Mental Health training in Somaliland - Day 1

Delivering Psychiatry Training in Somaliland

Dr Lauren Gavaghan is a Specialist Psychiatrist and Mental Health lead for the King's THET Somaliland Partnership (KTSP). She is spending eight weeks in Somaliland as a volunteer teaching Mental Health (MH) to medical students and delivering a Training of Trainer (TOT) course for MH focal people and Medical Faculties.

Everyday until the 8th November Dr. Gavaghan will be posting a new diary entry on the THET blog page to give readers a unique insight into delivering mental health training in Somaliland. 

Here's the first...

 Day 1 - 18th September 2013

Arriving from Nairobi on the ECHO humanitarian flight was a familiar journey this time. I have visited Somaliland twice before as a volunteer, working alongside THET, though only for 2 weeks at a time. This time my trip is for 2 months. I am excited, yet also a little nervous given the longer time period and the fact that this time I leave the UK alone- with co-workers arriving later on during my trip to work with me.

I am pleasantly surprised by the new runway at Hargeisa airport, which makes for a softer landing than in May when we landed in the bush.

As always, I am greeted at the airport by the driver from THET, who rapidly teaches me some Somali on the way to the THET office, which I rapidly forget!

I meet the team, most of whom I have met before and at once feel at home again. Samatar, the Logistics and Security Officer runs me through a further security briefing and the logistics of my extended trip. I also meet with Thomas the Programme Manager and Wario, the Country representative.  A number of emails and phone-calls later, and I have plans for the following day, to meet with members of the Core Mental Health Working group, a group made up of doctors who have an interest in mental health, many of whom have been mental health representatives in the past and continue to advocate for better mental health in Somaliland. 

Students in Somaliland receiving mental health training

To find out more about THET's work in Somaliland, visit our Somaliland Programme page.

Galvanizing Health Partnerships to Create a Movement

Blog from Christina Chandra. Christina is working as a communications intern for THET this summer. She is a senior at Yale University majoring in the History of Science, Medicine, and Public Health. 

Last evening I made my second trip to the Houses of Parliament. This time, instead of visiting as a tourist, I had the privilege of being a guest at the launch of the All-Party Parliamentary Group on Global Health’s report, Improving health at home and abroad: How overseas volunteering from the NHS benefits the UK and the world. The report addresses the role of NHS staff who volunteer overseas in advancing health globally and bringing new knowledge, skills and ideas back to the UK, and what can be done to facilitate this work further. The gathering hosted around a hundred people working in the health sector, from those that have volunteered abroad to those who have expertise in sending volunteers abroad.

After shaking off my initial daze from soaking in the experience, I had the chance to reflect on the meaning of this report and how it directly impacted the people in the room. As an outsider looking in, what I found was a community of passionate people in the same line of work who have an opportunity to work together to put their work on the radar of leaders who will be able to support their continuing success in the future.

For example, Kevin Barron, MP to Rother Valley and a speaker at the event, is one such leader who has been convinced that partnerships are great for both his constituency and for communities overseas. His excitement about the report stemmed from his knowledge of the work of secondary school links in his constituency to schools in Africa.  The enthusiasm he expressed about partnerships is the enthusiasm that more MPs should have for health partnerships, specifically. The benefits of volunteering have been clearly outlined and should be passed on. Health partnerships can meet with their MPs and tell them about the amazing work their health partnerships have been able to achieve. If this happens, I can see that the next time such an event happens, there will be a plethora of MPs lined up to proudly talk about the health partnerships within their constituencies.

As the room filled with chatter following the speeches and Q&A session, I could see that people were no doubt excited about health partnerships. People were sharing their stories with each other and making connections for future collaboration. I believe this enthusiasm can be translated into action. The report stated that health partnerships are often ‘under the radar’, but with this report, the opportunity has presented itself to put health partnerships on the radar and to make volunteering the norm, not the exception. Now it’s up to health partnerships to pave the way by sharing their stories with the wider community.

If you are reading this and have been involved in a health partnership, there are a few things you can do to contribute to the movement for creating an enabling environment for people who want to volunteer through health partnerships: write, share, and tell. Find out more ways to get involved with THET’s advocacy toolkit for health partnerships.

