Strengthening Global Mental Health partnerships - #LetsTalk Depression

A new mental health collaborative was inspired to come together after the Health Partnership Symposium, Petty and Randy explain why sharing knowledge and practice across country borders is so crucial in the battle to improve mental health care. 

“Seeing mental health and substance misuse patients suffering, neglected by the community, families and other healthcare workers; motivated me to work with mental health. Working as a health Administrator and a Project Coordinator at a Tanzania National Mental Health Hospital, I found I could help these individuals so that they can be provided with an environment that will allow them to recover from their illnesses, reduce relapses and lead a normal life.”

Perpetua Mwambingu- Tanzania Link Project Coordinator

“In Ghana mental illness is often attributed to spiritual causes and people who suffer from mental illness do not get the help that they need. Stigma and discrimination is high and people who suffer from mental illness lose their dignity, respect and self-worth. My passion for awareness creation and advocacy and my belief that someday Ghana will appreciate the importance of mental health motivates me even during moments of burnout”

Randy Agbodo- Project Lead for Ghana - Zambia - NHS Highlands Partnership

The Story Remains the Same

According to the World Health Organization, for every four people, one will be affected by a mental or neurological disorder in their lifetime. The magnitude of mental health burden is not matched by the size and effectiveness of the response it demands. Currently, more than 33% of countries allocate less than 1% of their total health budget to mental health[1].

Sadly, in Tanzania and Ghana where Randy and I are working, the story remains the same, mental health services are underfunded, and most of the donor funded programs go to communicable diseases. There is inadequate human resource and insufficient supply of medications. Stigma and discrimination towards persons with mental disorders is still prominent and effective mental health prevention and promotion programs are woefully inadequate.

 No Health without Mental Health

Depression is ranked first in the list of top ten leading causes of years lived with disability (YLDs)[2]. Globally, an estimated 350 million people of all ages suffer from depression[3]. At its worst depression can lead to suicide and close to 800,000 people die due to suicide every year[4].

This is why it is so vital that World Health Day this year is addressing depression, bringing it to the fore of global health discussions. It gives health managers and policy advisers the opportunity to appreciate that depression affects productivity and therefore prioritizing and investing heavily in mental health would, in the long run, culminate in populations with healthy outcomes, respect for human rights and stronger economies.

The Health Partnership Symposium ‘effect’

In order to make this a reality, we believe that collaboration and the sharing of approaches is key and at the recent Health Partnership Symposium, organized by THET, we found we were not alone in this thinking.

Our passion for working in mental health was further cemented at the event where a certain chemistry brought colleagues from Ghana, India, Kenya, Nepal, Scotland, Tanzania, Uganda and Zambia together to form the ‘Mental Health group’.

We all wanted to come together to tackle and develop our learning on different mental health issues.  Ultimately we wanted LMIC’s to start collaborating and to share experiences which can strengthen the partnerships we work in. That’s when a luncheon ‘chat’ was called, then a dinner ‘talk’ happened and then we came to form a WhatsApp group, a way for us to easily reach out to each other.

The world is facing many challenges; political unrest, war, economic hardship, unemployment, etc., all are contributing factors to depression. This must be a wake-up call for the global community, the need to re-think, and re-act to this global crises, now is the time to re-set our priorities with regards to mental health and to act together through partnerships and shared learning. After all there is no health without mental health.

Perpetua Mwambingu

Tanzania Link Project Coordinator,

Tanzania

Randy Agbodo

Project Lead for Ghana - Zambia - NHS Highlands Partnership,

Ghana

[1] http://www.who.int/whr/2001/media_centre/press_release/en/

[2] http://www.who.int/mediacentre/factsheets/fs369/en/

[3] Ibid

[4] Ibid

Together We Can Overcome - #LetsTalk Depression

The grief and grievances for those suffering from mental health problems are largely overlooked by both health and social sectors.

In every street, in every corner, we find those suffering from neuropsychiatric disorders. They are silent victims of neglect and abuse experiencing human rights violations across the globe. Those we called our friends, fathers, mothers, sisters, brothers, sons and daughters in the past, today have become our enemies without committing any crime.

Depression is the most commonly diagnosed mental illness in Zambia[1], alongside other neuropsychiatric disorders such as those relating to drug and alcohol abuse. Stigma attached to mental illness, the prevalence of HIV, high unemployment and socio-economic difficulties all significantly increase the risk of mortality[2]. At a global level, over 300 million people are estimated to suffer from depression, equivalent to 4.4% of the world’s population[3].

