Mental health training in Somaliland - Day 9

Thursday 26^th September

Again, a participant starts the day for us by re-capping on the previous days activities and exercises. I am pleased with the groups feedback and their delivery of this to their peers. There is an incredible respect shown between member of the group, which makes for a safe and enjoyable learning environment for them all, something that is integral when running a course of this kind. The participant led teaching session today concentrates on using OSCE/ role as a teaching technique. This has not always been used here, though is one that doctors and students enjoy and is also an incredibly helpful teaching method as it tests many different skills at the same time. The groups work well in a team and prove that they have thought about their teaching, organisational leadership and presentation skills. We visit the mental ward at the hospital for the third time this week. Each day a different doctor has led the teaching on the ward and each day they are met with new and different challenges of teaching in a clinical environment. This is useful, as they appreciate that it is not always as simple as it sounds in theory. The fact that they have practiced these skills all week has really led to them getting a feel for the challenges of each, something that is very difficult to appreciate just through learning about the theory. 

Mental health training in Somaliland - Day 8

Wednesday 25^th September

Now over half way through the teaching the teachers course. Today the groups teach the rest of us using group work/discussion as a teaching technique. They seem to really enjoy the practical aspects of the course and as such, I am tweaking the course as I go along, to match both their enjoyment and also the learning objectives we have set. Dr Mariam cannot attend today, as she is meeting with the Ministry to discuss her role as lead for STI’s in Somaliland. A few of the doctors we know have now started to work within the Ministry; Mariam, a previous mental health rep, who is helping me with the organization of this course is one of those. She previously worked in Hargeisa Group Hospital, though does so less now. Dr Abdirazak, also a previous mental health rep, now also works with the Ministry, as lead for mental health. I hear from him today, as he is also busy in meetings, though hopes to come by and witness some of the teaching at some point this week. 

Dr Abdirazak was, when I last visited in May 2013, working closely alongside the mental ward at Hargeisa Group Hospital and had much to arrange for our students to get clinical experience on the ward with patients. Today we visit the ward again. This time a course participant leads the teaching session, as an example of how one might teach in a clinical setting. The participants soon find out that putting into practice the theory is often much harder than it seems. We are met with a number of challenges, including it being lunchtime on the ward, to having enthusiastic patients wish to join in our discussion. Today we meet with Mariam and Mustafe, who are nurses on the ward and do much for the patients here. 

There have been significant changes on the ward over the last few years. Up until 2010, patients were still chained, now  they are not, which represents a huge leap forwards in how mental illness is viewed, even by those working in it. Mariam and Mustafe ask that I come back and conduct some training on the ward. I agree that I will explore whether I can come back next week and do some then. The course participants then work in groups to explore how they might lead or design a teaching course. Many questions and feedback are generated from this exercise and I am thrilled that now they are starting to get the hang of more analytical ways of thinking and expressing themselves through feedback. 

The afternoon is spent with the 6^th year medical students who are keen to practice their OSCE skills. We do a number of role plays, with them acting as both doctors and patients and also discuss their ongoing online supervision and tutorials on Medicine Africa, an online learning portal which adds and follows-up their training in country. They will all begin online courses with Medicine Africa. 

Mental health training in Somaliland - Day 7

Day 7 - Tuesday 24^th September

The Mental Health Skills Training Course continued for the second day at Hargeisa Group Hospital today. It is a joy to see the participants develop and become more confident, as they try out teaching techniques and move away from using only familiar techniques. Giving and receiving feedback and constructive criticism is something the doctors are not as comfortable with and so we spend some time practicing this. We visit the mental ward in the hospital grounds, in order that the participants can explore how they might lead a group of students if they were teaching in the clinical setting. The doctors appear calm and confident on the ward and I remember back to last year during their psychiatry course when many of them stated how scared they were to go onto a mental ward.  It illustrates their opinions and attitudes have changed. I see a patient who was there in May when I last taught on this ward. She is a young female with learning disabilities who now unfortunately lives on the ward as her family cannot look after her. She is happy to see us and spends much time watching the doctors carefully as they answer questions asked about teaching. 

Mental health training in Somaliland – Day 6

Day 6 - Monday 23^rd September

An early start to begin the Mental Health Skills Training course in Hargeisa. This is a ‘teaching the trainers’ course.  I shall be teaching mainly new doctors and junior doctors teaching skills that they may utilise in their own practice. This is the first time such a course has been run in mental health and it is an exciting opportunity. 15 participants attend, and I find I know many of the participants as they were medical students when I taught in 2012 in Somaliland. It is a real privilege to be here and to be able to facilitate their development further. They have all recently graduated as new doctors. 

Also on the course are more senior doctors who wish to improve their teaching skills. Many of the course participants comment that they have rarely taught using techniques other than lectures/ powerpoint, and they are keen to learn. They are also aware that their involvement in the course has changed, and rather than being passive recipients of information that is given, during this course they will all be practicing their teaching skills. Some are confident, others a little more nervous, though as the day progresses, I am impressed by their level of interaction. We spend today thinking about what makes a good teacher, what skills a teacher needs to use, what different roles a teacher may take on and how teaching is very much linked to professionalism, leadership, team work, supervision and audit. Most doctors were not familiar with audit, something which is very much needed here in Somaliland to improve the quality of services. 

Mental health training in Somaliland - Day 5

Day 5 - Sunday 22^nd September

This morning begins with a meeting with the Dean and the head of clinical work at Hargeisa University, to discuss the upcoming medical student teaching. This year we are due to teach a total of 68 5^th year medical students, which is a record number. We will have to adapt our plans to facilitate this number and the meeting discusses such plans.  Following this meeting I head back to the THET office where I take part in a filmed interview with Naj, a Somalilander, who currently lives in London, though is undertaking a placement with THET to document the work we are doing. She would like to film my current work as a volunteer and the interview is focused on my current hopes and expectations for my extended trip. 

Mental health training in Somaliland - Day 4

Day 4 - Saturday 21^st September

Further preparation for the teaching on Monday. I meet today with a previous mental health representative, Dr Adam, at the Mansoor hotel. Dr Adam was previously chosen for the position of mental health rep as he was keen to learn more about psychiatry and teaching.  Mental health reps are newly qualified doctors, who are chosen competitively each year for the position. They assist KTSP in the annual teaching of medical students, which gives them the opportunity to improve their teaching skills and gain leadership and team working skills.  They also participate in online supervision and act as mental health advocates in Somaliland amongst their peer group. Many previous reps are still heavily involved in psychiatry/mental health work, and some have made great progress with projects they have started and published articles about their work.  

Mental health training in Somaliland - Day 3

Day 3 – 20^th September 2013

The weekend in Somaliland is Friday and so I spend today preparing for my course on Monday, emailing friends, having Skype discussions with those in more distant places. I also receive supervision from Dr Susie Whitwell, Consultant Psychiatrist and Lead for KTSP.