Join the movement. Support Volunteers. Act Now.

Getting to grips with THET's Resource Library.

THET’s Evaluation & Learning Officer, Emily Burn, guides us through the Resource Library on thet.org/hps and explains why it’s useful for those working in health partnerships.

The Resource Library of the Health Partnership Scheme website provides a unique range of materials to help health partnerships deliver diverse projects. Everything in the Resource Library is aimed at partnerships both new and old and we add to the content on a regular basis in order to make sure we are providing current and relevant information. 

The library includes publications, case studies and good practice guidance. For example, you’ll find the Monitoring and Evaluation planning template helps with rigorous, resource specific M&E plans; interviews with health workers from the Kambia District, gathered by The Kambia Appeal as part of their evaluation of their IHLFS grant; and case studies of IHLFS projects in Zambia and Uganda. 

Many of the resources we have published take inspiration from or are using your stories and experiences to educate and support others who are engaged in health partnership work.  For instance, we heard directly from both the UK and developing country partners about their experience of Health Links under the IHLFS and we have produced good practice guidelines and advice that cites the challenges and effective solutions they found.

We now need to hear from you: what do you want to see on the Resource Library pages?  We are always looking at templates and guidelines that help to make sense of key project planning activities, specifically in the context of health partnerships, but what else would you like to see here that will help you and your partners to work effectively together? Comment below or contact us directly at hps@thet.org

A Student's Perspective on Global Health

Christina Chandra is working as a communications intern for THET this summer. She is a senior at Yale University majoring in the History of Science, Medicine, and Public Health. In this blog, she reflects on her experiences with global health.

My interest in global health began in high school. For summer reading one year, I chose to read Mountains Beyond Mountains by Tracy Kidder. It was an inspirational story about Paul Farmer, a doctor and anthropologist who co-founded Partners in Health with some of his friends, including Jim Kim who is currently the president of the World Bank. For the next few years, Paul Farmer was my idol. I had always wanted to become a doctor, yet I could never decide on what kind of doctor I wanted to be. But now, I wanted to become a doctor who volunteered overseas part-time and specialised in infectious diseases, just like Paul Farmer.

Since I have been in college, I have realized how naïve I was. Although reading Mountains Beyond Mountains inspired me to develop my own convictions that health is a human right, I was naïve in thinking that the message of the book was that the world needed more doctors who volunteered overseas. I actually thought that was how impact would be made: by healing one patient at a time. Naturally, I became frustrated with not having the skills, expertise, or funds to do anything to help those suffering in a country miles and miles away from me. But then my perspective changed once I started taking classes on global health and joined the Yale Student Global Health and AIDS Coalition.

Through my coursework and experiences as a student AIDS activist, I learned that doctors alone could not rid the world of health inequalities and eliminate all barriers to healthcare. I also learned that institutional power played a major role in the health of nations, that global also means local, that inequalities in a society would be reflected in health inequalities, and that I had a role to play as a student. Since then, I’ve gone to actions and have met with my congressmen and community leaders to talk about both domestic and international health policy. What I love about global health is its strong roots in social justice. Global health is interconnected with advocacy for everything from LGBT rights, women’s rights, and minority and immigrant rights. Therefore, I have been able to engage in grassroots activities that have also encompassed many of the issues I care about.

These experiences brought me to where I am today, working as a communications intern for THET. I have only been at THET for a week, but I already have a strong sense of purpose within this organization. Every day I learn something new about how policies are implemented, how to successfully carry out programmes, and how a small NGO with global impact operates. It has been exciting to see what I have learned in my courses be put to practice at THET. Although I do not know what the future holds for me, I know that I will continue to be involved in global health work and my experience here at THET will be a valuable one.

I am very grateful to the THET team for making me feel welcome and for giving me this opportunity to learn and work with them.  I am looking forward to the rest of the summer together!

Nurses at the centre of stroke care in Ghana

The Wessex-Stroke Partnership was established in 2009, supported with funding from THET’s Health Partnership Scheme. The partnership works collaboratively to support the development of stroke care in Ghana at the Korle Bu Teaching Hospital (KBTH), Accra.  Stroke is the second biggest cause of death in greater Accra, only preceded by Malaria (de-Graft Aikins, 2007).