Although mental health constitutes a large number of disease burdens in developing countries, it is largely overlooked and given inadequate attention.

It is in this context that THET is working hard to help those facing mental health challenges, among other global health issues. As part of their work they have provided funding for the Mental Health Literacy and Improved Patients Safety Empowering Communities Project run by the NHS Highlands – Chipata General Hospital Partnership.

Located in the eastern part of Zambia is Chipata Central Hospital. The hospital is the biggest referral Centre in the province and is well known for its specialized treatment of mental health services. Like any other hospital in low income countries, Chipata Central Hospital suffers from huge medical demand with limited financial resources that put mental health in the periphery of priorities.

People can recover from mental illness but traditional beliefs and cultural practices have led to a persistent belief that mental conditions are untreatable, and this in turn has led to the marginalization of the issue in the public domain. The stigma and limited public knowledge diminishes grassroots demands for mental health policy and service developments which are weak and poorly implemented. As a result traditional medicine and spiritual management are the most common forms of treatment. Thus the need for the project is apparent.

The main aim of our partnership is to empower communities and patients to take action for better and safer mental health by creating positive change in:

• Perception, attitudes and understanding of mental illness,

• Improving levels of safety and support by health institutions and local communities

• Providing relevant mental health educational materials delivered appropriately and creatively to communities deprived of contemporary communication channels

We also acquired bicycles to be used by community volunteers and as a social enterprise, to provide greater access to creative Arts, explaining mental health and helping to disseminate more accurate information to communities regarding mental health.

I have met so many people through the partnership and have seen the positive impact that reaching out and empowering communities on mental health literacy can have. It is increasingly clear that supporting such projects in any way possible can help overcome the challenges mental health is facing.

People with mental health problems, deserve your attention. Together we can overcome.

Pearson Moyo

Project Coordinator - Zambia

Mental Health Literacy and Patient Safety: Empowering communities.

[1] http://www.commonwealthhealth.org/africa/zambia/mental_health_in_zambia/

[2] Ibid

[3] http://apps.who.int/iris/bitstream/10665/254610/1/WHO-MSD-MER-2017.2-eng.pdf?ua=1

Medical Equipment in Top Condition

Since 2011, THET with support from the UK Government’s Department for International Development (DFID) has been working with the Northern Technical College (NORTEC) to develop the first pre-service training course for Biomedical Engineering Technologists (BMETs).

In this blog, Chris Mol, a lecturer in Biomedical Engineering at NORTEC, celebrates the projects most recent successes and comments on the complexity of the tasks ahead.

At the end of 2016, our first cohort of Biomedical engineering technologists (BMET’s) in Zambia completed their final examinations. 

Every year from now on, some thirty new technologists will become available to improve the poor maintenance situation of the medical equipment in the country. We have also trained enough local BME lecturers to make this teaching program sustainable! Good reasons to be proud! Surely this will have a major impact on the availability of working medical equipment for patient diagnosis and treatment!

Well…maybe not. Whereas the presence of well-trained BMETs is a necessary condition, it may not be sufficient. When you think about it, what good can a BMET do in a hospital where a workshop or tools are extremely limited? Or where there is no substantial budget to purchase spare parts for repair? Or where spare parts purchasing procedures are so cumbersome that it may take up to one year to acquire these, even if a budget is allocated? Or where service and user manuals are available only in the Chinese language because they came as part of a business package and there are no regulations on local language documents? Or where donated equipment comes without adequate documentation and spare part provisions? Or where the local culture is to wait with repairing a piece of equipment until it is really broken, rather than doing preventive maintenance? Or where the status of the BMET is such that (s)he is supposed to sit in the cellar of the hospital, waiting for a phone call to come and fix a unit, rather than pro-actively managing the installed base of equipment in the hospital?

When you come close, the issue of good medical equipment appears to grow in complexity. Such is life! This is not a reason to despair and give up, but rather to remove our blinders and consider the total complexity (‘eco-system’) of the task at hand. 

Let’s appreciate the potentially limited but still crucial importance of our contributions and diligently hammer away at the next roadblock.  

