16 August 2012
Below is a blog written by Denis Nkahirwa, one of the team of Ugandan mental health workers currently on a visit to Sheffield. He will be writng about the Gulu-Sheffield Link, and will be keeping this updated for the duration of their visit so please keep checking back for more. The blog displays with the most recent update at the top of the page.
The three people team:
Denis Nkahirwa, Psychiatric Clinical Officer & Occupational Therapist
Paul Aluma, Psychiatric clinical Officer
Immaculate Akello, Psychiatric Nurse.
Coming to Great Britain has been such a fabulous experience in our lives since we, as commonwealth fellows have in mind that a lot of trips are on our plate; but that was not about to be as if serious work was involved. Our circadian rhythms changed in nature to an extent that deep sleep was reduced up to 5:00am and wakefulness could not let us stay in bed, so all would end in a shower then rush through the corridors as if we’ve been summoned by a platoon commander or else a fire alarm went off. As usual breakfast was always waiting from 7:30-8:00am, which we were supposed to beat before our tight schedules that appeared different in nature.
The fellows were always separated by work on reaching the centre.
At Rowan home visits were done besides routine ward activities where users were visited in their homes and assessments done. The same was done at Burbage; besides MDT, hand overs and O.T breakfast sessions with clients, a community outreach was conducted. At Stanage, besides routine MDTs and handovers, O.T was also very good outside the hospital. Different users were visited under different users’ associations such as:-SUN-RISE, SPACES & CAST. At the Sun-rise group, users meet and discuss different projects that not only target income generating but also meant to improve on their mental health, Spaces operates a day care centre only Thursdays for recovering people who have been discharged but still require social support. Here, they come together and spend quite a long day while involving themselves in various activities such as poetry, painting as well as games that can improve on their skills especially social and occupational skills.
The CAST group had a big aim at improving mental health through art and music hence income generation.
Some of the art pieces made by users.
Besides art, poetry and other crafts, O.T involves quite a lot of tasks to do as far as mental health of an individual is concerned and some of these were:
• Relaxation techniques,
• Tai chi,
• Breakfast preparation,
• Cycling in the park and many many other techniques specifically for assessment of the patient’s strength and deficits.
Being from a land-locked country and at the same time working far away from lakes, we had not thought about ever seeing a big water body bigger than a fish pond, but here we were facing the biblical sea in reality, very salty water but good fish. It was a fabulous experience and more scenes accompanied this spectacular view as we then felt like explorers self styled.
It was a tight weekend as it was approaching the bank holiday the following Monday so, pleasure was on our side, that Saturday was on menu too. We had a great trek to the plague village to discover more, where sad stories about the plague village during the 17th century were displayed in the museum for us to prove. More stories were displayed in artistic form and others were written. We arrived in the week of remembrance of some of the victims of the plague.
The plague comes to Eyam village.
The weekend still had enough balance on it so London city was our next victim. We had under estimated the tour since we had mastered Sheffield city, but that wasn’t going to be similar in London. The bus, 120, 87 and the trams are not London style. Here we were, moving underground like moles on a very supersonic speed which could block our ears or even open them altogether. The city was too much for us that we couldn’t complete it in a single day even when we used high speed tubes. Thanks to our guides, Alex, Uganda-UK health partnership member from London and Saiqua from Sheffield IAPT. Alex made the day very colourful since he knew all corners of London that could be of our interest.
The tour guides (Alex and Saiqua)
The big Ben
No one would wish to go back to Uganda without ever comparing anything, but we were unable to compare the parliament building to ours back home.
The London Eye.
With much exhaustion but excited, Monday still looked like a weekend since it was a long awaited holiday code named ‘’bank holiday’’. If you were to compare this in Uganda, it sounds like Labor day, though in Uganda people still go to gardens on that day, open shops as if nothing happened.
As previously mentioned, we have had much fun in England despite the nights being too short. The sun goes down by 22:00pm making a short night, with it rising again by 4:00am.
