Mental health training in Somaliland - Day 16

Thursday 3^rd October

The morning is spent seeing new patients from the community with the ward doctor on the mental ward. We see two patients together, and we are joined by a 6^th year medical student, Abdilahi, who is keen to participate in the history taking and then another 5^th year medical student who will soon be doing the 2 week psychiatry teaching.  We use the morning as an opportunity for learning and the medical students take the history, with the ward doctor Dr. Abdifatar, adding to this and formulating the management plans. The first patient is a 30 year old female, who likely has a genetic disorder, given her appearance. She has never visited a doctor, despite there having been problems with her walking, her speech, eyesight at times and more recently her behaviour, which has involved her burning and hitting herself. This is not unsurprising in Somaliland where most often the first port of call is the traditional healer or ‘Sheikh.’ She has been taken by her family to see the Sheikh a number of times and he has done many things to attempt to cure her, including slaughtering animals and praying for her.

At home now, she is often locked up if she becomes angry, and this usually leads to her burning herself. Her relative shows us burn scars on her body. It is a difficult case, though not uncommon, where there are significant problems, including social issues, with the family not feeling able to look after her anymore; however, the reality is that in-patient admission on a mental health ward is likely very inappropriate for this lady. We devise a plan for her to be checked by the medical doctors and prescribe some medication to aid her sleep, which at present is very poor. The team will continue to follow her up as an out-patient at home. The next patient is an elderly man who denies all psychiatric symptoms, though there are reports from his family (who are not present to give a history) that he has been found talking to himself. He is not psychotic when we meet him and in fact only complains of headache and pain in his arm. Often depressive illness or psychiatric illness manifests with somatic symptoms in this part of the world and so we cannot rule it out. He also looks rather flat, though we are at a disadvantage as there is no corroborative history. The team makes a plan for him to be seen to rule out organic causes for his reported symptoms, given his age and suggests he returns with a family member next time who can give some history. We are joined by Dr. Liban on the ward who gives an explanation to the medical student and the patient and they leave.

The afternoon is spent organizing all the paperwork for the 5^th year medical student teaching that will happen in October. There is a huge amount of paperwork to get ready and Samatar and Saafi in the THET team have worked hard to ensure it will all be ready on time.

One of the THET team members is leaving soon and so we all have a barbeque together at the end of the day.