Considering the crucial position of the Ministry of Health in managing local healthcare, support of local policy generation will be one of the focal points of our follow up actions. Another one will be to support process improvement activities in local hospitals and the support of a national BME Association to advance the profession. Only a broad and integral approach will, in the not too long  term, deliver bottom line value to the Zambian patients. Let’s do it!

Chris Mol
Lecturer in Biomedical Engineering
NORTEC, Zambia 

BMET training in Zambia: the money

As described in a previous blog, I am supported by THET to work at a Technical College in Zambia to train local students to become hospital equipment maintenance professionals. In this blog I want to share with you some of my experiences on what it means to be in what the ‘International Development’ world calls a ‘low resourced country’.

Training to become a Biomedical Technician is quite an expensive undertaking. The college is over 90% funded by the fees from students. The main fee is about 300 USD per term (900 USD/year).  On top of that come examination fees (100 USD/year) and housing fees (60 USD/term), for which you have a bed in a small room with two-four co-students plus some facilities. Altogether, that is quite a lot of money in a country where 60% of the population lives below the poverty line and 42% are considered to be in extreme poverty.

Chris Mol lecturing to BMET students.

Our BMET students are usually funded by their family. This includes not only parents, but also uncles, aunts and older brothers and sisters. It is very difficult for ‘older brothers’ with a reasonable income to save money or purchase a house while their (many) younger siblings still require education. These contributions are not considered a loan and won’t be paid back. Money is spent in the family where it is needed.

On top of family funding, many of our students have to work to earn money during their school terms as well as in between terms. The work they do is what they call piece work: washing cars, helping in building works, and whatever else they can find. The salary for this, as for gardeners and house maids, is in the order of 40 cents/hour, if you can find the work!

Students take notes during a lecture.

In this context it is not surprising that many students have little money left for anything that is not an absolute must. Most students do not have a computer and if they do, are dependent on the overloaded network at the college to get internet access. However, most of them do have a mobile phone which is frequently used. The cost of talking is about 10 cents per minute, but many schemes give cheaper access under certain conditions. Also, special offers for ongoing Facebook access are popular. 

Coming from a high resource country, it at first appears to be a good idea to help students by offering them loans to finance their studies or a computer, something that is currently not done by the government. But this becomes less attractive considering the near certainty that such loans will not be paid back, simply because students would not feel this as a strong moral obligation.  And a problem of gifts is to define where to begin and where to end and how to do this in a way that appears fair and does enable you to continue to be related to your environment in a ‘normal’ way.  The advice I am currently following is not to interfere in these matters and consider my teaching of the BMET course and the long-term improvements to healthcare graduates will make as the best contribution I can make.

Your comments are welcome at: chrisr.mol@gmail.com

A New Generation Takes On Chronic Malnutrition

THET’s Communications Officer, Timur Bekir, traveled to Lusaka, Zambia, to document the activity of two ground breaking training courses in nutrition.  

100 acutely malnourished children. That’s how many cases University Teaching Hospital (UTH) in Lusaka has in the severe acute malnutrition ward at any one time during its peak season. It’s a shocking number for a country edging towards middle income status.

It’s a number that becomes more overwhelming when you’re told that the whole hospital only has four Nutritionists. Just four to deal with the multitude of nutrition related cases such as under-nutrition, diabetes, obesity, renal failure, the list goes on.

Mr Zimba, one of UTH’s valuable Nutritionists, is showing me around the children’s ward. He explains that the peak season is from April to September, this is before harvest time when food stores are low:  

‘Malnutrition is about bad nutrition so there is over nutrition and under nutrition, so on this ward we are dealing with under nutrition. Nutrition intervention is not a remedy but it is a supplement to whatever doctors are doing.’

60% of the population lives below the poverty line and 42% are considered to be in extreme poverty, with much of the population surviving on subsistence farming. Chronic malnutrition, or stunting, is a serious concern in Zambia. With a prevalence of 45% among children under five years of age, substantially higher than the average of 38% for sub-Saharan Africa and the eighth highest prevalence among the 123 countries for which data exist.[1]

Mr Zimba takes me to another ward where the role of the Nutritionist is crucial. At the Renal Unit he explains the tests he does on patients to find out if they are deficient in nutrients or electrolytes or minerals like iron, potassium, sodium. Those tests allow him to see where the deficiencies are, do calculations and know the amount of nutrients needed in the fluid. This is a specialised role but the hospital does not have any specialists in the field of nutrition:

‘Right now in Zambia we do not have Nutritionists who are specialised in treating all these outlying cases, and with only four Nutritionists we are struggling in the field of nutrition.’

