Knuckling down to some work
| The
placement is progressing quickly - It is about time to talk about
some of the expected outputs from the RCPsych link. The first
part that I have been working on with Professor Mullick is a
research project to culturally validate life stressor rating scales
for both adolescents and adults in Bangladesh. This has been
identified as a local priority area – stigma surrounding mental
health is huge here, but people do seem to understand the role of
life stressors, and placing mental illness in this context can help
individuals understand.
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| There is a huge respect
for qualifications in Bangladesh, and perhaps more importance is
placed on these than outright experience – because of my Msc in
Transcultural psychiatry I have been judged the right person to
write the research protocols for the adolescent and adult rating
scale validations - which I have just sent to local research and
ethics for approval. |
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To summarise, the
research will be of mixed methodology and comprise of focus groups
and a survey phase. The current life stressor scale commonly used
was designed in the states in the 1960s and has less relevance to
Bangladesh today. A large number of potential life stressors need
to be added that are culturally appropriate here - eve teasing,
dowry stress, effect of siblings getting married, to name a few.
The research will continue after I have left, but it is hoped that
a validated rating scale will be produced by the end of the year
which can be utilised in Bangladesh and possibly in areas of the UK
with larger Bangladesh communities
The curriculum for the
mental health trainees in Bangladesh is a mix of that in the United
Kingdom, the States, and Canada, and is being re-written at the
moment. A lot of the buzz words familiar to those trained in
the UK are becoming topical here – competency based learning is in
the process of being introduced, with a slight shift from purely
relying on knowledge. I have been working with the curriculum
designers here to improve the curriculum a little (although it is
already very comprehensive) and will be working on an OSCE
programme for the trainees over the next few weeks. The other
project just starting is working with the doctors here to establish
whether an early intervention service would be
feasible.
There clearly isn’t any
more budget, and there isn’t any community psychiatry, so the work
centres around whether such a service could be re-created at
outpatients to cover pharmacological and psychological
interventions, and by the use of the family to provide some of the
social interventions. Patients here usually have the benefit
of a stronger family network than compared to the west. Watch
this space.
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Aside from the above, I
have been giving weekly talks at the journal club, up to now on
transcultural psychiatry, the royal college scheme and early
intervention in psychosis, and am hosting more informal teaching
sessions each week for the trainees on a variety of
practical-experience-based topics, including treating early onset
psychosis and presenting a lecture (trying to think about what I
was taught on training the trainers….)
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| I spend a large
proportion of the week working directly with the junior doctors
seeing patients on the ward, and at outpatients, which I am finding
the most rewarding, including a very interesting steroid induced
psychosis case on the medical ward, which we had to assess in the
corridor surrounded by about twenty people holding their drip bags
above their heads as the ward was being fumigated for bed
bugs. |
I have a few interesting visits lined up
for the next few weeks – I shall be going to Patna, the “tertiary”
referral centre I guess, which is the largest inpatient unit in
Bangladesh and is around five hours away. I don’t want to end on a
negative point, but have heard a few “rumours” about conditions
there, and, I guess, want to make up my own opinion. Afterwards I
will be going along with the WHO to one rural Upazilla health
centres to look at the work they are doing educating primary care
staff in mental health.
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About this blog
Dr Adrian Phillipson is an ST5 in general adult psychiatry,
based in South Yorkshire. He is currently part way through a
year out from his training rotation, utilising the time to pursue
research and travel interests. Adrian is the first
psychiatrist to take part in a new Royal College of Psychiatrists
Volunteer Scheme Link with the Bangabandhu Sheikh Mujib Medical University in Dhaka,
Bangladesh. He hopes that this blog will provide good insight
into the link, and will encourage others thinking of taking part in
the volunteer scheme.
Adrian’s attraction to transcultural psychiatry stemmed from a
chance encounter with a local practitioner in Malawi in 2003, where
he witnessed a traditional healing ceremony for psychosis. He
has further developed his interest through completing a masters
degree in Transcultural
Mental Health Care at Queen Mary, University of London, as well as
through further overseas exposure. In 2010 Adrian made
an initial scoping visit to Bangladesh to look at mental health
services and help establish a sustainable link. A report from
this project can be found here.