Almost all of our weekends have been booked up for us by our hosts, and this showed hospitality that existed among the natives and even other Ugandans living in the UK.
One of the Ugandan evenings in Sheffield
One might think the above picture was taken in Uganda but it was actually taken in the UK with other Ugandans we have met. During the evenings we discuss issues concerning Uganda and how best we can improve our country in terms of service provision, with support from our brothers and sisters living in UK.
As I have said, we haven't had any free time at all because our hands have been full with activities during evenings and weekends ranging from bird watching, countryside walks with dogs, Ugandan evenings, English dinners, journeys to the seaside, to a trip to London.
Lots of money isn't needed for one to obtain big plots of land to create space for patients' assessment. All you need is just a few metres of land near the wards.
Patients during their time in hospital undergo varous occupational assessments to check their level of functioning in Activities of Daily Living (ADL) prior to discharge. This is done in the OT departments at the Longley Center and the Micheal Carlisle hospital.
Every activity carried out is recorded using assessment tools and the level of performance is graded to help during the MDT discussion for opinions from a bigger group. Not only do patients receive their assessments from within the hospital area; they also get assessed in the community to see how they can live with other people. This is done on a guided tour in town, for shopping or group cycling in the park by OT staff and various other members of staff. During this assessment process, if the patient requests to sleep at home for a one off night, they may be picked up by a relative or dropped off by staff depending on the level of their illness.
As we Ugandans hire askaris (guards) to control the entrance and exits to wards, it is a very different story in the UK. The Longely Centre doesn't hire anybody to keep near the door to control people's actions. It is just a matter of pressing a few digits next to the door and the door will open briefly and through you pass. This not only improves the security of property on the wards but also the safety of patients as well.
One thing we appreciated was the way everyone treated us. The two of us who started from Longley, that is Denis and Immaculate, had much fun in Occupational Therapy (OT) on our first day with Richard the senior OT, and this automatically made us aware of how important OT is to mental health, in that, every patient needs OT to get back on the road. Our next stop was at the recycling centre where used bicycles are recycled and put back on the road. This is a charity organisation that works with youths to improve their vocational skills thus helping the community.
The week ended in style with two of us spending long hours on wrong routes deeper into Longley village instead of heading for town hence we almost missed the evaluation exercise at the Tudor house.
The Monday activities at the Michael Carlisle Centre involved ward rounds and handing over patients. This was so interesting as during the hand over, each nurse involved must have observed the patients allocated to him or her in a sense that every detail of conduct is reported which then gives the other nurse taking over a chance to know from where to start, either starting with a violent, restless patient or calm patient. On the other hand, ward rounds seem different from the Ugandan style as patients are discussed in absentia, but on a giant screen with a copy printed out for the patient's file. Only those patients who have special issues are brought in person for discussion.
An MDT Ward round (Dr, Nurses, O.T, Pharmacist & a projector).
It might sound strange if one is told to go for group cookery or group pottery, group Tai-chi or even group breakfast, but to our surprise it determines the recovery level a patient is at at that time and hence determines the deficits and strengths one has. On top of that, OT improves social skills and which may almost go due to mental illness and in that context, the OT department is well equipped with every household and industrial tool ranging a fully furnished kitchen, a well equipped gym, to nice gardens and pottery facilities.
The gymnasium that is used during group work.
We are getting more and more ideas for activities which may be easy to apply back in Uganda, such as crafts, games like badminton, aerobics, group breakfast cooking and gardening. The most interesting bit were the community meetings whereby members of staff for example nurses, OTs, students, and support staff, meet with patients and discuss issues affecting them on the wards. This gives the patient the knowledge that he/she is being listened to.