THET responded to the lack of Nutritionists and the problem of chronic malnutrition by working in partnership with the University of Zambia (UNZA) to develop the first BSc and MSc in Human Nutrition. This level of teaching in Nutrition has never existed in Zambia before and will go a long way to supporting the Zambian government’s commitment to improving the nutritional situation of its population.

The country’s National Food and Nutrition Strategy and the First 1000 Most Critical Days Programme were launched in 2013.  Central to the Government’s strategy are the objectives to significantly reduce chronic malnutrition in young children and increase investment in nutrition and nutrition-sensitive interventions.  The Government of Zambia acknowledges that achievement of their objectives is constrained by the shortfall of adequately qualified nutritionists and dieticians in Zambia.

Five volunteer lecturers from the UK, east and southern Africa are delivering the programme until UNZA has enough qualified lecturers to run the programme themselves.  Lecturers like Tonderai Matsungo from Zimbabwe:

‘The skills that the students are going to get from the programme are very crucial in terms of improving the quality of care that patients receive at the different health institutions, either government or private. An integral part of any nutrition training, besides the clinical part, is an emphasis on preventing and prevention is the one that covers public health and community aspects of nutrition so that is very important and those components are well covered in the BSc and MSc nutrition programme.’

Lecturer Tonderai Matsungo teaching in class at UTH. (Photo: Timur Bekir)

22 students graduated from the BSc on the 8th of December 2015 and there are nine students currently enrolled in the MSc Programme. Adana has one more year left of training, after which she hopes to go back to her local community and carry on her work as a Nutritionist. But, as she states, if the course wasn’t there she may have chosen a different career path altogether due to the lack of career development:

 ‘If this course was not there, probably I would have been doing other courses in other fields and I’m sure by now I would have gone to do another profession or career. But now that there’s this course I will continue as a nutritionist and I will go back to my province to make sure malnutrition levels are low.’

Adana, BSc Nutrition student. (Photo: Timur Bekir)

Back in the acute ward at UTH a mother is feeding her child, who was brought in with severe malnutrition. Talking to the mother was a stark reminder of how important the role of Nutritionist is, not only to cure nutrition related problems but to improve public knowledge of what good nutrition is. By training a new generation of Nutritionists THET is ensuring that the causes of malnutrition are addressed. Education and training is not a quick fix to health problems, it’s a long-term approach, but one that means a health service, with skilled health workers on the frontline, can offer quality care to patients not just in the short-term but well into the future. 

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Mother with under nourished child receiving treatment at UTH. (Photo: Timur Bekir)

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[1] UNICEF (2014) State of the World’s Children

Zambia: training health workers to make a difference

Sophie Pinder, Evaluation and Learning Officer at THET in London, shares her impressions following a recent monitoring visit to health partnership projects in Zambia which are funded through the DFID/THET Health Partnership Scheme (HPS).

In May 2016, my colleagues Pippa, Viki and I visited five health partnership projects in Zambia working on different health themes in major hospitals across the country. The week-long monitoring visit involved meeting local leads and stakeholders at the sites where these projects are being implemented.

Beyond the monitoring purpose of the trip, this was an excellent opportunity for me to gain a deeper understanding of the local context these partnerships are working in, of the perspectives of local stakeholders and which direction they want to take their projects – aspects that can often be difficult to grasp just by reading project reports when sitting at my desk in London.

One of these projects is being implemented by the Zambian Union of Nurses Organisation (ZUNO) and the Royal College of Nursing in the UK. They established their partnership in 2012. Their project aims to build ZUNO’s capacity to influence nursing policy and improve nursing practice in Zambia. 
At the ZUNO offices in Lusaka, Jennifer Munsaka, Director of Programmes and Professional Affairs and lead for this project along with Rita Mutale, Programmes Officer, explained to us how the partnership has trained twelve staff members at the University Teaching Hospital (UTH) in Lusaka in advocacy skills and supported them to become champions for the implementation of the WHO safe surgery checklist, enabling them to build their advocacy skills in practice. Not only did the champions go on to train 164 members of theatre staff to implement the checklist, they now form a strong collective voice to bring issues and needs, backed by evidence, to the attention of hospital management and advocate for improvements. Their work has also improved interdisciplinary team work and raised the profile of ZUNO at the University Teaching Hospital, the largest hospital in the country. 
The partnership now plans to train the regional directors of ZUNO in advocacy so that they can influence national policy. This expansion has the full support of ZUNO’s new General Secretary, Michelo Fray, who stressed how this project is in line with ZUNO’s strategy of empowering nurses and midwives and protecting and promoting their interests.