In this blog, senior nurse, Colleen Lloyd, describes her experience volunteering with the partnership.

I felt very privileged to get involved with the partnership, and it was the start of an amazing journey with the Ghanaian nursing team. My first day on the wards at KBTH was a very humbling experience. I was used to working in UK hospitals with a great deal of resources, so I admired greatly the dedication of the Ghanaian nurses who worked with little resources, relying on their personal skills and whatever patient’s families could afford to care for patients.  Consequently, all aspects of my UK practice had to be re-thought and adapted to be meaningful in Ghana. And to match the compassion, dignity and a genuine passion for the role that the nurses had, which was very evident at all levels.

The UK nursing team, working alongside a multidisciplinary team, established nursing stroke skills on the medical wards at KBTH. The four clinical areas identified for development were swallowing, positioning, communication and continence.

The Ghanaian lead nurse was very welcoming and receptive to learning and improving her patient’s outcomes.  It was apparent from the outset that the goals would be small and very specific.

Dysphagia (swallowing problems) training was initially undertaken on a one-to-one basis using the train the trainer model.  The Ghanaian team had no experience of swallow assessments or the risk of aspiration despite pneumonia being very common in stroke patients in Ghana.  Having observed the patients being fed on my first day, I asked to meet the dietitian  Once I had explained the rationale behind our teaching, the response was amazing.  We looked at local foods which were cheaply available to families and adapted the various foods and fluids to suit the consistency required. The following day the lead stroke nurse proudly showed me her nursing team feeding patients the appropriate diets in the correct position.

All stroke patients admitted to the medical wards now have access to a stroke diet provided by the hospital kitchen. A major step in a very short time.

The importance of supporting families to understand the impact of stroke was also a key development aim. We produced a secondary prevention leaflet, which the lead nurse distributed during family meetings.

Funding has now been secured locally for the publication of this leaflet, which will be used to educate families of stroke patients and, hopefully, further influence families in the community. 

The lead nurse has a comprehensive learning log evidencing her learning as do all Ghanaian nurses who complete the training in the four stated clinical skills.  She also leads dedicated training sessions to all medical wards within KBTH and has visited other hospitals in Accra.

The stoke profile has been raised considerably at the hospital and a dedicated stroke unit at KBTH is due to open very soon.

I would strongly recommend working with an overseas health partnership. It is one of the most rewarding challenges a nurse can accept.

Colleen Lloyd (right) with Ghanaian consultant and team physio.

Visit the THET website to find out more about the Wessex-Stroke Partnership.

Preventing Malaria in Sierra Leone

In this blog post, Dr. Suzanne Howell, volunteer at the Kambia District Hospital, Sierra Leone, for The Kambia Appeal, shares her experience of treating children with Malaria.

The Kambia Appeal, which received a grant under THET's Health Partnership Scheme, aims to send 30 long-term, UK health worker volunteers to Kambia to improve health outcomes and quality of healthcare delivery within the Kambia District.

Preventing Malaria in Sierra Leone

I was working in the northern province of Sierra Leone for the last 6 months as a volunteer for The Kambia Appeal, and dutifully took my antimalarial tablets everyday as instructed.  For the majority of the people in this part of the world malaria isn't just the annoyance of taking a daily pill, it's the reason you have extra children.  I arrived in the middle of the rainy season in Kambia District when malaria was at a peak. Young children were being admitted to the ward in great numbers and dying on a near daily basis just in this small area.  It was very distressing to see these little ones arrive so sick, but such a joy to see the effects that a few medical supplies and the simple care of incredibly hard working nurses can make.  Unfortunately, children can deteriorate very rapidly and mothers went to unimaginable lengths to try to save their children, but everything is against them getting to hospital in time.

Through the shared sadness with these families, the local hospital staff and I were encouraged to promote simple malaria prevention education, so that families would know how to prevent the deaths of more beautiful children and present a united message that malaria does not need to be a way of life. The parents who care so much for their kids have a huge role to play in stopping this disease.  

