My name is Dr. Katie Williams and
I am three weeks into a three month “Out of Programme Experience” (referring to
my UK training programme), in Lusaka, as part of the MMed Psychiatry programme.
Back
in the UK, I am based in Nottingham and I am a Specialty Registrar in General
Adult Psychiatry, in my final year of training. When I heard of the exciting
opportunity to spend three months working with the MMed psychiatry programme in
Zambia, I thought it was too good an opportunity to miss, and so here I am!
My main base whilst I am here is Chainama,
the main mental health hospital in Zambia, where the trainees gain a lot of
their clinical experience. There are clinical officers working at
Chainama, who are trained for only 3 years in mental health but are not trained
nurses or doctors. They are expected to take
on a lot of duties, such as deciding which patients should be admitted,
clerking patients, making diagnoses and prescribing! There is a lot of
difficulty recruiting doctors into psychiatry (same as in the UK), and at the
moment there are only 7 doctors in the whole of Zambia doing postgraduate specialist
training in psychiatry. My main role during my time in Zambia is to be involved
in mentoring the first year MMed trainees in
their clinical work, by providing ward and clinic-based teaching and tutorials.
At Chainama, I am based on a male acute ward, which has about 30
patients per firm. You enter the ward through a padlocked iron gate, and unsurprisingly
there is usually a gaggle of patients hovering at the same door trying to
leave. The ward reviews are slightly chaotic, as many patients
wander in and out as you are trying to review somebody else, shouting, singing,
praying, or becoming agitated and asking to go home. Usually the patient
you are trying to see sits there quietly, as others join him uninvited, sitting
next to him on the bench, as if there is no reason they shouldn't be there.
The nursing staff try their best to encourage these patients to
leave the room, however it doesn't take them long until they're back.
We have a lot of patients admitted due to alcohol problems, mostly withdrawal problems - delirium tremens, and also "alcohol induced psychosis", which I haven't previously come across in the UK. There is a big drinking culture in Zambia, especially for those with low incomes, and the local brew is apparently very strong. As well as the patients with mania, schizophrenia, and alcohol-related problems, we recently have had a patient admitted following a high-profile suicide attempt. He had climbed up one of the telecommunication towers in the city centre planning to jump, and had been rescued by the fire service sparking a lot of media attention. He had stated that he was going to jump because he could not get a job and needed better housing, and the government had taken interest in this, sending victim support counsellors to Chianama to follow him up. His story was a genuinely sad one. He was a man in his 30s, the sole breadwinner, with a heavily pregnant wife and two young children already. His permanent job had ended a few months back as the company had folded and temporary jobs were getting more difficult to find. He had reported to the local government to seek advice and support, as he had no money and no food for his family. After attending again and again with no offer of a solution, he eventually started to feel hopeless about the future, hence impulsively climbing the tower with the thought of killing himself. Since being on the ward, a social worker and clinical psychologist have visited his one-roomed family home and were appalled at the squalid and bare conditions, and the lack of food for his wife and children. There have been some donations of baby clothes for when the new baby arrives, and the social worker is going to provide the family with some basic food, also using money from donations. There is no benefit system in Zambia, and I am told if you don't work, you don't eat. People in this situation often then rely on extended family to help them out financially; however, this man's mother had also joined them asking to be provided for by him, adding to the pressure of the situation. We are hoping that the ward social worker will be able to help with his social circumstances, which would have a significant positive effect on his mental health.
We have a lot of patients admitted due to alcohol problems, mostly withdrawal problems - delirium tremens, and also "alcohol induced psychosis", which I haven't previously come across in the UK. There is a big drinking culture in Zambia, especially for those with low incomes, and the local brew is apparently very strong. As well as the patients with mania, schizophrenia, and alcohol-related problems, we recently have had a patient admitted following a high-profile suicide attempt. He had climbed up one of the telecommunication towers in the city centre planning to jump, and had been rescued by the fire service sparking a lot of media attention. He had stated that he was going to jump because he could not get a job and needed better housing, and the government had taken interest in this, sending victim support counsellors to Chianama to follow him up. His story was a genuinely sad one. He was a man in his 30s, the sole breadwinner, with a heavily pregnant wife and two young children already. His permanent job had ended a few months back as the company had folded and temporary jobs were getting more difficult to find. He had reported to the local government to seek advice and support, as he had no money and no food for his family. After attending again and again with no offer of a solution, he eventually started to feel hopeless about the future, hence impulsively climbing the tower with the thought of killing himself. Since being on the ward, a social worker and clinical psychologist have visited his one-roomed family home and were appalled at the squalid and bare conditions, and the lack of food for his wife and children. There have been some donations of baby clothes for when the new baby arrives, and the social worker is going to provide the family with some basic food, also using money from donations. There is no benefit system in Zambia, and I am told if you don't work, you don't eat. People in this situation often then rely on extended family to help them out financially; however, this man's mother had also joined them asking to be provided for by him, adding to the pressure of the situation. We are hoping that the ward social worker will be able to help with his social circumstances, which would have a significant positive effect on his mental health.
Another of the key aims of the
programme currently is to support each MMed trainee to complete an audit, with
the goal of directly improving patient care locally. There are different ways
of doing things here, such as rapid tranquilisation, and there are some
clinical areas which would greatly benefit from interventions to improve
patient safety and service quality. Once these audits are completed, we hope
that the trainees will present and publish their results both at a national and
international level. I am also involved
in teaching medical students of the University of Zambia during their
psychiatry rotation, both on the wards and in tutorials and lectures. I understand that recruitment into psychiatry
in Zambia is a challenge, similar to the problem we face in the UK, so our
intention is to stimulate an interest in psychiatry at an early level, so that
they may consider psychiatry as a future career. With World Mental Health Day on
the 10th October, we are arranging events for spreading awareness
and education about mental health disorders, including designing informative
posters, arranging a film club with a psychiatry theme, a medical student essay
competition, and a carers meeting.
Finally, since arriving I have
been most struck by the friendliness and politeness of the Zambian people. Zambia itself seems to be a diverse and
fascinating country, from the modern malls in Lusaka to the natural beauty of
the national parks and of course the Victoria Falls, which I am looking forward
to visiting at some point during my trip.
I am very grateful to all of the MMed trainees, Dr. Ravi Paul and all of
the THET staff for such a warm welcome to Zambia and I am looking forward to a
productive and rewarding few months ahead.
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| Katherine Williams with nurses and clinical officer students, Zambia. |
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