minutes of poetry for the end of the course, as he was an extremely talented poet. He recited a 6 page poem that he had himself written. I was stunned. He talked about a man who was apparently psychotic, about the challenges of mental illness and the loneliness it often results in, and went on to talk about the capacity people have to make change. He also talked about suicide and the issues related to this in the Somaliland context.  His recital was stunning, insightful, clever and also humorous in parts and I truly felt privileged to have been witness to this. We were also read another poem by a female medical student and even a song by one of our co-facilitators, Hodan. Her voice was incredible and you could have heard a pin drop when she sang. One of our students was in fact a Sheikh and also read a poem. He commented that as my name did not quite fit with the words of the poem, he would have to give me a Somali name.  This was ‘Cawo’ (pronounced Ao) which means lucky or luck. I felt absolutely blessed and lucky! What a gift to me this was! Finally the evening was rounded up with a wonderful traditional Somali dinner, which was delicious and then…..photos! The night was long and a happy one for all and one I shall never forget. The hospitality and the welcoming of everyone was just beautiful.