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www.kambia.org.uk

Strengthening Palliative Care in 4 African Countries

Dr. Liz Grant from the University of Edinburgh discusses the burden of cancer, partnership and improving palliative care in sub-Saharan Africa.


We are all born equal but into very unequal circumstances.  And we all die. And, like birth, the circumstances and the experiences of dying across the globe are markedly different.  Despite good analgesia and good care systems to enable people to live towards death in as pain free and comfortable a way as possible, an estimated three quarters of the world’s population do not die well. Many in low income countries fail to receive any diagnosis of illness. They die in pain, unsure of what is happening, unclear of what is curable, what is treatable, and what is inevitable. Dying is also costly. Many spend their money ‘forever searching for cures and never finding them.' The process of dying can drain families’ incomes, destroy life chances of children getting educated (as school fees are not paid), while farm land and farm animals have to be sold to in the hope that the money raised will be enough to make a loved one better.  

The burden of cancer looms large. With an estimated 600,000 men, women and children dying from cancer last year in Africa alone, less than 1% of them are able to access any specific cancer treatments. The most common cancers recorded in Africa are cervical cancer, breast cancer, and cancer of the liver and prostate, alongside Kaposi's sarcoma and non-Hodgkin's lymphoma.  The global consumption of morphine, one of the cheapest, most powerful and effective analgesics is centred in high income countries with North America, Europe, Australia, New Zealand and Japan consuming 92% of morphine in 2008.  Less than 0.3% of morphine was available in Africa.  

Though globally there are a number of shared risk factors leading to cancer such as tobacco, sexual activity, alcohol and obesity, the causes of a significant proportion of the burden of cancer in low income countries appears to be linked to poverty and injustice, where those most vulnerable are exposed to most risks: sexually transmitted HPV-infection, urban air pollution and exposure to indoor smoke from charcoal and other fuels burned in cooking. 

Set alongside these risks are chronic health and social care system failures which result in the failure of many cancers to be detected early enough for effective interventions. As well as the failure of on-going treatment plans to alleviate suffering and stave the progress of the disease. Ultimately there is the unacceptable failure to provide care as patients move towards the end of their lives. Many die screaming from searing, constant pain. The words of one woman dying of breast cancer in Kenya speak of a terrible injustice. Speaking of her pain she explained, ‘I want to go to sleep and wake up dead.'

In April 2012 THET funded an extraordinary programme focussed on building and integrating palliative care into the health systems of four countries in Sub Saharan Africa. The University of Edinburgh, the African Palliative Care Association (APCA) and Makerere University Palliative Care Unit are working in partnership to strengthen current palliative care programmes in Kenya, Rwanda Uganda and Zambia. Guided by the Ministry of Health in each country, and working through the excellent National Associations of Palliative care, the programme is setting up additional training in palliative care approaches. In practices they are training link nurses and hospital and community staff in key areas such as symptom relief and holistic pain assessment.

Twelve hospitals, three in each country, are being tasked to model a new form of palliative care, comprehensive palliative care that does not stop at one disease. This care recognises that the patient rather than the illness determines the care needs, and builds on the importance of engagement from a multi-disciplinary team, and response from nurses, clinical officers, clinic and hospital based renal physicians, obstetricians and gynaecologists, paediatricians, cardiologists, diabetologists, internal physicians, surgeons, pharmacy and  social workers and laboratory technicians. They all play a role in proving, enabling and supporting care systems. Systems that enable timely identification of illnesses that are life limiting, identification of the right pain control and symptom management, and  holistic care that supports patients emotional, social and spiritual needs as well as their physical needs.    

As one Chief Executive of a hospital engaged in the programme explained, ‘up until now we sent home patients who were dying, with the words “discharged to hospice at home” knowing that there was nothing more we could do in hospital, but also knowing that there was no hospice at home.  It was our way of coping.' He explained that now things were different. Through the programme a system of comprehensive care is being built. A system that establishes a pathway of care for all those with palliative care needs that includes an assessment of physical, social and spiritual needs, and ensures that patients are not just neglected or lost from care.  


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