Mental health training in Somaliland - Day 44

Monday 4^th November

Today we set off early as we are travelling north to Berbera. Berbera is situated on the north coast of Somaliland and as such has historically been an important strategic point due to its port. The drive up is beautiful and it is lovely to be on the road again. I adore being able to see some of the country as usually our movements are limited to between the hotel and places of work. We see many herders with their sheep and goats, lots of camels, including unfortunately those in trucks that shall apparently be exported to places like Yemen for people to eat and even wart hogs along the way. We pass through many villages along the way, with khat stalls still dotted along the way and people going about their daily business. We stop of at the Laas Geel caves on the way up to Berbera, a place I have wanted to visit for some time. These are a set of caves which feature beautiful rock art paintings, which are thought to be some of the best preserved in Africa. It was beautiful, we were taken up into the highest caves and I was amazed at just how clear the paintings were. There were paintings of people with their animals, including cows and dogs and even depictions of giraffes and pregnant women. The views from atop the caves across the arid land were stunning.

Onwards to Berbera and we stopped off briefly at a bakers, intimately tied up with a love poem written by a famous Somaliland poet. Then onto the most famous fish restaurant in Berbera, and home to many of the regions cats who were ready for any left overs.  We quickly checked into the hotel and then myself and film-maker Najaat went on to meet with the Regional health officer, Dr. Abdirahim. He was very helpful in giving us the details of the mental health service in Berbera at present. We join him on a visit across from the main hospital to the mental ward.

The psychiatric hospital is the only one in the whole of the Sahil region and Dr. Abdirahim tells us the population is about 220,000 people. There are no psychiatrists in the region and no trained mental health nurses. The work on the ward is done by ‘social workers’ who have been given some brief training by a medical doctor in how to administer medications and a doctor who spends each morning on the ward. There has been no formal mental health training in this region and the only doctor who was trained in the use of the WHO mhGAP approach has now left the region.

The staff manage on incentives rather than any formal salary and there are a number of watchmen on the ward. Though the ward is very positive in some respects, such as it having a large open area and shade structure, with electricity and running water available, it is clear that much could be improved. Patients are still chained, with five male patients seen to be chained to concrete pillars. The sanitation is poor and many patients are locked in their rooms, with waste draining from the rooms. Though it is very difficult to see, it is also easy to see the challenges faced by the staff here, who willingly dedicate their lives to helping those with mental illness, without proper salaries. With a shortage of trained staff, little in the way of money, a sporadic supply of medications and a rather challenging patient population when admitted to the ward, (often acutely psychotic or manic, with co-morbid khat use which often presents with aggression and violence) it is obvious that these people are trying to do their best under the circumstances. Though it is shocking, it is also positive to see that much could be changed and training would help immensely in order to effect this change. Tomorrow we shall visit the female part of the ward and speak to both staff members and the administrators to compile a comprehensive needs assessment report.

The day is wrapped up with a meeting with Najaat, who has been an incredible support during my time here, often tirelessly and enthusiastically shadowing me over the past 2 months, filming the work we do, so that the footage may be used to make a short documentary of THET’s work here in Somaliland. We work on the narration for the documentary, which she has asked me to do.