Mental health training in Somaliland - Day 8

Wednesday 25^th September

Now over half way through the teaching the teachers course. Today the groups teach the rest of us using group work/discussion as a teaching technique. They seem to really enjoy the practical aspects of the course and as such, I am tweaking the course as I go along, to match both their enjoyment and also the learning objectives we have set. Dr Mariam cannot attend today, as she is meeting with the Ministry to discuss her role as lead for STI’s in Somaliland. A few of the doctors we know have now started to work within the Ministry; Mariam, a previous mental health rep, who is helping me with the organization of this course is one of those. She previously worked in Hargeisa Group Hospital, though does so less now. Dr Abdirazak, also a previous mental health rep, now also works with the Ministry, as lead for mental health. I hear from him today, as he is also busy in meetings, though hopes to come by and witness some of the teaching at some point this week. 

Dr Abdirazak was, when I last visited in May 2013, working closely alongside the mental ward at Hargeisa Group Hospital and had much to arrange for our students to get clinical experience on the ward with patients. Today we visit the ward again. This time a course participant leads the teaching session, as an example of how one might teach in a clinical setting. The participants soon find out that putting into practice the theory is often much harder than it seems. We are met with a number of challenges, including it being lunchtime on the ward, to having enthusiastic patients wish to join in our discussion. Today we meet with Mariam and Mustafe, who are nurses on the ward and do much for the patients here. 

There have been significant changes on the ward over the last few years. Up until 2010, patients were still chained, now  they are not, which represents a huge leap forwards in how mental illness is viewed, even by those working in it. Mariam and Mustafe ask that I come back and conduct some training on the ward. I agree that I will explore whether I can come back next week and do some then. The course participants then work in groups to explore how they might lead or design a teaching course. Many questions and feedback are generated from this exercise and I am thrilled that now they are starting to get the hang of more analytical ways of thinking and expressing themselves through feedback. 

The afternoon is spent with the 6^th year medical students who are keen to practice their OSCE skills. We do a number of role plays, with them acting as both doctors and patients and also discuss their ongoing online supervision and tutorials on Medicine Africa, an online learning portal which adds and follows-up their training in country. They will all begin online courses with Medicine Africa.