Mental health training in Somaliland - Day 25

Monday 14^th October

The morning is spent with continuous meetings from 8 am until 12:00 midday. It is the day before the Eid celebrations and so there will be two days of holiday and we need to ensure things are going to plan for the medical student teaching that shall begin next week with 68 students! 

I first meet Jibril and we talk more about the audit he has started on the mental ward. He is looking into drug prescribing for patients admitted over a 6 month period, against the drugs suggested by the mhGAP Intervention guide, the WHO evidence-based document that aids diagnosis and management of mental disorders. This is an interesting area and we review some of his data together. It is not uncommon here for patients to be treated using multiple psychotropic medications and from his results it is clear to see that many patients have been medicated using more than one antipsychotic. With the older antipsychotic drugs being commonly used in Somaliland, the risk of polypharmacy is an increased side effect burden, increased morbidity and possibly mortality also. This is a great beginning to analyzing more closely what is happening on the ward in terms of treatment, and we think together about the reasons why this may be happening. One issue is whether the patients are receiving the correct diagnosis. Another is whether their symptoms have been documented accurately in the notes. Documentation is always an issue in audit. Another is whether patients behaviour changed during their admission, or soon after admission, thus warranting more acute treatment, which resulted in multiple drugs being used. There are many questions to ask and the positive thing is that they are being asked and considered.

The next meeting is with Zainab, the mental health representative, who is also a new intern doctor. Today is the first of our supervision sessions. We talk generally about supervision, and she brings along her ideas of what she would like to achieve through supervision. We make a plan for her to begin a portfolio, so that she can collect evidence for all the great work she will be doing. She will be taking on more of a leadership role in the near future and working part of her week on the mental ward, so she will benefit from documenting her experiences.