Surely no-one who comes to the Longley Centre can fail to ask about the meaning of the statue, at the very least how it got there or even who put it there. The tortoise symbolises recoveryand is perfect as far as mental illness is concerned, especially the slowness of the illness progression that mostly begins insidiously and also the recovery process which is a gradual process. To cut the story short, the statue has been made by users who learnt pottery from the Occupational therapy department in the Longley centre, hence they made sure that they put their work to good use by donating this wonderful piece of work to the centre.
It was a colourful afternoon event in the heart of the city but as usual our journey to meet Anna who was to accompany us had suggested that we link up in the middle of the city which we did but it took us almost an hour finding ourselves in the city maze. Eventually everything became fantastic including winning cappuccinos, and a few presents.
Being a familiar and common phrase, respect wasn't something we expected to appear very new to us in our practice, and here we were, very old people who are used to teaching our children how to show respect but we are having respect as one of the courses on the time table. However, that perception was completely changed on the first day of training when we were taught the meaning of it and how it is applicable in mental health practice.
It encompasses the following:
• Listening to the patient.
• Asking questions,
• Summarising and many other skills.
All the above go hand in hand with the way a person is supposed to be handled with dignity, minus force and harm, thus resulting in prevention of rebellion from patients.
"It is like moving from wrestling to dancing".
This city is so beautiful with nice old structures especially in Endcliffe, Fulwood, Broomhill and many other surrounding suburbs. On top of that, the city is so clean, no dust and no potholes!
As I write this, my shoes haven't required any brushing at all since there is no mud, even shortcuts and footpaths in parks are all tarmacked. However this beauty did not spare us either. For days we continuously got lost on our way home until we realised that all roads have names and numbers - unlike in our country!
However, the city centre has became such a maze to all of us, to the extent that we even use the tallest buildings to help trace our way. Even the tram routes we master seem to change or even disappear! However, all in all getting lost in the city was part of the daily routine until key buildings were memorised.
We checked in to our hostel at 11:00am, a sky scraper compared to the tallest buildings in Uganda. Luckily enough we didn't need the lift since our rooms were on the ground level. Each one of us was handed a magnetic key for a room that was fully furnished, with the kitchen shared between the three of us. We get a continental breakfast where all kinds of foods are served on a self service basis which could make you not need lunch.
From Brussels airport we were treated with a low flight in a light aircraft that gave us the chance to view the plains, rivers and clouds on the way, and although one of our group was too scared to look out, the rest of us enjoyed the spectacular sights.
At Manchester, we disembarked from the plane at 9:30am, through terminal 3 and were welcomed by Greg and Kim with a VIP welcome, who gave us a special ride to our new home - 'The Edge' (University of Sheffield hostel), situated at Endcliffe in Sheffield.
It was an extraordinary flight - all of us were in a good mood prior to takeoff, belted up, headphones on, DVDs playing overhead and air conditioning blasting out. All that excitement changed to mild anxiety as the plane took off. Everyone on board was quiet until the plane was 1000km away from this earth.
The journey took close to 8 hours in the air and across the seas from 11:00pm to 6:00pm, thus everyone on board slept till an announcement was made to 'please belt up' and everyone sprang into action. We landed safely at Brussels airport which was ten times bigger than our local airport at Entebbe.
Unfortunately the long-winded checking procedure proved to be international. We obeyed the rules of belts and shoes off, passed them through the x-ray machine. The worst bit was the size of the airport. Our terminal for the flight to Manchester was number 85, and here we were in terminal 1. One of us got lost, another member's shoe was cut by the conveyor belt but we all managed to safely reach our terminal where we spent close to 4 hours waiting for 9:30am which was our flight time
It was a normal Friday. Paul and Immaculate travelled down from Gulu and Denis was with his family in Kampala, until 8:00pm when the team converged in Entebbe, ready to go through the metal detector without shoes. This was successful and we advanced to the second checkpoint then the third, right up to the fifth where we reached the last x-ray machine and were lead into the waiting room; so exhausted as the exercise involved removing belts, shoes, shirts and so on.