21 June 2012
Friday 22nd June - and they're off!!!
With the help of a grant from the Department of International Development, a team of 6 staff from across SHSC have today set off on a 2 week visit to Uganda. The aim is establish a structure for future working with staff at Gulu Hospital, and identify the priorities for future development. The link will initially focus on
patient safety in an Inpatient setting
We will keep this page updated with news of their progress, photos and a diary whilst they are away - so keep checking back for updates.
Day 1 (Friday 22nd June)
After a rather stressful and very long journey we finally arrived in Uganda. We are staying on one of Kampala's 7 hills known as Makindye surrounded by greenery, lush tropical vegetation, birds, and bars that play music to the early hours! Kampala is a comparatively small and accessible city, safe and great to walk around.
The first walk into the city took us one and a half hours so we were almost late for our first meeting.
Our first official meeting was with Julius Kayiira, the executive director of Mental Health Uganda, an equivalent of Mind in the UK. Their work centres on supporting carers - particularly mothers of service users and addressing human rights. They are working with the Ministry of Health to influence government policy and the development of the mental health act, across 19 different districts. They are also working to address stigma through the use of art, theatre and drama. We discussed the tensions between the medical approach to the treatment of mental illness and the use of traditional healers.
Julius gave us a contact with the Mental Health Uganda lead in Gulu, and a link to the rotary club as many people here are Rotarians. We committed to pass on his details to the Ugandan diaspora group in Yorkshire.
Day 2 (Sat 23rd June)
The mixed weather continues, with a heavy down our of rain most of day.
We visited Heartsounds, a mental health service user led organisation. Heartsounds is primarily run by Joseph Atukunda who runs the organisation from his house. It consists of an Internet cafe, library, photocopying service, save to share scheme, and a newly developed peer support service with support from East London and Nottingham mental health trusts.
This massive development of their service has allowed Heatsounds to have an office in Butabika Hospital where staff can in-reach onto wards and service users and staff can access Heartsounds staff easily in the hospital.
Heartsounds is a formally governed organisation that makes decisions through an established committee made up of 8 service user members and 3 lay persons.
Click here to view theHeartsounds website.
We had the opportunity to meet many inspirational service users who all had very different perspectives on their own mental health and the mental health services provided, however the one common feature that shone through was the positive and crucial impact that Heartsounds has had on individual lives - given people the family they may not have and the opportunities they may not have had.
Recovery as a concept came naturally to the people that we have met rather than a learned approach. The individuals that we met are incredibly inspirational and progressive in their views, attitudes and approach to dealing with mental health.
We are learning so much from being here in Uganda, how an individual's motivation to provide support can have such an impact on the service that people receive from minimally resourced people that are driven by love and care.
The two mental health non government organisations we have met and spent time with are hugely impressive. They are genuinely advanced in their thinking and approach and espouse a level of understanding and sophistication regarding care from a service user perspective, that we in Sheffield are privileged to hear about and could and will learn a lot from.
Day 4 (Monday 25th June)
The trip took 6 hours in 2 cars. The road appeared to be never ending and very long with many pot holes thus various parts of the journey were on the other side of the road. The highlights were stopping off to buy fresh fruit from street-side vendors and crossing the Nile at Karuma Falls. The falls were magnificent but we were unable to stop and admire them as there were armed guards by the roadside moving us on. Secret photographs were taken of the falls and the baboons that greeted us by the roadside.
We arrived in Gulu and had a very warm welcome from our Manchester University colleagues although it took until the next day to actually see what they looked like due to the power cuts ( which has been a constant feature of our stay…we are currently writing this blog via candle light and a wind up torch which isn’t winding very well!!)
Met with the Assistant Hospital Director of Gulu Referral Hospital to outline our hopes for the link and the intentions of our visit, this was well received. We had a tour of the hospital with a colleague from Manchester who is working on a medical ward for 6 months, visiting the A+E, Acute Care, Medical ward and labs. Observations of this tour were that this is a hospital trying to provide the best care with negligible resources available, the differences to our services were stark, an example being that patients do not receive any food and bedding from the wards unless it is provided by their families.
Days 5 -7 (Tuesday 26th - Thursday 28th June)
We met with the three senior staff who are coming to England later this year; Principle Psychiatric Clinical Officer (PPCO) Paul (with a background in nursing), In Charge Nurse Sister Immaculate and Psychiatric Clinical Officer (PCO) Dennis (with a background in Occupational Therapy).
The PCO role was developed to address the shortage of psychiatrists in Uganda and is a development of the professional role which allows PCO’s to prescribe and direct medical treatment. This is mainly perceived as a medical role.
Not only are the PCO’s responsible for the inpatient service, they also hold a daily outpatients clinic (based on the ward) seeing up to 60 people a day. PCO’s also hold a monthly outreach assessment clinic in the community based health centres.
At Gulu Mental Health Unit there are currently 6 PCO’S, 3 nurses and 11 ‘mental attendants’ (a locally used term equivalent to our support workers). The unit is a training ward and the central courtyard acts as a venue for student nurse lectures, usually the whole class of 50 .
There are two voluntary organisations working within the unit:
• Children for tomorrow – working with children, particularly children affected by war
• PCAF – specializing in working with people with Post Traumatic Stress Disorder
There are an average of 15 patients on a 40 bedded ward which is divided into a female and a male area. There is currently no age limit for inpatients therefore children and adults are admitted into the same unit. The first day we visited, the age of patients ranged from between 3 and 70 years old.
One main difference that was noticed immediately was that patients cannot be admitted unless they have an ‘attendant’ (family member or friend) with them. The attendant is responsible for the general day-to-day care of the patient, including providing bed linen and food.
Another striking observation was that epilepsy is considered a mental illness and a large proportion of patients on the ward had a primary diagnosis of and received treatment for epilepsy.
We had the opportunity to sit in on the outpatient clinic and were shocked by the distance some people travelled by foot for a brief consultation and to collect a further month’s supply of medication. One person seen had taken a 100km round trip to the outpatient service!
There is a system similar to what we might recognize as ‘patient held records’ in which the patient brings along their book with all information of previous consultations and prescribed treatment.
Prescribed medication is an issue in that supplies often run out, hence patients being told to purchase their own. Medication is expensive and difficult to obtain causing breaks in treatment and potential relapse. Doses are often much higher than prescribed in the UK and can include intra-venous administration. The variety of medicine available is limited therefore patients are frequently prescribed what is available, namely Chlorpromazine, Amitriptyline and Diazepam.
There are no current activities available for patients on the ward and Gulu staff identified occupational therapy as an area they wish to develop.
We observed that patients were often sleeping in bed for long periods of time so when the opportunity arose, card and ball games were played with patients which were greatly welcomed. This emphasized that the need for an occupational therapy service was desired by both staff and patients alike.
There are clear environmental factors that impact on both the appearance and safety of the unit that need immediate attention. A growing pile of rubbish, including clinical waste is burned within the hospital grounds, in close proximity to the mental health unit, causing a daily hazard to patients, staff and visitors.
Following our observations and numerous meetings with Gulu staff, patients and senior management, we have formulated a Needs Analysis. This will form the basis of our action plan in partnership with Gulu Mental Health Services.