In the Eastern Province, Chipata General Hospital has been working in partnership with NHS Highlands since early 2014. The objective of their current HPS project is to empower communities to address mental issues through an improved understanding of mental ill health and how to provide a safe and supportive environment. Communications lead, Pearson Moyo and professional lead, Marron Mugala, introduced us to the hospital staff who are volunteering to deliver messages on mental health in 20 communities around Chipata. We participated in one of the mental health education sessions organised by the volunteers and I found that the community members were very active in the discussion and their answers reflected their awareness of how to deal with mental health issues. At the end of the session, they even told us that they hope this project would be extended to other communities in the region so that volunteers could continue to raise awareness on mental health. The volunteers come from different specialities and wards across the hospital and some of them live nearby or in the communities themselves. As such, I had the feeling that the entire hospital was mobilizing itself for this project and that this could raise the profile of psychiatry and mental health as a speciality with the hospital.

After every project we visited, I felt a real sense of commitment of those engaged, from the UK volunteers delivering training to hospital staff to health workers volunteering their time to drive the projects forward. All have the ambition to expand their work at regional or national level, despite the challenging environment and obstacles they face along the way. On a number of occasions, projects mentioned the lack of resources and workload, hospital budget cuts that are putting a clear strain on already over-stretched services and health workforce.

On a personal level, this visit has broadened my understanding of health partnership work on the ground. It has also inspired me and my colleagues to think more deeply about how THET can support health partnerships working in the same geographical area to collaborate with each other and how this can enable them to become stronger catalysts for change at national level. In light of this visit and others to come, my team and I are discussing how we can support partnerships to connect with each other and deepen their influence and impact.

Training the next generation of bio-meds

Chris Mol is a volunteer lecturer for THET’s BMET Programme. Here he describes his experience training the next generation of technologists in Zambia. 

I have now been working more than a year at, the Northern Technical College (NORTEC), in Ndola, Zambia. It has been an interesting year. This blog is to share my experiences and my enthusiasm for this attractive country and its friendly people as well as my findings on the world of medical equipment, which is so essential for modern healthcare.

This THET/DFID supported activity is based on a 2011 needs assessment in Zambian government hospitals which established that the medical equipment situation in the country was indeed quite poor.  Typically, only 50-65% of all medical equipment that is found in hospitals is functional. One of the root causes for this was found to be the absence of technical personnel who have been trained to repair medical equipment. No such training was available in the country.

Following up on this, THET has worked with the Ministry of Health as well as the Ministry of Education to set up a training course for Biomedical Equipment Technologists (BMETs). NORTEC, one of the leading Technology Colleges in Zambia, was selected as the training institute to implement this new curriculum. The BMET course is for a good part based on course modules that were already given at NORTEC, such as on electronics, mathematics, and computer skills. THET has supported NORTEC by installing a BMET workshop, acquiring 2^nd hand Medical Equipment for student practice, instruments/toolboxes and last but not least hiring and funding volunteer lecturers to present the Medical equipment specific lectures, this is where I come in.

NORTEC has now taken on 95 students, including 20 women, divided over the three years of the BMET curriculum. The first cohort will complete their studies at the end of 2016. THET is working with the Ministry of Health to ensure that new positions for BMETs will be created at the hospitals by 2017.

While working here at the College, visiting hospitals and talking to local experts, it has become clear to us that more needs to be done in the country to substantially improve the medical equipment situation. To have well-trained BMETs is certainly essential, but if the workshops at the hospital continue to be so poorly equipped, if the number of technical people in the hospital remains so limited (one technical person in a 700 bed hospital is common), if the procedures to purchase spare parts remain so cumbersome, only limited impact can be expected from well-trained BMETs.

Therefore, the THET focus is now moving from education only to also include hospital processes and decision making processes at the Ministry of Health. THET has acquired DFID funding to look further into these issues during 2016. It will be an interesting year. I will keep you posted. 

Working on equipment at Ndola Hospital, Zambia.